Page 1 of 7 Fungi Chitin made of glycosides. Membrane has ergosterol and zymosterol Yeast: unicellular. At higher temperatures. Budding.

ng. Pseudohyphae if they dont separate after budding. Mold: multicellular. Spores are their reproducing bodies Septate: membranes separate individual cells Identify with 10% KOH to remove host cell. Sabourads agar Amphotericin (polyene) binds ergosterol punch holes in it Azoles inhibit P450 no ergosteorl synthesis Superficial No invasion. Tinea Malassezia furfur: tinea versicolor. Spaghetti and meatballs. Exophiala weneckii: tinea nigra. Usually soles and palms Cutaneous infections Only hyphae. Monomorphic Dermatophytes: microsporum, trichophyton, epidermophyton Tinea corporis: ringworm. Healing in center. Red and raised border. Ag but not fungi can spread. Transmit through skin or contaminated items Epidermyphyton: skin and nails only. Micro: bright green with Woods light Tricho: tinea corporis Subcutaneous Sporothrichosis, rose gardeners disease Dimorphic, low virulence Local pustules and ulcers along lymphatic tract Systemic Dimorphic, no interpersonal transmission (unlike TB) From inhaling spores local infection in lungs IC: pneumonia that looks like TB disseminate to meninges, bone, skin as granulomas Can see with silver stain Coccidiodes immitis Valley fever Arthroconidia Mild pneumonia in healthy Hyphae and spherule with endospores SW, alklaline soil, erythema nodosum, urease and EC protease, most common lab acquired fungus Branched septate, disjunctor cells Histoplasma capsulatum Miss river. Bird and bat droppings RES disease Uninucleate buds in macrophages, macroconidia Stain with Wright Giemsa No capsule Blastomycosis dermatidis Miss river Round yeast, broad single bud, small conidia, thick walled budding yeast

 Ulcerated granuloma Most rare but most severe fungal infection Paracoccidiodes brasilensis Budding yeast, captain wheel formation Acidic soil Opportunistic Mucormycosis Sinus, brain, lungs, cranial bones, vessels Irregular hyphae Candida Healthy: thrush, vaginitis, diaper rash Can disseminate to any organ Fluffy patches on retina In normal flora, but never normal in blood Germ tubes and pseudohyphae, beta D glucan Aspergillus fumigates Septate hyphae, only as mold, dichotomous branches with V shape, fruiting body Allergic bronhopulmonary aspergillosus: like asthma, type I reaction and can also be type IV Aspergilloma: fungus ball when you have TB or malignancy Cryptococcus neoformans Major manifestation is meningitis. Can also cause pneumonia In bird poop Polysaccharide capsule, see with India ink Protozoa Eukaryotes, single cell, sexual and asexual reproduction Trophozoites: feeding and reproducing form, in favorable environments Cysts: protective and dormant form, infectious form Cryptosporidium Transmitted in contaminated water (think municipal water, day care centers) Fecal oral transmission Self limiting enterocolitis, watery diarrhea Monoxenous: all stages in host Only coccidian where cysts are infectious immediately Cyst release four sporozites Degrade and penetrate mucous, attach to MV. Low infectious dose Asymptomatic carriage Can detect with acid fast stain Giardia intestinalis (lamblia) From contaminated water, cysts resist chloride, cyst and tropho in stool Zoonotic: beavers and muskrats Trichrome Flatten villi malabsorption, no necrosis Can have asymptomatic carriage Not always in feces No invasion no blood in stool. But fatty and foul smelling. Most people no symptoms

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Page 3 of 7 Treat with metro

Trichomonas vaginalis Strawberry cervix: punctuate hemorrhages No cyst (so does not survive in external environment), invasion, Diagnose: discharge, urine More in females Entaemoeba histolytica Intestinal colitis, liver abscesses Can see RBC inside. Uses pseudopod to move. 1 cyst is enough to infect. Most no symptoms Invade submucosa, flask shaped ulcer, lectin adheres to mucin, sick have trophozoites in stool Liver: well definied, chocolate pus, moves through diaphragm to hit lungs, stool has Ag and not organinism. RUQ, enlarged liver Invasion blood in stool Adherence is through Gal/GalNAc lectin: virulence factor Sick have trophozoites in stool, cysts in stool in carriers o When have liver disease, may just find Ag in stool Amoeboma: amoebic granuloma: inflammatory thickening of intestinal wall around abscess, will be palpable Uninicleated quadnucleate cyst Naegleria flowleri Fulminant meningocephalitis: LP will look like bacterial If get disease, fatal in one week Amoebastome From swimming in natural water Culture will be negative Acanthamoeba Granulomatous amoebic encephalitis and keratitis Can enter through eye, nose, broken skin Spreads through blood to CNS Treatment has limited efficacy Trypanosome brucei African sleeping sickness Tsetse fly CNS Variant surface glycoproteins intermittent fever. Act as T cell independent so no memory response Gambiense: slower incubation, West African, Winterbottom sign (posterior cervical lmphadenopathy), chronic, no animal reservoir Rhodiense: shorter incubation, East African, cattle vector, lymphadenopathy is uncommon CNS: headache, stiff neck, palsies, seizures, lethargy, wasting and emaciation Death: coma, infection, cardiac failure Chancre: painful? Trypansoome cruzi Chagas disease, American trypanosome Southern US Animal reservoir: armadillo, possum Vector: kissing bug aka reduviid bug

