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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?

What is the treatment of mucormycosis?

The treatment of mucormycosis includes rapid diagnosis in conjunction with correction of any underlying diseases. Biopsy sample of necrotic tissue demonstrates thick, nonseptate hyphae branching at right angles. Culture is only positive in 30% of cases. Also indicated is administration of amphotericin B, and aggressive surgical debridement of necrotic tissue in order to minimize mortality. Emerging treatments include posaconazole, and adjuvant treatment with interferon gamma and granulocyte-macrophage– or granulocyte colony–stimulating factors.

Tarrand JJ, Lichterfeld M, Warraich I, et al: Diagnosis of invasive septate mold infections. A correlation of microbiological culture and histologic or cytologic examination, Am J Clin Pathol 119(6):854–858, 2003.