Summary of Clinical Cases by Subject Area

Name of Student: Pittzman Jo R. Acosta

Subject Area: Mycology-Virology

Case Title: Bilateral Candida keratitis in an HIV patient with asymptomatic genitourinary candidiasis in Uganda
Disease/Condition: Bilateral Candida Keratitis
Summary of the Case Presented
Textbook Information
The case is about a 35-year old man which presented with a red and painful left eye. His history was not significant where he had the same
painful eye years ago that had healed. By this time, he was unaware that he was HIV-positive. To start, corneal scrapings were used for
microscopy. Upon direct examination, Calcofluor White (CFW) stained specimen showed fungal elements. Candida spp. was also found in the
cultures of blood agar, potato dextrose agar, chocolate agar, and brain heart infusion. As protocol for Candidiasis infections in Uganda, he was
tested for HIV. This came back positive. Unfortunately, his eye did not recover, and the doctors had to perform its removal. Five months later, he
went back to the same hospital presenting the same case. The same techniques were performed for direct examination and culture with
potassium hydroxide and gram stain showing hyphae. Urine culture was additionally performed and had come back with growth of the
suspected causative agent. With a now more aggressive way of treatment, the patient was able to recover with his remaining eye and
evisceration was not performed.

In HIV patients which acquired candidiasis, systemic dissemination in other parts of the body can be possible. (Mahon & Lehman, 2019).

In immunocompetent patients, infections caused by Candida are only localized whereas immunocompromised patients experience can form
secondary manifestations as a result of dissemination in almost any site (Mahon & Lehman, 2019)..

References
Mahon, C., & Lehman, D. (2019). Textbook of Diagnostic Microbiology. St. Louis, Missouri: Elsevier.

Reflection with Integration of Faith and Learning:

We should be responsible of ourselves when we do something that may lead us to harm. The patient at first was not aware of HIV-positive
status. This played an important as to why his eye infection became so severe that it lead to the surgical removal of his eye. Just like in our lives,
our past can play an important role in our future. We must address it if we know that it can negatively affect us in the long run. We must always
ask God for this guidance in helping us address the things that we may have irresponsibly done in the past.
Case Title: Disseminated histoplasmosis in an immunocompetent patient - utility of skin scrape cytology in diagnosis
Disease/Condition: Disseminated Histoplasmosis
Summary of the Case Presented
Textbook Information
The case is about a 46-year old man which presented with fever and weight loss in 5 months, numerous red papules and a month-old cough. By
these, he was suspected of having malaria and was treated as it is. The only significant thing in his history is his selling of teas under a tree which
means that he was chronically exposed to bird droppings. For his laboratory results, he had leukocytosis and high C-reactive protein. Scrape
cytology was used on his am blisters were performed. For cultures, toluidine smears showed multinucleated cells, epithelioid granulomas,
inflammatory cells with numerous histiocytes. He was negative for Ziehl-Neelsen and mucicarmine. He tested positive for Gomori Methenamine
Silver. Saboraud dextrose agar showed mold colonies with brown cottony appearance. Lactophenol blue had thick walled macroconidia with
septate hyphae. In the latter parts of testing which started with mucicarmine, suspected agents such as L. donovani, C. neoformans, P. marneffei
was cancelled out and Histoplasma capsulatum was the causative agent to have been seen as a diagnosis. He was then treated after the
diagnosis.
Inhalation of microconidia is the most common way of acquiring Histoplasma capsulatum. In cultures, the species grow as a mold form having a
pigmentation of white to brownish (Mahon & Lehman, 2019).

References
Mahon, C., & Lehman, D. (2019). Textbook of Diagnostic Microbiology. St. Louis, Missouri: Elsevier.

Reflection with Integration of Faith and Learning:

It is not easy to find a living. We must find a suitable place by which we can do our business. In his fifteen years of selling teas, the risk of bird
droppings as a source of his present condition had played a role. So, whenever we are planning to do something, we must include all the
necessary strengths and weaknesses that may come up with. When we tread on our spiritual mission of sharing the gospel to others, we must
know first the people we are ministering in addition to knowing who we are. If this is practiced, we can win more souls to Jesus.