This document provides information on various topics related to medical mycology: 1. It lists various types of fungal spores and describes staining techniques used to identify fungi like Gomori methenamine silver stain. 2. It describes different types of fungi like dermatophytes, dimorphic fungi, opportunistic fungi etc. and their characteristics. 3. It discusses various antifungal drugs like polyenes, azoles, echinocandins and their mechanisms of action and side effects. 4. Mnemonics and clinical features of various systemic and cutaneous mycoses are summarized.

1. -DR.AKIF A.B

2. Mnemonic : ZAB
Z- Zygospores (Phycomycetes)
A-Ascospores (aspergillus)
B-Basidiospores (Cryptococcus)
SEXUAL SPORES
Ascospores
Basidiospores

3. Methanamine silver
BEST FUNGAL STAIN
Mucicarmine stain and Alcian stain is used for Cryptococcus

4. Gomori methenamine silver
stain
- used to stain for fungi and for Pneumocystis jiroveci (carinii).
-The cell walls of these organisms are stained, so the organisms are outlined by
the brown to black stain.
-There is a tendency for this stain to produce a lot of artefact from background
staining, so it is essential to be sure of the morphology of the organism being
sought.

5. GMS stain for Pneumocystis carinii

6. GMS stain for Coccidoides immitis.

7. GMS stain for Cryptococcus
neoformans

8. His = Histoplasma
Pistol =Penicillium
Shoots = Sporothrix
Bullets & = Blastomyces
Cartridge =Coccidiodes/Paracocci
DIMORPHIC FUNGI
-These can exist in 2 forms
At 25* C = Mould
At 37*C = Yeast
- Sporothrix is Subcutaneous Dimorphic fungi whereas rest are systemic fungi

10. -Gel immunodiffusion precipitin test
-Antigens are detected using specific antibodies
- Detects mould form of dimorphic fungi
EXO ANTIGEN TEST

11. YEAST LIKE FUNGUS
Candida forms pseudohyphae apart from existing as
Unicellular cells.
Pseudohyphae

12. YEAST
Cryptococcus
Saccharomyces
- Multiply by budding

13. clumps of intertwined branching hyphae
M – Mucor
A -Aspergillus
R - Rhizopus
D –Dermatophytes
MOULDS: (MYCELIA)

17. Fungi without identifiable sexual stage
e.g: most medically important fungi
DEUTEROMYCOTA
(FUNGI IMPERFECTI)

18. Produced by fragmentation of hyphae.
E.g: Coccidiodes,
Paracoccidiodes
ARTHROSPORES

20. MC media used for culture of fungi
Antibiotics incorporated are : Cycloheximide,
Chloramphenicol
Gentamycin
SABOURAUD’S DEXTROSE AGAR

21. Cutaneous T cell lymphoma
MYCOSIS FUNGOIDES

22. -C.neoformans : Soil with pigeon droppings
-C.gatti : Eucalyptus tree (Gumtree)
-CD4<200
-MC cause of meningitis in HIV/AIDS
-Encapsulated budding yeast
-Causes Buschke disease
-MC form : Pulmonary Cryptococcus
-Confirmatory test : Latex agglutination test for polysaccharide antigen
- Stains: 1) Mucicarmine stain
2) Alcian stain
3) Indian Ink stain : -ve stain i.e it stains background rather than organism
- In HIV with CNS involvement : Induction: Amphotericin B +/- Flucytosine
Maintenance: Fluconazole
CRYPTOCOCCUS

23. The cytoplasm of the cells lining this are pink with the mucicarmine stain,
indicative of mucin production.

25. Hortae(Exophilia) wernickii
Painless, non scaly patches present on Palms and soles.
TINEA NIGRA

26. White Piedra Black Piedra
Trichosporon Beigelii (Bhijli i.e current is white
when sparks)
Piedrae hortae
Loosely attached to hair shaft (white hairs are
loosely attached to scalp)
Tightly attached to hair shaft
Arthrospores Ascospores

