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ID Boards > Fungal > Flashcards

Fungal Flashcards

1
Q

Inda Ink

GMS, PAS on histopath - narrow-based budding w/ large capsule

A

crypto

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2
Q

acellular, foamy, eosinophilic, intra-alveolar exudates on H&E

GMS/PAS stains on path = cysts (diff from alveolar proteinosis)

A

PJP

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3
Q

RF a/w chronic mucocutaneous candidiasis (disfiguring hyperkeratotic lesions, can have stricturing of esophagus)

A

Autoimmune regular (AIRE) gene mutation

STAT1 mutation

IL-7 receptor mutation

Dectin-1 deficiency

TLR-3 defect

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4
Q

chronic mucocutaneous candidasis

hypoPTH

adrenal insufficiency

A

autoimmune polyendocrinopathy-candidasis-ectodermal dystrophy/dyplasia (APECED)

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5
Q

Concerning/unique SEs of:

  • itra
  • vori
A
  • itra - heart failure, cardiomyopathy
  • vori - CNS and visual disturbances
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6
Q

Interpretation of histo Abs

A

H and M bands via immunodiffusion

M band: becomes + sooner. Seen with ANY exposure. persists for yrs

H band: only seen >20%. VERY spec for dissimen, chronic cavitary, severe acute pulm disease. Clears w/in 6mos

  • H+M = active histo
  • M alone = early/chronic disease
  • >1:32 = highly sensitive for active infection
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7
Q

FP results with histo Ag

A
  • blasto (commonly used to dx blasto)
  • cocci
  • talaromycosis
  • paracocci
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8
Q

FP results with CrAg

A

(esp w/ latex agglutination methods)

  • Trichosporon asahii
  • Rothia
  • Capnocytophaga
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9
Q

What are testing for with galactomannan?

What results in FP?

A

IAI

  • FP: fusarium, penicillium, histo
  • can have FP w/ zosyn or augmentin (though not in formulations after 2010)
  • also w/ IVIG
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10
Q

Fungi that will/may test + with beta-D-glucan

A
  • candida and invasive aspergillosis
  • may see with histo and PJP as well

**(will always test negative with crypto and zygomycetes)

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11
Q

Generally considered a positive beta-D-glucan test

A

>80 pg/mL

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12
Q

Ampho-R Fungi

A
  • C lusitaniae
  • some isolates of C auris
  • some fusarium spp (why empir AMB+VCZ)
  • aspergillus terreus
  • some scedosporium
  • all lemontospora prolificans
  • sporothrix
  • pseudallescharia boydii
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13
Q

fever + skin lesions (starting as cellulitis, sometimes around toenails)

pt in engraftment period post-HSCT

dx and tx

A

Fusarium

empiric AMB + vori (diff spp have varying susc)

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14
Q

S China

SE Asia

a/w AIDS and IC hosts

cultures w/ red diffusible pigment

Clin: dissemination, skin, CNS, bone

A

talaromyces

  • small oval non-budding yeast at 37C
  • smooth conidiophores w/ 4-5 terminal metulae at 25-30C (above pic)
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15
Q

S America (male, farmer predominance)

A

Paracocci

large round thick-walled yeast w/ budding = ship’s wheel appearance at 37C (body temp)

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16
Q

SW US

N Mexico

Central/South America

A

Cocci

  • round, thick-walled spherules containing endospores at 37C
  • (septated branched hyphae w/ thick-walled arthroconidia at 25-30C)
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17
Q

MS and OH River valleys

St Lawrence Seaway

Africa, Asia, S America

A

Blastomyces

broad-based buddying yeast (37C = body temp)

(septated branched hyphae at 25-30C)

The B’s: broad based budding, breath (PNA), bone, brain, body (skin)

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18
Q

MS, OH River valleys

A

Histo

small oval budding yeast at 37C = body temp (2-5um)

septated hyphae w/ round/pear shaped microconidia at 25-30C

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19
Q

BSI

(rarely causes disease except when a/w probiotic use)

A

Saccharomyces

unicellular, globose, ellipsoid-elongated blastoconidia

multipolar budding

*cases of misID. If not on MALDI, consider C auris

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20
Q
A
  • orange, red, “coral red” growth
  • unicellular blastoconidia, globose-elongated shape
  • no hyphae/pseudohyphae

Rhodotorula

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21
Q
A

Geotrichum

causes BSI, PNA in neutropenic pts

arthroconidia are unicellular/in chains/rectangle/barrel shaped

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22
Q
A

Trichosporon

  • septated hyphae/pseudohyphae
  • barrel-shaped arthroconidia (a sexual spore that is formed by breaking up of a hypha at point of septation
  • pleomorphic budding yeast
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23
Q
A
  • round budding yeast + capsule
  • NO hyphae/pseudohyphae
  • India ink, GMS/PAS

Crypto

24
Q
A

Candida

  • round-oval yeast w/ pseudohyphea
  • clusters of blastoconidia at septa
25
Q

important susc patterns in Candida spp:

