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Mycology and Virology > SYSTEMIC MYCOSES > Flashcards

SYSTEMIC MYCOSES Flashcards

1
Q

Inhalation of air borne spores
produced by molds (soil)

A

SYSTEMIC MYCOSES

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2
Q

Present as saprophytes in soil and on
plant material

A

SYSTEMIC MYCOSES

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3
Q

They are caused by dimorphic fungi

A

SYSTEMIC MYCOSES

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4
Q

Infected persons do not communicate these diseases to others

A

SYSTEMIC MYCOSES

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5
Q

TYPES OF SYSTEMIC MYCOSES

A

-BLASTOMYCES
-COCCIDIODES
-HISTOPLASMA
-PARACOCCIDIODES

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6
Q

Gilchrist’s disease / blastomycosis

A

Blastomycosis

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7
Q

North American Blastomycosis

A

Blastomycosis

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8
Q

Blastomycosis
a chronic granulomatous and
suppurative disease that may affect
the following:

A

Skin and mucous membrane
Bones
Lungs
GUT

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9
Q

Blastomycosis
Ecological
Niche:

A

• Wet acid soil
• Moist environments in wood, tree bark, rotting vegetation

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10
Q

Blastomycosis
Endemic in:

A

North America in areas surrounding
the Mississippi Missouri and Ohio
rivers and their tributaries
Kentucky & Carolinas and the
Appalachian regions
Canada
Wisconsin

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11
Q
  • elevated, macerated, ill-defined,
    scaly borders, central ulcer
A

A. (skin) Blastomycosis

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12
Q

(lungs)
Blastomycosis

Inhalation —
lungs —
disseminated

A

Pulmonary
Blastomycosis

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13
Q
  • Affects the spine, ribs, long
    bones
A

Osteoarticular
Blastomycosis

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14
Q
  • painful debilitating arthritis
    or osteomyelitis
A

Osteoarticular
Blastomycosis

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15
Q
  • Affects the prostate and
    epididymis in males
A

Genitourinary Blastomycosis

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16
Q

Tissue specimens:

A

 fixed and
stained with
H & E
GMS stain
Giemsa stain

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17
Q

two antigens:

A

A and B

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18
Q

(?) is reported to be the more useful of the two

A

A

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19
Q

(?): extract of the yeast
form; used for skin testing

A

Blastomycin

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20
Q

-
specificity of 84% to 100%, sensitivity of 57% to 62%

A

Immunodiffusion (ID) tests

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21
Q

-sensitivity of 80%, specificity of 98%

A

Enzyme Immunoassay (EIA)

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22
Q

Methods

A

Immunodiffusion (ID) tests
Enzyme Immunoassay (EIA)
Complement Fixation (CF) method
Chemiluminescent DNA probe
method

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23
Q

Laboratory personnel who are working with any fluffy white colony should take (?) and adhere stringently to laboratory procedures.

A

special precautions

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24
Q

Optimal temperature for growth is 25° to 30°C on routine media

A

Mould form

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25
Q

37°C is needed to induce the yeast phase

A

Yeast form

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26
Q

Primary cultures for B. dermatitidis
should be held for (?) weeks before being discarded as “no growth”

A

4 to 8

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27
Q

white or beige to brown at first

A

Blastomyces dermatitidis Mould form

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28
Q

with a waxy or glabrous texture

A

Blastomyces dermatitidis Mould form

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29
Q

some isolates may be fluffy

A

Blastomyces dermatitidis Mould form

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30
Q

are prickly in the center

A

Blastomyces dermatitidis Mould form

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31
Q

(?) of the colonies is tan to brown

A

Reverse pigment

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32
Q

Later, colonies tend to become (?), and some develop concentric rings.

