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|  |USMLE Step 1 Web Prep — Medically Important Fungi |

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| |131190 >>> 0:00:00.2 |

| |SLIDE 1 of 66 |

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| |Mycology is the study of fungi (molds, yeasts, and mushrooms) |

| |• Eukaryotic (e.g., true nucleus, 80S ribosomes, mitochondria, as are humans) |

| |• Complex carbohydrate cell walls: chitin, glucan, and mannan |

| |• Ergosterol :Imidazole antifungals inhibit synthesis of ergosterol |

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| |Fungal Morphology |

| |• Hyphae = Filamentous Cellular Units of Molds and Mushrooms |

| |• Nonseptate Hyphae |

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| |SLIDE 2 of 66 |

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| |Fungal Morphology |

| |• Septate Hyphae |

| |• With cross walls |

| |• Width is fairly regular (tube-like) |

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| |SLIDE 3 of 66 |

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| |Hyphal Coloration |

| |• Dematiaceous: Dark colored (gray, olive, brown, black) |

| |• Hyaline: Clear |

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| |SLIDE 4 of 66 |

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| |Fungal Morphology |

| |• Yeasts = Single Celled (Round To Oval) Fungi |

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| |SLIDE 5 of 66 |

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| |Dimorphic Fungi |

| |• Fungi able to convert from hyphal to yeast or yeast-like forms |

| |• Thermally dimorphic: In the "cold" are the mold form |

| |• Histoplasma |

| |• Blastomyces |

| |• Coccidioides |

| |• Sporothrix |

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| |131210 >>> 0:05:10.2 |

| |SLIDE 6 of 66 |

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| |Pseudohyphae (Candida albicans): Hyphae with constrictions at each septum |

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| |SLIDE 7 of 66 |

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| |Spore Types: |

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| |Conidia |

| |Asexual spores |

| |Formed off of hyphae |

| |Common |

| |Airborne |

| |Blastoconidia |

| |• “Buds” on yeasts (asexual budding daughter yeast cells) |

| |Arthroconidia |

| |• Asexual spores formed by a “joint.” |

| |Spherules and Endospores (Coccidioides) |

| |• Spores inside the spherules in tissues |

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| |131220 >>> 0:06:05.2 |

| |SLIDE 8 of 66 |

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| |Spore Types: |

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| |Conidia |

| |Asexual spores |

| |Formed off of hyphae |

| |Common |

| |Airborne |

| |Blastoconidia |

| |• “Buds” on yeasts (asexual budding daughter yeast cells) |

| |Arthroconidia |

| |• Asexual spores formed by a “joint.” |

| |Spherules and Endospores (Coccidioides) |

| |• Spores inside the spherules in tissues |

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| |Spore Types: |

| |Conidia: Asexual spores, formed off of hyphae, common, airborne |

| |Blastoconidia: “Buds” on yeasts (asexual budding daughter yeast cells) |

| |Arthroconidia: Asexual spores formed by a “joint” |

| |Spherules and Endospores (Coccidioides): Spores inside the spherules in tissues |

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| |131230 >>> 0:07:27.2 |

| |SLIDE 10 of 66 |

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| |Diagnosis |

| |Table III-1. Microscopic Methods/Special Fungal Stains |

| |Preparation |

| |Fungal color |

| |Notes |

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| |KOH wet mount |

| |(KOH degrades human tissues releasing hyphae and yeasts) |

| |Colorless  (hyaline) refractive green or light olive to brown (dematiaceous) fungal elements  |

| |Heat gently; let set 10 minutes; dissolves human cells |

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| |PAS |

| |Hot pink |

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| |Silver stain |

| |Old rose gray to black |

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| |Calcofluor White |

| |(Can be done on wet mounts.) |

| |Bright blue-white on black |

| |Scrapings or sections, fluorescent microscope needed |

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| |India ink wet mount of CSF sediment |

| |Colorless cells with halos (capsule) on a black particulate background (Cryptococcus neoformans) |

| |Only "rules in." Insensitive; misses 50%. |

| |[Figure III-10. India ink mount of Crypto 5/8"] |

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| |SLIDE 11 of 66 |

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| |Diagnosis |

| |Table III-1. Microscopic Methods/Special Fungal Stains |

| |Preparation |

| |Fungal color |

| |Notes |

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| |KOH wet mount |

| |(KOH degrades human tissues releasing hyphae and yeasts) |

| |Colorless  (hyaline) refractive green or light olive to brown (dematiaceous) fungal elements  |

| |Heat gently; let set 10 minutes; dissolves human cells |

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| |PAS |

| |Hot pink |

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| |Silver stain |

| |Old rose gray to black |

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| |Calcofluor White |

| |(Can be done on wet mounts.) |

| |Bright blue-white on black |

| |Scrapings or sections, fluorescent microscope needed |

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| |India ink wet mount of CSF sediment |

| |Colorless cells with halos (capsule) on a black particulate background (Cryptococcus neoformans) |

