by mtoom

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Name the Yeasts (3) and Yeast-Like (1)
  • Candida
  • Cryptococcus
  • Malassezia furfur (Tinea versicolor)
  • Pneumocystis
Name Molds (5), 2 organisms, 3 classes
Molds (organisms)
  • Aspergillus
  • Fusarium

Molds (classes)
  • Agents of mucormycosis
  • Dermatophytes
  • Dimorphic fungi
Name the Dimorphic Fungi (3)
  • Histoplasmosis
  • Blastomycosis
  • Coccidiomycosis
Describe the general pathology of yeasts (2)
  • Opportunistic
  • Normally colonizes alimentary tract and mucocutaneous membranes
How do you treat a systemic Candida infection (with regard to IVs)?
1. Remove IVs
2. Start new IVs with anti-fungals specific to Candida
What are the 2 types of Cryptococcus?
C. neoformans var. neoformans
C. gattii
For the 2 types of Cryptococcus, who are the typical patients? How do you get it?
You get it by inhaling spores.
  • C. neoformans: In general only immunocompromised people get this. However, normal people can get it with sufficiently high innoculum (e.g. pigeon droppings)
  • C. gattii: Affects immunocompetent people. Found on Vancouver Island.
What kind of patients (5) might get Cryptococcus as an opportunistic infection?
  • AIDS patients
  • Transplant recipients
  • Sarcoidosis
  • Leukemia
  • Lymphoma
Describe the clinical relevance of Pneumocystis jirovecci?
The main/defining opportunistic infection associated with AIDS patients
  • PJP = PCP
What are symptoms of PCP infection, seen in immunocompromised?
Non-productive cough, chest tightness, night sweats, low grade fever, tachypnea.
  • Physical exam: Fine basilar rales
  • Chest x-ray: Diffuse, symmetrical interstitial infiltrates
Who is seropositive for PCP? How is it transmitted?
Most people seropositive in early life (C. jirovecci normally lives in lungs)
  • Transmitted by airbourne route
  • Transmitted from immunosuppressed to immune intact
What kind of fungus is Malassezia furfur?
What does Malassezia furfur cause?
  • Yeast
  • Tinea versicolor
How does Tinea versicolor present?
  • Macules or patches of variable appearance (unusual presentation)
  • Usually affects back
How is Tinea versicolor normally treated? What is a potentially serious side-effect in neonates?
  • Treated with topical anti-fungals
  • Long-term TNP (total parenteral nutrition) in neonates can cause catheter-related infection
Name 2 important genera of Molds
  • Aspergillus
  • Fusarium
What are the dermatophytes (3)?
  • Trichophyton
  • Microsporum
  • Epidermophyton
What are the (2) most common Aspergillus species?
  • Aspergillus fumigatus (most invasive; pathogenic)
  • Aspergillus flavus (sinusitis; skin infection; aflatoxin)
What are 3 non-invasive classifications of Aspergillus infection?
  • Allergic syndromes
  • Colonization and superficial syndromes
  • Direction inoculation (cutaneous, immunocompromised with surgical infection, nosocomial associated with construction)
What is Pulmonary Aspergilloma and name 2 other superficial syndromes caused by Aspergillus
Pulmonary Aspergilloma
  • Colonisation of a free fungal ball in residual lung cavity (usually post-TB)
  • Minimal inflammation, evolves to cavitation; symptoms include haemoptysis
Other superficial syndromes
  • Otomycosis
  • Keratitis
What is Allergic Bornchopulmonary Aspergillosis (ABPA)?
  • Exposure to fungus cases allergic respiratory symptoms
  • Affects people with asthma, cystic fibrosis
What is Invasive pulmonary Aspergillosis (IPA)?
Infection with pneumonia that spreads by blood to heart, lungs, brain
  • Most common invasive syndrome
  • Usually fatal
  • At risk: neutropenia for 10-12 days
What are the (4) invasive Aspergillus syndromes?

