SYSTEMIC MYCOSES Flashcards
1
Q
IN SYSTEMIC MYCOSES -
Asymptomatic or subclinical infection is
common with
A
H. capsulatum and
Coccidioides
2
Q
Factors that influence dimorphism
TEMPERATURE
A
HIGH TEMP = YEAST
LOW TEMP = MOLD
3
Q
Oxidation-reduction potential in yeast and mold
A
Mold form - oxidized
Yeast - reduced
4
Q
Availability of sulfhydryl groups
mold or yeast
A
increased = mold
decreased = yeast
5
Q
co2 tension yeast and mold
A
increased = yeast
decreased = mold
6
Q
2 phase of fungi
A
environmental and human
7
Q
phase wherein hyphae which can create
spores can easily be dispersed by air
A
○ Environmental phase
8
Q
Once spore enters a human
host, it will enter this phase
and there will be a different
temp
A
○ Human phase or yeast form
9
Q
Reproduce via budding
or endospores
A
■ Yeast form
10
Q
Reside in macrophage
of humans
A
yeast
11
Q
can be found in the soil and infects
humans in North, Central, and South America
as well as in Europe, Asia, and Africa.
A
Emmonsia crescens
12
Q
● Nonreplicating and rare causes of human infection
A
Emmonsia crescens
13
Q
produces a self-limited, localized pulmonary
infection that may appear asymptomatic.
A
Emmonsia crescens
14
Q
The organism produces adiaspores, which
enlarge but do not reproduce in the patient.
A
Emmonsia crescens
15
Q
spores that increase in
size inside an animal host
A
adiaspores
16
Q
produces 25 to 400 µm adiaspores in
vitro on BHI agar incubated at 37°C.
A
Emmonsia crescens
17
Q
Symptoms include fever, cough, dyspnea, hemoptysis, weight loss, fatigue, and possible respiratory failure
A
adiaspiromycosis
18
Q
Their adiaspores do not contain endospores
and are typically much larger than spherules.
A
Emmonsia crescens
19
Q
beige, slow growing filamentous
colonies at room temperature
A
Emergomyces spp.
20
Q
most commonly diagnosed dimorphic fungal
pathogen
A
Emergomyces spp.
21
Q
does not produce adiaspores in vitro on
brain-heart infusion (BHI) agar incubated at
37°C like Emmonsia spp
A
Emergomyces spp.
22
Q
can be differentiated from Emmonsia by the
presence of budding yeasts and the absence
of adiaspores.␣
A
Emergomyces spp.
23
Q
60% asymptomatic 35 self limiting 5% leads
to disseminated disease
A
Coccidoidomycosis
24
Q
NATURAL HABITAT:dry alkaline dessert soil
like those in san joaquin valley in california
A
coccidoides imitis
25
MODE OF TRANSMISSION of cocidioides
-inhalation of the infective arthroconidia.
- person-to-person spread has
- fomites
- organ donor to a recipient.
26
Very few arthroconidia required for infections, Outbreaks have followed windstorms and
earthquake
coccidoides
27
Hormone receptors are present in fungal
surfaces and growth stimulated by
testosterone, progesterone and 17B estradiol
coccidiodes
28
inhibits transition from
mycelial to yeast conversion of cocidiodes
Estrogen
29
elevated levels of estradiol and
progesterone stimulate its growth
coccidoides
30
Presence of HLA - A9 and type B blood
(more susceptible)
coccidoides
31
Clinical type of coccidoidomycoses
can be primary and secondary
primary consists of pulmonary and cutnaeous infection
secondary consists of pulmonary, cutnaeous, meningeal and disseminated
32
Clinical manifestation in cocciodes
● Erythema nodosum in women
● Erythema multiforme in children
33
IT CAUSES self-limited influenza-like illness with fever,
malaise, cough, arthralgia, and headache.
