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244 Cards in this Set
- Front
- Back
|
What does fungi have in the membrane?
|
Ergosterol lipid
|
|
|
Fungi Like what type of environment?
|
Warmth and Moisture (btwn skin folds, groin, axilla, vagina), loves sugar (think diabetic pt)
|
|
|
How do fungi stain?
|
Methenamine silver stains
|
|
|
Best preventative measure for fungal infection?
|
Keep area cool, dry and control sugar
|
|
|
Polyene Antifungals mechanism of action
|
BIND ergosterol→ pores in fungal wall. Nystatin (Topical), Amphotericin B (Systemic)
|
|
|
Azole antifungals m.o.a.
|
INHIBIT ergosterol Synthesis
|
|
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Topical Azoles
|
Miconazole, Clotrimazole, Econazole
|
|
|
Systemic Azoles
|
Ketoconazole, Itraconazole, Fluconazole
|
|
|
Mictrotubule inhibitor antifungal
|
Griseofulvin (fat soluble)
|
|
|
Anti-metabolite Antifungal
|
Terbinafine, Flucytosine
|
|
|
Terbinafine treats
|
Cutaneous fungi
|
|
|
Flucytosine MOA
|
Stops DNA replication (given w/ Amphotericin B)
|
|
|
Topical Antifungals Mechanism of Action
|
Do not get absorbed. BIND to Ergosterol→ punch holes in cell membrane→ K+leak out, N+ leak IN→ cell swells→Lysis of cell
|
|
|
Topical Antifungal Drugs
|
Nystatin, Clotrimazole, Econazole, Tinactin, Micatin, Miconazole
|
|
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Topical Antifungals Side Effects
|
Erythema of Skin; Rash
|
|
|
What drug would you give for a systemic fungal infection?
|
amphotericin B (IM/IV) + Flucytosine then send home w/ oral antifungal for 2 weeks
|
|
|
Amphotericin B Mechanism of action
|
Also BINDS to Ergosterol, but also pokes holes in CHOLESTEROL (human cell membrane)
|
|
|
Amphotericin B MC SE
|
#1 MC- Hyperkalemia (systemic toxicity b/c pokes holes in cells in body→ K+ leaks out in plasma)
|
|
|
Amphotericin B SE
|
#1-Hyperkalemia (systemic toxicity) #2- HYPOkalemia (renal toxicity→ K+ leak out in urine) #3- Renal Failure (loosing K+ less likely to depol) #4-SIADH (occasionally)
|
|
|
Ketoconazole
|
Systemic Azole. Inhibits P450 and 5- α reductase⇒ Gynecomastia, excess menstruation
|
|
|
What antifungal gets the best CNS penetration?
|
Fluconazole (systemic azole)
|
|
|
1 dose PO tx against Candidiasis (Diflucan)
|
Fluconazole
|
|
|
Griseofulvin mechanism of action
|
Fat soluble drug that Inhibits Microtubule (inhibits Mitosis)
|
|
|
What drugs inhibit Ergosterol Synthesis and prevent fungal Ix in HIV pts?
|
Itraconazole, Ketoconazole, Fluconazole, Griseofulvin
|
|
|
Vincristine, Vinblastine, Colchicine, Paclitaxel all share in common?
|
Microtuble Inhibitors ( Paclitaxel- only one to inhibit microtubules after they are made)
|
|
|
What antifungal inhibits microtubules?
|
griseofulvin
|
|
|
4 MC Cutaneous Fungi Ix in general
|
Dermatophyton (skin), Trichophyton (hair), Epidermaphyton (epidermis), Microsporum
|
|
|
What cutaneous fungi is the only one that is woods lamp positive?
|
Microsporum
|
|
|
What does Tinea (cutaneous infections) look like under the microscope?
|
Mold Hyphae in KOH prep, not dimorphic
|
|
|
What is piedre hortae? Treatment
|
superficial, little black balls on the hair shaft- eats Keratin off of hair shaft. Mc involves Scalp (does NOT enter scalp). Tx: haircut/shave head
|
|
|
How do kids get Piedra?
|
Wearing eachothers hats
|
|
|
Keratin in hair has what amino acid?