| |Only "rules in." Insensitive; misses 50%. |

| |[Figure III-10. India ink mount of Crypto 5/8"] |

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| |131240 >>> 0:09:14.2 |

| |SLIDE 12 of 66 |

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| |Diagnosis |

| |Table III-1. Microscopic Methods/Special Fungal Stains |

| |Preparation |

| |Fungal color |

| |Notes |

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| |KOH wet mount |

| |(KOH degrades human tissues releasing hyphae and yeasts) |

| |Colorless  (hyaline) refractive green or light olive to brown (dematiaceous) fungal elements  |

| |Heat gently; let set 10 minutes; dissolves human cells |

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| |PAS |

| |Hot pink |

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| |Silver stain |

| |Old rose gray to black |

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| |Calcofluor White |

| |(Can be done on wet mounts.) |

| |Bright blue-white on black |

| |Scrapings or sections, fluorescent microscope needed |

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| |India ink wet mount of CSF sediment |

| |Colorless cells with halos (capsule) on a black particulate background (Cryptococcus neoformans) |

| |Only "rules in." Insensitive; misses 50%. |

| |[Figure III-10. India ink mount of Crypto 5/8"] |

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| |131245 >>> 0:09:26.2 |

| |SLIDE 13 of 66 |

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| |Diagnosis |

| |Table III-1. Microscopic Methods/Special Fungal Stains |

| |Preparation |

| |Fungal color |

| |Notes |

| | |

| |KOH wet mount |

| |(KOH degrades human tissues releasing hyphae and yeasts) |

| |Colorless  (hyaline) refractive green or light olive to brown (dematiaceous) fungal elements  |

| |Heat gently; let set 10 minutes; dissolves human cells |

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| |PAS |

| |Hot pink |

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| |Silver stain |

| |Old rose gray to black |

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| |Calcofluor White |

| |(Can be done on wet mounts.) |

| |Bright blue-white on black |

| |Scrapings or sections, fluorescent microscope needed |

| | |

| |India ink wet mount of CSF sediment |

| |Colorless cells with halos (capsule) on a black particulate background (Cryptococcus neoformans) |

| |Only "rules in." Insensitive; misses 50%. |

| |[Figure III-10. India ink mount of Crypto 5/8"] |

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| |131246 >>> 0:09:57.2 |

| |SLIDE 14 of 66 |

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| |• Culture: Special fungal media: Inhibitory mold agar modification of Sabouraud's with antibiotics |

| |Sabouraud’s |

| |Blood agar |

| |Both of the above with antibiotics |

| |• Serology: Antibody screen, complement fixation, etc. |

| |• Fungal Antigen Detection: (CSF, serum); Cryptococcal capsular polysaccharide detection by latex particle agglutination (LPA) or |

| |counter immuno electrophoresis |

| |• Skin Tests: Most useful for epidemiology or demonstration of anergy to an agent you know patient is infected with (grave prognosis); |

| |Otherwise, like tuberculosis, a skin test only indicates exposure to the agent. |

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| |131250 >>> 0:11:08.2 |

| |SLIDE 15 of 66 |

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| |Sporothrix schenckii |

| |• Dimorphic Fungus |

| |• Environmental form: On plant material, worldwide as hyphae with rosettes and sleeves of conidia |

| |• Traumatic implantation (rose or plum tree thorns, wire/sphagnum moss) |

| |• Tissue form: cigar-shaped yeast in tissue |

| |• Sporotrichosis (rose gardener’s disease): subcutaneous or lymphocutaneous lesions |

| |• Treatment: Itraconazole or potassium iodide in milk (no antifungal activity) |

| |• Pulmonary (acute or chronic) sporotrichosis: Urban alcoholics, particularly homeless |

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| |131255 >>> 0:12:13.2 |

| |SLIDE 16 of 66 |

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| |Sporothrix schenckii |

| |• Dimorphic Fungus |

| |• Environmental form: On plant material, worldwide as hyphae with rosettes and sleeves of conidia |

| |• Traumatic implantation (rose or plum tree thorns, wire/sphagnum moss) |

| |• Tissue form: cigar-shaped yeast in tissue |

| |• Sporotrichosis (rose gardener’s disease): subcutaneous or lymphocutaneous lesions |

| |• Treatment: Itraconazole or potassium iodide in milk (no antifungal activity) |

| |• Pulmonary (acute or chronic) sporotrichosis: Urban alcoholics, particularly homeless |

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| |131260 >>> 0:12:21.2 |

| |SLIDE 17 of 66 |

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| |Sporothrix schenckii |

| |• Dimorphic Fungus |

| |• Environmental form: On plant material, worldwide as hyphae with rosettes and sleeves of conidia |

| |• Traumatic implantation (rose or plum tree thorns, wire/sphagnum moss) |

| |• Tissue form: cigar-shaped yeast in tissue |

| |• Sporotrichosis (rose gardener’s disease): subcutaneous or lymphocutaneous lesions |

| |• Treatment: Itraconazole or potassium iodide in milk (no antifungal activity) |

| |• Pulmonary (acute or chronic) sporotrichosis: Urban alcoholics, particularly homeless |

