Lecture 14: Mycology 1 Flashcards by Anaili Abreu

Direct examination for diagnosis of fungi
KOH
PAS
GMS
H&E
GRAM
INDIA INK
Culturing

KOH: easier identification/ cheap/ quick
PAS: contrast b/w yeast/hyphae; pink-red
GMS: Fungal cell wall black
H&E: Fungi cytoplasm stains pink w/ blue nuclei
GRAM: stains mostly everything (dark purple) -bacteria
INDIA INK: for seeing capsule (stains background instead of fungal)
CULTURING: TO ID A PATHOGEN; agar plates- size, texture, color, colony

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Most common oral fungal infection in humans and cause various opportunistic infections

Candidiasis

Risk factor- immuno compromised
Transmitted- person- to- person, nosocomial, fomites

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Which fungal infection would cause sudden tooth mobility, perforation of hard palate, necrotic ulcerations, gingival thickening and halitosis

Mucormycosis

opportunistic pathogens
-canidiasis
-mucormycosis
-asperigillus

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Which fungal infection can be invade and affect the soft palate, tongue and Gingiva. And is also known as an allergic fungal sinusitis?

Aspergillosis

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Which fungal infection would show a proliferation or ulcerated oral lesions on the hard palate, gingiva, tongue, or lips?

Blastomycosis

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Which fungal infection presents as acute, chronic, pulmonary or progressive disseminated disease?

Histoplasmosis

true pathogen
-blastomycosis- acute pulmonary/chronic pneumonia… diss- idk
-histoplasmosis- acute/chronic pulmonary disease
… diss- acute/subacute
-cocciodiomycosis

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Which fungal infection presents as oral lesions, which may be verrucous and present w/ ulceration, can result from either primary or secondary infection?

Coccidioidomycosis

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Which fungal infections are considered opportunistic?
Which fungal infections are considered true viral infections?

Opportunistic
-candidiasis
-mucormycosis
-aspergillosis

True viral infection
-blastomycosis
-histoplasmosis
-Coccidioidomycosis

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Which fungal infections are considered opportunistic?
Which fungal infections are considered true viral infections?

Opportunistic
-candidiasis
-mucormycosis
-aspergillosis

True viral infection
-blastomycosis
-histoplasmosis
-Coccidioidomycosis

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Candida infections in oral and perioral tissue (10)

-pseudomembranous candidiasis (oral thrush)= lesions on the palate
-chronic erythematous candidiasis= palatal mucosa on denture wearing
-plaque like/nodular candidiasis= at the commissary of upper and lower lips (mucosal)
-angular cheilitis
-acute atrophic candidiasis: “antibiotic sore mouth”, “bald tongue”=diffuse loss of Filiform papillae
-median rhomboid glossitis: “central papillary atrophy” = “kissing lesion” - chronic
-denture stomatitis: mild inflammation of oral mucosa membranes= chronic

-circumoral dermatitis: topical steroid over-use around the mouth
-generalized cutaneous candidiasis: diffused popular rash (infants)
-Intertrigo: ass. W/ obesity (in folds of skins)

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Which candidiasis infection is known as “kissing lesion” on soft palate and known as a chronic infection?

Median rhomboid glossitis
Aka central papillary atrophy

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Which candidiasis infection is known as “bald tongue”?

Acute atrophic
“Antibiotic sore mouth”
Diffuse loss of Filiform papillae
Xerostomia

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Which candidiasis is known as oral thrush ?

Pseudomembranous candidiasis
-lesions on the palate

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What candidiasis is involved w/ obesity due to an infection in creases and folds of skin

Intertrigo

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What infection is known to newborn and its involved in a diffused erythematous popular rash?

Generalized cutaneous candidiasis

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What infection is known to be associated with topical steroids over-use around the mouth?

Circumoral dermatitis = CANDIDIASIS INFECTION

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What infection is known to be associated with topical steroids over-use around the mouth?

Circumoral dermatitis = CANDIDIASIS INFECTION

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What is the term for when a candidiasis infection becomes systemic?

Candidemia
=the most common form and may disseminate to nearly any organ in the body.
=signs of sepsis, tachycardia, altered mental status, hypotension

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What strain of candidia is newly emerging, drug-resistant and causing serious outbreaks?

C. Auris

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Diagnosis for candidiasis vs. candidemia

Candidiasis
-clinical evaluation + infected tissue/blood will have budding yeast cells and pseudohyphae w/ contstrictions at the septa

Candidemia (systemic- invasive)
-blood culture- GOLD STANDARD TO ID
-B-D-Glucan detection

T2 candida panel= identification of species
PCR= identification of species

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What is the gold standard to ID Candidemia?