|
Cysteine
|
|
|
Trichosporon beigelii
|
Superficial Fungi. Causes White Piedra- little white balls
|
|
|
White Piedra appearance
|
Nodules are loos aggregates of hyphae and arthroconidia. Easily detach from hair shaft. Color- white to light brown
|
|
|
White Piedra MC infects what areas?
|
Pubic hair, beard, mustache. May affect also scalp, body and genital area
|
|
|
Tinea capitus affects?
|
Scalp
|
|
|
Tinea capitis is what kind of fungi? Affects? MC affects who?
|
Cutaneous. Thick flaky crusty lesions on scalp, hair loss. Lives in Stratum Corneum. Children
|
|
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Tinea Capitis (Trichophyton) Tx?
|
Terbinafine
|
|
|
Kerion is a complication of?
|
=complication of Tinea capitis. Ix of Hair follicles+ secondary Bacterial Infection (Staph aureus)
|
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A complication caused by bacterial Ix (S.aureus) of flaky lesion, swollen lesion underneath is?
|
Kerion
|
|
|
Kerion Treat:
|
1. Fungus w/ Griseofulvin (fat soluble- only one can penetrate Stratum corneum). 2. Inflammation (steroids) 3. Bacteria (s. aureus) w/ antibiotic
|
|
|
How does a Kerion present?
|
Raised, Pus-filled and spony lesions. Classic Clue “SOFT BOGGY mass” underneath crusty lesions
|
|
|
Tinea versicolor clue and causes?
|
V on back. causes rxn on skin that destroys Melanin (degradation of lipids produce acids that damage melanocytes)
|
|
|
Tinea versicolor is caused by?
|
Malassezia furfur
|
|
|
Tinea Versicolor appearance?
|
Hypopigmented macules (varying shades of hypopigmentation/Hyperpigmentation). On Back “V Pattern”- upside down Christmas tree (ie pattern of how sweat runs down back)
|
|
|
“spaghetti and Meatball” appearance on KOH prep , worse in Hot, Humid weather?
|
Tinea Versicolor
|
|
|
Tinea Versicolor Tx?
|
Ketokonazole. Griseofulvin 1st line (drink w/ milk), then pt go jog sweat push fungus to surface attacked by drug. 2.5% selenium or “selsun blue”
|
|
|
Tinea Barbae
|
Looks like “razor bumps” on chin, but if are RED that means fungus in there
|
|
|
Tinea corporis?
|
on body anywhere (mc face)- ring worm (from cats)
|
|
|
Tinea Corporis Treatment?
|
Antifungal cream w/ fingertips and NOT scrape lesion in order to limit spread to others
|
|
|
Tinea manis?
|
“Red appealing” between fingers, digits, finger webs “Maceration”
|
|
|
Tinea nigra?
|
palms- lines get real dark (flaky lesion on palm of hand and “lifelines” turn black d/t irritation)
|
|
|
Tinea Intertrigo?
|
Btwn Skin Folds (where skin touches skin)- Armpits, under Breast, Neck (baby w/ big head) , Waste, Large breasted women. Red Macerated area
|
|
|
Tinea cruris?
|
Jock itch
|
|
|
Tinea pedis?
|
Between toes (athletes foot) Tx: Terbinafine or Tolnaftate cream
|
|
|
“smells like corn chips”
|
Tinea Pedis
|
|
|
Tinea unguum?
|
under nail beds (1 nail affected)= DISCOLORED nail in diabetic. Need to remove nail (turns black)
|
|
|
Cutaneous Fungi Treatment
|
Topical Clotrimazole (for most), Griseofulvin (best for capitus and versicolor), Selsun Blue (5% selenium), codl water and air to dry.
|
|
|
What are the 2 deep fungi?
|
Onychomycosis, Candidiasis
|
|
|
What is onychomycosis?
|
fungus of the ALL your nails. Diabetics. Tx: remove entire nail bed.
|
|
|
Candidiasis is normal flora where? Common sites of it?
|
Normal Skin Flora, BUT loves mucosal surfaces- GI, Respiratory, and GU tract
|
|
|
Candidiasis is the MCC of?
