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Fungi (Identifiers (Size vs RBC (Smaller than RBCs Histoplasmosis, Larger…
Fungi
Identifiers
Size vs RBC
-
Larger Than RBCs
- Coccidioidomycosis
- Paracoccidioidomycosis
-
-
Dimorphics
Dimorphic
Mold in Cold
Spherule of Endospores in the Heat
Dimorphic
Mold in Cold
Yeast in Heat
- Histomycosis
- Blastomycosis
- Coccidiodomycosis
- Paracoccidioidomycosis (captain's Wheel yeast)
- Sporothrix schenckii (cigar shaped yeast)
Dimorphic
Dimorphic Budding Yeast (Pseduohyphae) in Cold
Germ Tubes (Hyphae) in the Heat
Erythema Nodsum
- Histoplasmosis
- Coccidioidomycosis
In the Lungs
Granulomas in the Lungs
- Histoplasmosis
- Paracoccidioidomycosis
Cavities in the Lungs
- Blastomycosis
- Coccidioidesimmitis
Hyphae (+)
- Dermatophytes
- Branching Hyphae - Sporothrix schenckii
- Cold Pseudohyphae - Candida albicans
- Acute Angle Branching Hyphae - Aspergillus fumigatus
- Wide Angle Branching Hyphae - Non-septate Mucormycosis
Catalse (+)
- Candida albicans
- Aspergillus fumigatus
-
Necrosis Around the Nose
- Aspergillus fumigatus
- Mucormycosis
-
Intracellular
- Cryptococcus neoformans
- Histoplasma capsulatum
Systemic Mycoses
Are all Dimorphic
- Mold in the gold
- Yeast in Heat
Histoplasma capsulatum
More in the SOUTH
("Historian in the Cave")Special
- Intracellular
Smaller than RBC
Bimorphic small ovoid budding yeast cells
- Found within Macrophages
Can cause ulcerated lesions on the tongue
- Bird and bat droppings or someone in a cave or working in chicken coops
Midwestern US - Mississippi and Ohio River valley but is more in the south and doesn't touch the east coast
- Disseminated form can cause hepatosplenomegaly
Virulence Factors
1. Spores in droppings are inhaled where they enter the lungs when inhaled and are ingested by macrophages. They replicate inside the macrophage
- Fungus targets cells of the reticule-endothelial system such as macrophages and are prevalent through the spleen and liver hence the hepatosplenomegaly
Lab Identifiers
- Histology shows Macrophages full of histoplasmosis
- Microscopy usually can use KOH prep
- Rapid Histoplasma serum antigen test
- Rapid Histoplasma urine antigen test
- Dimorphic
- Exist as filamentous mold in the environment and is found in soil contaminated with bird or bat droppings. Spores exist in soil
- Spores are inhaled into the alveoli and the spores germinate into yeasts and are phagocytosed alveolar macrophages but they elude macrophage-mediated destruction by preventing acidification of the phagolysosome
Sabouraud agar grows hyphae
Small and found intracellularly.
-
Management
Local
- Flucanazole
- Ketoconazole
Systemic
- Amphotericin B
Diseases
- Histoplasmosis : Granuloma formation and pneumonia the rare cases
- Chronic disease can lead to the formation of cavitary lesions in the upper lobes, and calcified nodules with fibrotic scarring. (looks like TB)
- Erythema Nodosum - red painful nodules on the shins
Immunocompromised
- Dissemeniation of the fungus will cause hepatomegaly and splenomegaly
- Ulcerated lesions on the tongue
Blastomycosis dermatitidis
("Blast of the Cannon")Special
Same size as RBC
KOH Stain : Round Yeast with Single Broad Based Bud
Doubly refractive Wall
- Dimorphic
Great Lakes, the East coast, and the Ohio River Valley
- Broad based budding - bud off each other
Virulence Factors
- Forms spores in soil and dirt and is aerosolized and becomes yeast once it colonizes the lungs
- Replicates via Broad based budding
Lab Identifiers
- Dimorphic
- KOH stain - round yeast with single broad based bud
- Detection via urine antigen test
-
-
Management
Local
- Azoles
Systemic
- Amphotericin B
Diseases
- Patchy alveolar infiltrate (Haziness)
- Lesions or cavities in the lung
Immunocompromised
- Systemic infections can spread to the skin and the bone
- Osteomyelitis - with chronic infections
Coccidioides immitis
("Presidio San Joaquin")Special
- Large, irregularly sized, thick-walled spherules with round endospores
- Most Associated with Erythema Nodsum
- Meningitis in immunocompromised
Larger than RBCs
Blasto is same size
Histo is smaller (in macrophages)
DUST and after Earthquake
- California and Southern USA
Dimorphic - mold in the soil
Virulence Factors
- Lives in dust
Lab Identifiers
- CXR may show nothing, cavities, or nodules
- KOH stain
- Antibodies to Cocci - IgM reactivity
Management
Local Infection - Lungs
- Ketoconazole
Systemic Infection
- Amphotericin B
-
Diseases
Cocci infections increase when lots of dust is released into the air. Usually only seen in the immunocompromised.