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| |131265 >>> 0:12:46.2 |

| |SLIDE 18 of 66 |

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| |Sporothrix schenckii |

| |• Dimorphic Fungus |

| |• Environmental form: On plant material, worldwide as hyphae with rosettes and sleeves of conidia |

| |• Traumatic implantation (rose or plum tree thorns, wire/sphagnum moss) |

| |• Tissue form: cigar-shaped yeast in tissue |

| |• Sporotrichosis (rose gardener’s disease): subcutaneous or lymphocutaneous lesions |

| |• Treatment: Itraconazole or potassium iodide in milk (no antifungal activity) |

| |• Pulmonary (acute or chronic) sporotrichosis: Urban alcoholics, particularly homeless |

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| |131270 >>> 0:12:56.2 |

| |SLIDE 19 of 66 |

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| |Sporothrix schenckii |

| |• Dimorphic Fungus |

| |• Environmental form: On plant material, worldwide as hyphae with rosettes and sleeves of conidia |

| |• Traumatic implantation (rose or plum tree thorns, wire/sphagnum moss) |

| |• Tissue form: cigar-shaped yeast in tissue |

| |• Sporotrichosis (rose gardener’s disease): subcutaneous or lymphocutaneous lesions |

| |• Treatment: Itraconazole or potassium iodide in milk (no antifungal activity) |

| |• Pulmonary (acute or chronic) sporotrichosis: Urban alcoholics, particularly homeless |

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| |131275 >>> 0:13:06.2 |

| |SLIDE 20 of 66 |

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| |Sporothrix schenckii |

| |• Dimorphic Fungus |

| |• Environmental form: On plant material, worldwide as hyphae with rosettes and sleeves of conidia |

| |• Traumatic implantation (rose or plum tree thorns, wire/sphagnum moss) |

| |• Tissue form: cigar-shaped yeast in tissue |

| |• Sporotrichosis (rose gardener’s disease): subcutaneous or lymphocutaneous lesions |

| |• Treatment: Itraconazole or potassium iodide in milk (no antifungal activity) |

| |• Pulmonary (acute or chronic) sporotrichosis: Urban alcoholics, particularly homeless |

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| |131280 >>> 0:13:12.2 |

| |SLIDE 21 of 66 |

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| |Sporothrix schenckii |

| |• Dimorphic Fungus |

| |• Environmental form: On plant material, worldwide as hyphae with rosettes and sleeves of conidia |

| |• Traumatic implantation (rose or plum tree thorns, wire/sphagnum moss) |

| |• Tissue form: cigar-shaped yeast in tissue |

| |• Sporotrichosis (rose gardener’s disease): subcutaneous or lymphocutaneous lesions |

| |• Treatment: Itraconazole or potassium iodide in milk (no antifungal activity) |

| |• Pulmonary (acute or chronic) sporotrichosis: Urban alcoholics, particularly homeless |

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| |131285 >>> 0:13:19.2 |

| |SLIDE 22 of 66 |

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| |Sporothrix schenckii |

| |• Dimorphic Fungus |

| |• Environmental form: On plant material, worldwide as hyphae with rosettes and sleeves of conidia |

| |• Traumatic implantation (rose or plum tree thorns, wire/sphagnum moss) |

| |• Tissue form: cigar-shaped yeast in tissue |

| |• Sporotrichosis (rose gardener’s disease): subcutaneous or lymphocutaneous lesions |

| |• Treatment: Itraconazole or potassium iodide in milk (no antifungal activity) |

| |• Pulmonary (acute or chronic) sporotrichosis: Urban alcoholics, particularly homeless |

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| |131290 >>> 0:14:30.2 |

| |SLIDE 23 of 66 |

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| |Deep Fungal Infections |

| |Histoplasma |

| |Coccidioides |

| |Blastomyces |

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| |All three cause: |

| |Acute pulmonary (asymptomatic or self-resolving in about 95% of the cases) |

| |Chronic pulmonary, or |

| |Disseminated infections |

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| |SLIDE 24 of 66 |

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| |Histoplasma capsulatum |

| |• Dimorphic fungus |

| |• Environmental form: Hyphae with microconidia and tuberculate macroconidia |

| |• Endemic region: Eastern Great Lakes, Ohio, Mississippi, and Missouri River beds |

| |• Found in soil (dust) enriched with bird or bat feces |

| |• Spelunking (cave exploring), cleaning chicken coops, or bulldozing starling roosts |

| |• Tissue form: Small intracellular yeasts with narrow neck on bud; no capsule |

| |• Facultative intracellular parasite found in reticuloendothelial (RES) cells |

