Mycology Case Study I

You have a possible infectious condition that you are embarrassed to discuss with the
physician with whom you work. You have worn artificial nails for several months now and
noticed that the one on your left ring finger falls off regularly. The real nail underneath has
become white and chalky, and the skin around the nail is beginning to have little white lines in
it and look a bit chalky, as well.

1. What disease do you suspect? Explain why.

Since the patient has been using acrylic nails for months, she may have Onychomycosis, a
fungal infection of the nails. The reason being is that hyphae, branching filaments that make
up the mycelium of a fungus, can cause nails to become white and chalky.

2. What would you suggest be done for a more definitive diagnosis?

Performing a potassium hydroxide smear will provide a more definitive diagnosis

3. Can you treat this yourself with an over-the-counter drug, or do you need to see a
physician?
Fungal infections are difficult to treat so it would be in the patients best interest to see a
physician to obtain an antifungal medication prescription that will guarantee treatment of the
infection and proper healing

4. You see cures for this condition mentioned on TV and on the Internet—do you think they
work?
Fungal infections, on average, can take several weeks to months to be cured with just
physician prescribed medications and they are very resistant. Yes, there’s a chance that
advertised drugs can work against fungal infections however, if the drug in question is not
potent enough to combat against the fungus then the time it takes for a fungal infection to be
cured will be extended.

5. What other conditions are caused by dermatophytes (Microsporum, Trichophyton, and

Epidermophyton)? What is special about them that makes them capable of thriving in their
anatomical niche on their hosts?

Scalp itch, Tinea pedis (athletes’ foot), Tinea cruris (jock itch), Tinea corporis (trunk and legs
are affected), and Dermatophytoses (ringworm).They are special because they contain the
enzyme keratinice and require keratin to proliferate, therefore they are limited to hair, nails,
and superficial skin. They also require their habitat to be moist.
 Mycology Case Study II

You are working in the emergency department of a regional hospital in rural Kentucky. A
patient is brought in by emergency medical technicians (EMTs). Their initial report is
suspected meningitis because the patient has a headache and a stiff neck. The EMTs add that
the patient’s meningitis symptoms appear rather mild—he still has neck movement, and the
headaches are not severe. The patient’s overall condition is poor, however. He is very thin,
has dark spots on his face and upper body, and open bloody-looking eruptions on his lips. His
fever is 104°F, and his blood pressure is low. He also has severe diarrhea.

1. What is the first step in determining if the patient has meningitis?

Performing a spinal tap to obtain CSF sample

2. This test reveals the presence of very large cells that appear to be eukaryotic, surrounded
by a large capsule. What is the probable diagnosis? Name some other eukaryotic
organisms that can cause meningitis symptoms.
Cryptococcal meningitis, disease caused by cryptococcus neoformans, may be the probable
diagnosis. Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and
Listeria monocytogenes are other eukaryotic organisms that can cause meningitis symptoms.

3. What groups of people are at risk for this infection?

Immunocompromised patients like AIDS and transplant personnel

4. How is it acquired?
It is acquired through contact with infected fecal matter or an infected bird

5. What anatomical sites are most often infected with this fungus?
The CNS (brain and spinal cord) and the respiratory system

6. Let’s say your initial suspicion (your answer to question 2) was correct. What other
diagnostic test should be performed on this patient?
An HIV test