|
Vaginaitis (vulvovaginal) in females and Thrush in Neonates- white curdy discharge and itching. MCC of Opportunistic Mycosis (in IC pts)
|
|
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When does Candidiasis go from being deep fungal to a Systemic fungal infection?
|
When you are Immunocompromised. (PN, Esophagitis, R.Endocarditis, Abscess, Candidemia (sepsis).
|
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Candidiasis exists as? On LM?
|
Exist in yeast form (single cell). On LM- Budding Yeast w/ PSEUDOHYPHAE (+KOH)
|
|
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Diagnostic Test for C. Albicans
|
Germ Tube Test. At 37 degrees form true Hyphae from yeast
|
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|
What is the most common cause of vaginitis?
|
Candidiasis
|
|
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Vaginitis described as a curdy white discharge is caused by what? Treatment?
|
Candida- treat with fluconazle (one dose tx)
|
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Vaginitis described as a fishy odor with clue cells is caused by what? Treatment?
|
Gardnerella- treat with metronidazole
|
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Vaginitis described as a frothy green discharge is caused by what? Treat?
|
Trichomonas- treat with metronidazole
|
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What fungi can cause Systemic Mycoses?
|
Histoplasmosis, Blastomycosis, Coccidiomycosis, para-coccidiomycosis
|
|
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All Systemic Mycoses can cause?
|
PNEUMONIA and can disseminate
|
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All systemic mycosis are caused by what morphological type of fungi? Except
|
Dimporphic fungi: cold (20degrees)=MOLD; Heat (37degrees)=YEAST. (except Coccidiomycosis=Spherule (not yeast) in tissue.
|
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How can you differentiate systemic mycosis from TB?
|
b/c it can mimc TB (granuloma formation) it may like same, but there is NO person-person transmission w/ systemic mycoses.
|
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What fungi is associated with the Midwest, pigeon droppings and bat poop (missisipi river)?
|
Histoplasmosis (NO CAPSULE!)- only fungus that can live w/in Macrophages! Oral ulcers
|
|
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Spelunker may get what?
|
Hes a Cave Explorer. May get Histoplasma Capsulatum
|
|
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Histoplasma Capasulatum Exists as? On LM?
|
DIMOPRHIC Fungi. Exist in Yeast form at body temp. on LM→ OVAL YEAST CELLS w/in Macrophages. Does NOT form germ tubes.
|
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What fungi is associated with the northeast and pigeon droppings?
|
Blastomycosis
|
|
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Main way to get Blastomyces dermatidis?
|
Pigeon poop, rotting wood in beaver dam.
|
|
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How does Blastomyces Dermatides present?
|
Black nodules on your skin. BIG BROAD BASED Budding Hypahe → Cavitary Lesions (can cause inflammatory lung dz and disseminate to skin and bone—form granulomatous nodules)
|
|
|
Only FUNGI associated with the Southwestrn US?
|
Coccidiomycosis (likes dry heat)- California
|
|
|
Coccidiomycosis general properties
|
Broad Based Cavity. Thin wall cavity (can keep off ALL free radicals). Dimporphic Fungi (forms molds at 25degrees, but exist as Spherules in human tissue)
|
|
|
Coccidiomycosis infection rate increased after earthquakes b/c?
|
Spores in dust are thrown up in air and become spherules in lungs
|
|
|
Soil (arizona), Desert pump Fever, Budding Yeast
|
Coccidiomycosis
|
|
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Coccidiomycosis exist as what in human tissue?
|
Spherules- covered by a capsule + contain Endospores
|
|
|
Only VIRUS that likes southwest?
|
Hanta Virus (transmitted by rats)
|
|
|
Only BACTERIA that likes Southwest?
|
Yersinia enterocolitica (transmitted by rats)
|
|
|
What fungi is associated with South America and looks like a ships wheel or mariners wheel?
|
Paracoccidiomycosis (aka South American Blastomycosis)
|
|
|
What fungi is associated with rose bushes?
|
Sporothrix
|
|
|
Sporothrix Schenckii Tx
|
Potassium Iodide (KI) on skin and Ampho B if gets systemic.