A

fluffy or woolly

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33
Q

• ropelike strands

A

Mould form

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34
Q

• fine (1 to 2 um) hyaline and septated hyphae

A

Mould form

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35
Q

• hyaline, pyriform or globose
• average diameter of 6 um.
• Borne directly or
llaterally (“lollipop”)

A

Blastomyces dermatitidis Conidia

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36
Q

The thick, smooth walls of the conidia are doubly refractile (double image)

A

Blastomyces dermatitidis

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37
Q

 Hyaline

A

Blastomyces dermatitidis Yeast Form

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38
Q

 large (up to 20 um)

A

Blastomyces dermatitidis Yeast Form

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39
Q

 spherical to pyriform

A

Blastomyces dermatitidis Yeast Form

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40
Q

 with thick walls

A

Blastomyces dermatitidis Yeast Form

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41
Q

 broad based budding yeast

A

Blastomyces dermatitidis Yeast Form

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42
Q

 “figure eight,” or hourglass, configuration of the parent-daughter combination

A

Blastomyces dermatitidis Yeast Form

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43
Q

reproduce by forming buds that are typically attached to the mother cell by broad (4 to 5 um) necks.

A

Blastomyces dermatitidis Yeast Form

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44
Q

In GMS stain the wall of the organisms stains black.

A

Blastomyces dermatitidis Stains

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45
Q

In PAS stain the internal structure of the organism is
red.

A

Blastomyces dermatitidis Stains

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46
Q

H & E

A

Blastomyces dermatitidis Stains

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47
Q

It can be converted from the mold form to the yeast form (using enriched media at 37°C) to confirm identification

A

Blastomyces dermatitidis Laboratory
Identification

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48
Q

is a thermally dimorphic organism.

A

Blastomyces dermatitidis Laboratory
Identification

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49
Q

• Mold form: white or beige to brown, waxy or glabrous texture to fluffy colonies

A

Blastomyces dermatitidis:
Culture

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50
Q

• Yeast form: waxy, wrinkled, light brown colonies

A

Blastomyces dermatitidis:
Culture

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51
Q

• RT: lollipop-like mycelial forms

A

Blastomyces dermatitidis: Morphology

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52
Q

• 37C: thick-walled broad based budding yeast (“figure of 8”or “hour glass”)

A

Blastomyces dermatitidis: Morphology

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53
Q

first recognized in
1892 & as a fungal
infection in 1900

A

Coccidioides immitis
Coccidioides posadasii

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54
Q

endemic in:
Southwestern
United States
Mexico
Pacific coast of
the United
States
Central and
South America

A

Coccidioides immitis
Coccidioides posadasii

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55
Q

 Reservoir:
Alkaline desert soil
Dust storms
Semiarid, very hot
summers, little
rain, few freezes
Desert rodents
(vectors)

A

Coccidioides immitis
Coccidioides posadasii

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56
Q

 Outbreaks are
associated
dust storms
archeological digs
climatic conditions
earthquakes

A

Coccidioides immitis
Coccidioides posadasii

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57
Q

Competent immune system:
Relatively small threat

A

Coccidioides immitis
Coccidioides posadasii

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58
Q

More severe in:
Dark skinned people
Pregnancy
High levels of ESTRADIOL and
PROGESTERONE

A

Coccidioides immitis
Coccidioides posadasii

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59
Q

Occupational hazard:
Construction workers
Farmers

A

Coccidioides immitis
Coccidioides posadasii

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60
Q

Coccidioides immitis
Coccidioides posadasii

Highest Risk Factor Age

A

Infants and elderly

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61
Q

Coccidioides immitis
Coccidioides posadasii

Highest Risk Factor Sex

A

Male

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62
Q

Coccidioides immitis
Coccidioides posadasii

Highest Risk Factor Genetics

A

Filipino, African American, Native American, Hispanic, Asian

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63
Q

Coccidioides immitis
Coccidioides posadasii

Highest Risk Factor Serum CF antibody titer

A

1:32

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64
Q

Coccidioides immitis
Coccidioides posadasii

Highest Risk Factor Pregnancy

A

Late pregnancy amd postpartum

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65
Q

Coccidioides immitis
Coccidioides posadasii

Highest Risk Factor skin test

A

negative

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66
Q

Coccidioides immitis
Coccidioides posadasii

Highest Risk Factor depressed cell-mediated immunity

A

malignancy, chemotherapy, steriod treatment, hiv infection

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67
Q

Coccidioides immitis
Coccidioides posadasii
Causes:

A

Coccidioidomycosis
aka: “San Joaquin fever”; “Desert
fever”, “Posada’s disease”, “Desert
rheumatism”, Valley fever

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68
Q

Coccidioides immitis
Coccidioides posadasii
Causes:

A

 erythema nodosum, or erythema
multiforme

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69
Q

(?) is probably the most virulent
of all agents of human mycoses

A

C. immitis

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70
Q

Very contagious

A

C. immitis

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71
Q

requires biosafety level 3 cabinet

A

C. immitis

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72
Q

Forms of
Coccidioidomycosis:

A

Cutaneous
Coccidioidomycosis

Primary Pulmonary
Coccidioidomycosis

Chronic Pulmonary
Coccidioidomycosis

  1. Disseminated Coccidioidomycosis
  2. Coccidioidomycosis in AIDS patients
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73
Q

• CXR: “egg-shaped
deformity”

A

Primary Pulmonary
Coccidioidomycosis

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74
Q

• Hemoptysis due to
cavitations
• fatal

A

Chronic Pulmonary
Coccidioidomycosis

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75
Q

 showing granulomatous lesions of the face, neck
and chin (Courtesy of John Rippon, USA)

A

Chronic Cutaneous
Coccidioidomycosis

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76
Q

“egg-shaped deformity”

A

Pulmonary Coccidioidomycosis

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77
Q

 Extension of pulmonary coccidioidomycosis showing a
large superficial, ulcerated plaque (Courtesy of John
Rippon, USA)

A

Pulmonary Coccidioidomycosis

78
Q
  • Fatal
    -Meningitis & hydrocephalus
A

Disseminated Coccidioidomycosis

79
Q
  • most common complication
  • Common cause of mortality
A

Meningitis & hydrocephalus

80
Q
  • pulmonary in form
A

Coccidioidomycosis in AIDS patients

81
Q

 2 substances used as antigen

A

Coccidioidin
Spherulin

82
Q

: Is a filtrate prepared from mould cultures

A

Coccidioidin

83
Q

: Extract from a tissue
culture of the yeast form

A

Spherulin

84
Q

• conversion from a negative to
a positive skin test is
diagnostic of infection

A

Skin test

85
Q

• quite specific, but a few cross-
reactions with other mycotic
infections

A

Complement Fixation (CF)

86
Q

• Highly specific with very few
cross-reactions

A

Tube Precipitin (TP) Test

87
Q

Coccidioides immitis
Coccidioides posadasii
colonies:

A

are white and floccose at first
Mature colonies
white to gray, but strains with lavender, buff,
cinnamon, yellow or brown pigment
Reverse: tan to dark brown or orange
Texture: Powdery
membranous or glabrous with hyphae that are
adherent to the agar
Surface = Partially or completely covered with a
cottony aerial mycelium that resembles
COBWEB

88
Q

Culture of (?) showing a suede-like to
downy, greyish white colony with a tan to brown reverse

A

Coccidioides immitis

89
Q

Coccidioides immitis
Coccidioides posadasii
Hyphae:

A

 septate and hyaline
RACQUET hyphae may also be observed in culture

90
Q

Coccidioides immitis
Coccidioides posadasii
Disjunctors (disjuncture cells):

A

contains the arthroconidia
they fragment when mature, freeing the
arthroconidia to disperse

91
Q

Coccidioides immitis
Coccidioides posadasii
Arthroconidia:

A

single celled, barrel-shaped or rectangular
May round up in tissues — spherules
Mature: contains endospores or asteroid bodies

92
Q

“barrel-shaped arthroconidia”

A

Coccidioides immitis

93
Q

(?)
spherule filled with endospores

A

Coccidioides immitis

94
Q

Coccidioides immitis
Coccidioides posadasii
Direct Examination
In host tissues:

A

Spherules are round and refractive
and usually have thick walls.
Endospores are freed when the
mature spherule ruptures
Can be seen in intact or rupturing
spherules in tissue sections and
other specimens

95
Q

Hyphae and developing
spherules (?)