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| |131300 >>> 0:16:21.2 |

| |SLIDE 25 of 66 |

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| |Histoplasma capsulatum |

| |• Dimorphic fungus |

| |• Environmental form: Hyphae with microconidia and tuberculate macroconidia |

| |• Endemic region: Eastern Great Lakes, Ohio, Mississippi, and Missouri River beds |

| |• Found in soil (dust) enriched with bird or bat feces |

| |• Spelunking (cave exploring), cleaning chicken coops, or bulldozing starling roosts |

| |• Tissue form: Small intracellular yeasts with narrow neck on bud; no capsule |

| |• Facultative intracellular parasite found in reticuloendothelial (RES) cells |

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| |131305 >>> 0:17:06.2 |

| |SLIDE 26 of 66 |

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| |Histoplasma capsulatum |

| |• Dimorphic fungus |

| |• Environmental form: Hyphae with microconidia and tuberculate macroconidia |

| |• Endemic region: Eastern Great Lakes, Ohio, Mississippi, and Missouri River beds |

| |• Found in soil (dust) enriched with bird or bat feces |

| |• Spelunking (cave exploring), cleaning chicken coops, or bulldozing starling roosts |

| |• Tissue form: Small intracellular yeasts with narrow neck on bud; no capsule |

| |• Facultative intracellular parasite found in reticuloendothelial (RES) cells |

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| |131310 >>> 0:18:52.2 |

| |SLIDE 27 of 66 |

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| |Histoplasma capsulatum |

| |Fungus flu (a pneumonia) |

| |• Asymptomatic or acute (but self-resolving) pneumonia with flu-like symptomatology |

| |• Hepatosplenomegaly may be present even in acute pulmonary infections (facultative intracellular-RES) |

| |• Very common in summer in endemic areas: kids or newcomers (80% of adults are skin test positive in some areas) |

| |• Lesions have a tendency to calcify as they heal |

| |• Relapse potential increases with T cell immunosuppression |

| |• Disseminated infections: Mucocutaneous lesions are common; also common in AIDS patients in endemic area |

| |• Treat with amphotericin B |

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| |131315 >>> 0:19:07.2 |

| |SLIDE 28 of 66 |

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| |Histoplasma capsulatum |

| |Fungus flu (a pneumonia) |

| |• Asymptomatic or acute (but self-resolving) pneumonia with flu-like symptomatology |

| |• Hepatosplenomegaly may be present even in acute pulmonary infections (facultative intracellular-RES) |

| |• Very common in summer in endemic areas: kids or newcomers (80% of adults are skin test positive in some areas) |

| |• Lesions have a tendency to calcify as they heal |

| |• Relapse potential increases with T cell immunosuppression |

| |• Disseminated infections: Mucocutaneous lesions are common; also common in AIDS patients in endemic area |

| |• Treat with amphotericin B |

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| |131320 >>> 0:20:11.2 |

| |SLIDE 29 of 66 |

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| |Coccidioides immitis |

| |• Dimorphic Fungus |

| |• Environmental form: Hyphae breaking up into arthroconidia found in desert sand |

| |• Endemic region: Southwestern United States, Southern California (especially San Joaquin Valley), Arizona, New Mexico, Texas, Nevada |

| |• Arthroconidia are inhaled, round up, and enlarged becoming spherules inside which the cytoplasm wall off, forming endospores within |

| |which the endospore develop |

| |• Tissue form: Spherules with endospores |

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| |SLIDE 30 of 66 |

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| |Coccidioides immitis |

| |• Dimorphic Fungus |

| |• Environmental form: Hyphae breaking up into arthroconidia found in desert sand |

| |• Endemic region: Southwestern United States, Southern California (especially San Joaquin Valley), Arizona, New Mexico, Texas, Nevada |

| |• Arthroconidia are inhaled, round up, and enlarged becoming spherules inside which the cytoplasm wall off, forming endospores within |

| |which the endospore develop |

| |• Tissue form: Spherules with endospores |

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| |131330 >>> 0:21:40.2 |

| |SLIDE 31 of 66 |

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| |Coccidioides immitis |

| |• Dimorphic Fungus |

| |• Environmental form: Hyphae breaking up into arthroconidia found in desert sand |

| |• Endemic region: Southwestern United States, Southern California (especially San Joaquin Valley), Arizona, New Mexico, Texas, Nevada |

| |• Arthroconidia are inhaled, round up, and enlarged becoming spherules inside which the cytoplasm wall off, forming endospores within |

| |which the endospore develop |

| |• Tissue form: Spherules with endospores |

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| |131335 >>> 0:21:54.2 |

| |SLIDE 32 of 66 |

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| |Coccidioides immitis |

| |• Dimorphic Fungus |

| |• Environmental form: Hyphae breaking up into arthroconidia found in desert sand |

| |• Endemic region: Southwestern United States, Southern California (especially San Joaquin Valley), Arizona, New Mexico, Texas, Nevada |

| |• Arthroconidia are inhaled, round up, and enlarged becoming spherules inside which the cytoplasm wall off, forming endospores within |

