DIMORPHIC MYCOSES

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DIMORPHIC MYCOSES

• CONTINUED

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Histoplasmosis

• PAGE 18

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DIMORPHIC FUNGI

• DISEASES
• Blastomycosis
• Histoplasmosis
• Coccidioidomycosis
• Paracoccidioidomycosis
• Sporotrichosis
• Common in South Carolina

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HISTOPLASMOSIS

• Histoplasma capsulatum

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Histoplasmosis

• An intracellular mycoses of the
  reticuloendothelial system, attacking lungs,
  liver, spleen, bone marrow and occasionally
  kidneys, adrenals and intestines.

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PORTAL OF ENTRY

• INHALATION
• INOCULATION
• (rare)

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HISTOPLASMOSIS

• ACUTE PULMONARY
• ASYMPTOMATIC
• SYMPTOMATIC
• CHRONIC PULMONARY
• DISSEMINATED

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Pulmonary Symptoms

• Shortness of breath
• Productive cough (purulent or bloody)
• Anorexia
• Weight loss
• Night sweats

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ECOLOGICAL ASSOCIATION

• Blackbird roosts
• Bats
• Bat guano
• Chicken houses

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Histoplasmosis outbreak Laurens County, S. C.
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ISOLATION OF H. CAPSULATUM FROM ENVIRONMENTAL
SOURCES S. C.
NUMBER EXAMINE POSITIVE PERCENT
SITES 68 12 18
SAMPLES 565 74 13
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CLINICAL SPECIMENS

• SPUTUM
• BONE MARROW
• BIOPSY MATERIAL
• BRONCHIAL WASHINGS
• PERIPHERAL BLOOD
• GASTRIC WASHINGS

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Identification

• 1. Microscopic observation
• 2. Conversion
• 3. DNA Probe

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SEROLGICAL TEST

• COMPLEMENT FIXATION
• MYCELIAL FORM ANTIGEN
• YEAST FORM ANTIGEN
• IMMUNODIFFUSION
• H ACUTE INFECTION
• M PAST, PRESENT OR SKIN TEST

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SEROLGICAL TESTS

• EIA detects antibody
• EIA to detect ANTIGEN
• (systemic disease)

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DRUGS OF CHOICE

• ITRACONAZOLE
• (mild disease static)
• AMPHOTERICIN B
• (severe disease - cidal)

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COCCIDIOIDOMYCOSIS
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DIMORPHIC FUNGI

• DISEASES
• Blastomycosis
• Histoplasmosis
• Coccidioidomycosis
• Paracoccidioidomycosis
• Sporotrichosis
• Common in South Carolina

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COCCIDIOIDOMYCOSIS

• Coccidioides immitis

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COCCIDIOIDOMYCOSIS

• It may occur as either an acute, benign,
  self-limited disease or a chronic, malignant
  disseminated disease involving the cutaneous,
  subcutaneous, visceral or osseous tissue.

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PORTAL OF ENTRY

• INHALATION
• INOCULATION
• (Rare)

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Pulmonary Symptoms

• Anorexia
• Shortness of breath
• Weight loss
• Productive cough
• Night sweats
• Arthralgia
• Erythema multiforme

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ECOLOGICAL ASSOCIATION

• Desert soil
• Archeological middens
• Pottery
• Rodent burrows
• Cotton
• Construction sites

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SOIL
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ARTHROCONIDIA
ANIMAL HUMAN
ENDOSPORES
SPHERULE
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SPHERULES
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CLINICAL SPECIMENS

• Sputum
• Pus
• Gastric washings
• CSF
• Bronchial washings
• Biopsy material

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ARTHROCONIDIA
(Barrel shaped)
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Spherules (endospores)
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SOIL
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ARTHROCONIDIA
ANIMAL HUMAN
ENDOSPORES
SPHERULE
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SEROLOGICAL TESTS

• Complement fixation
• Immunodiffusion
• Slide agglutination
• EIA

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DRUGS OF CHOICE

• Fluconazole
• (mild infection)
• Itraconazole
• (mild infection)
• Amphotericin B
• (severe infections)

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PARACOCCIDIOIDOMYCOSIS

• Paracoccidioides brasiliensis

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DIMORPHIC FUNGI

• DISEASES
• Blastomycosis
• Histoplasmosis
• Coccidioidomycosis
• Paracoccidioidomycosis
• Sporotrichosis
• Common in South Carolina

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PARACOCCIDIOIDOMYCOSIS

• A chronic granulomatous disease of the lungs,
  mucous membranes, skin and lymph nodes.

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5 25 u
A. Restrepo
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Wanke/Londero
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ECOLOGICAL ASSOCIATION

• Probably soil
• Armadillos

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Paracoccidioidomycosis Triad

• Pulmonary lesion
• Cervical adenopathy
• Edentulous

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Paracoccidioidomycosis Triad

1. Pulmonary lesion

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Paracoccidioidomycosis Triad

1. Pulmonary lesions
2. Cervical adenopathy

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Paracoccidioidomycosis Triad

1. Pulmonary lesion
2. Cervical adenopathy
3. Edentulous

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Prolonged latency

• 10 20 years

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CLINICAL SPECIMENS

• Sputum
• Biopsy material
• Pus
• Crusts
• Bronchial washings

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Mycology

• At 25 degrees it is a white, dense, septate
  mycelium
• Terminal or intercalary spores (non-diagnostic)
• Slow growing 20 30 days

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A. Restrepo
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Mycology

• At 37 degrees it is a white-tan, creamy,
  cerebriform colony.
• Single or multiple buds
• Narrow base.

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A. Restrepo
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THE CAPTAINS WHEEL
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SEROLOGICAL TEST

• IMMUNODIFFUSION
• Sensitivity - 99
• Specificity - 84

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DRUGS OF CHOICE

• Amphotericin B
• Sulphonamide-trimethoprim
• Itraconazole
• Voriconazole

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SPOROTRICHOSIS

• Sporothrix schenckii

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DIMORPHIC FUNGI

• DISEASES
• Blastomycosis
• Histoplasmosis
• Coccidioidomycosis
• Paracoccidioidomycosis
• Sporotrichosis
• Common in South Carolina

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SPOROTRICHOSIS

• Primarily a disease of the cutaneous tissue and
  lymph nodes. Recently, pulmonary disease.

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PORTALS OF ENTRY

• Inhalation
• Inoculation

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ECOLOGICAL ASSOCIATIONS

• Rose thorns
• Sphagnum moss
• Timbers
• Soil

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SPOROTRICHOSIS
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CATEGORY NUMBER PERCENT
Children 22 27
Forestry 14 17
Florists 8 10
Soil Related 13 16
Non-soil 11 14
Unknown 13 16
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DISSEMINATION

• Alcohol abuse
• Sarcoidosis
• HIV infection
• Malignancy
• Diabetes

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GEOGRAPHIC DISTRIBUTION

• World-wide

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CLINICAL SPECIMENS

• Pus
• Biopsy material
• Sputum
• Bronchial washings

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Indiana Pathology Images
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Indiana Pathology Images
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Daisies
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Cigar-shaped
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SEROLGICAL TEST

• No commercial serologic reagents

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DRUGS OF CHOICE

• CUTANEOUS OR SYSTEMIC FORM
• Itraconazole