Malassezia furfur Fungi Bio Clinical Presentation:

- Lipophilic yeast 1) Pityriasis – superficial infection

- Normal flora on most adults, not a - Hyper- or hypopigmented macular lesions on
dermatophyte trunk and limbs
- Spaghetti and meatballs appearance - Does not affect hair or nails
2) Invasive infection – in NICU when receiving
parenteral nutrition (high lipid content)
- risk of fungemia

Disease: Tinea versicolor, pityriasis

Carrierstate: normal flora Diagnosis:
- Direct microscopy

Treatment and resistance:

- Largely aesthetic issue, treatment not necessary
- Must treat infected infants, immunocompromised
Sporothrix schenckii Fungi Bio Clinical Presentation:
- Dimorphic fungus 1) Rose-handler’s disease
- Not an endemic - Deep ulcerated skin lesions with spread along
- Subcutaneous infection requiring trauma to lymphatic channels
enter (thorn, barb or pine needle injury) - Lesions are granulomas
- Present in soil and moss worldwide
- Rarely invades deeper tissues
- Rose handlers, tree farmers, hay bailers,
gardeners more likely to get infected

Disease: see clinical presentation

Carrierstate: N/A Diagnosis:
- Tissue biopsy of leading nodules (swabs of lesions
are low yield)
- Direct microscopy and culture
Treatment and resistance:
- Don’t need to know
Candida sp. Fungi Bio Clinical Presentation:
- yeast 1) Immunocompetent – frequently asymptomatic
- common species include C. albicans (50-60% - Thrush, vaginitis, diaper rash
of all infections), C. glabrata, C. tropicalis, C. - Candidemia ranges from asymptomatic to
parapsilosis, C. krusei sepsis (fever common)
- endogenous flora on skin, mouth, GI tract,
2) Immunocompromised
vagina
- budding yeast with pseudohyphae - severe thrush, esophagitis, endophthalmitis,
- risks: entry point for candida, endocarditis, meningitis, UTI, peritonitis,
immunosuppressed hepatosplenomegaly, abscess

Disease: see clinical presentation

Carrierstate: normal flora Diagnosis:
- Cellular morphology on agar
- Microscopic examination of blood/tissue
- Germ tube (C. albicans only)
Treatment and resistance:
- ALL positive blood cultures require treatment, do NOT
delay, remove all lines
- Fluconazole or Caspofungin then Ampho B (+/- resistance)
- Surgery for endocarditis, intravitreal injections for
endophthtalmitis,
- Topical treatment, nystatin useful for non-invasive infection
-
Superficial infections Fungi Bio
- 3 genera: Trichophyton, Microsporum,
Epidermophyton
- moulds, tropism for keratinized tissue (skin,
hair, nails) and chronic growth
- Do not invade deeper than skin due to tropism,
inability to grow at 37° C, and inability to
withstand innate immunity
- Keratinases and binding factors allow
germination
- May be zoophilic, anthropophilic or geophilic
Disease: see clinical presentation
Carrierstate: N/A
Diagnosis
Treatment and resistance
Clinical Presentation:
1) Tinea capitis – head
- annular scaling patch with raised margin, +/-
pustules and hair loss, dandruff
- M. Canis from dogs, common in kids
2) Tinea corporis – body (ring worm)
- Trichophyton species, common in athletes
- annular scaling patch with raised margin
3) Tinea pedis – feet (athlete’s foot)
- Itching, erythema, scaling +/- pustules
- E. floccosum, T. mentagrophytes in sports, wet,
poor hygiene
4) Tinea cruris – groin (jock itch)
- scaling and irritation of groin and inner thigh, no
pustules
- T. rubrum, E. floccosum, in military and
institutionalized
5) Tinea unguium – nails
- onchomycosis, discoloration, thickening, scaling
- T. rubrum, Candida sp.
- Skin/nail scraping or collection of hair stubs
- Direct microscopy or culture
- Topical treatments
Coccidioides immitis Fungi Bio Clinical Presentation:
- Dimorphic fungus – hyphae and spherules 1) Primary infections
- Endemic to central USA, particularly Arizona - 60% asymptomatic, 40% flu-like illness
- “Snowbird” disease - usually resolves without treatment in 2-3
- Present in soil and arthroconidia may be kicked weeks
up by dust storms
2) Pulmonary disease
- chronic pneumonia, pulmonary nodules and
cavitation – quickly progresses, fatal
3) Extrapulmonary disease
- dissemination in blood, seeds to skin, joints,
bone and brain (meningitis)

Disease: see clinical presentation

Carrierstate: N/A Diagnosis:
- CXR with infiltrates and hilar lymphadenopathy
- Biopsy and culture
- Ab detection

Treatment and resistance:

- Amphotericin B, fluconazole or itraconazole
- Treat only serious infections or infections in
immunocompromised
Blastomycosis dermatitidis Fungi Bio
- Dimorphic fungus – mould and yeast
- Endemic to south eastern USA, river basins
- Infection in pet dogs may be a sentinel event
- No anthropophilic transmission
Disease: see clinical presentation
Carrierstate: N/A Diagnosis:
Treatment and resistance:
Clinical Presentation:
1) Pulmonary disease – inhalation of conidia
- Highly variable disease, may be asympomatic
or flu-like
- Cough initially nonproductive, but later
becomes purulent
2) Extrapulmonary disease
- dissemination in blood, seeds to skin
(lesions), joints and bones, genitourinary tract
and brain (meningitis or abscess)
- CXR with lobular consolidation +/- cavitation, hilar
lymphadenopathy rare
- Smear from tissue or exudate
- All cases MUST be treated – mortality reaches 60%
otherwise
- Ketoconazole or itraconazole in most cases, Ampho B in
severe/immunocompromised
Histoplasmosis capsulatum Fungi Bio
- Dimorphic fungus – mould and yeast
- Endemic to Mississippi and Ohio river valleys
- Bird and bat feces aids growth (watch out for
spelunkers, chicken coop cleaners, etc.)
- Favors moderate climate and humidity
- Disease severity is related to the size of the
inoculum
Disease: see clinical presentation
Carrierstate: N/A
Clinical Presentation:
1) Pulmonary disease – inhalation of conidia
- May cause granulomas, calcification of
masses, fibrosis, cavitation, hemoptysis,
2) Acute progressive disseminated disease
- Abrupt onset of fever, malaise, weight loss,
cough, diarrhea, rash, pancytopenia
- 100% fatal if untreated
- may be chronic if a slower onset
- complications include CNS involvement,
endocarditis
Diagnosis:
- CXR with patchy infiltrates and hilar
lymphadenopathy
- Fungal stain most useful, culture, serology and Ag
detection helpful
Treatment and resistance:
- Symptoms usually resolve in 10 days
- Itraconazole in most cases, Ampho B then itraconazole in
severe/immunocompromised