Updated: 2/4/2018

Fungi

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Fungi Table
 
Cutaneous and Subcutaneous Mycoses 
Fungi Disease Treatment
Malassezia furfur
  • Tinea versicolor
  • Miconazole
  • Selenium sulfide
Trichophyton, Microsporum, and Epidermophyton
  • Tineas (ringworm, jock itch, and athlete's foot)
  • Imidazoles
Sporothrix schenckii
  • Sporotrichosis (rose gardner's disease)
  • Itraconazole
Systemic Mycoses 
Histoplasma capsulatum 
  • Histoplasmosis (pneumonia)
  • Fluconazole
  • Amphotericin B
Coccidioides immitis  
  • Coccidioidomycosis (pneumonia, meningitis, and skin/bone infection) 
  • Fluconazole
  • Amphotericin B
Blastomyces dermatitidis
  • Blastomycosis (chronic inflammatory lung disease and skin/bone infection)
  • Fluconazole
  • Amphotericin B
Paracoccidioides brasiliensis 
  • Paracoccidioidomycosis (pneumonia)
  • Fluconazole
  • Amphotericin B
Opportunistic Mycoses 
Candida albicans 
  • Oral thrush
  • Candida intertrigo
  • Vaginitis
  • Disseminated disease in immunocompromised (neutropenia)  
  • Nystatin
  • Amphotericin B
Cryptococcus neoformans
  • Cryptococcosis (meningitis, pneumonia, and skin/bone infections)
  • Amphotericin B
  • Flucytosine
Aspergillus
  • Allergic bronchopulmonary aspergillosis
  • Aspergilloma
  • Invasive aspergillosis
  • Itraconazole
  • Amphotericin B
Mucor and Rhizopus
  • Mucormycosis (rhinocerebral infection)
  • Amphotericin B
Pneumocystis jiroveci 
  • PCP (diffuse interstitial pneumonia)
  • TMP-SMX
 
Fungi Introduction
  • Fungi is a large group of eukaryotic organisms including yeasts, molds, and mushrooms
  • Yeast
    • unicellular fungi
    • reproduce by budding
      • reproduce more slowly than bacteria
    • cells are spherical to ellipsoidal in shape
    • buds that do not separate form long chains of yeast cells called pseudohyphae
      • Candida albicans forms pseudohyphae
  • Molds
    • multicellular colonies
      • composed of clumps of intertwined branching hyphae
    • grow by longitudinal extension
    • produce spores
  • Dimorphic fungi
    • can grow as either yeast or mold depending on the environmental conditions
      • usually grows as a yeast at body temperatures
      • "mold in the cold"
    • examples
      • Histoplasma
      • Blastomyces
      • Coccidioides
      • Sporothrix
Fungal Morphology
  • Spores
    • the reproductive structure of molds
      • adapted for dispersal
    • conidia are asexual fungal spores (Greek: "konia" = "dust")
      • most fungal spores are asexual
      • types of conidia include blastoconidia and arthroconidia
      • coccidioidomycosis and histoplasmosis are transmitted by inhalation of asexual species
  • Hyphae
    • long, threadlike, branching, filamentous, tubular structure of a fungus
    • composed of fungal cells attached end to end
    • grow by extending from the ends of the tubules
  • Cell membrane
    • innermost layer around fungal cytoplasm
    • contains ergosterol
      • analogous to cholesterol in humans
      • amphotericin B and nystatin bind to ergosterol
      • ketoconazole inhibits ergosterol synthesis
  • Cell wall
    • surrounds cell membrane
    • contains mostly complex carbohydrates
      • explains calcification in chronic infection
    • fungal cell walls are potent antigens
  • Capsule
    • polysaccharide coating surrounding the cell wall
    • visualized with India ink stain
    • can be an antiphagocytic virulence factor
      • used by Cryptococcus neoformans
 

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Questions (5)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M1.MC.75) A 34-year-old male from Southern California presents to his primary care physician with a complaint of cough, fever, night sweats, and general malaise. He also reports that he recently developed a rash that is very concerning. He states that he has had these symptoms for a few days and they have failed to resolve. Upon questioning, the patient complains of having to work outside recently to complete repairs on his house, which was damaged in a recent earthquake. The physician states that he believes the patient to have a fungal pneumonia. Which of the following histologic images best represents this patient's infection? Review Topic

QID: 106718
FIGURES:
1

Figure A

4%

(7/196)

2

Figure B

12%

(23/196)

3

Figure C

11%

(22/196)

4

Figure D

60%

(118/196)

5

Figure E

11%

(22/196)

M1

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