|
|
|
What fungi is associated with meningitis in AIDS pts?
|
Cryptococcus
|
|
|
How is Cryptococcus neoformans acquired?
|
Inhalation w/ hematogenous dissemination
|
|
|
Cryptococcus Neoformans exist in what form?
|
Oval Buddying Yeast w/ THICK CAPSULE. Urease Positive
|
|
|
How do you test for Cyrptococcus neoformans?
|
Culture on Sabouraud’s agar. Stain w/ INDIA INK (clear zone around nucleus=unstained capsule). And LATEX AGGLUTINATION
|
|
|
What does Latex agglutination test detect?
|
Polysaccharide capsular antigen and is more specific test for Cryptococcus neoformans.
|
|
|
“Soap bubble” lesions in brain
|
Cryptococcus neoformans
|
|
|
Cyrptococcus neoformans Lung Tx, Meningitis Tx
|
Lung Tx- Fluconazole. Meningitis Tx: Ampho B/Flucytosine and life long fluconazole
|
|
|
What fungi is associated with moldy hay or basements?
|
Aspergillus
|
|
|
Aspergillus fmigatus exist in what form?
|
Only MOLD form (ie True Hypahe).
|
|
|
Aspergillus Fumigatus infection will present how in pt?
|
Severe Vasculitis (b.c invades BVs). Petechae, purpura, echymosis, Hemoptysis, Pulmonary hemorrhage, Intracerebral hemorrhage
|
|
|
Fungus ball
|
Aspergillus- lives in Old TB cavity
|
|
|
MCCOD in Aspergillus
|
Heart failure b/c of Vasculitis
|
|
|
Aspergillus affect on lung?
|
Can cause Severe Allergic Rxn in Lungs d/t Fibers (Mimics Ashtma**)- PIE Syndrome
|
|
|
Pulmonary Infiltrate w/ Eosinophilia (PIE) can be caused by?
|
ABPA in (most common)- Allergic BronchoPulmonary Aspergillosis, Loeffler (worms), Churg Strauss
|
|
|
ABPA affects who the most?
|
CF pts and Asthmatics (5-10% steroid resistant ones). → Proximal Bronchiectasis
|
|
|
What are the lab values in ABPA?
|
Very high IgE, Eosinophils, IgG, serum Ab to Aspergillus
|
|
|
Churg Strauss
|
Necrotizing vasculitis, idiopathic; mimcs asthma in kids. P-ANC+, sudden severe asthma in person
|
|
|
Aspergillus Fumigatus Tx
|
Steroids or Voriconazole if necrotizing
|
|
|
What fungus can cause hepatocellular carcinoma?
|
Aspergillus (via alfatoxins)
|
|
|
5 parasites that go thru your lung as part of their life cycle:
|
Aka 5 causes of Loeffler Syndrome. “NASSA”- Necator americanus, Ancylostoma duodenale, Schistomoniasis, Strongyloides, Ascaris lumbricoides
|
|
|
What fungi is found in the nose of diabetic pts?
|
Rhizor/mucor
|
|
|
Disease mostly in ketoacidotic diabetic and leukemic pts
|
Mucormycosis
|
|
|
Rhizopus/Mucor exist only in what form? Like to attack what? How do you Diagnos
|
Mold Form (true hyphae). Eats eyes, Nose Sinus. Dx- Orbital CT. Tx: cut out surgery + ampho B
|
|
|
T-cell defect involving only candidiasis
|
Mucocutaneous Candidiasis
|
|
|
Macrophage filled w/ histoplasma
|
Histoplasmosis (smaller than RC)
|
|
|
Broad-base budding
|
Blastomycosis (same size as RBC)
|
|
|
Spherule filled w/ endospores
|
Coccidiomycosis (much larger than RBC)
|
|
|
Budding yeast w/ “captain’s wheel” formation
|
Para-coccidiomycosis (much larger than RBC)
|
|
|
Dimorphic yeast. Pseudohyphae and budding yeasts at 20 degrees, germ tube at 37 degree
|
Candida albicans
|
|
|
Septate hypahe that branch at acute angles (<45) Conidiophore w/ rare fruiting bodies
|
Aspergillus
|
|
|
Yeast w/ wide capsular halos and unequal budding in light india ink stain
|
Cryptococcus neofrmans
|
|
|
Irregular, broad, nonseptate hyphae branching at wide angles
|
Mucor
|
|
|
Cigar shaped buddying yeast that lives on vegetation
|
Sporothrix schenckii
|
|
|
What does fungi have in the membrane?
