Mycology

Mississippi river basin, Great Lakes, Southeast
In the Feces of birds and batrs
-- caused by a dimorphic fungus, Blastomyces dermatitidis

symptomatic in less than 50% of people.
Acute lobar consolidation (like bacterial), chronic infiltrates may look like carcinoma. Outside of the lungs, skin and bones most affected. Also prostate, liver spleen, kidney, and CNS

diagnosed by KOH of sputum -> yeast cells, single broad based buds

treat with Amphotericin B, Itraconazole, voriconazole

South America, Mexico and central America (Brazil most reported)
Etiological Agent - Dimorphic fungus -- P braziliensis

granulomatous disease of mucous membranse, skin, and pulmonary system. Can cause teeth to fall out. White plaques in the mucosa (differentiate from TB)

Diagnose yeast in sputum, lavage fluid, biopsy, lymph nodes, and CSF, Yeast are round, double walls, single or multiple buds. "pilits wheel" morphology

treat with Itraconazole. severe infection my require amphotercerin B first, followed by Itraconazole

H. Capsulatum -Ohio and Mississippi River valleys
Mexico and Central and South America
H. duboisii - Africa
Bird and Bat dropping

H. Capsulatum - dimorphic fungus

Acute pulmonary disease w. flu like symptoms, may progress to chronic phase which mimics TB

diagnose with direct micvroscopy, blood culture, BM. serology/antigen detection in blood and urine

treat with amphitercerin B

Western hemisphere, Sonoran desert, SW USA. Some in Mexico and Central and South America

dimorphic fungus, coccidiodes immitis

Can cause pulmonary disease, or a flu like illness. Patients can have allergic reactions due to complex formation. Can see rash.
diagnose with microscopy (not culture)
Treat with amphoterecin B followed by an azole

systemic mycosis, encapsulated yeast. Worldwide distribution.
Pigeon droppings

C. Neoformans pathogenic for immune competent people, but is most often an opportunistic pathogen
It causes meningitis, infects people with AIDS
Diagnose with Microscopy of CSF, also can culture
positive for phenoloxidase activity

treatment: 2 weeks of amphotericin B and flucytosine, then 8 weeks of azole.
AIDS patients might be on lifetime azole therapy

ubiquitous

cause allergic bronchopulmonary asperigillosis, more common in CF patients
Asperillogosis can cause granuloma o form in people with preexisting lung cavities
can also cause a disseminated disease

Diagnosis by culture and examination of tissue - long hyphae

treat with Amphotericin B or 5-flucytosine if invasive

opportunistic

pneumocustis carini pneumonia - common in AIDS patients, diffuse interstitial pneumonia

diagnose: Gomori's methenamine silver stain - rounded cup organism

treat with TMSM or pentamidine isothionate