Cottage cheese
True or False. Endemic mycoses occur primarily in immunocompromised patients, particularly those with malignancies and acquired immunodeficiency syndrome (AIDS) and after major surgery, severe burn injury, blood and marrow (BMT) and solid organ (SOT) transplantation.
What is False.
This statement characterizes opportunistic mycoses.
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The endemic mycoses are those in which susceptibility to the infection is acquired by living in a geographic area constituting the natural habitat of the particular fungus. The most commonly encountered endemic mycoses in North America are due to Histoplasma capsulatum, Coccidioides immitis/posadasii, Blastomyces dermatitidis, and Sporothrix schenckii.
This genus of f cryptococcosis is a systemic mycosis is worldwide in distribution and is found as a ubiquitous in soil, especially that enriched with pigeon droppings.
What is C. neoformans.
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There are four serotypes: A, B, C, D.
Serotypes A and D are common worldwide and may be recovered in large numbers from environmental sources contaminated with the droppings of pigeons and other birds.
Serotypes B and C (var. gattii) are found in tropical and subtropical regions in association with Eucalyptus trees.
Aersolized conidia from this genus of fungus have been associated with several major outbreaks with exposure by hospital construction, insulation and fireproofing materials. They can be also isolated from soil, grain (aflatoxin), leaves, grass, and air.
What is Aspergillosis.
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Although several hundred species of Aspergillus have been described, relatively few are known to cause disease in humans. Aspergillus fumigatus remains the most common cause of aspergillosis.
Rhizopus is the most common agent of human zygomycosis. Clinically, zygomycosis is a fulminant infectious process that produces rhinocerebral disease in patients with this disease process.
What is diabetic ketoacidosis.
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Death can occur within 3-10 days in untreated patients. Although classically the major risk factor for zygomycosis is diabetic acidosis, it is now clear that neutropenia, hematologic malignancy, and cytotoxic or immunosuppressive therapy place patients at risk for these infections.
This type of dermatophytosis is the most common infection in the U.S.
What is tinea pedis.
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The interdigital form is the most common and is characterized by fissuring, maceration, and scaling in the interdigital spaces of the fourth and fifth toes. Patients with this infection frequently complain of itching or burn- ing.
A second form presents in a moccasin-like distribution with the plantar skin appearing scaly and thickened.
The third form is vesiculobullous tinea pedis; it is characterized by the development of vesicles, pustules, or bullae on the soles.
Treat with prolonged topicals.
Local mucocutaneous candidiasis is most commonly caused by this species of Candida and may involve the oropharynx (thrush) and the entire gastrointestinal tract, including the esophagus, stomach, and large and small bowel.
What is C. albicans.
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Chronic mucocutaneous candidiasis is a rare syndrome associated with defects in T cell mediated immunity. These patients have persistent superficial Candida infection of skin, scalp, nails, and mucous membranes. Disease onset may begin at any age and may be associated with various endocrinopathies with clinical manifests limited or extensive.
This type of clinical manifest occurs in patients with underlying immunodeficiency.
What is meningitis.
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Cryptococcosis may present as a pneumonic process but more often as a CNS infection secondary to hematogenous and lymphatic spread from a primary pulmonary focus.
This type of clinical manifestation is described as masses of mycelia and amorphous debris localized in preexisting pulmonary cavities, usually in the upper lobes.
What are aspergillomas.
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Aspergillomas may be clinically silent; however, hemoptysis secondary to ulceration of the epithelial lining of the cavity is observed in 50–80% of cases.
Rhinocerebral disease may present with nasal stuffiness, blood-tinged nasal discharge, facial swelling, and facial or orbital pain. Major diagnostic clues are the presence of a this on the nasal or palatine mucosa.
What is black eschar.
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May also have drainage of “black pus” from the eye.
This highly contagious disease accounts for over 90% of fungal infections in children under age 10 in the United States.
What is tinea capitis.
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Also known as ringworm of the scalp.
Unlike other tinea infections, tinea capitis is rarely pruritic. However, if left untreated or misdiagnosed, the plaques can evolve into an inflammatory nodue, referred to as a kerion.
Treatment with oral therapy requires 6-12 weeks. Topical therapy not adequate as primary therapy but can be used to deter or decrease transmission in conjunction with oral therapy.
This is the most common clinical presentation of superficial cadidiasis.
What is white or gray pseudomembranous plaques overlying the mucosal surface.
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Removal of the plaques reveals a red, painful base with ulcerations and necrosis. Oropharyngeal and esophageal involvement may be quite painful with considerable dysphagia and pain on swallowing.
Examination of the CSF in patients with meningitis usually suggests a chronic lymphocytic meningitis with a low-grade (less than 500/mm3) lymphocytic pleocytosis, elevated protein, and high glucose. True or False.