|
Ergosterol lipid
|
|
|
Fungi Like what type of environment?
|
Warmth and Moisture (btwn skin folds, groin, axilla, vagina), loves sugar (think diabetic pt)
|
|
|
How do fungi stain?
|
Methenamine silver stains
|
|
|
Best preventative measure for fungal infection?
|
Keep area cool, dry and control sugar
|
|
|
Polyene Antifungals mechanism of action
|
BIND ergosterol→ pores in fungal wall. Nystatin (Topical), Amphotericin B (Systemic)
|
|
|
Azole antifungals m.o.a.
|
INHIBIT ergosterol Synthesis
|
|
|
Topical Azoles
|
Miconazole, Clotrimazole, Econazole
|
|
|
Systemic Azoles
|
Ketoconazole, Itraconazole, Fluconazole
|
|
|
Mictrotubule inhibitor antifungal
|
Griseofulvin (fat soluble)
|
|
|
Anti-metabolite Antifungal
|
Terbinafine, Flucytosine
|
|
|
Terbinafine treats
|
Cutaneous fungi
|
|
|
Flucytosine MOA
|
Stops DNA replication (given w/ Amphotericin B)
|
|
|
Topical Antifungals Mechanism of Action
|
Do not get absorbed. BIND to Ergosterol→ punch holes in cell membrane→ K+leak out, N+ leak IN→ cell swells→Lysis of cell
|
|
|
Topical Antifungal Drugs
|
Nystatin, Clotrimazole, Econazole, Tinactin, Micatin, Miconazole
|
|
|
Topical Antifungals Side Effects
|
Erythema of Skin; Rash
|
|
|
What drug would you give for a systemic fungal infection?
|
amphotericin B (IM/IV) + Flucytosine then send home w/ oral antifungal for 2 weeks
|
|
|
Amphotericin B Mechanism of action
|
Also BINDS to Ergosterol, but also pokes holes in CHOLESTEROL (human cell membrane)
|
|
|
Amphotericin B MC SE
|
#1 MC- Hyperkalemia (systemic toxicity b/c pokes holes in cells in body→ K+ leaks out in plasma)
|
|
|
Amphotericin B SE
|
#1-Hyperkalemia (systemic toxicity) #2- HYPOkalemia (renal toxicity→ K+ leak out in urine) #3- Renal Failure (loosing K+ less likely to depol) #4-SIADH (occasionally)
|
|
|
Ketoconazole
|
Systemic Azole. Inhibits P450 and 5- α reductase⇒ Gynecomastia, excess menstruation
|
|
|
What antifungal gets the best CNS penetration?
|
Fluconazole (systemic azole)
|
|
|
1 dose PO tx against Candidiasis (Diflucan)
|
Fluconazole
|
|
|
Griseofulvin mechanism of action
|
Fat soluble drug that Inhibits Microtubule (inhibits Mitosis)
|
|
|
What drugs inhibit Ergosterol Synthesis and prevent fungal Ix in HIV pts?
|
Itraconazole, Ketoconazole, Fluconazole, Griseofulvin
|
|
|
Vincristine, Vinblastine, Colchicine, Paclitaxel all share in common?
|
Microtuble Inhibitors ( Paclitaxel- only one to inhibit microtubules after they are made)
|
|
|
What antifungal inhibits microtubules?
|
griseofulvin
|
|
|
4 MC Cutaneous Fungi Ix in general
|
Dermatophyton (skin), Trichophyton (hair), Epidermaphyton (epidermis), Microsporum
|
|
|
What cutaneous fungi is the only one that is woods lamp positive?
|
Microsporum
|
|
|
What does Tinea (cutaneous infections) look like under the microscope?
