Medical Mycology Learning Presentation

Medical Mycology Learning PPTs are intended to familiarize students with some basics of Medical Mycology through consideration of Hypothetical Person cases.
DISCLAIMER: ALL information presented in these ppts is not in any way based on data from any real Patient or Person.ALL “PERSONS”in this presentation are HYPOTHETICAL and are NOT intended as a diagnostic or treatment tool for anyone.ALL PPTS IN THIS PRESENTATION ARE INTENDED TO HELP USERS LEARN A BIT ABOUT FUNGAL INFECTIONS AND THEIR AVAILABLE TREATMENT AND TO FAMILIARIZE STUDENTS W FEATURES OF DIFFERENT FUNGI. REFERENCES ARE INCLUDED WHERE AVAILABLE.

Transcript

1. MEDICAL MYCOLOGY HYPOTHETICAL PATIENT CASES • DISCLAIMER: ALL information presented in these ppts is not in any way based on data from any real Patient or Person.ALL “PERSONS”in this presentation are HYPOTHETICAL and are NOT intended as a diagnostic or treatment tool for anyone.ALL PPTS IN THIS PRESENTATION ARE INTENDED TO HELP USERS LEARN A BIT ABOUT FUNGAL INFECTIONS AND THEIR AVAILABLE TREATMENT AND TO FAMILIARIZE STUDENTS W FEATURES OF DIFFERENT FUNGI. REFERENCES ARE INCLUDED WHERE AVAILABLE.
2. PERSON 1 • Ron is a 34 y.o.person with lymphoma undergoing chemotherapy for his cancer. His Oncologist noted he was doing reasonably well until he presented with sore mucous membranes of his oral cavity which made it more difficult for him to eat.On examination his tongue was covered with white clumps that looked like cottage cheese. The “clumps” wiped off easily with a warm tissue but returned .He attempted to self treat by rinsing with an OTC mouthwash but it had no impact.His Oncology Nurse recognized this and cultured his tongue and mucous membranes of his mouth.
3. Describe what you see in the photo below so that someone who doesn’t see it could visualize it.
4. Which organism grew from this persons tongue?Why did we incubate the culture at 98.6F?
5. For Person 1,Answer these Questions • 1.List 5 factors that predispose people to oral candidiasis. • 2.List 5 precautionary measures do you recommend to prevent further occurrences of this. • 3.List this persons risk factors and other potential risk factors for this infection. Explain how each of the risk factors you listed contribute to development of an infection with oral candidiasis. • 4.What are the most commonly used treatments for oral candidiasis? • Describe the mecahism of action of each agent used to treat Candida albicans. • 5.List 4 features of the organism Candida albicans that explain its pathogenic potential.
6. PERSON 2: • Ben is a 49 year old person with Type 2 diabetes .He was relatively healthy and his diabetes well-controlled with metformin, ADA diet and exercise. He walked an hour each day.. He developed a cough, fever, chills and loss of appetite.over a 2 week period. He said he makes himself a healthy lunch everyday usually a turkey sandwich with lettuce and tomatoe on a slice of bread ,and a few days after eating the sandwich he felt ill. His physician first performed a physical exam and covid screen which was negative.His nasal passages appeared not inflamed.His lungs on auscultation had rales and rhonci esp at the apices.They were not there on his last visit for chemotherapy.He had dry cough initially without sputum production but two weeks after the onset of symptoms he coughed up blood-tinged sputum.On presentation,his physician performed sputum cultures ,CXR and a CT of the lungs. CT scan findings were consistent w necrotizing aspergillosis w areas of chronic, progressive, peripheral consolidation; multiple nodular opacities; and low- attenuating, masslike lesions. . Abnormalities were bilateral, with an upper-lobe predilection.No tumors were visible but there was some slight thickening of the pleura on the R and L.
7. • On presentation, his physician performed sputum cultures ,CXR (shown below and a CT of the lungs. Describe the findings in hisChest X Ray below.Doctor requested cultures for all the usual causal organisms of pneumonia and Mycoplasma and cytology of sputum.Culture was reported as NO GROWTH. He did not order cultures for fungi.A CT scan was then performed There was some slight thickening of the pleura on the R and L. Part of his CT scan is shown in the next ppt. CT scan findings were consistent w necrotizing aspergillosis w areas of chronic, progressive, peripheral consolidation; multiple nodular opacities; and low-attenuating, masslike lesions. . Abnormalities were bilateral, with an upper-lobe predilection.No tumors were visible but there was some slight thickening of the pleura on the R and L.
8. PERSON 2Based on the CT findings (R lower image), a bronchoscopy and bronchialveolar lavage was performed and histopathological exam confirmed pulmonary aspergillosis.