  • Invasive Pulmonary Aspergillosis (IPA)

  • Tracheobronchitis

  • Sinusitis

  • Disseminated infection

Describe Disseminated Aspergillus Infection
  • Can occur as part of IPA
  • At risk: immunocompromised patients
  • Mortality: 90%
  • Response to therapy <20%
Where would you potentially find Fusarium? Who gets infected?
Soil and organic debris (it infects plants but rarely humans) 
  • Healthy get infected (traumatic inoculation)
  • Immunocompromised get infected (inhalation or minor trauma) 
What sort of infections (4) does Fusarium cause?
  • Keratitis (Contact lenses)
  • Onychomycosis
  • Endophthalmitis
  • Skin/MSK infections (Puncture wounds)
Who is vulnerable for getting Disseminated Fusariosus? What are the symptoms?
Vulnerable people: AIDS patients, burn victims, acute leukemia, hematologic malignancy patients

Symptoms: Skin lesions (starting flat that become necrotic), papules and deep nodules. Progresses to death in neutropenic patients.
The Agents of Mucormycosis are of what order?

Name 3 of them.

What form do they grow as?
Order: Mucorales

3 types: Rhizopus, Mucor, Absidia

They grow in the hyphae form, and access the body by the respiratory tract
What are dimorphic fungi?

Name 3 genera.
They are mold-like in the environment and yeast-like in tissue.

3 genera:
  • Histoplasma
  • Blastomyces
  • Coccidioides 
Where is Histoplasma found geographically (4)?
Mississippi and Ohio river valleys

Asia, Australia
What are the vectors for Histoplasma?
Bird, bat, chicken droppings

What are the 5 clinical forms of Histoplasma?
  • Asymptomatic
  • Acute benign respiratory
  • Acute disseminated histoplasmosis
  • Chronic disseminated disease
  • Chronic pulmonary disease
Where does Histoplasma first infect?
Describe Acute disseminated Histoplasmosis
Symptoms: Rapid onset, GI symptoms, bone marrow suppression, hepatosplenomegaly

In young children and immunocompromised
Describe Chronic disseminated histoplasmosis
  • Subacute course, 10-12 month progression
  • Eventually fatal
  • Low grade fever, weakness, mild blood abnormalities
  • Hepatosplenomegaly
Describe chronic pulmonary disease
  • Clinically/radiologically resembles TB
  • Granulomatous
  • Can cure spontaneously
  • Similar to TB on X-Ray
On what type of terrain is Blastomyces found?

Where, geographically is it found (4)?
Found in forest on soil and organic matter (leaves/wood)

Found in states adjacent to Mississippi and Ohio river valleys, Northwestern Ontario, St. Lawrence River
How does Blastomycosis present?
  • 50% show symptoms
  • After 3-15 weeks, symptoms similar to flu (fever, chills, cough, muscle aches, joint pain, chest pain)
  • Dissemination can occur (with skin lesions)
Where is Coccidioides found geographically? How is it transmitted? What is it also known as?
Found in arid areas of California and Texas

Transmitted by inhalation

Also known as Valley Fever
Describe symptoms of Valley Fever (5)
  • Flu like symptoms
  • 1-4 week incubation
  • 1 in 5 cases have erythema nodosum
  • Rarely (1/1000) disseminated
  • Can have granulomas (indistinguishable from TB)
What kind of fungus are Dermatophytes?
Amorphic fungi
What are the 3 kinds of dermatophytes?
  • Trichophyton
  • Microsporum
  • Epidermophyton
What is Ringworm?
It is not a worm!

It is a fungal infection caused by a dermatophyte.
Describe pathophysiology of Ringworm
Dermatophytes infect non-living skin tissue. The startum corneum is colonized. Digestive enzymes from the fungus lead to an eczematous response.
What does Tinea mean? What are the 6 Tineas and which one is special?
Tinea = "Ringworm of the"
  • Tinea capitis: Ringworm of the head
  • Tinea corporis: Ringworm of the skin
  • Tinea pedis: Ringworm of the foot
  • Tinea cruris: Ringworm of the groin
  • Tinea unguium: Ringworm of the nails
Tinea versicolor: Caused by malassezia furfur not by a dermatophyte!
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