|
Mold Hyphae in KOH prep, not dimorphic
|
|
|
What is piedre hortae? Treatment
|
superficial, little black balls on the hair shaft- eats Keratin off of hair shaft. Mc involves Scalp (does NOT enter scalp). Tx: haircut/shave head
|
|
|
How do kids get Piedra?
|
Wearing eachothers hats
|
|
|
Keratin in hair has what amino acid?
|
Cysteine
|
|
|
Trichosporon beigelii
|
Superficial Fungi. Causes White Piedra- little white balls
|
|
|
White Piedra appearance
|
Nodules are loos aggregates of hyphae and arthroconidia. Easily detach from hair shaft. Color- white to light brown
|
|
|
White Piedra MC infects what areas?
|
Pubic hair, beard, mustache. May affect also scalp, body and genital area
|
|
|
Tinea capitus affects?
|
Scalp
|
|
|
Tinea capitis is what kind of fungi? Affects? MC affects who?
|
Cutaneous. Thick flaky crusty lesions on scalp, hair loss. Lives in Stratum Corneum. Children
|
|
|
Tinea Capitis (Trichophyton) Tx?
|
Terbinafine
|
|
|
Kerion is a complication of?
|
=complication of Tinea capitis. Ix of Hair follicles+ secondary Bacterial Infection (Staph aureus)
|
|
|
A complication caused by bacterial Ix (S.aureus) of flaky lesion, swollen lesion underneath is?
|
Kerion
|
|
|
Kerion Treat:
|
1. Fungus w/ Griseofulvin (fat soluble- only one can penetrate Stratum corneum). 2. Inflammation (steroids) 3. Bacteria (s. aureus) w/ antibiotic
|
|
|
How does a Kerion present?
|
Raised, Pus-filled and spony lesions. Classic Clue “SOFT BOGGY mass” underneath crusty lesions
|
|
|
Tinea versicolor clue and causes?
|
V on back. causes rxn on skin that destroys Melanin (degradation of lipids produce acids that damage melanocytes)
|
|
|
Tinea versicolor is caused by?
|
Malassezia furfur
|
|
|
Tinea Versicolor appearance?
|
Hypopigmented macules (varying shades of hypopigmentation/Hyperpigmentation). On Back “V Pattern”- upside down Christmas tree (ie pattern of how sweat runs down back)
|
|
|
“spaghetti and Meatball” appearance on KOH prep , worse in Hot, Humid weather?
|
Tinea Versicolor
|
|
|
Tinea Versicolor Tx?
|
Ketokonazole. Griseofulvin 1st line (drink w/ milk), then pt go jog sweat push fungus to surface attacked by drug. 2.5% selenium or “selsun blue”
|
|
|
Tinea Barbae
|
Looks like “razor bumps” on chin, but if are RED that means fungus in there
|
|
|
Tinea corporis?
|
on body anywhere (mc face)- ring worm (from cats)
|
|
|
Tinea Corporis Treatment?
|
Antifungal cream w/ fingertips and NOT scrape lesion in order to limit spread to others
|
|
|
Tinea manis?
|
“Red appealing” between fingers, digits, finger webs “Maceration”
|
|
|
Tinea nigra?
|
palms- lines get real dark (flaky lesion on palm of hand and “lifelines” turn black d/t irritation)
|
|
|
Tinea Intertrigo?
|
Btwn Skin Folds (where skin touches skin)- Armpits, under Breast, Neck (baby w/ big head) , Waste, Large breasted women. Red Macerated area
|
|
|
Tinea cruris?
|
Jock itch
|
|
|
Tinea pedis?
|
Between toes (athletes foot) Tx: Terbinafine or Tolnaftate cream
|
|
|
“smells like corn chips”
|
Tinea Pedis
|
|
|
Tinea unguum?
|
under nail beds (1 nail affected)= DISCOLORED nail in diabetic. Need to remove nail (turns black)
|
|
|
Cutaneous Fungi Treatment
|
Topical Clotrimazole (for most), Griseofulvin (best for capitus and versicolor), Selsun Blue (5% selenium), codl water and air to dry.
