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Deep Fungal Infections

»What is a deep fungal infection?
Subcutaneous Fungal Infections
»Discuss the characteristics of subcutaneous mycotic infections.
»What is a dimorphic fungus?
»What occupations are at increased risk of sporotrichosis?
»Describe the clinical manifestations of sporotrichosis.
»How is the diagnosis of cutaneous sporotrichosis made?
»How do you treat cutaneous sporotrichosis?
»What other organisms may present with lymphocutaneous disease?
»What are dematiaceous fungi?
»How do you differentiate chromomycosis from phaeohyphomycosis?
»Which organisms may cause chromoblastomycosis?
»Which organisms cause phaeohyphomycosis?
»How does chromomycosis present?
»Describe the clinical features of phaeohyphomycosis.
»What is Madura foot?
»What are the clinical features of Madura foot?
Systemic Fungal Infections
»Discuss the pathogenesis of the systemic respiratory deep fungi.
»Where is blastomycosis endemic?
»What are the clinical manifestations of blastomycosis?
»Describe the cutaneous findings in disseminated blastomycosis.
»Are immunosuppressed patients at increased risk of disseminated disease with blastomycosis?
»What is the treatment of blastomycosis?
»Where is histoplasmosis endemic?
»What factors are necessary for production of the disease histoplasmosis?
»Discuss the clinical manifestations of histoplasmosis.
»How common are mucocutaneous findings in disseminated histoplasmosis?
»Are there any other cutaneous manifestations of histoplasmosis?
»Where is coccidioidomycosis endemic?
»What are the clinical manifestations of coccidioidomycosis?
»Where is paracoccidioidomycosis endemic?
»Why is paracoccidioidomycosis more common in men?
»What is the most common presenting complaint of paracoccidioidomycosis?
»Which organism is responsible for penicilliosis?
»Where is penicilliosis endemic?
»How does penicilliosis present clinically?
»What is a parasitized histocyte?

Opportunistic Fungal Infections

»Define opportunistic infection.
»What are the common fungal pathogens in HIV infection?
»Discuss the fungal infections seen in organ transplant recipients.
»Discuss the important epidemiologic factors of cryptococcosis.
»How is an infection with cryptococcosis acquired?
»What are the cutaneous manifestations of disseminated cryptococcosis?
»What patient population is at increased risk of aspergillosis?
»How common are cutaneous lesions in aspergillosis?
»Describe the cutaneous lesions in aspergillosis.
»What opportunistic fungus is clinically and histologically similar to Aspergillus?
»What are the most important predisposing factors for acquiring mucormycosis?
»Discuss the clinical manifestations of rhinocerebral mucormycosis.
»Can mucormycosis be acquired from contaminated dressings?
»What is the treatment of mucormycosis?
»For what fungal infections might patients on biologic therapies be at risk?
»What fungal species are considered potential agents of bioterrorism?

 
 
 

Describe the clinical features of phaeohyphomycosis.

The spectrum of clinical infections is broad. The most typical presentation is a subcutaneous cyst or abscess at the site of trauma and Exophiala jeanselmei is the most common organism. The primary lesion is a painless nodule. The nodule evolves into a fluctuant abscess. Immunocompromised patients present with multiple nodules. Dissemination is rare; however, the incidence has increased over the past 10 years. Scedosporium proliferans (42% cases), Bipolaris spicifera (8%), and Wangiella dermatitidis (7%) are the most common causes of disseminated disease. The primary risk factor is decreased host immunity, especially prolonged neutropenia. The outcome is poor, despite antifungal therapy, with an overall mortality rate of 79%. Cerebral phaeohyphomycosis acquired through inhalation and hematogenous dissemination is most commonly seen in immunocompetent persons with no obvious risk factors.