| |which the endospore develop |

| |• Tissue form: Spherules with endospores |

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| |SLIDE 33 of 66 |

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| |Coccidioides immitis |

| |Valley Fever (asymptomatic to self-resolving pneumonia) |

| |• Desert bumps (erythema nodosum) and arthritis are generally good prognostic signs |

| |• Very common in endemic region |

| |• Pulmonary lesions have a tendency to calcify as they heal |

| |• Systemic infections are a problem in AIDS and immunocompromised patients in endemic region |

| |• Cocci has a tendency to disseminate in 3rd trimester of pregnancy |

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| |SLIDE 34 of 66 |

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| |Blastomyces dermatitidis |

| |• Dimorphic Fungus |

| |• Environmental form: Hyphae with nondescript conidia |

| |• Association not definitively known, appears to be associated with rotting wood such as beaver dams |

| |• Endemic region: Upper Great Lakes, Ohio, Mississippi River beds plus the southeastern seaboard of the U.S. and northern Minnesota |

| |into Canada |

| |• Tissue form: Broad-based budding yeasts and a double refractile cell wall |

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| |131350 >>> 0:24:33.2 |

| |SLIDE 35 of 66 |

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| |Blastomyces dermatitidis |

| |Blastomycosis |

| |• Acute and chronic pulmonary disease |

| |• Considered less likely to self-resolve than Histoplasma or Coccidioides. So many physicians will treat even acute infections with |

| |ketoconazole. |

| |• Disseminated disease |

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| |131355 >>> 0:24:47.2 |

| |SLIDE 36 of 66 |

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| |Blastomyces dermatitidis |

| |Blastomycosis |

| |• Acute and chronic pulmonary disease |

| |• Considered less likely to self-resolve than Histoplasma or Coccidioides. So many physicians will treat even acute infections with |

| |ketoconazole. |

| |• Disseminated disease |

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| |131360 >>> 0:25:01.2 |

| |SLIDE 37 of 66 |

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| |Blastomyces dermatitidis |

| |Blastomycosis |

| |• Acute and chronic pulmonary disease |

| |• Considered less likely to self-resolve than Histoplasma or Coccidioides. So many physicians will treat even acute infections with |

| |ketoconazole. |

| |• Disseminated disease |

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| |131365 >>> 0:25:09.2 |

| |SLIDE 38 of 66 |

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| |Blastomyces dermatitidis |

| |Blastomycosis |

| |• Acute and chronic pulmonary disease |

| |• Considered less likely to self-resolve than Histoplasma or Coccidioides. So many physicians will treat even acute infections with |

| |ketoconazole. |

| |• Disseminated disease |

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| |131370 >>> 0:25:12.2 |

| |SLIDE 39 of 66 |

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| |Blastomyces dermatitidis |

| |Blastomycosis |

| |• Acute and chronic pulmonary disease |

| |• Considered less likely to self-resolve than Histoplasma or Coccidioides. So many physicians will treat even acute infections with |

| |ketoconazole. |

| |• Disseminated disease |

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| |131375 >>> 0:25:43.2 |

| |SLIDE 40 of 66 |

| | |

| | |

| |Aspergillus fumigatus |

| |• Monomorphic filamentous fungus: Dichotomously branching, Generally acute angles, Septate |

| |• One of our major recyclers: compost pits, moldy |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131380 >>> 0:26:18.2 |

| |SLIDE 41 of 66 |

| | |

| | |

| |Aspergillus fumigatus |

| | |

| |Diseases/Predisposing Conditions |

| |• Allergic bronchopulmonary aspergillosis/asthma, allergies (growing in mucous plugs in the lung but not penetrating the lung tissue) |

| |• Fungus ball: free in preformed lung cavities (surgical removal to reduce coughing, which may induce pulmonary hemorrhage) |

| |• Invasive aspergillosis/severe neutropenia, CGD, CF, burns |

| |Invades tissues causing infarcts and hemorrhage |

| |Nasal colonization [pic]pneumonia or meningitis |

| |Cellulitis/in burn patients; may also disseminate |

| |• Treatment: Depends on severity of disease and underlying conditions - Itraconazole or Amphotericin B |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131385 >>> 0:26:26.2 |

| |SLIDE 42 of 66 |

| | |

| | |

| |Aspergillus fumigatus |

| | |

| |Diseases/Predisposing Conditions |

| |• Allergic bronchopulmonary aspergillosis/asthma, allergies (growing in mucous plugs in the lung but not penetrating the lung tissue) |

| |• Fungus ball: free in preformed lung cavities (surgical removal to reduce coughing, which may induce pulmonary hemorrhage) |

| |• Invasive aspergillosis/severe neutropenia, CGD, CF, burns |

| |Invades tissues causing infarcts and hemorrhage |

| |Nasal colonization [pic]pneumonia or meningitis |

| |Cellulitis/in burn patients; may also disseminate |

| |• Treatment: Depends on severity of disease and underlying conditions - Itraconazole or Amphotericin B |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131390 >>> 0:26:45.2 |