27. -malassezia furfur (Pityrosporum orbiculare)
Infects Stratum corneum
Microscopy: Sphaggetti and meat ball appearance
SDA culture: Fried egg appearance
Wood lamps : Golden yellow fluorescence
TINEA (PITYRIASIS) VERSICOLOR

28. TINEA (PITYRIASIS) VERSICOLOR

29. Microscopy: Sphaggetti and meat ball
appearance
TINEA (PITYRIASIS) VERSICOLOR

30. TINEA (PITYRIASIS) VERSICOLOR
Wood lamps : Golden yellow fluorescence

31. -Tinea /Ringworm
-MC superficial mycosis
-MC type : Anthrophilic (Humans)

32. Microsporon Trichophyton Epidermophyton
Infects Skin,Hair Skin,hair and Nail Skin, Nail
Microconidia Rare Abundant absent
Macroconidia Spindle shaped Pencil shape Club
/clavate/paddle
shaped

33. 1) T.equinum
2)T.verrucosum
3)M.canis
4)M.equinum

34. -M.canis
-T.tonsurans
-Seen on scalp
-Commonly in Children

35. Tinea corporis Tinea cruris Tinea pedis
body ringworm Groin or jock itch athlete foot
M.Canis
T.mentagraphytes
T.Rubrum
T.Mentagraphytes
E.floccosum
T.Rubrum
T.Mentagraphytes
E.floccosum

39. -form of T.capitis
-caused by T.schoenlenii

40. -Hypersensitivity reaction to Dermatophyte antigens
- Secondary lesion appears distal to primary lesion.

41. .
MYCETOMA
Eumycetoma Actinomycetoma
Fungus –(40%) Bacteria – (60%)
Single mass with well defined
margins,
Serous, black in colour,
Osteosclerotic
Multiple, ill defined margins,
osteolytic,Purulet,
White/Red
Black granules : Madurella MC: Nocardia
>Actinomadura madurae>
Streptomyces : white
granules
White granules:
Pseudoallescheria,
Aspergillus fusarium
Actinomadura pelletieri :Pink
to Red granules
Triad :
Subcutaneous swelling
+
Discharging sinuses
+
Granules in sinuses
Granules contains Silver
Mycetoma- Histology Showing Splendore Hoeppli Phenomenon

42. MYCETOMA

43. MYCETOMA
Mycetoma- Histology Showing Splendore Hoeppli Phenomenon

44. Similar to mycetoma but is caused by :
Staphylococci
Streptococci
Pseudomonas
E.coli
BOTRYOMYCOSIS

45. -Sclerotic /Medlar bodies (copper pennies) : Brown septate bodies forming pus
-Subcutaneous fungal infection
- Darkly pigmented fungi
CHROMOBLASTOMYCOSIS

46. -MC in Tamil Nadu/A.P/KERELA/Orissa
-HPE : Polyp reveals spherules (Large sporangia containing numerous endospores)
-MC site : Nasal cavity
- Source : Stagnant water
RHINOSPORIDIOSIS

47. -MC fungal infection in Humans both in HIV & non HIV pt.
-MC :Candida albicans (Thick wall terminal
chlamydospore on corn meal agar)
-Sugar assimilation/fermentation test : Used for species
other than Candida albicans
C.glabrata : Only species which doesn’t produce
Pseudohyphae
C.kefyr(Pseudotropicalis) :Used as standard strain for
antifungal drug susceptibility testing
CANDIDA
Pseudohyphae

48. PSEUDOHYPHAE TRUE HYPHAE
Constricted septa No constriction
Origin of branch is constricted and septate No septum
Grows by budding Atypical elongation

49. GERM TUBE TEST (REYNAULD’S
BRAUDE PHENOMENON)
- Differentiates hyphae with pseudohyphae
- Serum at 37*C – True hyphae is formed
CANDIDA