9. PERSON 2: QUESTIONS 1.What Organism is Visible in these Photomicrographs? 2.List 4 features of the organism Aspergillus fumigatum . 3.Describe the pathogenesis of Aspergillus fumigatus infection. 4.What factors of a Patient may predispose them to this infection? 5.List 4 possible sources of Aspergillus fumigatus infection.Why are these sourcesof infection?
10. Additional tests that are helpful in diagnosis of Aspergillus infection •Aspergillus antibody test. •Chest x-ray. •Complete blood count. •CT scan. •Galactomannan (a sugar molecule shed from the fungus that is sometimes found in the blood) •Immunoglobulin E (IgE) blood level. •Lung function tests. More items...
11. What is the Standard Treatment for Pulmonary Aspergillosis? • He was admitted to the hospital for treatment. • The standard treatment is antifungal medications, such as voriconazole (Vfend) or amphotericin B, taken orally or intravenously for several weeks. These drugs can have serious side effects, including kidney and liver damage, and may interact with other medications. • He therefore remained in isolation in the hospital and renal and hepatic function were monitored regularly.Physical therapy was also started and continued throughout the duration to help him regain his physical strength and be able to remain ambulatory.
12. PERSON 2 1.List actions that can be taken to prevent Re-infection with Aspergillus fumigatus. 2.List possible reasons that fungal infections are often not suspected clinically. 3.What 4 species of Aspergillus are most often associated with infections? 4.Which species of Aspergillus is most often associated with pulmonary aspergillosis? 5.Why don’t fungal organisms grow in routine cultures sent to the Microbiology Laboratory? 6.List factors that may have predisposed this Person to a fungal infection. 7.Describe three features of aspergillus that contribute to its ability to invade human tissue. 8.Draw an illustration of the life cycle of Aspergillus fumigatus.
14. PERSON 3: John is a 52y.o person who says he”has enjoyed good health throughout his life.”He is the owner of a Housekeeping Service and the short staffing has made it necessary for him to assist 5 days a week.His hands are in water and detergent a lot as he needs to help clean.For the past month he has noticed his nails looking thickener and turning a brownish yellow color. Describe his hands.
15. After taking a careful history his doctor told him he has paronychia and it may be caused by several organisms. 1.List organisms which cause paronychia. 2.His Doctor ordered cultures for bacteria and fungi.Which do you suspect as the causative organism and why? 3.During treatment and afterwards list the precautions he can take to prevent exacerbation or recurrence.
16. https://www.aafp.org/pubs/afp/issues/2008/0201/p339 .html Grateful acknowledgement of AAFP.
17. PERSON 4 • A 65 year old woman is undergoing a very aggressive chemotherapy protocol .She is working from home as a Clinical Trials Director for a few weeks as advised by her Oncologist. Her nausea ifrom her chemo is treated with Zofran .She made herself soup and sat on the deck of her downtown city apt to eat her lunch in the sun. Her deck was relatively clean but as she sat there she noticed some bird droppings in her area.She went inside and returned to working on her computer.About 1.5 weeks later she develops worsening fatigue, a fever of 101F and a dry cough.Her home covid test was negative. She masked, then called a friend to take her to the ER .The physician ordered a CBC, sputum cultures for bacteria AND fungi given the history the patient provided,blood gases, covid screened her again, placed her on oxygen and orders a CT of the lungs.
18. PERSON 4Given her current illness with cancer, the Radiologist suspected metastases to the lungs.But the appearance on CT demonstrated well-defined nodules with calcified centers which is pathognomonic of histoplasmosis.The gold standard test to confirm Histoplasmosis is biopsyand histological eval but it was determined the person is too weak.Therefore urine and blood samples were tested via enzyme immune assay (EIA antigen test).Sputum culture was inconclusive. https://radiopaedia.org/articles/thoracic-histoplasmosis-1?lang=us
19. PERSON 4:Answer the Following Questions • 1.List 5 facts about the etiology of Histoplasmosis.What species is most commonly seen in infection? • 2.Discuss four features of the organism Histoplasmosis capsulatum.Describe the pathogenesis of this disease. • 3.. What Kingdom is it classified in? • 4.In what states is this organism found to be endemic in North America? Why is the prevalence of this organism more abundant there than in other areas of the US? • 5.Approximately how many people in that geography will be exposed to Histoplasmosis capsulatum? What percentage of those will actually develop symptoms of infection?