USMLE Step 1 Flash Cards

Dimorphic Fungi
Blastomyces

Histoplasma
Body Heat Changes Shape
Coccidioides for the dimorphic fungi
Sporothrix

Pseudohyphae (Candida albicans)

Hyphae with constrictions at each septum
Spore types
Conidia
Asexual spores; formed off hyphae; common; air-borne

Blastoconidia
Buds on yeasts (asexual budding daughter yeast cells)

Arthroconidia
Asexual spores formed by a joint

Spherules and Endospores (Coccidioides)

Spores inside the spherules in tissues
Malassezia furfur
Normal skin flora (lipophilic yeast)

Patient with blotchy hypo-pigmentation of skin

KOH scrapping shows spaghetti and meatballs or

bacon and eggs yeast clusters & short curved septate
hyphae
Treatment :
Topical selenium sulfide; recurs
Dermatophytes (group of fungi)
Filamentous (monomorphic) fungi

Three genera:
Trichophyton skin, hair and nails

Mircrosporum hair and skin

Epidermophyton skin and nails

Patient with scaly, ringlike lesions (Tineas) of skin. May involve hair shaft or
nails.
KOH scrapping shows athroconidia and hyphae

Treatment :
Topical imidazole or tolnafate

ID reaction (dermatophytID) = allergic response to circulating fungal antigens.

Sporothrix schenckii
Subcutaneous mycoses

Patient with subcutaneous/lymphocutaneous

mycetoma
Gardener, florist, basket weaver, or alcoholic rose-
garden sleeper disease (homeless)
Cigar-shaped yeast in pus

Treatment : intraconazole or amphotericin B

Histoplasma capsulatum
Deep fungal infection; dimorphic fungi

Normal patient with acute pulmonary; IC patient with chronic

pulmonary or disseminated infection (FUNGUS FLU)
States following drainages of Great Lakes to Gulf of Mexico

Exposure to bird or bat excrement

Sputum or blood cultures with mononuclear cells packed with

yeast cells (tiny yeast inside macrophages)
Treatment : Ketoconazole, amphotericin B
Coccidioides immitis
Deep fungal infection; dimorphic fungi

Normal patient with erythema nodosum or self-resolving

pneumonia
IC patient with calcifying chronic pulmonary or disseminated
infections
Pregnant female in 3rd trimester, disseminated infection

Desert southwest

Sputum has spherules with endospores

Treatment : Amphotericin B
Blastomyces dermatitidis
Deep fungal infection; dimorphic fungi

Normal patient with acute pulmonary symptoms

IC patient with chronic pulmonary or disseminated infection

North and South Carolina (otherwise coexists with

Histoplasma)

Sputum has broad-based, budding yeasts with double,

refractile cell walls.

Treatment : Amphotericin B
Aspergillus fumigatus
Monomorphic filamentous OPPORTUNISTIC fungi

Patient with asthma allergies growing mucous plugs in

lung
Patient with cavitary lung lesions fungus ball

Patient with burns cellulitis, invasion

IC patient pneumonia, meningitis

Septate hyphae branch at acute angles

Treatment : Itraconazole or Amphotericin B

Candida albicans
OPPORTUNISTIC fungi
Forms germ tubes at 37C; pseudohyphae & true hyphae when invades
tissues
Germ tube test demonstrates pseudohyphae and hyphae

IC patient, overuse of antibiotics thrush, spread down GIT,

septicemia
IV drug abusers - endocarditis
Treatment :
topical or oral imidazoles; nystatin

Disseminated : Amphotericin B or fluconazole

Cryptococcus neoformans
Encapsulated (monomorphic) yeast;
OPPORTUNISTIC fungi

Pigeon breeder with acute pulmonary symptoms

Hodgkins/AIDS patient with meningitis

India Ink mount of CSF with encapsulated yeasts

Treatment : Amphotericin B + flucytosine until

afebrile (minumum 10 wks), then fluconazole
Mucor, Rhizopus, Absidia
Ketoacidotic diabetic or leukemic patient with
rhinocerebral infection

Biopsy with non-septate irregular-width hyphae

branching at 90 angles.

Treatment :

High fatality rate (rapid growth and invasion)

Debride necrotic tissue & start Amphotericin B fast.

Pneumocystis jiroveci
Obligate extracellular parasite

Premature infant or AIDS patient with atypical pneumonia

Biopsy with honeycomb exudates and silver-staining cysts

X-ray ground glass

Treatment :

TMP-SMX for mild

Dapsone for moderate to severe