A

in lung tissue

96
Q

arthroconidium; ruptured spherule

A

Coccidioides immitis

97
Q

HISTOPLASMA capsulatum
Teleomorph:

A

Ajellomyces capsulatus

98
Q

Most common cause of fungal respiratory
infection

A

H. capsulatum var. capsulatum

99
Q

Causes African Histoplasmosis which involves
the bones and skin

A

H. capsulatum var. duboisii

100
Q

Has larger thick walled yeast cells

A

H. capsulatum var. duboisii

101
Q

Causes epizootic lymphangitis and infectious
keratitis in horses

A

H.capsulatum var. farciminosum

102
Q

HISTOPLASMA CAPSULATUM diseases

A

Darling’s disease
Spelunker’s disease
Caver’s disease
Ohio valley disease
Reticuloendotheliosis
Reticuloendothelial cytomycosis
Tingo
Maria fever

103
Q

HISTOPLASMA CAPSULATUM
RESERVOIR:

A

Found in soil with high nitrogen content
Droppings of starlings, chickens and bats
Poultry house litter

104
Q

HISTOPLASMA CAPSULATUM
UNIQUE RISK FACTORS:

A

 Airborne transmission
 Highly contagious
 Epidemics occur in group activities via inhalation of a
large number of conidia
 Poses no threat to people who are not immune
compromised.

105
Q

Endemic in:
Central North America in areas surrounding the
Mississippi, Missouri, and Ohio rivers

A

HISTOPLASMA CAPSULATUM

106
Q

Chronic granulomatous and suppurative
disease that involves the lungs and the RE system.

A

HISTOPLASMOSIS

107
Q

5% of which progress to chronic disease or acute fulminating disease which is fatal.

A

Primary pulmonary histoplasmosis

108
Q

Common in children

A

Primary pulmonary histoplasmosis

109
Q

Untreated infections causes the macrophage
to spread the disease to other organs

A

Primary pulmonary histoplasmosis

110
Q

Scattered erythematous
papules and pustules in an HIV-
infected individual with
disseminated (?).

A

histoplasmosis

111
Q

Periodontal recession
and deep ulceration
with exposed necrotic
alveolar bone. Deep
ulceration of the
gingivae also associated
with necrotic bone

A

Histoplasmosis.

112
Q

HISTOPLASMOSIS
SPECIMEN SOURCES:

A

 Sputum and oropharyngeal scrapings
 Pulmonary aspirates
 Biopsied lung lesions
 Aspirated pus, subcutaneous abscesses and skin
scrapings
 Blood, bone marrow
and CSF

113
Q

Histoplasma capsulatum yeasts in
the cytoplasm of (?)
neutrophils

A

two of three

114
Q

HISTOPLASMA capsulatum
DIRECT EXAMINATION:

A

Found within cells (histiocytes)

115
Q
  • Wright’s and Giemsa stains
A

BM

116
Q
  • Wet preparation
A

Pus

117
Q

– fixed and stained

A

Tissue

118
Q

– treated with N-acetyl-L-cysteine

A

Mucus

119
Q

Specimens are cultured in rich media,
such as glucosecysteine blood agar at 37°C and on Sabouraud’s agar or inhibitory mold agar at 25–30°C

A

HISTOPLASMA capsulatum

120
Q

HISTOPLASMA capsulatum
Mold form:

A

Produced in 15-25 days
Color - white, beige, brown
Texture - fluffy or glabrous, woolly
Pigment – tan

121
Q

HISTOPLASMA capsulatum
Yeast form

A

Produced in 10-15 days
on BHIA with blood
Color – white, light tan
Texture – mucoid, rough
membranous

122
Q

HISTOPLASMA capsulatum
Mold form:
(?) – very fine, septate, ropelike strands

A

Hyphae

123
Q

HISTOPLASMA capsulatum
Mold form:
(?) – borne directly on hyphae

A

Microconidia

124
Q

HISTOPLASMA capsulatum
Mold form:
(?) – unicellular, hyaline, smooth,
echinolate

A

Conidiophore

125
Q

HISTOPLASMA capsulatum
Mold form:
(?) – develop directly on hyphae, hyaline, unicellular, large, spherical to
pyriform in shape.