What is False. CSF would show low glucose.
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Cultures of CSF and other clinical material are usually pos- itive. Occasionally repeated lumbar punctures, cisternal taps, or sam- pling of large volumes (up to 10 mL) of CSF may be necessary to establish the diagnosis.
There are no commercially available kits to aid in the identification of Aspergillus species. True or False.
What is True.
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In tissue, Aspergillus hyphae stain well with Gomori methenamine silver stain and are uniform, 2–7 μm in diameter, septate, and dichotomously branched with angles of approximately 45 degrees. These features are not diagnostic and are shared by several other opportunistic fungal pathogens.
Examination of the CSF may reveal elevated protein, normal glucose, and a modest pleocytosis. True or False.
What is True.
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Culture and microscopic examination of CSF is uniformly negative.
This type of dermatophytosis affects the nonscalp skin infections of the trunk and extremities.
What is tinea corporis.
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Unlike tinea pedis or tinea cruris, tinea coporis infection is more common in women.
Appear as single or multiple, annular, scaly lesions with central clearing, slightly elevated, reddened edge, and sharp imagination on the trunk or extremities.
Treat with topicals, if large surface area or immunocompromised, oral therapy may be required.
Lab diagnosis of candidiasis has been limited because available methods are insensitive and nonspecific. However, superficial infection may be diagnosed with this type of chemical preparation under microscopic examination.
What is Calcofluor-KOH-treated.
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Can also gram-stain material from infected lesions.
Disseminated candidiasis by histopathologic demonstration of tissue invasion on biopsy or recovery of species on sterile body fluids.
Pulmonary cryptococcosis may not require therapy as long as the process appears to be resolving and the patient is intact immunologically. True or False.
What is True.
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Patients with progressive pulmonary infection, particularly those who are immunocompromised, and all patients with extrapulmonary infection require systemic antifungal therapy. At present, such therapy consists of intravenous amphotericin B.
This type of imaging may be useful in the diagnosis of aspergilloma with the appearance of a freely movable intracavitary mass surrounded by a crescent of air (Monod’s sign).
What is chest radiograph.
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In contrast, the most common radiographic picture of invasive pulmonary aspergillosis is that of a patchy density or well-defined nodule, which may be single or multifocal with progression to diffuse consolidation or cavitation. However, invasive pulmonary aspergillosis is often inapparent on routine chest radiographs and require high resolution CT for diagnosis.
Serologic tests are not reliable, and microscopic exam- ination of sputum or wound drainage is rarely positive for fungal elements. True or False.
What is True.
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Key diagnosis based on characteristic broad, hyaline, ribbon-like, irregular fungal hyphae with wide-angle branching, accompanied by tissue necrosis and angioinvasion of the fungi.
This type of dermatophytosis includes infections of the genitalia, pubic area, perineal skin, and perianal skin.
What is tinea cruris.
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This condition is common throughout the world, with men being affected more frequently than women.
Treat with topicals.
This is the type of treatment used for superficial mucocutaenous infections.
What are antifungal agents such as nystatin, clotrimazole, or miconazole.
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Oral therapy with fluconazole has proved extremely useful in the treatment of oral candidiasis in AIDS patients and other immunocompromised individuals.
For disseminated, systemic treatment with amphotericin B, fluconazole, voriconazole, and caspofungin.
Cryptococcal meningitis is almost universally fatal without therapy, but approximately 80–90% of patients (non-AIDS) can be cured with current therapeutic regimens. True or False.
What is True.
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Current therapeutic recommendations are amphotericin B plus 5-fluorocytosine acutely for two weeks (induction therapy), followed by 8-week consolidation with oral fluconazole.
Antifungals are treatment of choice for allergic syndromes such as ABPA. True or False.
What is False.
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Treatment of aspergillosis is difficult and is probably not indicated for aspergilloma unless life-threatening hemoptysis occurs, in which case segmental resection or lobectomy is indicated. Systemic anti-fungal therapy has been of no value. Likewise, neither systemic nor aerosolized antifungal therapy has been effective in treatment of the allergic syndromes such as ABPA. Corticosteroids are considered the treatment of choice.
Successful therapy of zygomycosis requires early diagnosis, systemic antifungal therapy with this agent, aggressive surgical débridement of the involved area, and control of the underlying disorder.
What is amphotericin B.
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Most of the Zygomycetes appear quite susceptible to amphotercin B and are generally not susceptible to azoles or echinocandins.
This type of dermatophytosis accounts for almost half of all nail disorders worldwide.
What is tinea unguium (onychomycosis).
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Characterized by symptoms of pain, discoloration, thickening, onycholysis, accumulation of subungual debris, and brittleness of the nails.
Onychomycosis presents with contiguous tinea pedis in 50% of cases.
Treatment requires at least 3 months of oral therapy.