| |SLIDE 43 of 66 |

| | |

| | |

| |Aspergillus fumigatus |

| | |

| |Diseases/Predisposing Conditions |

| |• Allergic bronchopulmonary aspergillosis/asthma, allergies (growing in mucous plugs in the lung but not penetrating the lung tissue) |

| |• Fungus ball: free in preformed lung cavities (surgical removal to reduce coughing, which may induce pulmonary hemorrhage) |

| |• Invasive aspergillosis/severe neutropenia, CGD, CF, burns |

| |Invades tissues causing infarcts and hemorrhage |

| |Nasal colonization [pic]pneumonia or meningitis |

| |Cellulitis/in burn patients; may also disseminate |

| |• Treatment: Depends on severity of disease and underlying conditions - Itraconazole or Amphotericin B |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131395 >>> 0:28:23.2 |

| |SLIDE 44 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| |• Yeast endogenous to our mucous membrane normal flora |

| |• C. albicans yeasts form germ tubes at 37°C in serum |

| |• Form pseudohyphae and true hyphae when it invades tissues (nonpathogenic Candida do not) |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131396 >>> 0:29:29.2 |

| |SLIDE 45 of 66 |

| | |

| |Candida albicans (And Other Species of Candida) |

| | |

| |Diagnosis |

| |• KOH: pseudohyphae, true hyphae, budding yeasts |

| |• Septicemia: Culture lab identification: biochemical tests/formation of germ tubes |

| |[pic] |

| |131400 >>> 0:29:47.2 |

| |SLIDE 46 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| | |

| |Diagnosis |

| |• KOH: pseudohyphae, true hyphae, budding yeasts |

| |• Septicemia: Culture lab identification: biochemical tests/formation of germ tubes |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131405 >>> 0:30:13.2 |

| |SLIDE 47 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| | |

| |Diagnosis |

| |• KOH: pseudohyphae, true hyphae, budding yeasts |

| |• Septicemia: Culture lab identification: biochemical tests/formation of germ tubes |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131410 >>> 0:30:47.2 |

| |SLIDE 48 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| |Diseases/Predisposing Conditions |

| |• Perlèche - crevices of mouth: malnutrition |

| |• Oral thrush: prematurity, antibiotic use, immunocompromised (IC) host, AIDS |

| |• Esophagitis: antibiotic use, IC host, AIDS |

| |• Gastritis: antibiotic use, IC host, AIDS |

| |• Septicemia (with endophthalmitis and macronodular skin lesions): immunocompromised, cancer and intravenous (IV) patients |

| |• Endocarditis (with transient septicemias):IV drug abusers |

| |• Cutaneous infections: obesity and infants; patients with rubber gloves |

| |• Yeast vaginitis: particularly a problem in diabetic women |

| |• Chronic mucocutaneous candidiasis: endocrine defects; anergy to Candida |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131415 >>> 0:31:04.2 |

| |SLIDE 49 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| |Diseases/Predisposing Conditions |

| |• Perlèche - crevices of mouth: malnutrition |

| |• Oral thrush: prematurity, antibiotic use, immunocompromised (IC) host, AIDS |

| |• Esophagitis: antibiotic use, IC host, AIDS |

| |• Gastritis: antibiotic use, IC host, AIDS |

| |• Septicemia (with endophthalmitis and macronodular skin lesions): immunocompromised, cancer and intravenous (IV) patients |

| |• Endocarditis (with transient septicemias):IV drug abusers |

| |• Cutaneous infections: obesity and infants; patients with rubber gloves |

| |• Yeast vaginitis: particularly a problem in diabetic women |

| |• Chronic mucocutaneous candidiasis: endocrine defects; anergy to Candida |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131420 >>> 0:31:56.2 |

| |SLIDE 50 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| |Diseases/Predisposing Conditions |

| |• Perlèche - crevices of mouth: malnutrition |

| |• Oral thrush: prematurity, antibiotic use, immunocompromised (IC) host, AIDS |

| |• Esophagitis: antibiotic use, IC host, AIDS |

| |• Gastritis: antibiotic use, IC host, AIDS |

| |• Septicemia (with endophthalmitis and macronodular skin lesions): immunocompromised, cancer and intravenous (IV) patients |

| |• Endocarditis (with transient septicemias):IV drug abusers |

| |• Cutaneous infections: obesity and infants; patients with rubber gloves |

| |• Yeast vaginitis: particularly a problem in diabetic women |

| |• Chronic mucocutaneous candidiasis: endocrine defects; anergy to Candida |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131425 >>> 0:32:20.2 |

| |SLIDE 51 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| |Diseases/Predisposing Conditions |

| |• Perlèche - crevices of mouth: malnutrition |

| |• Oral thrush: prematurity, antibiotic use, immunocompromised (IC) host, AIDS |

| |• Esophagitis: antibiotic use, IC host, AIDS |

| |• Gastritis: antibiotic use, IC host, AIDS |

| |• Septicemia (with endophthalmitis and macronodular skin lesions): immunocompromised, cancer and intravenous (IV) patients |

