1. immunocompromised

2. not dimorphic

3. nL flora, ubq in env

4. grow fast

5. serology NOT helpful

6. PMNs (CMI for cryptococcus, pneumocystis)

Aspergillosis

(A. fumigatus, A. flavus)

aspergus w/ PEPPER in artery! (opportune mold)

branching, SEPTATE hyphae

breathe conidia (too big for PMNs, so CMI) host= neutropenic

angioinvasive--> pleuritic--> CNS, seizure

(Tx invasive w/ echinocandins)

VORICONAZOLE + AMPHO B

Mucormycosis

(mucor, rhizopus)

lg, non-septated hyphae

pulmo infarx, RHINOSINUSITIS

diabetics, ketoacidosis

^^R, Surgery + AmphoB

Cryptococcus Meningitis

(cryptococcus neoformans, c. gattii<- PNW)

Bloods and crypts, pigeons, cap in yo ass, w/ tats.

Yeast. Bird poop.

HUUGE slimy capsule. (CMI bc PMNs can't eat)

Subacute-chronic meningitis 

neg stain on India ink.

AmphoB + Flucytosine, then Fluconazole forev.

Candidiasis

(c. albicans, c. glabrata)

YEAST INFX (most common fun infx in humans)

nL, low CMI= LOCAL skin, muc memb "sattelite lesions"

low PMNs=disseminated- liver abscess

Cent cath, ICU, Abx, parent nutrit'n, GI surg, dialysis= candidemia (blood)- endopthalmitis (ketchup+cottage chz)

Azoles(glabrata-R), AmphoB, Echinocandins

Pneumocyctis Pneumonia

(pneumocystis jiroveci)

Italian guy/sausage w/ silver necklace SOB

ALWAYS immunosuppressed host

attach to alveolar wall, lots of prot. fluids

presents as hypoxemia! AIDS!

DOES NOT GROW on CULTURE OR TISS; Silver stain

Bactrim

Tinea versicolor-salmon patch on chest, itchy

Seborrheic dermatitis- nose, eyebrow, itch, scaly

stratum corneum, nL host

topical cream

Trichophyton

Microsporum

Epidermophyton

tinea- (all itchy)

-capitis- hair/scalp

-corporis- bod, face

-Cruris- jock itch

-pedis- athlete's foot

unguum (onychomycosis)- nail beds thickened

Madonna/Schram- deep

Dimorphic, ROSE GARDENER

innoculat'n- SQ, sore, lymph spread

Itraconazole

ampho the terrible- warrier on roids/fat

Binds ergosterol- PORE (we have sterols too)

IV only, sequestered in cells (so bad AEx)

AEx: NEPHROTOXliposomal form help, fever, anemia

synerg w 5flucytosine

histo, blasto, coccidio, cryptococcs, candida

Flu-> FU! ->FdUMP

activated by fungal cyto deaminase (5-FU) >> (FdUMP) inhibits thymidylate synthase > DNA

R= activation, uptake, occurs rapidly

AEx: Bone marrow

Synergy w AmphoB

comp. inhib of ergosterol (lanosterol 14a demethylase)

R: efflux, less binding, more exp of enz

Flucon- CSF, Itra- , Vori- lots metabolism (6hr), visual disturb, Posa- 

AEx- GI, hepatotox, NO PREGGS

metab by and **INHIBITS P450! (so ^ warfarin, phenytoin)

Echinocandins

(caspofungin, micafungin, anidulafungin)

inhibit synth of b-13dglycan mesh in CELL WALL

IV only, t1/2= 40-50hr

AEx: flush, fever, phlebitis, HA, liv enz (low tox)

Candida, invasive aspergillosis