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5 Written Questions

5 Matching Questions

  1. Coccidioides immitis Morphology
  2. Paracoccidioides brasiliensis Diagnosis
  3. Mechanism of Dimorphic Switch
  4. Histoplasma capsilatum Treatment
  5. Coccidioides immitis Reservoir
  1. a Dimorphic
    1. Mycelial forms with spores at 25 C
    2. Yeast forms at 37 C
  2. b 1. Itraconazole
    2. Amphotericin B (in immunocompromised patients)
  3. c 1. Desert areas of the southwestern US & northern Mexico
    2. Respiratory transmission
  4. d 1. The shift from mold to yeast involves induction of the heat shock response and uncoupling of oxidative phosphorylation
    2. This is followed by shutdown of RNA synthesis
    3. The cells then pass through a metabolically inactive phase
    4. The metabolism in the yeast phase shifts to sulfhydryl compounds
    5. This is reversible and is one of the major virulence factors of these organisms
  5. e 1. Diagnosis is made by seeing the yeast with multiple blastoconidia (think of a ship's steering wheel)
    2. Measurement of antibodies have a 95% sensitivity

5 Multiple Choice Questions

  1. 1. Itraconazole (1st choice)
    2. Amphotericin B (2nd choice)
  2. 1. fevers, sweats, weight loss
    2. in disseminated disease, skin & subcutaneous nodules and mucous membrane ulcerations are not unusual (tongue, larynx)
  3. Blastomycosis
    1. Asymptomatic (uncommon)
    2. Pneumonia: lesions rarely calcify (most common)
    3. Disseminated (uncommon): present with weight loss, night sweats, lung involvement, and skin ulcers
    4. Cutaneous: skin ulcers
  4. 1. Not clear what the predominant host response is
    2. Complement, antibody and cell mediated immunity are all involved
  5. 1. Lung biopsy
    A. Silver stain specimen
    B. Culture on Sabouraud's agar will reveal hyphae at 25 C, and yeast at 37 C
    2. Serology
    3. Skin test (tests for exposure only)

5 True/False Questions

  1. Paracoccidioides brasiliensis Clinical Symptoms1. Pulmonary Infection
    2. Cough
    3. Fever
    4. Malaise
    5. Weight loss


  2. Coccidioides immitis ImmunityCoccidioidomycosis aka "Valley Fever"
    1. Asymptomatic (in most persons)
    2. Pneumonia
    3. Disseminated (<1%): can affect the LUNGS, SKIN, BONES, & MENINGES

    Note: a small percentage of individuals with this infection will develop painful erythematous nodular lesions called erythema nodosum


  3. Coccidioides immitis Clinical Symptoms1. Pulmonary Infection
    2. Cough
    3. Fever
    4. Malaise
    5. Weight loss


  4. Paracoccidioides brasiliensis Treatment1. trimethoprim/sulfamethoxazole (TMP sulfa): 1st choice
    2. itraconazole and amphotericin B


  5. Coccidiodes immitis Diagnosis1. Biopsy of affected tissue: lung, skin
    A. Silver stain or KOH prep
    B. Culture on Sabouraud's agar (warn lab!) 3-4 days
    2. Serology
    3. Skin tests (tests for exposire only)


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