Clinical Mycology

Question 1

Where is a person most likely to get histoplasmosis?

Answer 1

Mississippi and Ohio River valleys

Question 2

What disease does Histoplasmosis cause?

Answer 2

pneumonia

Question 3

What is unique about where histoplasmosis stays in the body?

Answer 3

histoplasmosis hides WITHIN macrophages

Question 4

How can a person get histoplasmosis?

Answer 4

bird or bat droppings

Question 5

Where is a person most likely to get blastomycosis?

Answer 5

states east of Mississippi River and Central America

Question 6

What disease does blastomycosis cause?

Answer 6

inflammatory lung disease and can disseminate to skin and bone

Question 7

What is a characteristic of blastomycosis replication?

Answer 7

broad based budding

Question 8

Where is a person most likely to get coccidioidomycosis?

Answer 8

Southwestern United States, California

Question 9

What disease does coccidioidomycosis cause?

Answer 9

pneumonia
meningitis
disseminate to bone and skin

Question 10

Coccidioidomycosis is unique in that is not a yeast. Instead, it takes what shape?

Answer 10

spherule

Question 11

After what natural disaster will cases of coccidioidomycosis increase?

Answer 11

earthquakes (spores in dust thrown up in the air)

Question 12

Where is a person most likely to get paracoccidioidomycosis?

Answer 12

Latin America

Question 13

What is the characteristic formation of paracoccidioidomycosis?

Answer 13

“captain’s wheel” formation

Question 14

List the systemic mycoses

Answer 14

histoplasmosis
blastomycosis
coccidioidomycosis
paracoccidioidomycosis
cutaneous mycoses

Question 15

What is the causative microorganism of Tinea versicolor?

Answer 15

Malassezia furfur

Question 16

How does Malassezia furfur cause hypo pigmentation or hyper pigmentation?

Answer 16

degradation of lipids –> acids that damage melanocytes –> hypo pigmentation or hyper pigmentation

Question 17

What is the treatment for Tinea versicolor?

Answer 17

topical miconazole
selenium sulfide (Selsun)

Question 18

What is the characteristic appearance of Malassezia furfur?

Answer 18

“spaghetti and meatball” appearance

Question 19

What is the treatment for other tinea (e.g. tinea pedis, tinea curries, tinea carpers, tinea capitis)?

Answer 19

ketoconazole

Question 20

List the opportunistic fungal infections

Answer 20

Candida albicans
Aspergillus fumigatus
Cryptococcus neoformans
Mucor and Rhizopus spp.
Pneumocystis jirovecii
Sporothrix schenckii

Question 21

What diseases are caused by Candida albicans?

Answer 21

oral and esophageal thrush in IC pts
vulvovaginitis
diaper rash
endocarditis in IV drug users
disseminated candidiasis
chronic mucocutaneous candidiasis

Question 22

What is the treatment for Candida albicans infection?

Answer 22

topical azole for vaginal
fluconazole or caspofungin for oral/esophageal
fluconazole, amphotericin B, or caspofungin for systemic

Question 23

What patients are most susceptible to Aspergillus fumigatus infections?

Answer 23

IC pts (chronic steroids and transplant patients)
chronic granulomatous disease

Question 24

Allergic bronchopulmonary aspergillosis (ABPA) is associated with which diseases?

Answer 24

asthma and cystic fibrosis

Question 25

When are aspergillomas most commonly seen?

Answer 25

after a TB infection

Question 26

What is a characteristic of Aspergillus fumigatus

Answer 26

septate hyphae that branch @ 45 degree angles

Question 27

Aflatoxins produced by Aspergillus are associated with what cancer?

Answer 27

hepatocellular carcinoma

Question 28

Where is Cryptococcus neoformans most often found?

Answer 28

soil and pigeon droppings

Question 29

What lesion is indicative of a cryptococcus neoforms infection in the brain?

Answer 29

"soap bubble" lesions in the brain

Question 30

What group of people is Mucor and Rhizopus spp. infection most commonly seen?

Answer 30

ketoacidotic diabetic and leukemic patients

Question 31

What is the pathogenesis of mucormycosis?

Answer 31

excess ketone and glucose --> fungi proliferate in blood vessel walls --> penetrate cribriform plate --> enter brain

Question 32

What area of the brain is most affected by mucormycosis?

Answer 32

frontal lobe (location of abscesses)

Question 33

What are symptoms of mucormycosis infection?

Answer 33

HA facial pain black necrotic eschar on face may have cranial nerve involvement

Question 34

What is the treatment for mucormycosis infection?

Answer 34

amphotericin B

Question 35

What disease is caused by Pneumocystic jirovecii?

Answer 35

Pneumocystis pneumonia (PCP), a diffuse interstitial pneumonia

Question 36

What patients is Pneumocystic jirovecii infection most commonly seen?

Answer 36

IC pts (e.g. AIDS)

Question 37

Disc shaped yeast forms on methenamine silver stain of lung tissue indicates what type of infection?

Answer 37

Pneumocystic jirovecii infection

Question 38

What is the treatment/prophylaxis for PCP infection?

Answer 38

TMP-SMX (1st line) pentamidine (if pt has a sulfa allergy) dapsone (prophylaxis only) atovaquone (prophylaxis only)

Question 39

When should you start prophylaxis for PCP in an IC pt?

Answer 39

when CD4 count drops <200 cells/mm3 in HIV pts

Question 40

Where is Sporothrix schenckii found?

Answer 40

vegetation

Question 41

What are physical characteristics of Sporothrix schenckii?

Answer 41

dimorphic, cigar-shaped budding yeast

Question 42

What is the pathogenesis of Sporotrichosis (infection from Sporothrix schenckii)?

Answer 42

spores introduced into the skin (typically by a thorn) (a.k.a. rose gardener's disease) --> local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis)

Question 43

What is the treatment for Sporotrichosis?

Answer 43

itraconazole or potassium iodide