USMLE Step 1 Flash Cards

Dimorphic Fungi
Blastomyces
Histoplasma
Coccidioides

Body Heat Changes Shape

for the dimorphic fungi

Sporothrix

Pseudohyphae (Candida albicans)

Hyphae with constrictions at each septum

Spore types
Conidia
Asexual spores; formed off hyphae; common; air-borne

Blastoconidia
Buds on yeasts (asexual budding daughter yeast cells)

Arthroconidia
Asexual spores formed by a joint

Spherules and Endospores (Coccidioides)

Spores inside the spherules in tissues

Malassezia furfur
Normal skin flora (lipophilic yeast)
Patient with blotchy hypo-pigmentation of skin
KOH scrapping shows spaghetti and meatballs or

bacon and eggs yeast clusters & short curved septate

hyphae
Treatment :
Topical selenium sulfide; recurs

Dermatophytes (group of fungi)

Filamentous (monomorphic) fungi
Three genera:
Trichophyton skin, hair and nails

Mircrosporum hair and skin

Epidermophyton skin and nails

Patient with scaly, ringlike lesions (Tineas) of skin. May involve hair shaft or

nails.
KOH scrapping shows athroconidia and hyphae
Treatment :
Topical imidazole or tolnafate
ID reaction (dermatophytID) = allergic response to circulating fungal antigens.

Sporothrix schenckii
Subcutaneous mycoses
Patient with subcutaneous/lymphocutaneous

mycetoma
Gardener, florist, basket weaver, or alcoholic rose-

garden sleeper disease (homeless)

Cigar-shaped yeast in pus
Treatment : intraconazole or amphotericin B

Histoplasma capsulatum
Deep fungal infection; dimorphic fungi

Normal patient with acute pulmonary; IC patient with chronic

pulmonary or disseminated infection (FUNGUS FLU)

States following drainages of Great Lakes to Gulf of Mexico
Exposure to bird or bat excrement
Sputum or blood cultures with mononuclear cells packed with

yeast cells (tiny yeast inside macrophages)

Treatment : Ketoconazole, amphotericin B

Coccidioides immitis
Deep fungal infection; dimorphic fungi

Normal patient with erythema nodosum or self-resolving

pneumonia
IC patient with calcifying chronic pulmonary or disseminated

infections
Pregnant female in 3rd trimester, disseminated infection
Desert southwest
Sputum has spherules with endospores
Treatment : Amphotericin B

Blastomyces dermatitidis
Deep fungal infection; dimorphic fungi
Normal patient with acute pulmonary symptoms
IC patient with chronic pulmonary or disseminated infection
North and South Carolina (otherwise coexists with

Histoplasma)
Sputum has broad-based, budding yeasts with double,

refractile cell walls.

Treatment : Amphotericin B

Aspergillus fumigatus
Monomorphic filamentous OPPORTUNISTIC fungi
Patient with asthma allergies growing mucous plugs in

lung
Patient with cavitary lung lesions fungus ball
Patient with burns cellulitis, invasion

IC patient pneumonia, meningitis

Septate hyphae branch at acute angles
Treatment : Itraconazole or Amphotericin B

Candida albicans
OPPORTUNISTIC fungi

Forms germ tubes at 37C; pseudohyphae & true hyphae when invades

tissues
Germ tube test demonstrates pseudohyphae and hyphae

IC patient, overuse of antibiotics thrush, spread down GIT,

septicemia
IV drug abusers - endocarditis
Treatment :
topical or oral imidazoles; nystatin

Disseminated : Amphotericin B or fluconazole

Cryptococcus neoformans
Encapsulated (monomorphic) yeast;

OPPORTUNISTIC fungi
Pigeon breeder with acute pulmonary symptoms
Hodgkins/AIDS patient with meningitis
India Ink mount of CSF with encapsulated yeasts
Treatment : Amphotericin B + flucytosine until

afebrile (minumum 10 wks), then fluconazole

Mucor, Rhizopus, Absidia

Ketoacidotic diabetic or leukemic patient with

rhinocerebral infection
Biopsy with non-septate irregular-width hyphae

branching at 90 angles.
Treatment :
High fatality rate (rapid growth and invasion)
Debride necrotic tissue & start Amphotericin B fast.

Pneumocystis jiroveci
Obligate extracellular parasite

Premature infant or AIDS patient with atypical pneumonia

Biopsy with honeycomb exudates and silver-staining cysts
X-ray ground glass
Treatment :
TMP-SMX for mild
Dapsone for moderate to severe