MYCOLOGY

*Causative agent is Cryptococcus Neoformans, which is NOT dimorphic fungi but is heavily encapsulated yeast,with thick polysaccharide capsule and Narrow based buds.*India ink of CSF will show oval yeasts surrounded by clear halo, but india ink misses 50% of casesso ,we prefer to use latex agglutination test(Latex beads coated by antibody will react with antigens of polysaccharide capsule)*Mucicarmine stain would stain polysacc. capsule bright red.*You can't get if from other person but it has been associated with Exposure to PIGEON droppings(Hence workers working under birdges are at higher risk).*Poor cell mediated immune system(HIV/AIDS,Transplant patient on immunosuppressants) makes you esp. susceptible to disseminated infection by this organism.*It is famous for spreading to meninges trough hematogenous spread after inhalation and causing meningitis, ENCEPHALITIS(extends to perivascular spaces of brain and creates characteristic Soap Bublle lesions in GREY matter of brain.)which are more common in Immunocompromised patients, while immoncompetent patients are more likely to suffer from pneumonia without meningitis.*Culture on Sabouraud agar.*Flucytosine, Amphotericin B is treatment, for prevention of meningitis you can use fluconazole.*Note that cryptococcus is AIDS-Defining and usually appears when CD4+Tcell count drops below 200.(Rx Videos want you to know that:)(Don't confuse this AIDS defining infection which can Form Ring-enhancing lesions in brain with Toxoplasma which can also form ring enhancing lesions but Toxoplasma presents when CD4Tcell count goes below 50)*Kaplan wants you to know that it is Urease+ yeast.

*Change shampoo, with Selenium Sulfide and/or ORAL antifungals.*Patient most likely has Tinea(pytririasis) VersicolorMalassezia spp.(PITYROSPORUM.spp), don't think that it is a dermatophyte just because it is called Tinea, Malassezia spp. is YEAST LIKE FUNGUS.*Hypopigmented/Pink patches are due to ability of malassezia to damage melanocytes by acids produced trough degradation of lipids.*This Fungus(Not a dermatophyte) loves humid environment and is more common in summer(+becomes apparent with tanning)*Classic KOH appearance on Microscopy would show short curved septate hyphae and yeast clusters .(Referred to as SPHAGETTI and MEATBALLS)*Also it has Coppery/orange fluorescence on wood lamp test(Not super HY,but is in golijan and kaplan)

*Patient most likely has Tinea Capitis(Yes it can cause Lymphadenopathy),remember that characteristic findings of Superficial Dermatophytes(Microsporum,Trichophyton,Epidermopyton) on KOH preparations with blue fungal stains is Branching septate hyphae on KOH.*Remember they are fungi, so if they ask you which culture medium you would choose for growth choose Sabouraud Dextrose agar(Low Ph, and antibiotics like chloramphenicol kill off bacteria and let fungi grow_

*Remember tOrsO for Tinea cOrpOris,more important clue was characteristic ringworm appearance*Tinea cruris does NOT show this central clearing and is more likely to involve Inguinal area.

*MOST likely as Interdigital form.*It can also be found in mocassin(Can involve hands/feet,characterized by fine scaling in creases) distribution or as vesicular type.*Vesiculobullous type is an example of type 4 hypersensitivity to dermatophyte.

*Monomorphic filamentous fungi.*Trichphyton,Microsporum,Epidermophyton.*Microsporum can't infect nails while epidermophyton can't infect hair.*Trichophyton-MC one is badass and can infect all 3 Skin,Nails,Hair.(THREEchophyton:P)*PRURITIS is common complain and they result in inflammation as they are in living tissue.*Remember ONLY MICROSPORUM fluoresces on wood's lamp(bright yellow green)*Artrochonidia(Fungal spore-result of segmentation of pre-existing hyphate) and Hyphae on KOH is diagnostic for these dermatophytes.

*REMEMBER SYSTEMIC SPOROTRICHOSIS Can indicate immunodeficiency, so if patient has disseminated form it is good idea to check them for HIV(First test would be ELISA, and if + you would use western blot for confirmation)*Kaplan wants you to know about Pulmonary sporotrichosis in "alcoholic rose gardenerer's disease" and that in sputum you would see Cigar shaped yeast(Just like in cutaneous/subc. lesions).*Treatment for sporotrichosis includes ITracoonazole or POTassium iodide.*Know that sporothricx schenkii is Dimorphic fungi which can live on vegetation(FA wants you to know this, don't understand why but...)

*Only the members of the genus Candida would produce a creamy surface growth. The erythematous base is due to the production of a cytotoxin.*High sugar levels in diabetics makes everything worse as candida eats it.