A

Macroconidia

126
Q

As they age, they become tuberculate
forming finger-like extensions resembling
sunflower in bloom

A

HISTOPLASMA capsulatum

127
Q

At 25°C tuberculate
macroconidia are formed on a
hypha-like conidiophores

A

HISTOPLASMA capsulatum

128
Q

HISTOPLASMA capsulatum
Yeast Form
(?) – small and ovoid

A

Blastoconidia

129
Q

When the daughter cell is produced, they form at
the smaller end of the mother cell with narrow
neck of attachment

A

Blastoconidia

130
Q

: mixture of H and M antigens

A

Histoplasmin

131
Q

: extracted from yeast cultures
of H. capsulatum (more sensitive)

A

Yeast antigen

132
Q

Of little diagnostic value

A

Skin test

133
Q

: more widely used for diagnosis of
histoplasmosis

A

CF test

134
Q

Titer between (?) is considered
presumptive evidence of histoplasmosis

A

8 to 32

135
Q

: using histoplasmin as the antigen

A

ID Test and CIE

136
Q

Useful screening procedures

A

ID Test and CIE

137
Q

Formation of 2 precipitating bands representing
specific reactions to the H and M antigens are
diagnostic

A

ID Test and CIE

138
Q

: present in active infection

A

H band

139
Q

: present in early and persists even after
recovery

A

M band

140
Q

Assess patient’s progress after treatment

A

ID Test and CIE

141
Q

: with false positives

A

Latex agglutination

142
Q

: can use serum, urine, and CSF

A

RIA

143
Q

Cross-reactions with C. immitis and B. dermatitidis

A

RIA

144
Q

HISTOPLASMA CAPSULATUM
Immunology

A

Urine antigen test (HPA) Test
Histoplasma polysaccharide antigen (HPA)

145
Q

Antigenuria precedes development of
antibodies

A

Histoplasma polysaccharide antigen (HPA)

146
Q

Histoplasma polysaccharide antigen (HPA)
Most useful in:

A

 disseminated histoplasmosis
Persons living with AIDS
Early in acute pulmonary histoplasmosis
Predicting relapse patients receiving chronic
suppressive therapy

147
Q

HISTOPLASMA CAPSULATUM
THERAPY:

A

Therapy of choice:amphotericin B followed
by fluconazole for 9 to 12 months
Patients with severe obstructive
mediastinal histoplasmosis require
amphotericin B therapy
 Itraconazole may be used for outpatient
therapy

148
Q

– acid soil in humid
areas (endemic)

A

Saprobic mould form

149
Q

 Plants

A

Saprobic mould form

150
Q

Paracoccidioides
brasiliensis
(?) - carrier

A

Armadillos

151
Q

MOT: Airborne (i.e., plants)

A

Paracoccidioides
brasiliensis

152
Q

Paracoccidioides
brasiliensis
 Risk factors:
 (?) – combined effect of hormonal
makeup and occupations

A

Adult males

153
Q

 Malnutrition and in immunocompromised
patients

A

Paracoccidioides
brasiliensis

154
Q

Endemic in:
 Holdridge life zones
(on both sides of the
equator and the
Tropic of Capricorn)
 Northwestern,
Central, and
southeastern South
America
 Central America
 Southern Mexico

A

Paracoccidioides
brasiliensis

155
Q

Paracoccidioides
brasiliensis

Pathogenesis:

A

• Primarily an oral lesion (mouth, palate, nasal) —
BV & lymphatics — disseminated to the lungs

156
Q

Paracoccidioides
brasiliensis Clinical Manifestations

A
  1. Primary Pulmonary
    Paracoccidioidomycosis
  2. Mucocutaneous
    Paracoccidioidomycosis
  3. Lymphonodular
    Paracoccidioidomycosis
  4. Disseminated Paracoccidioidomycosis
157
Q

• asymptomatic or subclinical
• self-limiting
• most common

A

Primary Pulmonary
Paracoccidioidomycosis

158
Q

Lymphadenitis is common in younger
patients.
Cervical and submandibular chains are the most obvious manifestation and lymph nodes may progress to form
abscesses with draining sinuses.