| |• Endocarditis (with transient septicemias):IV drug abusers |

| |• Cutaneous infections: obesity and infants; patients with rubber gloves |

| |• Yeast vaginitis: particularly a problem in diabetic women |

| |• Chronic mucocutaneous candidiasis: endocrine defects; anergy to Candida |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131430 >>> 0:32:38.2 |

| |SLIDE 52 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| |Diseases/Predisposing Conditions |

| |• Perlèche - crevices of mouth: malnutrition |

| |• Oral thrush: prematurity, antibiotic use, immunocompromised (IC) host, AIDS |

| |• Esophagitis: antibiotic use, IC host, AIDS |

| |• Gastritis: antibiotic use, IC host, AIDS |

| |• Septicemia (with endophthalmitis and macronodular skin lesions): immunocompromised, cancer and intravenous (IV) patients |

| |• Endocarditis (with transient septicemias):IV drug abusers |

| |• Cutaneous infections: obesity and infants; patients with rubber gloves |

| |• Yeast vaginitis: particularly a problem in diabetic women |

| |• Chronic mucocutaneous candidiasis: endocrine defects; anergy to Candida |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131435 >>> 0:32:46.2 |

| |SLIDE 53 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| |Diseases/Predisposing Conditions |

| |• Perlèche - crevices of mouth: malnutrition |

| |• Oral thrush: prematurity, antibiotic use, immunocompromised (IC) host, AIDS |

| |• Esophagitis: antibiotic use, IC host, AIDS |

| |• Gastritis: antibiotic use, IC host, AIDS |

| |• Septicemia (with endophthalmitis and macronodular skin lesions): immunocompromised, cancer and intravenous (IV) patients |

| |• Endocarditis (with transient septicemias):IV drug abusers |

| |• Cutaneous infections: obesity and infants; patients with rubber gloves |

| |• Yeast vaginitis: particularly a problem in diabetic women |

| |• Chronic mucocutaneous candidiasis: endocrine defects; anergy to Candida |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131440 >>> 0:32:57.2 |

| |SLIDE 54 of 66 |

| | |

| | |

| |Candida albicans (And Other Species of Candida) |

| |Diseases/Predisposing Conditions |

| |• Perlèche - crevices of mouth: malnutrition |

| |• Oral thrush: prematurity, antibiotic use, immunocompromised (IC) host, AIDS |

| |• Esophagitis: antibiotic use, IC host, AIDS |

| |• Gastritis: antibiotic use, IC host, AIDS |

| |• Septicemia (with endophthalmitis and macronodular skin lesions): immunocompromised, cancer and intravenous (IV) patients |

| |• Endocarditis (with transient septicemias):IV drug abusers |

| |• Cutaneous infections: obesity and infants; patients with rubber gloves |

| |• Yeast vaginitis: particularly a problem in diabetic women |

| |• Chronic mucocutaneous candidiasis: endocrine defects; anergy to Candida |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131441 >>> 0:33:07 |

| |SLIDE 55 of 66 |

| | |

| |Candida albicans (And Other Species of Candida) |

| |Treatment |

| |• Topical imidazoles or oral imidazoles; nystatin disseminated: |

| |• Amphotericin B or Fluconazole |

| |[pic] |

| |131445 >>> 0:33:38.2 |

| |SLIDE 56 of 66 |

| | |

| | |

| |Cryptococcus neoformans |

| |• Encapsulated Yeast (Monomorphic) |

| |• Environmental Source: Soil enriched with pigeon droppings |

| |• Meningitis: Hodgkin’s, AIDS (the dominant meningitis) |

| |• Acute pulmonary (usually asymptomatic): pigeon breeders |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131450 >>> 0:34:04.2 |

| |SLIDE 57 of 66 |

| | |

| | |

| |Cryptococcus neoformans |

| |• Encapsulated Yeast (Monomorphic) |

| |• Environmental Source: Soil enriched with pigeon droppings |

| |• Meningitis: Hodgkin’s, AIDS (the dominant meningitis) |

| |• Acute pulmonary (usually asymptomatic): pigeon breeders |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131455 >>> 0:34:15.2 |

| |SLIDE 58 of 66 |

| | |

| | |

| |Cryptococcus neoformans |

| |• Encapsulated Yeast (Monomorphic) |

| |• Environmental Source: Soil enriched with pigeon droppings |

| |• Meningitis: Hodgkin’s, AIDS (the dominant meningitis) |

| |• Acute pulmonary (usually asymptomatic): pigeon breeders |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131460 >>> 0:34:26.2 |

| |SLIDE 59 of 66 |

| | |

| | |

| |Cryptococcus neoformans |

| |• Encapsulated Yeast (Monomorphic) |

| |• Environmental Source: Soil enriched with pigeon droppings |

| |• Meningitis: Hodgkin’s, AIDS (the dominant meningitis) |

| |• Acute pulmonary (usually asymptomatic): pigeon breeders |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131465 >>> 0:34:36.2 |

