Histology of DIMORPHIC fungi:

 Sporothrix is a DIMORPHIC CIGAR-SHAPED YEAST that presents as a “nodular

cellulitis” with pustules / ulcers / nodules along LYMPHATIC DRAINAGE:
o Often occurs in GARDNERS / others coming into contact with ROSE
BUSHES
o 25C culture shows branching hyphae (mold):

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o Biopsy shows cigar-shaped budding yeast:
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 Histoplasma capsulatum is a systemic DIMORPHIC fungus that leads to pulmonary
infection, and disseminates RETICULOENDOTHELIAL SYSTEM (liver, spleen):
o Endemic to the Ohio river valley
o Symptoms often mimic REACTIVATION of LATENT TB
o Associated with soil & bird droppings, and with caves
o 25C culture shows MOLD with STELLATE FORMS:
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o Biopsy shows TINY THIN-BASED BUDDING YEASTS that are often in
MACROPHAGES:
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 Blastomyes dermatidis is a systemic DIMORPHIC fungus that leads to pulmonary
infection, and disseminates to the SKIN & BONE (osteomyelitis, ulcers):
o Endemic to the Great Lakes region & Ohio/Mississippi River valleys
o 25C culture shows MOLD:
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o BIOPSY shows “BROAD-BASED BUDDING YEAST” with DOUBLY-
REFRACTILE WALL:
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 Coccidiodes immitis is a systemic DIMORPHIC fungus that causes pulmonary
symptoms, erythema nodosa, skin and bone lesions, and meningitis:
o Endemic to the southwest US
o 25C culture shows “BOX-SHAPED” MOLD:

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o Biopsy shows THICK-WALLED SPHERULE:
 Paracoccidiodes brasilensis is a SYSTEMIC DIMORPHIC FUNGUS that is South
American in origin and leads to MUCOCUTANEOUS ULCERS and LYMPH
NODE & PULMONARY DISEASE:
o Produces oral mulberry-like lesions:

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o Massive cervical / pulmonary lymphadenopathy:

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o 25C culture shows MOLD FORM with MULTIPLE BLASTOCONIDIA:


o Biopsy shows YEAST with BUDDING BLASTOCONIDIA, forming
a “CAPTAIN WHEEL”:
 Candida is the major cause for fungal septic (blood) infections (fungemias), as it is
really the only major fungus that does this:
o Defies other dimorphic fungi in that it is a mold in the heat, yeast in the cold:

 Blood cultures (at 37C) will show budding yeast (single cell) forms
with pseudohyphae growing out of them (germ tubes):
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  Stains GRAM-POSITIVE, and produces BUDDING YEASTS that
are 4-um in size at LOW TEMPERATURE CULTURE (25C):


o Candida is a normal skin flora that will translocate into the blood in cases of
immunocompromise, specifically for neutropenic patients (as a cause of
neutropenic fever):
 Must be covered empirically in these patients with amphotericin B
(ambisome), caspofungin, voriconazole, or itraconazole (since many
Candida spp. are now resistant to fluconazole)
 In these patients, Candida may also cause the following infections:
 Endocarditis (usually right-sided in IV drug abusers)
 Abscesses
 Pneumonia (rare)
 Esophagitis