|
|
|
What are the 2 deep fungi?
|
Onychomycosis, Candidiasis
|
|
|
What is onychomycosis?
|
fungus of the ALL your nails. Diabetics. Tx: remove entire nail bed.
|
|
|
Candidiasis is normal flora where? Common sites of it?
|
Normal Skin Flora, BUT loves mucosal surfaces- GI, Respiratory, and GU tract
|
|
|
Candidiasis is the MCC of?
|
Vaginaitis (vulvovaginal) in females and Thrush in Neonates- white curdy discharge and itching. MCC of Opportunistic Mycosis (in IC pts)
|
|
|
When does Candidiasis go from being deep fungal to a Systemic fungal infection?
|
When you are Immunocompromised. (PN, Esophagitis, R.Endocarditis, Abscess, Candidemia (sepsis).
|
|
|
Candidiasis exists as? On LM?
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Exist in yeast form (single cell). On LM- Budding Yeast w/ PSEUDOHYPHAE (+KOH)
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Diagnostic Test for C. Albicans
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Germ Tube Test. At 37 degrees form true Hyphae from yeast
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What is the most common cause of vaginitis?
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Candidiasis
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Vaginitis described as a curdy white discharge is caused by what? Treatment?
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Candida- treat with fluconazle (one dose tx)
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Vaginitis described as a fishy odor with clue cells is caused by what? Treatment?
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Gardnerella- treat with metronidazole
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Vaginitis described as a frothy green discharge is caused by what? Treat?
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Trichomonas- treat with metronidazole
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What fungi can cause Systemic Mycoses?
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Histoplasmosis, Blastomycosis, Coccidiomycosis, para-coccidiomycosis
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All Systemic Mycoses can cause?
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PNEUMONIA and can disseminate
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All systemic mycosis are caused by what morphological type of fungi? Except
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Dimporphic fungi: cold (20degrees)=MOLD; Heat (37degrees)=YEAST. (except Coccidiomycosis=Spherule (not yeast) in tissue.
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How can you differentiate systemic mycosis from TB?
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b/c it can mimc TB (granuloma formation) it may like same, but there is NO person-person transmission w/ systemic mycoses.
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What fungi is associated with the Midwest, pigeon droppings and bat poop (missisipi river)?
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Histoplasmosis (NO CAPSULE!)- only fungus that can live w/in Macrophages! Oral ulcers
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Spelunker may get what?
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Hes a Cave Explorer. May get Histoplasma Capsulatum
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Histoplasma Capasulatum Exists as? On LM?
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DIMOPRHIC Fungi. Exist in Yeast form at body temp. on LM→ OVAL YEAST CELLS w/in Macrophages. Does NOT form germ tubes.
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What fungi is associated with the northeast and pigeon droppings?
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Blastomycosis
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Main way to get Blastomyces dermatidis?
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Pigeon poop, rotting wood in beaver dam.
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How does Blastomyces Dermatides present?
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Black nodules on your skin. BIG BROAD BASED Budding Hypahe → Cavitary Lesions (can cause inflammatory lung dz and disseminate to skin and bone—form granulomatous nodules)
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Only FUNGI associated with the Southwestrn US?
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Coccidiomycosis (likes dry heat)- California
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Coccidiomycosis general properties
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Broad Based Cavity. Thin wall cavity (can keep off ALL free radicals). Dimporphic Fungi (forms molds at 25degrees, but exist as Spherules in human tissue)
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Coccidiomycosis infection rate increased after earthquakes b/c?
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Spores in dust are thrown up in air and become spherules in lungs
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Soil (arizona), Desert pump Fever, Budding Yeast
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Coccidiomycosis
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Coccidiomycosis exist as what in human tissue?
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Spherules- covered by a capsule + contain Endospores
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Only VIRUS that likes southwest?
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Hanta Virus (transmitted by rats)
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Only BACTERIA that likes Southwest?
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Yersinia enterocolitica (transmitted by rats)
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What fungi is associated with South America and looks like a ships wheel or mariners wheel?
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Paracoccidiomycosis (aka South American Blastomycosis)
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What fungi is associated with rose bushes?