50. MC cause of Paranasal sinus mycosis
MC form = Pulmonary aspergillosis : seen in prior lung disease
Narrowed septate hyaline hyphae with long conidiophores with terminal vesicles
Invades pulmonary cavities - Fungal balls
In immunocompromised : Invades blood vessel – causes Thrombosis
Treatment :
Invasive aspergillosis : Voriconazole
ABPA : Itraconazole
Single aspergilloma : Surgery
Chronic pulmonary aspergillosis : Itraconazole/Voriconazole
ASPERGILLUS

51. A.FUMIGATUS
- Pulmonary and allergic

52. A.FLAVUS
-Skin
- Ocular infections
Mnemonic : flame is seen by eyes and it burns skin

53. A.NIGER
Otitis externa
Mnemonic: Nigear : ear otitis

54. -Caused by Rhizopus/Absidia/mucor
-Aseptate hyphae
-Sexual spores : Zygospores
-Asexually by : Sporangiospores
-MC form : Rhinocerebral mucormycosis(Presnts as orbital cellulitis,Proptosis and
vision loss) >Pulmonary mucormycosis
- Vascular invasion is very common : Mucormycosis >Aspergillus
- MC site of invasion ; Brain
MUCORMYCOSIS/
ZYGOMYCOSIS/PHYCOMYCOSIS

56. -Non cultivable fungus
-Environment : Cyst form
-Humans : Trophozoite and cyst form
-Methenamine silver : Cyst appears black coloured Pink pong balls against black
background
-Best sample : Bronchoalveolar lavage
-Cyst inhaled – enters lung –FORMS TROPHOZOITES –Plasma cell infiltrates –Frothy
exudates filling the alveoli
-B/L Perihilar exudates
- Treatment ; Immunocompetent : Cotrimoxazole * 14days
Immunocompromised : Cotrimoxazole * 21days
PNEUMOCYSTIS CARINII

57. -Methenamine silver : Cyst appears black
coloured Pink pong balls against black
background
PNEUMOCYSTIS CARINII

58. -Rose gardener’s disease
-Thorn of rose plant injury
-Painless nodulo-ulcerative lesion
-Spreads along Lymphatics
-R/F : Bare foot
-At 37*C : cigar shape asteroid bodies
-
-25*C : MOULDS
-Best test : Culture
-Portal of entry : Skin
- DOC :Itraconazole
SPOROTHRIX
cigar shape asteroid bodies

59. B -Blastomycosis
P - Penicillium marnefii
Cuff - Coccidiodomycosis
Humerus - Histoplasmosis
GRANULOMA FORMING FUNGI

60. -Hyaline thin septate hyphae
-Conidia arranged in brush border appearance
-At 37*C : Yeast cells : Oval or elliptical with central septation
- At 25*C : Brick red pigment mould
PENICILLIUM MARNEFII
Brush Border Appearance

61. Gilchrist disease
North American blastomycosis
HPE: Figure of 8 appearance (8-15MICRON) : B looks like 8
MC form :Pulmonary >skin
Route : RespiratoryRoute
Doesnt involve git
DOC : Amphotericin B
BLASTOMYCOSIS

62. Primarily infects Reticuloendothelial system
25*C : Tuberculate macronidia and thin micronidia
37*C : tiny oval yeast cell (2-4micron) with narrow based budding
Intracellular single budding yeast cells in tissue
Survives Within macrophage
Reservoir : Soil with bat or chicken faeces
HISTOPLASMOSIS

63. -Valley/ California fever
-Inhalation of arthrospores causes
disease
-MC form : Pulmonary
-Barrel shape arthrospores
-Mostly Seen in Desert areas. Hence k/a
Desert Rheumatism
- DOC :Itraconazole
COCCIDIODOMYCOSIS
-Barrel shape arthrospores

