Systemic Mycoses

Question 1

• immunosuppressed
• ubiquitous in soil, pigeon feces, high dose steroids
• mucous capsule prevents drying, resists phagocytosis
• meningitis or primary lung disease, solitary lung granuloma
• soap bubble, India ink prep for immunocompromised
• antigen testing of CSF

Answer 1

cryptococcus neoformans

Question 2

• hyalohyphomycosis, hyphae with acute angle branching
• from airborne spores
• allergic in asthmatics, aspergilloma in sinus cavity or abscess cavity (hemoptysis, no invasion), or disseminated in immunocompromised w/ high mortality

Answer 2

aspergillosis

Question 3

• bread molds, rhizopus and mucor
• hyphae with right angle branching
• risks: neutropenia, steroids, DM (likes acidic env), iron overload, skin breakdown

Answer 3

zygomycoses

Question 4

• invasion of nasal sinuses, orbit and brain, common with DM
• invasion - necrosis - arterial invasion - encephalitis - infarcts, thrombosis
• PAS: ribbon like hyphae

Answer 4

rhinocerebral zygomycosis

Question 5

histoplasma capsulatum, blastomyces dermatitidis, coccidiodes immitis, and paracoccidiooides brasiliensis are all?

Answer 5

dimorphic fungi (yeast and mycelial form depending on temperature)

Question 6

• common in Ohio and Mississippi River valleys
• self limited URTI, heals with calcified granuloma similar to TB (disseminated in immunocompromised)
• small budding yeast and 37C, found in macrophages, elicits granulomas
• coin lesion on xray

Answer 6

histoplasmosis capsulatum

Question 7

• southwest US and Mexico, desert fever, arthroconidia break off
• URTI, skin rash, erythema nodosum
• spherules containing endospores, inlammatory reaction type 4
• calciflour white: spherules with endospores

Answer 7

coccidioides immitis

Question 8

• large budding yeast, largest in north america

- forms granulomas, yeast found within giant cells

Answer 8

blastomyces dermatiditis

Question 9

• South america, esp brazil
• primary pulmonary infection - sometimes dissemination
• involves lip, tongue, hard palate
• wagon wheel appearance,

Answer 9

paracoccidioies brasiliensis

Question 10

• primarily immunocompromised
• replicates in lung - intra alveolar cysts
• aerosol rodent urine - lifelong asymptomatic infection - recrudescence with immunosuppression
• Xray: patchy pneumonia, ground glass, cant be cultured - silver stain - goblet shape
• foamy eosinophilic material in alveoli
• prevention with bactrim, IV TMP-SMX in severe

Answer 10

pneumocystic jiroveci