M1. Systemic Mycoses

Question 1

particularly “Primary” Systemic Mycoses– to differentiate it from other pathogenic fungal elements because some species can also cause disseminated systemic infections

Answer 1

ENDEMIC MYCOSES

Question 2

what are the primary systemic mycoses

Answer 2

● Coccidioidomycosis
● Histoplasmosis
● Blastomycosis
● Paracoccidioidomycosis

Question 3

● On Sabouraud Dextrose Agar at 25 - 30 deg C
● Saprophytic, observed in vitro

Answer 3

MYCELIAL PHASE

Question 3

● OnEnriched media w/ Blood, 35– 37 deg C
● Seen in vivo, aka “tissue/invasive phase”

Answer 3

YEAST PHASE

Question 4

MOT of systemic mycoses

Answer 4

● Inhalation of Fungal Spores (Most common)
● Dissemination
● Geographic Restrictions

Question 5

serological tests for systemic mycoses

Answer 5

Complement Fixation Test
Immunodiffusion Test
Tube precipitin Test
Enzyme Immunoassay

Question 6

The initial host defenses are provided by the __________,
which are usually capable of inactivating the conidia and inducing a robust immune response

Answer 6

alveolar macrophages

Question 7

coccidioidomycosis is aka

Answer 7

o Valleyfever
o SanJoaquinValley Fever
o Desert fever/ desert rheumatism

Question 8

mot of coccidioidomycosis

Answer 8

inhalation of arthroconidia

Question 9

valley fever is disseminated in what organs

Answer 9

visceral organs
meninges
skin
bone
lymph nodes
subcutaneous tissues

Question 10

coccidioidomycosis occurs more frequently in certain racial groups (commonly on dark-skinned individual); in decreasing order:

Answer 10

filipinos
african americans
native americans
hispanics
asians

Question 11

The new environment (37 deg C) signals a morphologic
change, and the arthroconidia become

Answer 11

SPHERULES

Question 12

california spp

Answer 12

Coccidioides immitis

Question 13

“Non-California” spp.
▪ CommoninMexico
▪ Slow growing on media with high salt
concentration (Halophilic)

Answer 13

Coccidioides posadasii

Question 14

Coccidioides immitis– LABORATORY DIAGNOSIS

Answer 14

1. blood testing, pcr, chest x-ray
2. direct examination (10-20% KOH; calcoflour white)

Question 15

Thick-walled barrel-shaped, rectangular arthroconidia that alternate with empty cells called

Answer 15

disjunctor cells

Question 16

Coccidioides immitis in yeast/tissue form
components of outer wall

Answer 16

Mannan, protein, lipid

Question 16

Coccidioides immitis in yeast/tissue form
components of inner wall

Answer 16

Chitin, 3-O-Methyl mannose

Question 16

1. agars used in c. immitis
2. texture and color

Answer 16

1. sabouraud dextrose agar and inhibitory mold agar
2. delicate, fluffy white, which turns tan or brown with age

Question 16

● The MOST INFECTIOUS of all fungi
● Formerly a “Select agent”– biological agent that has the potential to pose a severe threat to public health and safety

Answer 16

Coccidioides immitis

Question 17

Skin Tests for Coccidioidomycosis

Answer 17

1. Coccidioidin
2. Spherulin

Question 18

Confirmatory Tests for Coccidioidomycosis

Answer 18

IMMUNODIFFUSION TEST

Question 18

positive rxn of coccidioidomycosis in immunodiffusion test

Answer 18

Precipitin line/band formation

Question 19

treatment for severe cases of coccidioidomycosis

Answer 19

posaconazole or amphotericin b

Question 19

Serological Test for Coccidioidomycosis and what is the sample used

Answer 19

COMPLEMENTFIXATION TEST; px serumq

Question 19

treatment for moderate cases of coccidioidomycosis

Answer 19

fluconazole and itraconazole

Question 20

● Most prevalent pulmonary mycosis ● Chronicgranulomatous infection ● Beginsinthe lungs with Tuberculosis-like infections o ResemblesS/sof TB ● Mostlyasymptomatic and self-limited ● Maydisseminate and Re-infection may occur

