FUNGAL INFXNS—-DANIEL TODD, MD
THINK OF WITH NEUTROPENIA, POORLY CONTROLLED DM, AND IMMUNOCOMPROMISE
CAN GET DERMATOPHYTID (I.D.) RXNS–DISTANT IMMUNE REACTIONS TO FUNGAL INFXNS—MAY MASCARADE AS A CHRONIC E.O.

HISTOPLASMA CAPSULATUM (HISTOPLASMOSIS)
OHIO AND MISSISSIPPI RIVER VALLEY
AIRBORN TRANSMISSION
PRIMARILY PULM MANIFESTATIONS
CAN CAUSE LESIONS ANYWHERE IN THE UPPER AERODIGESTIVE TRACT
PAINFUL SLOW GROWING ULCERATIVE LESIONS WITH HEAPED UP EDGES
PRIMARILY ANT 1/3 OF GLOTTIC LARYNX
HILAR LAD ON CXR
SCATTERED INFILTRATES
GROWS ON SABOURAD’S MEDIUM
Rx AMPHO B

BLASTOMYCES DERMATITIDIS (BLASTOMYCOSIS)
AIRBORN TRANSMISSION
PRIMARILY PULM MANIFESTATIONS–75% NODULAR INFILTRATES ON CXR
CAN CAUSE LESIONS ANYWHERE IN THE UPPER AERODIGESTIVE TRACT
LESS LIKELY THAN HISTO TO CAUSE EXTRA PULM LESIONS
SKIN LESIONS= SHARPLY DEMARKATED RAISED MARGINS WITH CENTRAL SCARRING
PSUEDOEPITHELIOMATOUS HYPERPLASIA—-MULTIPLE MICROABSCESSES
PRIMARILY GLOTTIC LARYNX
BROAD BASED BUDS
GROWS ON SABOURAD’S MEDIUM
CAN Dx BY IMMUNE SEROLOGY
Rx AMPHO B FOR LIFE THREATENING Dz OR ITRACONAZOLE 400 MG Q D FOR 6 MO

SPOROTRICHOSIS SCHENKII (ROSE PICKER’S Dz)
SKIN OR FACE INNOCULATION
NODES LOOK GRANULOMATOUS AND MAY MIMIC W.G.

COCCIDIOIDES IMMITIS (COCCIDIOMYCOSIS)
SAN JOAQUIN VALLEY, CALIFORNIA
LESIONS = NODULES OR EROSIONS
Dx SKIN TEST AND COMPLEMENT FIXATION
Rx = AMPHO B

CANDIDA ALBICANS (CANDIDIASIS, THRUSH, DIAPER RASH, YEAST INFXN)
PREDISPOSED BY ANTIBIOTICS
CREAMY WHITE PEUSOMEMBRANOUS PATCHES
DIFFUSE UPPER AERODIGESTIVE TRACT MUCOSITIS
Rx NYSTATIN (LOZENGES/ELIXER), KETOCONAZOLE, DIFLUCAN, ITRACONAZOLE, AMPHO B FOR SEVERE CASES

PHYCOMYCOSIS / RHINOCEREBRAL PHYCOMYCOSIS = SAPROPHYTIC FACIAL FUNGAL INFXN
LIFE THREATENING—PRIMARILY IMMUNOCOMPROMISED HOST OR DKARHIZOPUS, ABSIDIA, RHINOSPORIDIOSIS, MUCORMYCOSIS

RHINOSPORIDIUM SEEBERI (RHINOSPORIDIOSIS)
A PHYCOMECETES M/O
SRI LANKA AND SOUTHERN INDIA
NAO, EPISTAXIS, SNEEZING, RHINORRHEA
“STRAWBERRY”, INDOLENT, PAINLESS, WARTY, FRIABLE, POLYPOID, MUCOSAL MASS—FAIRLY VASCULAR
Rx = EXCISION AND AMPHO B

MUCORMYCOSIS
IMMUNOCOMPROMISED HOST(AIDS), NEUTROPENIA,  AND OR DKA(ACIDOSIS AND HYPOGLYCEMIA), DEFEROXIMINE
LOW GRADE FEVER, DULL SEVERE SINUS PAIN, EPISTAXIS, FACIAL HYPESTHESIA——DIPLOPIA, OBTUNDATION, FEVER, BLACK TURBINATES, PROPTOSIS, FACIAL SWELLING, BLINDNESS—-COMA—-DEATH
PAY SPECIAL ATTENTION TO THE MIDDLE TURBINATE!
Rx = EARLY DIAGNOSIS—SUSPICION, BIOPSY—BRANCHING(90 DEGREES) AT RIGHT ANGLES, THICK WALLED NON-SEPTATE HYPHAE “M”—DEBRIDE–RADICAL MAXILLECTOMY, ORBITAL EXENTERATION, AMPHO B LIPOSOMAL —IRRIGATIONS, SYSTEMIC AMPHO B AND HBO!
STAIN + WITH HMB-45 (MELANIN STAIN)
CONSIDER GRANULOCYTE STIM FACTOR—THEIR RESPONSE PARALLELS THEIR SURVIVAL

ASPERGILLUS FUMIGATUS (ASPERGILLOSIS)
O.E. OTOMYCOSIS = EXTERNA MYCOTICA (ASPERGILLUS ALBICANS AND NIGER)
H&N CAN BE ALLERGIC, NON-INVASIVE,  INVASIVE, OR MYCETOMA (FUNGAL BALL)
MYCETOMA, ASPERGILLOMA

ALLERGIC FUNGAL SINUSITIS = A TYPE I HYPERSENSITIVITY RXN
CALCIUM PHOSPHATE CRYSTALS/FE++/MG++/MN  WITH INCREASED HOUNDSFIELD UNITS ON CT—CHARACTERISTIC HETEROGENOUS OPACIFICATIONS (Mangensese)
BIOPSY — ONOIN SKIN LESIONS ON H & E
CHARACTERISTIC ALLERGIC MUCIN INSPISSATED MUCOUS(LIKE GREEN PEANUT BUTTER)—SNOTOMA—NOT INVASIVE
CHARCOT-LAYDEN CRYSTALS–EOSINOPHILIC INFILTRATE
GOMORI METHENAMINE SILVER (GMS) STAIN WITH MUCIN + CHONDROID MATERIAL
OFTEN ASSOC POLYPOSIS
ALLERGIC FUNGAL SINUSITIS/ALLERGIC SINONASAL ASPERGILLOSIS–OTHERWISE HEALTHY HOST
Rx FOR AFS = DEBRIDEMENT/HTSI/TOPICAL AND SYSTEMIC STEROIDS/DIFLUCAN/ITRACONAZOLE
BRANCHING(45 DEGREES), SEPTATE HYPHAE “A”
Rx : DEBRIDEMENT AND AMPHO B, ALLERGEN SPECIFIC IMMUNOTHERAPY

CRYPTOCOCCUS NEOFORMANS (CRYPTOCOCCOSIS)
MEMBRANOUS NASOPHARYNGITIS, MENINGITIS, SNHL
Dx : FLOURESCENT Ab
Rx : AMPHO B
AMPHO B
—?LIPOSOMAL—-EASIER ON THE KIDNEYS
SINONASAL IRRIGATIONS
TEST DOSE 0.3MG/KG DISSOLVED IN 500 CC D5W IN OVER 1-3 HOURS
MEASURE BUN, CR
ADVANCE TO 0.5-0.6MG/KG IN 500 CC D5W IN OVER 1-3 HOURS Q D
MAY USE CONCURRENT ALPHA-2-IFN