*Biggest clue is SOUTHWEST (California)-Agent is Coccidiomyces(Spherules with endospores), infections with this dimorphic fungi that exists in body as SPHERULE with endospores is commonly acquired trough inhalation spores after earthquakes,Coccidiomyces can disseminate to skin and bone.(Causing Erythema nodosum=Desert bumps and Arthralgia=Desert rhematism),Do NOT forget about possible MENINGITIS(Meningitis+Pneumonia in patient who traveled to California<giveaway)*This fungi can result in granulomatous inflammation with caseous necrosis.*Don't write Coccidio, automatically when you see dissemination to skin and bones,think of Blastomyces when you see someone from East part of U.S and central America. patient might present with pneumonia and know that Blastomyces can disseminate to Skin and Bone too.*Blastomyces are Visualized as Thick-walled, refractile, double-contoured yeast cells (another way to say broad-based budding)which have Equal size to RBC, contrast this with coccidiomyces which is much larger than RBC.*Note blastomyces can also elicit granulomatous response.

*Patient has INVASIVE ASPERGILLOSIS.*patient was likely immunocompromised after transplant.

*Movable cavitary mass and hemoptysis in a patient with a history of sarcoidosis is strongly suggestive of aspergillomas. Preexisting conditions, such as tuberculosis, emphysema, or sarcoidosis, which promote pulmonary cavitation, are linked to the condition.*ABPA-is result of hypersensitivity response to this agent which has been associated with Cystic fibrosis, asthma and can actually lead to EOSINophilia and BRONCHIECTASIS.(Obstructive lung disease)*NADPH Oxidase deficiency(Can't create superoxide)=CGD, predisposes patients to catalase + organisms including Aspergillus.<People in immunocompromised states like AIDS and CGD can get INVASIVE aspergillosis.*Some Aspergillus can produce Aflatoxin>HCC.*Aspergillus has tendency to produce Necrotizing bronchopneumonia and hemorrhagic infarctions due to its ability to invade blood vessels.

*Patient most likely has Mucormycosis.*Patient likely had LEUKEMIA or other condition that could have caused NEUTROPENIA.*Patient Likely had history of Long-standing Diabetes and associated KETOACIDOSIS, as Mucor/Rhizopus Spp. can feed on glucose and ketones.*Very characteristically this fungi can PROLIFERATE IN BLOOD VESSELS,PENETRATE CRIBRIFORM PLATE and enter BRAIN.(Thus begin treatment with SURGICAL DEBRIDEMENT ASAP and you can also add Amphotericin B)*Black necrotic eschar on face,headache,face pain, rhinocerebral,frontal lobe abscess,cavernous sinus thrombosis are common presentations.*Don't get confused if patient presents with multiple cranial nerve palsies.

*Yeast like fungus or PCP is cause of Diffuse Interstitial pneumonia in patient with CD4+Th cell count<200,Biopsy/lavage is diagnostic.*TMP-SMX is main treatment and prophylaxis agent,pentamidine,Dapsone(For only prophylaxis),atovaquone can also be used for treatment and prophylaxis.

*Candida albicans can cause oral/esophageal thrush in malnourished babies and that can result in dysphagia and thus even failure to thrive.NYSTATIN,Fluconazole,Capsofungin.*When CD4Tcell count goes below 500 oral thrush is characteristic finding in patients with HIV/AIDS, *NEUTROPENIA increases risk of Disseminated infection.<(For systemic use fluconazole,capsofungin,AMPHOTERICIN B) while Tcell defects can result in Mucocutaneous Candidaiasis.*Steroid use and even diabetes increase your risk of developing this conditions.*B2 agonists like albuterol can cause oral thrush.(in asthma patients usually)*More commonly though babies are suffering from Diaper Rash(Also caused by C.albicans)*BUT Most commonly patient will be female who complains of pruritis and cottage white discharge as a result of vulvovaginitis(Predisposed by being DIABETIC and using Antibiotics which will kill normal flora and let candida grow)Topical Azole for treatment.*Don't get confused if IV drug user presents with endocarditis, as Candida can cause it too.(only oportunistic fungus able to do that)<REMBER TRICUSPID VALVE IS Most likely to be involved(Venous blood from systemic circulation will reach it)

*PARAcoccidiomycosis is common in LATIN AMERICA(like Mexico,Guatemala,Bolivia) and causative agent is Much larger than RBC.*If patient presents with Fungal pneumonia treat them with Fluconazole/Itraconazole NOT amphotericin B(Would be the choice if it was disseminated infection, like if you found granuloma related to fungus all over the body...)