The Fungi section provides High Yield Information needed for USMLE, COMLEX, Medical School, Residency, and as a practicing Physician.
Table Of Contents
Aspergillus Fumigatus
- About:
- catalase +
- transmission = inhaled condiophores (fruiting bodies)
- ALLERGIC BRONCHOPULMONARY – (type I hypersensitivity, high IgE levels) aka “Farmer’s lung”
- aflatoxins it produces are carcinogenic–> HEPATOCELLULAR CARCINOMA
- forms aspergillomas (fungus balls) in lungs
- pts w/ neutropenia at risk for angioinvasive form (renal failure, endocarditis, ring-enhancing brain lesions, nasal sinus necrosis)
- Dx:
- GALACTOMANN’S TEST.
- 45 degree ACUTE ANGLE BRANCHING
- Treatment:
- voriconazole for mild
- amphotericin B for angioinvasive
- surgical debridement for aspergillomas
Blastomycosis Dermatitidis
- About:
- GREAT LAKES AND SOUTHERN US
- dimorphic
- inhaled spores
- PULMONARY- XR shows patchy alveolar infiltrate
- also cutaneous form
- systemic infections in immunocompromised (osteomyelitis, damages skin and bones)
- Dx:
- urine antigen test, BROAD BASED BUDDING for replication, same size as RBCs
- Treatment:
- litraconazole for immunocompetent
- amphotericin B for systemic infections
Candida Albicans
- About:
- PSEUDOHYPHAE at 25 C and GERM TUBES at 37
- catalase +
- only endogenous fungus (GI & GU tracts)
- Diseases:
- DIAPER RASH
- THRUSH (can be scraped off, prepped w/ KOH)
- ESOPHAGITIS and white pseudomembranes
- VULUOVAGINITIS when pH > 4 (but it does NOT change the pH)
- CUTANEOUS- intertriginous areas
- SYSTEMIC- high mortality
- CHRONIC DISSEMINATED – hepatosplenic
- ENDOPTHALMITIS- “cotton ball” on eye exam
- AIDS-defining illness (pts w/ CD4 <200 at risk)
- other risk factors: diabetes, ABX use, birth control pills
- Dx:
- (1-3)beta-D-glucan test
- Treatment:
- azoles for minor
- amphotericin B for major
- nystatin for oral or esophageal
- capsofungin for resistant
Coccidioides Immitis
- About:
- SAN JOAQUIN VALLEY FEVER
- seen in CA, AZ, NM
- inhaled SPORES
- common after earthquakes
- forms SPHERULES PACKED WITH ENDOSPORES in lungs, not yeast
- arthralgia, pneumonia, fever, erythema nodosum (on shins) in immunocompetent pts only
- disseminates to skin, lungs, bones, meninges
- Dx:
- KOH prep, IgM against cocci indicates recent infection
- Treatment:
- azoles for local lung infections
- amphotericin B for severe
Cryptococcus Neoformans
- About:
- heavily ENCAPSULATED
- antiphagocytic repeating capsular antigen
- transmitted via PIGEON droppings
- inhaled into lungs then disseminates
- UREASE +
- risk factors: HIV, high dose steroids, malignancies
- resp sx aminly, can spread to CSF
- AIDS-defining illness (CD4< 200)
- #1 cause of FUNGAL MENINGITIS
- Dx:
- SOAP BUBBLE LESIONS (bronchopulmonary)
- stain with MUCOCARMINE OR INDIA INK
- latex agglutination test
- Treatment:
- joint therapy of ampho B and flucytosine, maintenance w/ fluconazole
Dermatophytes
Histoplasma Capsulatum
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- About:
- BAT droppings,CAVE, chicken coop
- MISSISSIPPI AND OHIO RIVER VALLEYS
- respiratory transmission of spores
- dimorphic
- smaller than an RBC
- Presentation:
- PNEUMONIA, forms granulomas, calcified fibrotic nodules in hilar region
- LOOKS LIKE TB
- erythema nodosum (painful lesions on shins)
- hepatosplenomegaly
- Dx:
- macrophages w/ intracellular OVOID BODIES seen on tissue sample w/ KOH prep, ELISA
- Treatment:
- azole for mild
- amphotericin B for severe
Malassezia Furfur
Mucormycoses
- About:
- 2 types: mucor and rhizopus (bread mold)
- inhaled, proliferate in blood vessels, and invade brain via cribirform plate
- black eschar on face, nasal cavity necrosis
- neural deficits and death
- populations at risk: immunocompromised (neutropenia), diabetics.
- most common predisposing factor is DKA!!
- Dx:
- 90 deg WIDE ANGLE BRANCHING hyphae
- Treatment:
- debride first
- amphotericin B
Paracoccidioides Brasiliensis
Pneumocystis Jiroveci
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Sporothrix Schenckii
Fungi Quiz
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Fungi 2 Quiz
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