  • glabrata
  • krusei
  • parapsilosis
  • lusitaniae
A
  • R fluc, S ech
  • R fluc, S ech. ?dec AMB
  • Incr MIC ech, S to fluc. Strong biofilm producer
  • R AMB, S to fluc and ech
26
Q

solitary lung cavity + eos meningitis

A

cocci

27
Q

previously healthy adults w/ indolent ulcerative crusted skin lesions + asx pulmonary infiltrate

A

consider blasto

28
Q

near drowning pt (or immunosuppressed)

A

scedosporiosis

tx: vori (**AMB resistant)

29
Q

GMS Stain

neutropenic pt w/ red, tender skin nodules –> rapidly spreads

A

Fusarium

30
Q
A

Reverse Halo Sign

consider mucor in right pt and presentation

31
Q

broad, variable non-septated hyphae

not well-vis here, but will have right-angle branching

  • dx
  • RF
  • tx
A

mucor

  • inhaled spores into lung/paranasal sinuses
  • RF: prolonged neutropenia, steroids, poorly controlled DM
  • TX: AMB

**can mimic cavernous sinus thrombosis following sinusitis

32
Q

Neutropenic patient

A

ecthyma gangrenosa

aspergillosis

33
Q
A

long hyphae, few septations = aspergillus

34
Q

Ddx

A

disseminated lesions w/ central ulceration

  • crypto
  • muluscum
  • talaormycosis
35
Q

Thailand, S China

bamboo rats

skin lesions, LN, liver, spleen, bone

dx and tx

A

Talaromycosis

  • dx: methenamine silver of skin/tissue, blood cx (1-2wks)
  • divide by binary fission (no budding) - seen in above pic
  • tx: AMB then itra
36
Q

children: acute/subacute F, wt loss, LAD, HSM, often skin/mucosal lesions

adults: farms of Latin America, indolent w/ skin/mucosal lesions + asx infiltrates on CXR

A

paracocci

can be latent for decades

37
Q
A

blasto

38
Q

thick-walled broad-based budding

moist earth near rivers, beaver dams

acute PNA vs indolent progressive PNA that disseminates (skin, bone, male GU tract - prostate, epididymitis)

MW, Great Lakes, Canada

A

blasto

39
Q

chronic bone, CNS, or skin infection

purulent

eosinophilia

A

consider cocci in right geography

40
Q
A

think cocci if right geography

41
Q
A

Cocci

  1. cocci arthrospore
  2. cocci spherule on HE (big, no budding)
42
Q

acute PNA +/- arthalgias or erythema nodosum

often residual nodule/thin walled pulm cavity persists

if disseminated: bone, skin, chronic (eosinophilic) meningitis

CA valley, AZ, NM, S Texas (Rio Grande), S America

A

think coccidiomycosis

tx fluc if CNS (non-men = itra)

43
Q

Manifestations of disseminated histo

A
  • subacute fever, pancytopenia, hypoadrenalism, miliary lung lesions
  • IE
  • chronic meningitis
  • 1/4 causes have oral/mucosal lesions
  • tongue and penile lesions (can look like SCC)
44
Q

pneumonitis +/- mediastinal or hilar LAD

A

consider acute pulmonary histo!

45
Q

stains that detect histo

A

Wright’s stain - blood

GMS or PAS in tissue

46
Q

Areas of disseminated blasto

A
  • seen in 25-75% pts (>>>histo or cocci)
  • skin = most common
    • single/mult, papular/pustular
    • chronic = ulcerative or verrucous
    • predilection for the face (esp nasolabial folds)
  • osteoarticular
    • chronic osteo - long bones, axial
    • septic arthritis
    • spinal (epidural, paravertebral, or psoas abscess)
  • GU - epididymoorchitis or chronic prostatitis (rare in women)
  • CNS (5-10% of disseminated cases)
47
Q

stains for blasto

A

sputum/BAL - KOH or calcofluor white

tissue - GMS, PAS

large (8-15um) yeast with broad-based budding

48
Q

fever, fatigue, cough, pelurisy, dyspnea

high ESR and peripheral eos (10-15%)

A

consider cocci in right epi setting (acute pulmonary cocci)

49
Q

Ddx for sporothrichoid lesion (nodular lymphangitis)

A
  • sporotrichosis
  • nocardia
  • M marinum
  • leishmania
50
Q

septate hyphae - nearly parallel to one another

dichotomous branching at 45º angles

A

aspergillus

51
Q
A

banana-shaped macroconidia typical of fusarium

52
Q
A

ribbon-like hyphae of mucor

irregular branching

53
Q

near-drowning in dirty fresh water

PNA + CNS

A

scedosporium

54
Q

extensive pseudomembranous or ulcerative lesions in the tracheobronchial tree in liver tx pts

A

ulcerative aspergillus tracheobronchitis

55
Q

toe cellulitis surrounding onychomycosis

neutropenic patient

A

Fusariosis

56
Q

refractory fever in neutropenic pt w/ metastatic skin lesions at different stages

A

consider fusarium

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