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No

Valley Fever.

Endemic in south-west USA, Mexico, Central / South America

Can be aerosolized. Infection through respiration.

Dimorphic because they form spheres or Hyphae (the form in the lungs)

Hyphae: IN VITRO. Mold and can be aerosolized
Sphere: IN VIVO. Sphere divides in tissue lesions

Can develop resistance after the first infection. (Hence can have vaccines).

60% subclinical. Symptomatic in 40%

Fever, Pneumonia, Rash. Most recover from this severity
ex. rash = Coccidioidal Erythema Nodosum


Dissemination of fungus -> skin, bones, meninges (Polygranulomatous lesions). Possibly lethal if it progresses to this stage

Bad for certain ethnic groups, late pregnancy, immunocompromised pts.

Surgery

Antifungal azoles: Fluconazle, Itraconazole, Voriconazole, Posaconazle

Polyene: Amphotericin B

Biopsy

Culture - molecular testing (ie DNA probe)

Serologic Testing - Antibody testing

AKA Reticuloendothelial Cytomycosis, Spelunker's Disease


Mississippi River Valley Soil (bird droppings)

Mold-like in nature. Lives in the soil.

Small yeast in hosts

Lives in mononuclear cells of Reticulendothelial System


Dimorphic at 37C

Patchy Pneumonia
Hilar Lymphadenopathy
Most recover.


If spreads within / outside of lungs=>

Can look like TB
Rarely in Bone

Can give pulmonary calcifications after healing

Look for small yeast in mononuclear cells

Molecular probe
Ab detection
Antigen in serum / urine

Stains:
H&E or Methamine Silver

Itraconazole (other azoles don't work so well)

Liposomal Amphotericin B



Found in human and non-human droppings
Endemic in the US.

Soil of USA

Large yeast phase (15 m)

Dimorphic (yeast at 37C)

Conidia inhaled, leading to respiratory infections.

Can spread to other systems (pyogranulomatous lesions)

Can look like tuberculosis, mycosis, carcinoma

Biopsy, Culture for dimorphic

KOH of pus.

Surgical
Itraconazole, fluconazole, voriconazle, amphotericin B (polyene antifungal)

Midwest - Easter US.

Some in Africa

S. America

Dimorphic mold - at 37C

Mostly in males because estrogen inhibits -Glucan which is necessary for conversion from hyphal to yeast form

Itraconazole
Amphotericin B
Sulfonamide

Only in tropical areas.
Armadillos only organisms infected

Biopsy/ Culture
Serology

Aspergillosis Fumigatus

Hyphal organisms in soil.
Ubiquitous. Probably breathing right now
Bad for immuno-compromised patients

Makes conidia which are inhaled

Toxicosis - aflatoxin
Allergic Bronchopulmonary disease
-Asthma-like (IgE)
-Farmers lung like (IgE, IgG)
Pneumonitis
Sinusitis
Fungus Ball - pulm cavity


Vasoinvasive disease in immunocompromised form (if Hyphal form)
-Nose / paranasal sinus
Lungs, skin - in neutropenic patients


Risk factors:
Diseases: lymphoma, diabetes mellitus, CF
- Neutropenic pts. (Aplastic Anemia)
- Immunocompromised pts. (organ transplant recipients)

Culture
Antigen
Galactomannan in serum

Steroids for allergic reaction
Itraconazole
Smphotericin B
Caspofungin
Voriconazole for invasive form

Never been cultivated in medium

Glucan, Mannan, Aminosugars in cell wall
- important for adhesion to cells

Cholesterols & Sterols present (but not ergosterol)

Looks kinda like a protozoa (cyst morpho)

Respiratory tract infection. Remains quiescent until immunocomprimise. (Leukemia, AIDS, protein deprived infants)
=> Then active, produces pneumonia.


Infectious cause of death in AIDS patients

Trimethoprim-sulfamethoxazole
Pentamidine, atovoquone
Clindamycin + Primaquine (unusual)
trimexetrexate, Caspofungin

Initially in lungs.
Lymphadenopathy (cervical nodes)
Mucocutaneous
Systemic Visceral
Pyogranulomatous lesions

First recognized patient with Coccidioidomycosis

Answer