Answer 20

Histoplasmosis

Question 21

mot of histoplasmosis

Answer 21

Inhalation of conidia or small hyphal fragment

Question 22

Sources of Infection: Histoplamosis

Answer 22

● Silos, air-conditioning units contaminated with BIRD DROPPINGS ● Accumulations of guano (debris of bats) in caves, attics, or parks ● Nitrogen-rich soils

Question 22

Clinical Manifestations of Histoplasmosis

Answer 22

ACUTE PULOMARYHISTOPLASMOSIS CHRONIC PULMONARYHISTOPLASMOSIS DISSEMINATED HISTOPLASMOSIS OCULARHISTOPLASMOSIS

Question 22

LaboratoryDiagnosisofHistoplasmacapsulatum Culture:

Answer 22

LYSIS CENTRIFUGATION METHOD

Question 22

1. agars used in c. immitis 2. texture and color

Answer 22

1. Sabouraud Dextrose Agar/ Inhibitory Mold Agar(mold)/ BrainHeart InfusionAgar (YEAST) 2. White→brown, finefluffy;white,yellow,or tanon reverseside

Question 23

● Produced by growing themycelium in asparagine broth medium ● PositiveReaction: indicated by an area oF induration>5mmin diameter after 48hours

Answer 23

Histoplasmin Skin TesT

Question 24

Serology Tests for Histoplasma Capsulatum

Answer 24

○ Complement FixationTest ○ ImmunodiffusionTest ○ Direct Fluorescent Antibody Test ○ Counterimmunoelectrophoresis Test

Question 25

Treatment for Histoplasma Capsulatum 1. Acute Pulmonary Histoplasmosis Management 2. Treatment for Mild to Moderate Infection 3. Disseminated Disease Treatment 4. AIDS Patients Treatment Approach

Answer 25

1. Supportive therapy and rest 2. Itraconazole 3. AmphotericinB 4. Maintenance therapy with itraconazole0

Question 25

● Chronicsuppurative and granulomatous infection ○ Withpusandgranules ○ CommonwithDogsandCats(Zoonotic)

Answer 25

Blastomycosis

Question 25

SEROLOGY TESTS OF BLASTOMYCOSIS

Answer 25

Complement Fixation Immunodiffusion Enzyme Immunoassay Test

Question 26

causative of blastomycosis

Answer 26

blastomycoses dermatitidis

Question 27

Clinical Manifestations of Blastomycosis

Answer 27

PRIMARY CUTANEOUS BLASTOMYCOSIS CHRONIC CUTANEOUS BLASTOMYCOSIS DISSEMINATED BLASTOMYCOSIS PULMONARY BLASTOMYCOSIS

Question 28

Most common from of blastomycosis clinical manifestation

Answer 28

PULMONARY BLASTOMYCOSIS

Question 29

Treatment for Blastomyces dermatitidis

Answer 29

Itraconazole (Oral) Amphotericin B (Intravenous)

Question 30

● Chronicgranulomatous infection ● Beginsasaprimary pulmonary infection ● Asymptomatic but may disseminate ● Infects: Nasal or oral cavity, gingiva, and conjunctiva ● Donotspreadfromperson-to-person

Answer 30

Paracoccidioidomycosis

Question 31

Clinical Manifestations of Paracoccidioidomycosis

Answer 31

● AsymptomaticForm(Most of the time) ○ Initial form ○ Latent ● SymptomaticForm ○ Juvenile type ■ swollenlymph node and skin lesions ○ Adult type (Pulmonary & Disseminated)

Question 32

MOT of Paracoccidioidomycosis

Answer 32

Inhalation of fungal structures

Question 33

Serologic Tests for Paracoccidioides brasiliensis infxn

Answer 33

Immunodiffusion Test (most useful) Complement Fixation Test (useful for assessing prognosis)