MICROBIOLOGY|
FINALS
Mycoses
SYSTEMIC MYCOSES
Organism Signs/Symptoms
Histoplasma capsulatum ● Pneumonia
● can look like TB w/ calcified
nodes and nodules in the
hilar region, granulomas
● Hepatosplenomegaly
● Erythema nodosum
Coccidioides immitis Asymptomatic in most
● Disseminates to bone/skin
● Pneumonia
● Fever
● Erythema nodosum (desert
bumps) or multiforme
● Knee pain, Arthralgias (desert
rheumatism)
● can cause meningitis
Blastomyces dermatidis ● Inflammatory lung disease
● Disseminates to bone/skin
(verrucous lesions, may
mimic SCC)
● Osteomyelitis
Paracoccidioides ● similar to blastomycosis
brasiliensis ● males > females
● lymphadenopathy in chains/
lymph nodes in cervical
region
● granulomatous nature of
disease
● mucosal ulcers and
cutaneous lesions in the
upper mouth leading to small
hemorrhages
MICROBIO
1ST Year – 1st Semester
A.Y. 2022 - 2023
Finals Reviewer
BUZZ WORDS Diagnostic Test
Endemic Location: Mississippi and Ohio River KOH
Valleys - Midwestern US Rapid serum or urine
antigen test
Coughing; transmission thru respiratory
macrophages with intracellular oval bodies
much smaller than RBC
DIMORPHIC: mold in the cold; yeast in heat
Tx: Azole drugs - for local/mild
Amphotericin B - for systemic infections
Endemic Location: Southwestern US, KOH
California
transmission via inhalation, very common after
earthquakes
bigger than RBCs
DIMORPHIC: mold in the cold; spherule of
endospores in the body (NOT yeast)
Tx: Azole drugs - for local/mild
Amphotericin B - for systemic infections
Endemic Location: Eastern and Central US, KOH
Great Lakes Urine antigen test
broad based budding
transmission of spores via inhalation
same size as RBCs
DIMORPHIC: mold in the cold; yeast in heat
Tx: Itraconazole - for local infections
Amphotericin B - for systemic infections
Endemic Location: Latin America
(Brazil/South America)
“captain’s wheel” - multiple buds radiation
out in a central pattern
major symptom & transmission thru respiratory
droplets
bigger than RBCs
DIMORPHIC: mold in the cold; yeast in heat
Tx: Itraconazole - for local infections
Amphotericin B - for severe
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 MICROBIOLOGY| 1ST Year – 1st Semester
FINALS A.Y. 2022 - 2023
Mycoses Finals Reviewer

CUTANEOUS MYCOSES

Organism Signs/Symptoms BUZZ WORDS Diagnostic Test

Malassezia furfur ● hypopigmentation a yeast-like fungus (NOT a dermatophyte despite KOH

● hyperpigmentation and/or being called tinea)
pink patches can also
occur due to inflammatory causes Tinea (Pityriasis) versicolor - manifests as
response hypo and/or hyperpigmented patches
● less pruritic than
dermatophytes spaghetti and meatball appearance

thrives under hot and humid conditions; fungus will

convert to disease form with humidity

degradation of lipids produces acids that inhibit

tyrosinase (involved in melanin synthesis) →
hypopigmentation

Tx: Selenium sulfide

Sporothrix ● causes sporotrichosis DIMORPHIC: cigar-shaped yeast at 37‫ہ‬C in the

schenckii aka rose gardener’s human body and as hyphae with spores in soil
disease (conidia)
● causes local pustule or
ulcer with nodules along Lives on vegetation. Found in rose thorns, tree bark
draining lymphatics and other plants
(ascending lymphangitis)
● disseminated disease rose gardener’s disease (commonly caused by cuts
possible in from a rose bush)
immunocompromised host
Tx: itraconazole or potassium iodide (only for
cutaneous/lymphocutaneous)

Dermatophytes branching septate hyphae visible on KOH KOH

(Tinea) preparation with blue fungal stain Woods Lamp
Microsporum
Trichophyton Associated with pruritus
Epidermophyton
Tinea capitis
● head, scalp
● associated with lymphadenopathy, alopecia,
scaling
Tinea corporis
● body (usually torso)
● characterized by enlarging erythematous,
scaly rings (“ringworm”) with central
clearing
● can be acquired from contact with infected
pets or farm animals
Tinea cruris
● inguinal area (“jock itch”)
● often does NOT show the central clearing
seen in tinea corporis
Tinea pedis
● Three varieties (“athlete’s foot”)
○ Interdigital (most common)
○ Moccasin distribution
○ Vesicular type
Tinea unguium
● Onychomycosis - occurs on nails