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BLOOD CULTURES

Treatment for candiadiasis

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-Amphotericin B
-Echinocandins
-fuconazole - (cocco-mycoses)
-nystatin

Mucormycosis Is part of what species

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Rhizopus

Risk factors for Mucormycosis

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DIABETES, LUNGS, GI, SKIN
-uncontrolled diabetes & severe COVID-19= Rhinocerebral Mucormycosis (most revenant to dentist)
-Immunocompromised = pulmonary Mucormycosis
-extreme malnutrition =GI Mucormycosis
-burn patients, wounds, and IV drug users = cutaneous Mucormycosis
different infection based on its localized

Rhinocerebral Mucormycosis -what is it? -initial symptoms -late symptoms

-severe infection of the facial sinuses extending into the brain (prevelenat in dentistry) Initial symptoms: headache, facial pain, fever, hyposmia (smell decrease) nasal congestion/obstruction… BLACK DISCHARGE Late: vision pobzzz, necrotic on nasal, palate face. Reduced level of consciousness

Pulmonary mucormycosis -risk factor -symptoms

-immunocompromised -bloody cough, fever, labored breathing >70% death

Gastrointestinal Mucormycosis -risk factor -symptoms

Extreme malnutrition >70% mortality Distension Bloody stool Abdominal pain Bowel obstruction* Vomiting/nausea

Cutaneous mucormycosis -risk factor -symptoms

Burn patients Cellulitis and progresses to dermal necrosis and black Escher formation

Mucormycosis Pathogenesis What type of WBC?

-hyphae invade vasculature and neuronal structures NEUTROPHILS ARE KEY DEFENSE -Innate immunity

Diagnosis of Mucormycosis

-combo of observed symtoms and microscopic identification in tissue biopsy -“twisted” “ribbon-like” appearance of broad, coenocytic hyphae

Treatment Mucormycosis Treatment of rhinocerebral disease

-Amphotericin B -excision of orbital contents and involved brain

Aspergillosis -transmission

-inhalation transmission -ubiquitous in air, soil, decaying matter **we breathe it in everyday**

Inhalation of conidia (aspergillus) with a lung disease patient

ASPERGILLOMA

Inhalation of conidia In a asthma/cystic fibrosis patient

ALLERGIC BRONCHO-PULMONARY ASPERGILLOSIS

Inhalation of conidia with chronic lung disease or mildly immunocompromised patient

Chronic pulmonary aspergillosis

Inhalation of conidia in a immunocompromised host (severe) patients

Invasive pulmonary aspergillosis (increase mortality rate)

ASPERGILLOMA -occurs when?

You have to have a lung disease (like TB) -mycetoma (fungus ball) forms in the cavity Asymptomatic, caugh +fever

ABPA allergic bronchopulmonary aspergillosis

-patients w/ asthma, and/or cystic fibrosis -allergic reaction -cough, wheezing, produce mucus plugs, shortness of breath -bronchial casts -little fungus in plugs

Chronic pulmonary aspergillosis (CPA)

IN PATIENTS who are mildly immunocompromised w/ steroid-dependent COPD, or have chronic lung disease -manifests as subacute pneumonia = fever, night sweats, cough, fever

Invasive pulmonary aspergillosis (IPA)

PATIENTS that are severely immunocompromised host -w/ or w/o blood cough, chest pain -mortality increase even w/ treatment -often disseminates (spleen most commonly infected)

Pathogenesis for CPA & IPA

CPA= chronic pulmonary aspergillosis IPA= invasive pulmonary aspergillosis -inhaled conidia -lack of innate immunity.. aspergillus will cause infection NEUTROPENIA = BIGGEST RISK FACTOR

Biggest risk factor for aspergillus

NEUTROPENIA

Diagnosis of aspergillus

-ELISA = galactomannan -B-D-GLUCAN

ASPERGILLOMA diagnosis

Radiology and positive serology (IgG, IgE)

ABPA diagnosis

Elevated total and aspergillus-specific IgE

CPA diagnosis

Anti-aspergillus antibody testing (IgG or IgE) combined with/ radiology

IPA diagnosis

Positive histology from affected organ = Hyphae have frequent septa Positive culture from a normally sterile site

CPA/IPA TREATMENT

Voriconazole

ABPA TREATMENT

Itraconazole and Oral corticosteroids

ASPERGILLOMA treatment

Surgery Yet 10% will spontaneously cough the fungus ball out

Mucormycosis vs. aspergillosis identification differences

Aspergillosis = septa Mucormycosis = no septa, irregular branching

Lecture 14: Mycology 1 Flashcards

(51 cards)