- Acute pneumonia with cough, fever, and arthralgia
- Nodules and cavity formation in lungs
- Erythema Nodsum - painful red nodules on the shins
Immunocompromised
- Commonly infects the skin and lungs
- Can disseminate into the skin, lung, bone, and meninges
- Meningitis
Paracoccidioides brasiliensis
(Brazilian Pirate) Special
Larger than RBC
- Mucocuteanous ulcers + Lymphadenopathy
- Dimorphic Mold in the cold : Yeast in the heat (lungs) (Captain's Wheel Yeast Form)
- Biopsy will show cells covered in budding blastoconidia
Associated with Brazil and South America
Virulence Factors
- Respiratory droplet transmission
Lab Identifiers
- Dimorphic
Captain's Wheel Shaped Yeast
Management
Local Infection
Itraconazole
Systemic Infection
- Amphotericin B
Diseases
- Inhalation allows fungus to disseminate and cause Lymphadenopathy - cervical, axillary, or inguinal
- Can progress to cause granulomas in the lungs
- Ulcers in Upper Respiratory Tract (especially the mouth)
- ragged borders with small spots of hemorrhage
-
Cutaneous Mycoses
Sporothrix schenckii
("Shanked by a Rose")Special
Dimorphic
- Cuts from thorns of rose bush
- Cigar shaped yeast and branching hyphae
- Cutaneous infection ascends Lymph nodes
Lab Identifiers
Dimorphic - cigar shaped yeast
Branching hyphae at 25C
- Culture
- Biopsy - Granulomas with histiocytes, Multinucleated Giant Yells, and Cigar Shaped Budding Yeasts
Management
Itraconazole
- Saturated Potassium Iodide Solution (not used)
Diseases
- Rose Gardener's Disease
- ulcer at site of trauma
further nodules form in ascending pattern along draining lymph nodes
Virulence Factors
- Cuts from the throne of a rose bush along with tree bark, bushes, and plants. Introduced to skin via trauma
Dermatophytes
("Tin-Man Tinea in Dermatophyte Forest")Special
Tinea Rashes ("Ringworm")
- Plant themselves on the skin but rarely invade into the skin
Athletes
- Wood lamp to Diagnose Microsporum
Lab Identifiers
Hyphae on KOH Prep
- Wood Lamp to Diagnose Microsproum
Management
- Topical Azoles - Clotrimazole
- Nail infection requires Oral Terbinafine
More Serious infections
- Griseofulvin ("grease for the tin man")- serious dermatophyte infections - lots of side effects with greasy foods
Diseases
Itchy skin rashes caused by:
- Trichophtyon (T)
- Epidermophyton (E)
- Microsporum (M) - Wood lamps Diagnoses Microsporum Only
Types
- Tinea capitis - head and scalp
- Tinea corporis - on body
- Tinea cruris - on the groin
- Tinea pedis - on the feet
- Onychomycosis - infection of nails
Virulence Factors
- Live on surface of skin only
Malassezia Furfur / Pityriasis versicolor
("Ristorante Italian di Malassezia" and "Versi di Colore Sauce")Special
Pityriasis Versicolor
- Spaghetti and meatballs appearance
- Hypo/hyperpigmentation in patches of skin
Lives in the Stratum Corneum -- treat with Selenium Sulfide which removes the Stratum Corneum layer of skin
Lab Identifiers
Spaghetti and Meatballs appearance on KOH Prep of skin scrapings
Management
Topical Selenium Sulfide - which helps shed Stratum corneum eliminating the environment of Malassezia
Diseases
- Pityriasis Versicolor - hypo/hyperpigmented patches on the skin on the back and chest and are not itchy
Systemic
- Malassezia Fungemia in Neonates with tube feeding
Lipid infusions through catheters received by neonates act as potent reservoirs for Malassezia growth
- Sepsis and thrombocytopenia
Virulence Factors
Thrives in hot and humid environments
- M. furfur able to degrade lipids leading to acid production and damage to the melanocytes