Systemic mycoses
- Histoplasmosis
- Blastomycosis
- Coccidioidomycosis
- Paracoccidioidomycosis
Histoplasmosis location
Mississippi & Ohio River Valleys
Blastomycosis location
Mississippi River
Central America
Coccidioidomycosis location
Southwestern US
California
Paracoccidioidomycosis location
Latin America
clinical presentation of histoplasmosis
pneumonia
clinical presentation of Blastomycosis
inflammatory lung disease
disseminates to skin & bone
clinical presentation of Coccidioidomycosis
- pneumonia
- meningitis
- disseminates to bone & skin
cases increase after earthquakes
Coccidioidomycosis
histoplasmosis histology
MΦ filled w/ histoplasma
smaller than RBC
blastomycosis histology
broad based budding
same size as RBC
coccidioidomycosis histology
spherule filled w/ endospores
much larger than RBC
paracoccidioidomycosis histology
budding yeast w/ “captain’s wheel” formation
much larger than RBC
*Malassezia furfur *
Tinea versicolor
**Tinea versicolor **
pathology
clinical presentation
- occurs in hot/humid weather
- degradation of lipids
- acids damage melanocytes
- hypo/hyper-pigmented patches
tinea versicolor treatment
topical Miconazole
selenium sulfide
“spaghetti & meatball appearance”
tinea versicolor
Definitions
- tinea pedis
- tinea cruris
- tinea corporis
- tinea capitis
- tinea unguium
- tinea pedis = foot
- tinea cruris = groin
- tinea corporis = ringworm (on body)
- tinea capitis = head, scalp
- tinea unguium = onychomycosis (fingernails)
dermatophytes
- microsporum
- trichophyton
- epidermophyton
how do the other tinae clinically present?
pruritic lesions w/ central clearing (ring)
mold hyphae on KOH
candida albicans clinical presentation
- oral & esophageal thrush (immunocompromised)
- vulvovaginitis
- diaper rash
- endocarditis in IV drug users
- disseminated candidiasis
- chronic mucocutaneous candidiasis
candida albicans treatment
- vaginal
- oral/esophageal
- systemic
- vaginal
- topical azole
- oral/esophageal
- fluconazole or caspofungin
- systemic
- fluconazole, amphotericin B, caspofungin
clinical diseases of Aspergillus fumigatus
- invasive aspergillosis
- allergic bronchopulmonary aspergillosis (ABPA)
- aspergilloma
who tends to get infected w/ invasive aspergillosis
- immunocompromised
- chronic granulomatous disease
allergic bronchopulmonary aspergillosis
- asthma & cystic fibrosis
- bronchiectasis & eosinophilia
aspergillomas infect the __________ post ______ infection.
lung cavities
TB
Aspergillus fumigatus aflatoxins
hepatocellular carcinoma
aspergillus branches at a _____ degree angle
45
“soap bubble” lesions in brain
Cryptococcus neoformans
Cryptococcus neoformans
morphology
spread/dissemination
- heavily encapsulated yeast (NOT dimorphic)
- soil, pigeon droppings
- inhalation –> hematogenous dissemination to meninges
Mucormycosis
Mucor & Rhizopus spp.
Mucormycosis patient population
ketoacidotic diabetic & leukemic patients
mucormycosis spread
- excess ketone & glucose
- fungi proliferate in BV walls
- penetrate cribriform plate
- enter brain
Mucormycosis clinical presentation
- Rhinocerebral, frontal lobe abscesses
- headache, facial pain, black necrotic eschar on face
- maybe CN involvement
Mucormycosis treatment
amphotericin B
inhaled yeast
diffuse bilateral CXR appearance
Pneumocystis jirovecii
when do you start PCP prophylaxis?
- CD4 <200 cells/mm3 in HIV patients
- dapsone, atovaquone
- TMP-SMX, pentamidine
diffuse interstitial pneumonia
Pneumocystis jirovecii (PCP)
dimorphic, cigar-shaped budding yeast
Sporothrix schenckii
How is sporothrix schenckii spread?
- vegetation –> thorn –> spores
- local pustule or ulcer w/ nodules along draining lymphatics
- ascending lymphangitis
Sporothrix schenckii treatment
itraconazole, potassium iodide
