Term
| What are the three classic fungal pathogens to cause deep infections? |
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Definition
1. Histoplasma
2. Coccidioides (immitis)
3. Blastomyces (dermatitidis)
-Well, this one's easy... His Cock Blast deeply (for deep infections lol)
-All three are dimorphic |
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Term
| What can they cause? What is the common cornerstone treatment for all three fungi? |
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Definition
-Acute pulmonary (usually asymptomatic and self resolving)
-Chronic pulmonary
-Disseminated infections (in immunocompromised)
-**Amphotericin B works for all of them (a polyene; binds ergosterol), can also throw in some ketoconazole |
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Term
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Definition
-We look at sputum sample cultures (on blood agar or other)
-Histoplasma actually lives in the macs, so we can do a blood culture to look for it |
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Term
| What does histoplasma look like? |
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Definition
-Environmental form; hyphae with macro and microconidia
-In vivo; small intracellular yeast in **macrophages (many) |
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Term
| Where do we see more histoplasma? |
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Definition
-It is often associated with *bat and bird droppings; histoplasmosis is sometimes called *spelunking disease, and is more common also in *chicken farmers
-We see it in the Eastern Great lakes, Ohio, Mississippi, and Missouri River beds (states below great lakes; drainage) |
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Term
| What disease can histoplasma cause? What do we see in a disseminated infection |
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Definition
Fungus flu (a pneumonia)
-Usually resolves on its own
-Common in the summer, esp. with people moving into endemic areas
-Along with flu-like symptoms, we may also see *hepatosplenomegaly and *calcification of healing lesions
-In IC'd patients, dissemination will involve mucocutaneous lesions |
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Term
| How do we treat fungus flu? |
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Definition
-*Amphotericin B
-Ketoconazole (an "-azole") |
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Term
| What does Coccidiodes immitis look like? |
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Definition
-Environmental; hyphae breaking up into arthroconidia found in desert sand
-In vivo; **spherules with endospores (very diagnostic) |
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Term
| Where do we find Coccidiodes immitis? |
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Definition
| -In the southwest; southern california, texas, new mexico, etc. |
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Term
| What disease does Coccidiodes immitis cause? |
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Definition
Valley fever; an asymptomatic to self-resolving pneumonia
-Presents with *erythema nodosum (desert bumps) and arthritis (fat inflammation)
http://en.wikipedia.org/wiki/File:ENlegs.JPG
-The lesions have a tendency to calcify
-Can go systemic in AIDS or third trimester moms (to meningitis or mucocutaneous lesions) |
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Term
| What is the treatment for coccidiodes immitis? |
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Definition
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Term
| What does Blastomyces dermatitidis look like? |
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Definition
-Environmental; hyphae with nondecript conidia
-In vivo; *broad-based budding yeast with a double cell wall* |
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Term
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Definition
-Same as Histoplasma with the addition of N. & S. Carolina. (Great lakes and states below)
-Think it is associated with rotting wood |
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Term
| What disease do we see from Blastomyces dermatitidis? How do we treat? Where does it disseminate? |
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Definition
Blastomycosis; acute and chronic pulmonary
-A bit less likely to self resolve
-Again, we treat with *Amphotericin B
-Disseminates into the skin (while others go to mucoQ) |
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Term
| What are the five types of opportunistic fungi? Where do we usually see these? |
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Definition
1. Aspergillus fumigatus
2. Candida Albicans
3. Cryptococcus neoformans
4. Mucor, Rhizopus, Absidia
5. Pneumocystis jiroveci
-Normally we see theses in HIV/AIDS |
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Term
| What does Aspergillus fumigatus look like? |
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Definition
-Monomorphic for the hyphae form
-Has frequent *septate hyphae with **45° branching angles (think piece sign, and then upside-down to make an A) |
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Term
| What are the diseases and treatment for Aspergillus fumigatus? |
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Definition
Allergic bronchopulmonary aspergillosis
-An allergic reaction to inhaling the mold (common in farmers with mold on hay, compost, etc.)