64. -South American blastomycosis
HPE : Mickey mouse appearance/ pilot wheel appearance
Arthrospores
DOC: Itraconazole
PARACOCCIDIODOMYCOSIS

65. MC cause of Meningitis in AIDS : Cryptococcal
MC cause of Seizure in AIDS pt. : Toxoplasmosis

66. -DR.AKIF A.B

67. -2 layered structure made of cell wall and cell membrane.
Cell wall Cell membrane
Made up of Chitins,Protein and beta
glucans
Ergosterol
Contains beta glucan
synthase that synthesise
beta glucans for cell wall
Squalene
Levonosterol
Ergosterol
Squalene epoxide
14-Alpha sterol
demethylase

68. Amphotericin B
Squalene
Levonosterol
Ergosterol
Squalene epoxide
14-Alpha sterol
demethylase
Azoles
Echinocandins
Terbinafine

69. -Amphipathic drug i.e it has both lipid and water soluble side
-water soluble side binds with ergosterol and forms pore in fungus
-Pores let water to accumulate inside cell and leads to lysis.
- Poor oral absorption and hence given i.v along with 5%Dextrose as carrier.
Amphotericin B

70. 1)Systemic fungal infections
2)Mucormycosis
3)Kala azar
4)Cryptococcal meningitis

71. 1) Nephrotoxic : To prevent patient is preloaded with 1-2L of Normal saline
-To prevent nephrotoxicity Amphotericin is combined with
liposomes,Lipid or colloid.
2) Hypokalemia
3) Hypomagnesemia
4) Anemia
5) Thrombocytopenia

72. -It is a Prodrug of anticancer drug 5-FU
-It is given along with Amphotericin B for Induction therapy in
Cryptococcal Meningitis
-It is given maximum for a duration of 2weeks because of risk of
bone marrow suppresion and colitis

73. Treatment of
Cryptococcal meningitis
Induction: Amphotericin B +
Flucytosine (Only for 2weeks)
Maintenance : Azoles

74. -Inhibits synthesis of ergosterol by inhibiting 14 alpha sterol demethylase
Fluconazole -DOC for Candidiasis and
coccidiomeningitis
Itraconazole -DOC for Endemic mycoses
-Antifungal of choice for Allergic
bronchopulmonary Aspergillosis
Voriconazole -DOC for invasive Aspergillosis
Ketoconazole -Inhibits Steroid synthesis and is
hence used in Cushings Sx

75. Squalene
Levonosterol
Ergosterol
Squalene epoxide
14-Alpha sterol
demethylase
Azoles

76. DRUG SIDE EFFECTS
Fluconazole -Hepatotoxic
Itraconazole Hepatotoxic,
CHF,
Hypokalemia
Voriconazole Hepatotoxic,
QT
prolongation
Ketoconazole Anti
androgenic
action and
causes
Gynecomastia

77. -Inhibits beta glucan synthase and hence breaks cell wall causing fungicidal
effect
-Poor oral absorption and hence given i.v.
-Caspafungin
- micafungin
Echinocandins

78. -Inhibits ergosterol synthesis by inhibiting Squalene epoxidase
-Given orally and it accumulates in Skin, Nail and fats. Hence, It is DOC for
Dermatophtosis.
- S/E: Steven Johnson Sx and hepatotoxicity

79. Squalene
Levonosterol
Ergosterol
Squalene epoxide
14-Alpha sterol
demethylase

80. -Stabilises Microtubules of Fungi and hence has fungistatic
effect
-Given orally and accumulates in S.corneum and hence is
used in
Dermatophytosis.
-DOC for treatment of Tinea Capitis in children
-S/E : Hepatotoxicity, Neutropenia, Neurological

81. B =Butenafine
H =Halprogin
U =Undencyclenic acid
T = Terbinafine
A =Azoles
N =Nystatin, Naftifine

82. 1) Isuvaconazole : Used for Mucormycosis and Aspergillosis
2) Efinaconazole : used for Fungal toe nail infection