Systemic Mycoses 1

Question 1

Name the 4 systemic mycoses discussed

Answer 1

Coccidiodes, Histoplasma, Blastomyces, Paracoccidioides

Question 2

Are they all thermally dimorphic?

Answer 2

Yes

Question 3

Thermal dimorphism of coccidiodes

Answer 3

Mold/Spherule

Question 4

Where is coccidiodes endemic to?

Answer 4

US Southwest

Question 5

What is the mechanism of infection by arthrospores in coccidiodes?

Answer 5

Mold grows in warm weather–> infectious arthrospores released in dry–> spores are inhaled–>spores change form (to spherule)

Question 6

Are most infections by coccidiodes mild? What are the symptoms? How are they contained?

Answer 6

Yes- 60% are mild. Either asymptomatic or flu-like. Innate immunity clears it or CMI contains it.

Question 7

What is moderate illness by coccidiodes like?

Answer 7

Valley fever/desert rheumatism- pulmonary + EN

Question 8

Severe infection by coccidiodes?

Answer 8

Major pneumonia or dissemination (bare or in macrophages)

Question 9

Risk factors for coccidiodes infection

Answer 9

Age, race, pregnancy, immunocompromised, occupational exposure

Question 10

How to diagnose coccidiodes

Answer 10

Exam, history, PPD, biopsy for spherules, culture for dimorphism, serology for dissemination

Question 11

If predisposed to complications, treat coccidiodes with this

Answer 11

Oral azoles

Question 12

If coccidiodes presents as meningitis treat with this

Answer 12

Fluconazole

Question 13

If pregnant or coccidiodes has disseminated treat with this

Answer 13

Amphotericin B

Question 14

Thermal dimorphism of histoplasma

Answer 14

Mold/yeast (yeast in tissue)

Question 15

Where is histoplasma endemic to

Answer 15

Ohio, Missouri, Mississippi River Valley

Question 16

Is histoplasma soil based?

Answer 16

Yes

Question 17

Microconidia, the infectious spores of histoplasma, are exposed how?

Answer 17

Kicked up by construction projects

Question 18

What kind of symptoms does histoplasma cause?

Answer 18

Pulmonary

Question 19

If healthy, how does your body handle histoplasma?

Answer 19

Clears it or contains in granuloma

Question 20

What does higher dose infection of histoplasma look like?

Answer 20

Tb

Question 21

How does histoplasma disseminate in an CMI-deficient host?

Answer 21

Macrophages

Question 22

Does histoplasma survive lysosomal fusion after being engulfed by macrophages?

Answer 22

Yes

Question 23

If disseminated, histoplasma causes what symptoms?

Answer 23

Pancytopenia and ulcerated lesions on the tongue

Question 24

How to diagnose histoplasma based on history

Answer 24

History (birds, bats, endemic area, immunocompromised, occupation)

Question 25

How to diagnose histoplasma based on biopsy

Answer 25

yeast in macrophages

Question 26

How to diagnose histoplasma based on culture

Answer 26

Look for dimorphism- use two temperatures

Question 27

Can you use ELISA for histoplasma diagnosis?

Answer 27

Yes, look for the antigen

Question 28

If serious lung involvement with histoplasma, how do you treat?

Answer 28

Itraconazole

Question 29

If histoplasma causes meningitis, how do you treat?

Answer 29

Fluconazole

Question 30

If histoplasma is disseminated, how do you treat?

Answer 30

Amphotericin B

Question 31

Thermal dimorphism of blastomyces

Answer 31

mold/yeast

Question 32

Where is blastomyces endemic to?

Answer 32

Eastern US

Question 33

Does innate immunity usually clear blastomyces?

Answer 33

Yes

Question 34

What is inhaled to infect us with blastomyces?

Answer 34

Conidia

Question 35

Is conidia readily destroyed?

Answer 35

Yes, our immune system takes care of it

Question 36

Conidia is transformed into yeast- is yeast readily destroyed in blastomyces?

Answer 36

No, they are harder to kill- they produce BAD1

Question 37

How is most of the infection of blastomyces contained?

Answer 37

A granulomatous response

Question 38

What predisposes you to hematogenous spread of blastomyces?

Answer 38

Immunosuppression

Question 39

Moderate acute form of blastomyces

Answer 39

pneumonia with purulent sputum

Question 40

Moderate chronic form of blastomyces

Answer 40

mimics Tb

Question 41

Severe acute form of blastomyces

Answer 41

ARDS

Question 42

Which form of blastomyces may include ulcerating skin lesions or EN and bone/joint pain?

Answer 42

All forms!

Question 43

Diagnosis of blastomyces by sputum

Answer 43

Look for yeast

Question 44

Diagnosis of blastomyces by culture

Answer 44

Look for hyphae with pear-shaped conida

Question 45

Diagnosis of blastomyces by biopsy

Answer 45

Look for yeast with suppurating (non-caseating) granules

Question 46

How to treat most blastomyces

Answer 46

Itraconazole

Question 47

How to treat blastomyces if meningitis is present

Answer 47

Fluconazole

Question 48

How to treat severe blastomyces

Answer 48

Amphotericin B

Question 49

Thermal dimorphism of paracoccidioides

Answer 49

mold/ multibud yeast

Question 50

Where is paracoccidioides endemic to?

Answer 50

Latin America

Question 51

In what populations is paracoccidioides severe?

Answer 51

Kids or immunocompromised

Question 52

Is paracoccidioides severe in adults?

Answer 52

No it's moderate and chronic

Question 53

Who gets the moderate, chronic form of paracoccidioides?

Answer 53

Men in agriculture or construction

Question 54

Does the adult form of paracoccidiodes have a long latency?

Answer 54

Yes!

Question 55

Where do we see lesions in the adult form of paracoccidioides?

Answer 55

Skin and mucous membranes

Question 56

Lymphadenopathy and hepatosplenomegaly are seen in which form of paracoccidioides?

Answer 56

Juvenile form

Question 57

You do a puss or tissue KOH mount to look for paracoccidioides. What're you looking for?

Answer 57

Multiple buds on yeast cells

Question 58

Should you culture for paracoccidioides?

Answer 58

Yes

Question 59

How do you treat paracoccidioides?

Answer 59

Itraconazole

Question 60

How do you treat severe paracoccidioides?

Answer 60

Amphotericin B

Question 61

What else can you do to treat paracoccidioides besides using meds?

Answer 61

Improvement towards a healthier lifestyle