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 MICROBIOLOGY| 1ST Year – 1st Semester
FINALS A.Y. 2022 - 2023
Mycoses Finals Reviewer

OPPORTUNISTIC MYCOSES

Organism Signs/Symptoms BUZZ WORDS Diagnostic Test

Aspergillus fumigatus Allergic Septate hyphae that branch at 45 ‫ہ‬C

bronchopulmonary Acute Angle branching
aspergillosis (ABPA)
● wheezing Causes invasive aspergillosis in
● fever immunocompromised patients, especially those with
● migratory neutrophil dysfunction (eg. chronic granulomatous
pulmonary disease) because Aspergillus is catalase (+)
infiltrate
Angioinvasive aspergillosis
Angioinvasive
aspergillosis Can cause aspergillomas in pre-existing lung
● kidney failure cavities, especially after TB infection
● endocarditis
● ring enhancing Some species of Aspergillus produce aflatoxins
lesions in the (associated with hepatocellular carcinoma)
brain
● invades nasal Allergic bronchopulmonary aspergillosis (ABPA)
sinus - Type I hypersensitivity response to Aspergillus
growing in lung mucus. Associated with asthma and
cystic fibrosis; may cause bronchiectasis and
eosinophilia

Tx: Voriconazole - for less serious infections

Amphotericin B for angioinvasive disease

Candida albicans ● causes oral and DIMORPHIC: forms pseudohyphae and budding KOH
esophageal thrush in yeasts at 20‫ہ‬C; germ tubes at 37‫ہ‬C (different from
alba = white immunocompromised other dimorphic fungi since it is a yeast in the cold,
(neonates, steroids, and mold in the heat)
diabetes, AIDS)
● vulvovaginitis (diabetes, most common cause of opportunistic mycoses
use of antibiotics)
● diaper rash normal flora of GI tract and oral cavity, commonly
● endocarditis (people contaminates sputum cultures
who inject drugs)
● disseminated catalase (+)
candidiasis (especially CGD (chronic granulomatous disease) patients are
in neutropenic patients) especially susceptible to this
● chronic mucocutaneous
candidiasis Tx:
oral fluconazole/topical azoles - for vaginal
nystatin, azoles, or rarely echinocandins - for oral
fluconazole, echinocandins, or amphotericin B - for
esophageal or systemic disease

Cryptococcus ● Pulmonary symptoms 5-10 μm with narrow budding highlighted with India ink
neoformans (cough, dyspnea, and (clear halo) and
other lung infections) heavily encapsulated yeast mucicarmine (red inner
● spread to CSF and capsule)
cause meningitis >> NOT DIMORPHIC
very often will lead to can also be stained by
permanent neuro found in soil, pigeon droppings methenamine silver
deficits stains
acquired through inhalation with hematogenous
dissemination to meninges Latex agglutination test
detects polysaccharide
urease (+) capsular antigen and is

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 MICROBIOLOGY| 1ST Year – 1st Semester
FINALS A.Y. 2022 - 2023
Mycoses Finals Reviewer
more sensitive and
● causes cryptococcosis specific.
● cryptococcal meningitis
● cryptococcal encephalitis (“soap bubble” Note: repeating
lesions in brain) primarily in polysaccharide antigen
immunocompromised - MAIN VIRULENCE
FACTOR
Tx: amphotericin B + flucytosine followed by
fluconazole for cryptococcal meningitis

Mucor and Rhizopus ● Rhinocerebral, frontal irregular, broad, non-septate hyphae branching
lobe abscess at wide angles (90 degree angle branching)
● cavernous sinus
thrombosis causes mucormycosis
● headache ● mostly in patients with DKA (Diabetic
● facial pain Ketone Acidosis) and/or neutropenia (eg
● black necrotic eschar on leukemia)
face ● fungi proliferate in blood vessel walls,
● may have cranial nerve penetrate cribriform plate, and enter brain
involvement
Tx: Surgical debridement, amphotericin B or
isavuconazole

Pneumocystis jirovecii Most infections are causes Pneumocystis pneumonia (PCP), a diffuse Bronchoalveolar lavage
asymptomatic. interstitial pneumonia or lung biopsy

Immunosuppression (eg yeast like-fungus (originally classified as protozoan) disc-shaped yeast seen
AIDS) predisposes to on methenamine silver
disease. Diffuse, bilateral ground-glass opacities on chest stain of lung tissue or
imaging, with pneumatoceles with fluorescent antibody

HIV (+) patients with pneumonia

● associated with AIDS

CD4 count under 200

● susceptibility to PCP becomes an issue
when CD4 count is <200

Bactrim
● can be used for prophylaxis and treatment
of PCP
● Components: Sulfamethoxazole +
Trimethoprim

Tx:
Pentamidine - can be used in ppl with sulfa allergies

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