| |SLIDE 60 of 66 |

| | |

| | |

| |Cryptococcus neoformans |

| |Diagnosis of Meningitis: CSF |

| |• Detect capsular antigen in CSF (by latex particle agglutination, or counter immunoelectrophoresis) |

| |• India ink mount (misses 50%) of CSF sediment to find budding yeasts with capsular “halos” |

| |• Cultures (urease positive yeast) |

| |• Treatment: AMB+5FC until afebrile and culture negative, then fluconazole |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131470 >>> 0:36:12.2 |

| |SLIDE 61 of 66 |

| | |

| | |

| |Cryptococcus neoformans |

| |Diagnosis of Meningitis: CSF |

| |• Detect capsular antigen in CSF (by latex particle agglutination, or counter immunoelectrophoresis) |

| |• India ink mount (misses 50%) of CSF sediment to find budding yeasts with capsular “halos” |

| |• Cultures (urease positive yeast) |

| |• Treatment: AMB+5FC until afebrile and culture negative, then fluconazole |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131475 >>> 0:36:47.2 |

| |SLIDE 62 of 66 |

| | |

| | |

| |Mucor, Rhizopus, Absidia (Zygomycophyta) |

| |• Nonseptate filamentous fungi |

| |• Environmental Source: Soil, sporangiospores are inhaled |

| |• Disease characterized by paranasal swelling, necrotic tissues, hemorrhagic exudates from nose and eyes, and mental lethargy |

| |• Occurs in ketoacidotic diabetic patients and leukemic patients |

| |• These fungi penetrate without respect to anatomical barriers, progressing rapidly from sinuses into the brain tissue |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131476 >>> 0:37:41.2 |

| |SLIDE 63 of 66 |

| | |

| |Pneumocystis carinii |

| |• Fungus (based on molecular techniques like ribotyping) |

| |• Obligate extracellular parasite |

| |• Silver stained cysts in tissues |

| |• Interstitial pneumonia |

| |[pic] |

| |131480 >>> 0:38:34.2 |

| |SLIDE 64 of 66 |

| | |

| | |

| |Pneumocystis carinii |

| |• Pneumonia in AIDS patients even with prophylaxis (mean CD4+/mm3 of 26) malnourished babies, premature neonates, and some other IC |

| |adults and kids |

| |• Symptoms: fever, cough, shortness of breath; sputum nonproductive except in smokers |

| |• Pneumocystosis attaches to and kills Type I pneumocytes causing excess replication of Type II pneumocytes and damage to alveolar |

| |epithelium. Serum leaks into alveoli producing an exudate with a foamy or honeycomb appearance on H & E stain. |

| |• X-ray: Patchy infiltrative (ground glass appearance), the lower lobe periphery may be spared |

| |• Diagnosis: Silver-staining cysts in bronchial alveolar lavage fluids or biopsy |

| |• Treatment: Trimethoprim/sulfamethoxazole |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131485 >>> 0:38:55.2 |

| |SLIDE 65 of 66 |

| | |

| | |

| |Pneumocystis carinii |

| |• Pneumonia in AIDS patients even with prophylaxis (mean CD4+/mm3 of 26) malnourished babies, premature neonates, and some other IC |

| |adults and kids |

| |• Symptoms: fever, cough, shortness of breath; sputum nonproductive except in smokers |

| |• Pneumocystosis attaches to and kills Type I pneumocytes causing excess replication of Type II pneumocytes and damage to alveolar |

| |epithelium. Serum leaks into alveoli producing an exudate with a foamy or honeycomb appearance on H & E stain. |

| |• X-ray: Patchy infiltrative (ground glass appearance), the lower lobe periphery may be spared |

| |• Diagnosis: Silver-staining cysts in bronchial alveolar lavage fluids or biopsy |

| |• Treatment: Trimethoprim/sulfamethoxazole |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

| |131490 >>> 0:39:01.2 |

| |SLIDE 66 of 66 |

| | |

| | |

| |Pneumocystis carinii |

| |• Pneumonia in AIDS patients even with prophylaxis (mean CD4+/mm3 of 26) malnourished babies, premature neonates, and some other IC |

| |adults and kids |

| |• Symptoms: fever, cough, shortness of breath; sputum nonproductive except in smokers |

| |• Pneumocystosis attaches to and kills Type I pneumocytes causing excess replication of Type II pneumocytes and damage to alveolar |

| |epithelium. Serum leaks into alveoli producing an exudate with a foamy or honeycomb appearance on H & E stain. |

| |• X-ray: Patchy infiltrative (ground glass appearance), the lower lobe periphery may be spared |

| |• Diagnosis: Silver-staining cysts in bronchial alveolar lavage fluids or biopsy |

| |• Treatment: Trimethoprim/sulfamethoxazole |

| |[pic] |

| |[pic] |

| | |

| |[pic] |

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