This condition is called valley fever, San Joaquin Valley fever, or desert rheumatism
DUE TO COCCIDOIDES
34
clinical course is often characterized by
remissions and relapses.
valley fever
35
appear as a nonbudding, thick-walled
spherule that contains either granular
material or numerous small
nonbudding endospores
COCCIDOIDES
36
○ “ghost” spherules may also be present
COCCIODES
37
lesions contain
typical granulomas with giant cells
and interspersed suppuration
coccidioidal LESIONS
38
Cultures on IMA or brain–heart infusion
blood agar slants can be incubated at room
temperature or at 37°C.
COCCIDOIDES
39
● produces a white to tan cottony colony.
C. posadasii.
40
hyphae form chains of arthroconidia. These chains
fragment into individual arthroconidia, which are readily airborne and highly resistant to adverse environmental conditions
C. posadasii.
41
● spherules have a thick, doubly refractile wall
C. posadasii.
42
TREATMENT OF COCCIDOIDES
IEFAS
- Itraconazole
- Amphotericin B
- Fluconazole
- Azole
- Surgery resectioon of pulmonary cavity
43
● North american blastomycosis
Blastomycosis dermatitides
44
Found in soil and decaying matters esp in great lakes of ohio river valley and southern
Blastomycosis dermatitides
45
producing a chronic infection that
contains a mixture of suppurative and granulomatous inflammation.
Blastomycosis dermatitides
46
● Characterized by formation of pyogranuloma
Blastomycosis dermatitides
47
thermally dimorphic fungus that grows as a mold in culture, producing hyaline, and branching septate hyphae and conidia
Blastomycosis dermatitides
48
Favors environment with High nitrogen content, Acidic ph
and Abundant moisture
Blastomycosis dermatitides
49
a chronic infection with granulomatous and suppurative lesions that is initiated in the lungs, whence
dissemination may occur to any organ
but preferentially to the skin and
bones.
Blastomycosis
50
Blastomycosis dermatitides
c/s
- blastomycosis
- ARDS
51
Risk factors
○ Occupations working near water
○ Campers and canoeists where soil has been disturbed while gathering firewood
○ Exposure to dust and excavations
Blastomycosis dermatitides
52
yeast colonies are wrinkled,
waxy, and soft usually with a single bud that is connected to the parent cell by a broad base
blastomyces
53
blastomyces incubation
○ grows after 2 wks
O
○ Cottony white that turns tan or light
brown with age
○ Morphology similar to histplasma
capsulatum
○ Can grow with cycloheximide
54
Conversion of mycelial to yeast form is confirmatory diagnosis
○ 37c they fail to convert to yeast
blastomyces
55
blastomyces treatment
● amphotericin B
56
● South american blastomycosis
Paraccocidiodomycosis
57
grow very slowly and produce
chlamydospores and conidia
P. brasiliensis
58
The yeasts are larger and have thinner walls
than those of B. dermatitidis.
Paraccocidiodomycosis
59
paraccocidoides treatment
itraconazole
60
Chronic granulomatous disease that produce
a primary infection often inapparent and then
disseminated to form ulcerative granuloma of
the buccal, nasal, skin, adrenal glands and
occasionally the gi tract
paraccidoides
61
Ulcerative lesions are commonly present in
the nasal and oral mucosa, gingivae, and less
commonly the con junctivae
paracoccidoides
62
lesions are characteristically ulcerative,
with a serpiginous (snakelike) active border
and a crusted surface.