Fungus ball
-Ball of fungus develops in lungs from previous cavitation
-Requires surgery usually
*Invasive aspergillosis
-Occurs basically only in severe/late AIDS
-Can cause all kinds of bad effects; MI, hemorrhage, pneumonia, meningitis, cellulitis, etc.
-Treat with good ol' amphotericin B, -azoles may also be used |
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Term
| What does candida albicans look like? Where do we normally find it? |
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Definition
-It is the one with the *pseudohyphae (form it takes in tissue)
-If incubated at 37C in serum, it also makes **germ tubes; look like lollipops (think candy for CANDIda lol)
-In infections, the discharge looks like cottage cheese
-It is a normal fora |
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Term
| What are some of the infections we can get with Candida albicans? WHen do we see them? |
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Definition
-Perleche; angles of mouth (aka angular cheilitis)
-Oral thrush; in mouth (white blotches, esp. on tongue)
-Esophagitis & gastritis
-Septicemia
-Endocarditis (in IV drug abusers)
-Cutaneous infections (obese and infants)
-Yeast vaginitis
-*Chronic mucocutaneous candidiasis (CMC); more in people with *endocrine defects or T cell defects (de George)
-Pretty much see all of them in AIDS, can also get a few from antibiotic use (such as vaginal, oral, esophageal, etc.) |
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Term
| How do we diagnose and treat candida albicans infections? |
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Definition
-Like with all the others, we diagnose by morphology
-We treat with amphotericin B or an -azole (fluconazole) |
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Term
| What does Cryptococcus neoformans look like? What do we find it associated with? |
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Definition
-Heavily encapsulated yeast (monomophic)
-It is the C in "Some Killers Have Pretty Nice Capsules"
-Associated with pigeon poo |
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Term
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Definition
| -It is the **leading cause of meningitis in AIDS patients** |
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Term
| How will we diagnose cryptococcus neoformans? How do we treat? |
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Definition
-We usually do a latex particle agglutination test of the CSF
-Could also do India ink, but it misses about %50 of the cases, so it can only rule in the diagnosis
-In a culture; they will be *urease-positive
-This one we treat with amphotericin B + flucytosine, later we also give fluconazole |
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Term
| What is the characteristic appearance of the *Mucor, Rhizopus, and Absidia species? |
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Definition
-They have 90° branching with **aseptrate hyphae
-Sometimes described as a ribbon-like hyphae |
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Term
| In what patients do we see these? |
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Definition
| -In ketoacidotic diabetic patients and leukemia patients |
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Term
| What do we see in infections with Mucor, Rhizopus, and Absidia? How do we treat? |
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Definition
-Paranasal swelling, before it goes into the brain (very deadly and usually fatal)
-We also see black puss
-We surgically remove the infected tissue and start Amphotericin B immediately |
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Term
| What does Pneumocystis jiroveci look like? Intra or extra? |
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Definition
-Looks like little un-unrolled condoms lol
-Stains with the silver-stain from alveolar lavage fluids/ biopsy
-It is obligate extracellular |
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Term
| What is the disease for Pneumocystis jiroveci? What is the specific virulence? |
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Definition
-Pneumonia in late stage AIDS patients and one of the leading causes of death for them (even with prophylaxis)
-It attaches to **type I pneumocytes and destroys them |
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Term
| What can we look for in diagnosis? How do we treat? |
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Definition
-Causes serum to leak into alveoli, causing a foamy, or *honeycomb appearance with H&E stain
-Also, there may be a *ground glass appearance in X-ray with lower lobe sparing
-Also we do a *silver-stain and see those condom shaped cells
-Treat with trimethoprim (inhibits DHFR), but usually without much success at this stage
-Remember also, this is the leading cause of death in AIDS patients, so this will be a big giveaway (AIDS + pneumonia) |
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