Infectious Agent Cryptococcus Neoformans (Cryptococcosis) - encapsulated yeast

Distribution - Worldwide - Primarily found in pigeon droppings

Clinical Presentation In healthy people: - usually asymptomatic, mild or self-limiting In immunocompromised: -Dissemination in CNS - Skin & viscera also involved in small % of Patients

Direct Examination - Using India ink: The yeast s polysaccharide capsule creates a halo around the cell - Antigen test is more sensitive for C.neoformans detection - Histology of clinical material: intracellular encapsulated yeast (occasionally)

Macroscopic - Colour: Ivory to beige - Texture: Mucoid

Microscopic - C. neoformans may be visible on direct Gram stain of CSF - Yeast cells may vary in size

Histoplasma capsulatum (Histoplasmosis) - thermally dimorphic: i. small, nonencapsulated yeast in macrophages within host tissue ii. mold in environment

- Worldwide - Endemic areas in US: Ohio-Mississipi valleys where the organism is found in soil enriched with bird or bat droppings

- Originates as an asymptomatic or self-limiting, mild pulmonary infection - A small % of patients develop chronic pulmonary lesions - Disseminated disease rare in normal people, but common in immunocompromised

Mold: Colour white to tan, pale yellow reverse Texture fluffy Yeast: Colour cream - may be glabrous Conversion between moldyeast forms important for identification - ADNA probe able to distinguish it from other white fluffy molds

Mold: - produces round, warty (tuberculate) macroconidia - Microconidia may also be present At 37C, small budding yeast cells produced.

Paracoccidioides - Limited to Central brasiliensis and south America (Paracoccidiodomycosis) - Slow growing, thermally dimorphic - Large, multiply budding yeasts in host tissue - Mold in environment

- Originates as a mild pulmonary infection that may disseminate hematogenously to the skin - Most patients present with cutaneous lesions and large cervical lymph nodes

Mold: - White & velvety - yellow to brown reverse Yeast: - White - Creamy Conversion between forms important for identification

Mold: - Usually do not produce distinctive structures - Chlamydoconidia, arthroconidia & microconidia may be present Yeast: - Multiple buds at 37C

Blastomyces dermatitidis (Blastomycosis) - Dimorphic

- Primarily in the United States along the major river valleys

- Majority of patients with blastomycosis have self limiting pulmonary infections - Most cases present with cutaneous lesions reflecting hematogenous dissemination - Less common sites of dissemination: viscera, bone, prostate gland

- Yeast cells divide with a characteristic broadbased bud

Mold: - slow growing - white to beige - fluffy texture Yeast: - cream colored - irregularly shaped Conversion between forms important for identification. - ADNA available for confirmation Mold: - Appear glabrous at first - Soon become white to tan with fluffy aerial hyphae - Reverse is neutral to gray Conversion of mold to spherules not routinely performed in clinical laboratory - ADNA probe available to distinguish from other white fluffy molds

Yeast: - Thick walled broadbased budding yeast forms at 37C Mold: - Round to oval conidia form at end of short conidiophores

Coccidioides immitis - dimorphic fungi - Appears as spherules in host tissue - Appears as mold in environment

- Found primarily in western hemisphere - Endemic areas in semi-arid regions e.g: southwestern Unites States, Mexico, parts of South America

- Majority of patients have selflimiting pulmonary infections with varying degrees of severity - Patients who develop flu-like symptoms are said to have Valley Fever due to high incidence in the San Joaquin Valley in California

Histological preparations of host tissue may reveal the presence of spherule form of C.immitis. - These spherules contain endospores

- With age, the hyphae begin to form arthroconidia - The arthroconidia are barrel-shaped and alternate with empty cells (disjunctor cells) - The hyphae fragment, releasing arthroconidia hich are readily airborne and highly infectious.

- The arthroconidia of coccidioides are readily airborne and pose a serious hazard to lab personnel. It is recommended that all molds be handled in a biosafety cabinet I made this table because my eyes cried when reading the notes Dr gave us. Squinting is not fun! (Not a true story. I didn t cry. But squinting is still not fun)

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