Paraccocidiodomycosis
63
yeast at 37C multiple budding cell
with narrow necked buds (Mariner’s
wheel or mickey mouse)
Paraccocidiodomycosis
64
paraccoidoides
c/s
acute = lymphadenopathy,
hepatommegaly or splenomegaly
chronic = Lung involvement
65
Long latency period - 10-20yrs may pass between infection
and manifestation in non-endemic
area -
paraccoccidoides
66
● Large round yeast cell with multiple buds
paracoccoides
67
Mold: fuzzy white to cream colored colonies,
boat shaped arrangement
paracoiccdoides
68
● Yeast- broad based budding yeast
paracoiccidoides
69
treatment of paraccoidoides
- itraconazole
- ketoconazole
- TMP-SXT
- amphotericin b
70
● Great “mimic” in mycosis
histoplasma capsulatum
71
chronic,granulomatous infection
(histoplasmosis) that is primary and begins in the lung and eventually invades the
reticuloendothelial system
histoplasma capsulatum
72
histoplasma capsulatum myceial and tissue phase
○ Mycelial phase (25C) - microconidia
and tuberculate macroconidia
○ Tissue Phase (37C) -thin walled
single budding cells inside
73
Found in area with high bird/ bat droppings or area with decaying matter or habitat ng chicken or birds
histoplasma capsulatum
74
Grows in soil with nitrogen content; prefers
rotting guano of bat and birds mixed with soil
HISTOPLASMA CAPSULATUM
75
● Affects the RES cells; lesions are not
confined to lungs
● Has intracellular survival kahit na
napahagocytize na siya pwede padin mag
survive and replicate
HISTOPLASMA CAPSULATUM
76
OPEN VS CLOSED ENVIRONMENT
OPEN ENVIRONMENT - containes bird guano, and nitrogen rich environment
CLOSED - bat caves have high guano deposits, cave explaration
77
First recognized as a disease among patients who were xray positive but tuberculin negative
histopklasma capsulatum
78
gaining ranuloma (cluster of immune cell)
around yeast cell as attempt to control
infection
h capsulatum
79
Person at risk for disseminated
infections and high mortality include
■ Defect in CMIR (large increase
since onset of HIV)
■ Malnutritio
h capsulatum
80
○ has patchy infiltration and prominent
hilar shadow
○ Contraction of left upper love
● Acute histoplasmosis
81
Raised red or purple papules,
ulcerated lesions in face, neck and upper body
● Histoplasmosis in skin and mucous area
82
cd4 count in histoplasma
○ histoplasmosis = 90% with cd4 count below 200/ul
○ Localized pulmonary disease =cd4 is higher than 300/ul
83
Red stained crescent shaped mass
cytoplasm
histoplasm capsulatum
84
which detects ag and ab in a sample in histoplasma capsulatumn
Double diffusion test
85
● African histoplsmosis
Histoplasma duboisii
86
Characterized by granulomatous and
suppurative lesions primarily of the cutaneous
,subcutaneous and bone tissues
Histoplasma duboisii
87
Large oval cell size with double cell or figure Q8 appearance
Histoplasma duboisii
88
Yeast like ovoid cells found inside
macrophage and giant cells;
extracellularly in pus and necrotic
tissues
Histoplasma duboisii
89
HISTOPLASMA DUBOISII
CUTNAEOUS, BONE, LYMPHATIC AND INTESTINAL
90
may have fat droplets within
the cell
H DUBOISII
91
associated with the bamboo rat (Rhizomys pruino sus) and the Vietnamese bamboo rat (Rhizomys sinensis)
Talaromyces marneffei
92
causes either a focal cutaneous or
mucocutaneous infection, or it may produce a
progressive disseminated and commonly fatal
infection.
Talaromyces marneffei
93
produces small, yeastlike cells (2 to 6 µm) that have internal cross-walls; no budding cells are produced
Talaromyces marneffei
94
detected in peripheral blood smears with
disseminated disease.
H. cap sulatum, AND T. marneffei
95
NATURAL HABITAT is living or dead
vegetation
Sporothrix spp.
96
HOW IS SPOROTHRIX SPP TRANSMITTED
TRANSMISSION: acquire the infection
(sporotrichosis) through trauma (thorns,
splinters, bites, or scratches), usu ally to the
hand, arm, or leg M
97
primary lesion begins as a small, nonhealing
ulcer, often of the index finger or the back of
the hanD
Sporothrix spp.
98
LAB DIAGNOSIS OF SPOROTHRIX
--
● Exudate aspirated from unopened
subcutaneous nodules or from open draining
lesions often is submitted for culture and
direct microscopic examination
● Sporothrix usually appear as small (2 to 5 µm
in diameter), round to oval to cigar-shaped
yeast cells
99
ROSE GARDENER DISEASE
SPOROTHRIX
100