A

Lymphonodular
Paracoccidioidomycosis

159
Q

including lesions of the small or large
intestine
hepatic lesions
adrenal gland destruction
osteomyelitis
arthritis
Endophthalmitis
meningoencephalitis or focal cerebral
lesions

A

Disseminated Paracoccidioidomycosis

160
Q

→ an E2 antigen extract from yeast

A

Paracoccidioidin

161
Q

“band 1” (apparently identical to the E2 antigen extracted from yeast

A

Precipitin Test

162
Q

– intradermal injection

A

Skin Tests

163
Q

epidemiological tool

A

Skin Tests

164
Q

first serologic test to be positive

A

Skin Tests

165
Q

do not differentiate between past exposure and current condition

A

Skin Tests

166
Q
  • Sensitivity, 94% and highly specific
A

ID Test

167
Q
  • (+) one to three precipitin
    continuous bands or identical with
    the reference sera.
A

ID Test

168
Q

useful for speeding the identification of cultures

A

Exoantigen Methods

169
Q

Detects cell-free antigens of fungus

A

Exoantigen Methods

170
Q

Used for the ID of cultures of
Blastomyces, Coccidioides, Histoplasma
& Paracoccidioides

A

Exoantigen Methods

171
Q

 detects P. brasiliensis cells in smears of clinical materials

A

Direct FA Tests

172
Q

 Faster, more sensitive, and more
specific than exoantigen tests

A

DNA probes

173
Q

 Too expensive

A

DNA probes

174
Q

 DNA probes use single strands of DNA
isolated from a known organism to
“probe” for the complementary DNA sequence in a culture or specimen

A

DNA probes

175
Q

 Detected with a dye, a radioisotope or an enzymatic reaction

A

DNA probes

176
Q

Paracoccidioides
brasiliensis
Mould Form
✓ Slow maturation –

A

2 cm after 2 to 3 wks.

177
Q

Paracoccidioides
brasiliensis
Young:

A

White to cream, with short, downy aerial
mycelia and elevated centers.

178
Q

Paracoccidioides
brasiliensis
Mature:

A

Flat, with a membranous or velvety
texture and cerebriform or folded topography.

179
Q

Paracoccidioides
brasiliensis
Pigment:

A

Beige or brown, with a yellow-brown
reverse in mature colonies.

180
Q

Paracoccidioides
brasiliensis
Hyphae:

A

Very fine, hyaline and septate

181
Q

Paracoccidioides
brasiliensis
Conidia:

A

Few small oval to pyriform truncate on
short conidiophores or sessile hyphae

182
Q

Paracoccidioides
brasiliensis
Chlamydoconidia:

A

Terminal and intercalary, w/
racquet and coiled hyphae

183
Q

Paracoccidioides
brasiliensis
Yeast Form:

A

✓ Large spherical to pyriform cells with thick
walls
✓ Reproduce by multiple budding with buds
that cover the entire surface of the parent
cell… “MARINER’s WHEEL” appearance
✓ BUDS: Attached by thin necks and easily
dislodged.

184
Q

Paracoccidioides
brasiliensis
Microscopic:

A

septated hyphae and chlamydospore formation
(cotton-blue preparation) (40 X)

185
Q

Yeast culture at (?) in trypticase soy agar.
Observe multiple budding yeast cells
characteristic of Paracoccidioides
brasiliensis (40 X).

A

36°C

186
Q

Paracoccidioides
brasiliensis
(?) →treatment of choice for
most forms of the disease

A

Itraconazole

187
Q

must be given for at least 6 months

A

Itraconazole

188
Q

Paracoccidioides
brasiliensis
(?) → more severe
forms

A

Amphotericin B therapy

189
Q

 followed by either itraconazole or
sulfonamide therapy.

A

Amphotericin B therapy

190
Q

(?) has some activity against
this organism, although frequent
relapses have limited its use for the
treatment of this disease

A

Fluconazole

Mycology and Virology (20 decks)

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