Medical Mastermind Community
| |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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| |131195 >>> 0:03:03.2 |
| |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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| |131200 >>> 0:03:14.2 |
| |SLIDE 3 of 66 |
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| |Hyphal Coloration |
| |• Dematiaceous: Dark colored (gray, olive, brown, black) |
| |• Hyaline: Clear |
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| |131205 >>> 0:03:40.2 |
| |SLIDE 4 of 66 |
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| |Fungal Morphology |
| |• Yeasts = Single Celled (Round To Oval) Fungi |
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| |131206 >>> 0:04:14.2 |
| |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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| |131215 >>> 0:05:42.2 |
| |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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| |131225 >>> 0:06:50.2 |
| |SLIDE 9 of 66 |
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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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| |131235 >>> 0:08:25.2 |
| |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 |
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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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| |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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| |131295 >>> 0:15:39.2 |
| |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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| |131325 >>> 0:21:08.2 |
| |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 |
| |[pic] |
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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 |
| |[pic] |
| |[pic] |
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| |131340 >>> 0:22:23.2 |
| |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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| |131345 >>> 0:23:13.2 |
| |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 |
| |[pic] |
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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 |
| |[pic] |
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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 |
| |[pic] |
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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 |
| |[pic] |
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| |131375 >>> 0:25:43.2 |
| |SLIDE 40 of 66 |
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| |Aspergillus fumigatus |
| |• Monomorphic filamentous fungus: Dichotomously branching, Generally acute angles, Septate |
| |• One of our major recyclers: compost pits, moldy |
| |[pic] |
| |[pic] |
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| |[pic] |
| |131380 >>> 0:26:18.2 |
| |SLIDE 41 of 66 |
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| |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 |
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| | |
| |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 |
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| | |
| |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 |
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| | |
| |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] |
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| |[pic] |
| |131396 >>> 0:29:29.2 |
| |SLIDE 45 of 66 |
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| |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 |
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| | |
| |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 |
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| | |
| |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 |
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| |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] |
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| |[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] |
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| |[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] |
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| |[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] |
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| |[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] |
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| |[pic] |
| |131450 >>> 0:34:04.2 |
| |SLIDE 57 of 66 |
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| | |
| |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] |
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| |[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 |
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| |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] |
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| |[pic] |
| |131470 >>> 0:36:12.2 |
| |SLIDE 61 of 66 |
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| | |
| |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 |
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| | |
| |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 |
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| |[pic] |
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| |[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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