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Sporothrix
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Sporothrix Schenckii Tx
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Potassium Iodide (KI) on skin and Ampho B if gets systemic.
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What fungi is associated with meningitis in AIDS pts?
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Cryptococcus
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How is Cryptococcus neoformans acquired?
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Inhalation w/ hematogenous dissemination
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Cryptococcus Neoformans exist in what form?
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Oval Buddying Yeast w/ THICK CAPSULE. Urease Positive
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How do you test for Cyrptococcus neoformans?
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Culture on Sabouraud’s agar. Stain w/ INDIA INK (clear zone around nucleus=unstained capsule). And LATEX AGGLUTINATION
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What does Latex agglutination test detect?
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Polysaccharide capsular antigen and is more specific test for Cryptococcus neoformans.
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“Soap bubble” lesions in brain
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Cryptococcus neoformans
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Cyrptococcus neoformans Lung Tx, Meningitis Tx
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Lung Tx- Fluconazole. Meningitis Tx: Ampho B/Flucytosine and life long fluconazole
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What fungi is associated with moldy hay or basements?
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Aspergillus
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Aspergillus fmigatus exist in what form?
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Only MOLD form (ie True Hypahe).
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Aspergillus Fumigatus infection will present how in pt?
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Severe Vasculitis (b.c invades BVs). Petechae, purpura, echymosis, Hemoptysis, Pulmonary hemorrhage, Intracerebral hemorrhage
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Fungus ball
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Aspergillus- lives in Old TB cavity
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MCCOD in Aspergillus
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Heart failure b/c of Vasculitis
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Aspergillus affect on lung?
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Can cause Severe Allergic Rxn in Lungs d/t Fibers (Mimics Ashtma**)- PIE Syndrome
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Pulmonary Infiltrate w/ Eosinophilia (PIE) can be caused by?
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ABPA in (most common)- Allergic BronchoPulmonary Aspergillosis, Loeffler (worms), Churg Strauss
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ABPA affects who the most?
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CF pts and Asthmatics (5-10% steroid resistant ones). → Proximal Bronchiectasis
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What are the lab values in ABPA?
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Very high IgE, Eosinophils, IgG, serum Ab to Aspergillus
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Churg Strauss
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Necrotizing vasculitis, idiopathic; mimcs asthma in kids. P-ANC+, sudden severe asthma in person
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Aspergillus Fumigatus Tx
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Steroids or Voriconazole if necrotizing
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What fungus can cause hepatocellular carcinoma?
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Aspergillus (via alfatoxins)
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5 parasites that go thru your lung as part of their life cycle:
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Aka 5 causes of Loeffler Syndrome. “NASSA”- Necator americanus, Ancylostoma duodenale, Schistomoniasis, Strongyloides, Ascaris lumbricoides
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What fungi is found in the nose of diabetic pts?
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Rhizor/mucor
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Disease mostly in ketoacidotic diabetic and leukemic pts
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Mucormycosis
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Rhizopus/Mucor exist only in what form? Like to attack what? How do you Diagnos
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Mold Form (true hyphae). Eats eyes, Nose Sinus. Dx- Orbital CT. Tx: cut out surgery + ampho B
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T-cell defect involving only candidiasis
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Mucocutaneous Candidiasis
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Macrophage filled w/ histoplasma
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Histoplasmosis (smaller than RC)
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Broad-base budding
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Blastomycosis (same size as RBC)
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Spherule filled w/ endospores
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Coccidiomycosis (much larger than RBC)
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Budding yeast w/ “captain’s wheel” formation
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Para-coccidiomycosis (much larger than RBC)
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Dimorphic yeast. Pseudohyphae and budding yeasts at 20 degrees, germ tube at 37 degree
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Candida albicans
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Septate hypahe that branch at acute angles (<45) Conidiophore w/ rare fruiting bodies
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Aspergillus
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Yeast w/ wide capsular halos and unequal budding in light india ink stain
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Cryptococcus neofrmans
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Irregular, broad, nonseptate hyphae branching at wide angles
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Mucor
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Cigar shaped buddying yeast that lives on vegetation
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Sporothrix schenckii
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