Page 4 of 7 Large: colon, esophagus, heart Deposits parasites from feces Acute: eye chagoma, Romanas sign (soft tissue and lymphoid swelling around eye), usually no symptoms in adults Indeterminate phase 10-30 years Chronic: arrhtymia, large organs Common to do xenodiagnosis: bug feeds on you and check GI for parasite Localize to RES Ipsilateral face symptoms

Leishmania donovani Texas Sandfly macrophage and granulocytes RES Cutaneous: most common, oriental sore in ulcer base Disease depends on cellular immunity (like leprosy) Diffuse when IC Visceral: kala azar: general RES infection, hella fatal, ab distension, HSM Malaria Recrudescent Heteroxenous life cycle, sexual stage in RBC Liver stage: exo-erythrocytic: lyse cells. Does not cause pathology Erythrocytic: feed on Hb and make hemozoin and modify RBC surface. Synchronous lysis Sporozoite trophozoite divides nuclearly schizont new membrane 1000s of merozoites burst Vivax and ovale o Relapse from hypnozoites. Dormant liver form o Tertian spike: every 48 hours o Invades reticulocytes o Radical cure does not work Vivax o Most widespread o Needs duffy blood group Ag to invade o Schnuffers dots: trophozoite Malariae: every 72 hours, quartan, longest incubation, rarely over 1% infection, older RBC, symptoms less common and severe Falciparum o Most lethal. Exports knobs on RBC surface increase ability to adhere to endothelium. PEMP1 to sequester RBC. With exception of ring stage, all infected cells will be in tissue. Will only see ring stage in blood. Prevent splenic clearance o Irregular or continuous cycle o Invades all RBC. Most virulent. Prodrome more severe. More cerebral malaria Prodrome paroxysm cold stage hot stage sweating o Prodrome: end of incubation. 2-3 days. Malaise, nausea, pain, anorexia o Paroxysm o Cold stage: peripheral vc skin is cold dry pale. Shiver and violent shaking o Hot stage: increase RR and HR. headache, vomit, fever o Sweating: feeling of relief and exhaustion Babesia microti Tick borne, emerging, transfusion threat Cycle between tick and white footed mouse

Page 5 of 7 Humans are dead end hosts Infect RBC Maltest cross with four merozoites Can see with Wright or Giemsa stain Infect RBC Ixodes dammini bite

Toxoplasma gondii Sexual reproduction only in cat In meat and cat poop, transplacental Highest risk third trimester, but first semester most severe Can go to all organs Usually no symptoms Can look like mono, maculopapular rash Intraocular inflammation Healthy people: general node enlargement Treatment only helps with tachy, so will still have brady and will get reactivation Helminths Roundworms (nematodes) Intestinal Mature in intestines. Through meat or egg ingestion or skin penetration Treat with bendazoles Trichuris trichura: whipworm Simple cycle (no filariform), no invasion no eosinophilia, no lung involvement, no autoinfection Eat eggs Superficial ulcers Posterior projects into lumen and anterior stays in mucosa and feeds on blood Ascaris lumbricoides Most common helminthic infection From soil or food Complex cycle. Penetrate duodenum blood liver, heart, lungs Alveoli cough swallow back to SI Symptoms: none or mild: cramps, pneumonia, liver necrosis and granulomas Necator americanus (hookworm) Penetrate skin. Develop in SI. cough and swallow Pneumonia, blood loss Symptoms: rash and skin at penetration site. Diarrhea, abdominal pain. Fe loss. Strongyloides stercolaris (threadworm) Complex cycle. Penetrate skin SI Transmission: sexual, pets, barefoot Results o Autoinfection: larva penetrate intestine directly lung continue cycle o Direct: feces soil next host lung (like necator) o Indirect: sexual cycle. Larvae stool soil and mate hatch reinfect human Symptoms: vomit, bloat, diarrhea, anemia, weight loss, itch, pulmonary symptoms, eosinophilia, autoinfection No eggs in stool Enterotest to diagnose

Enterobius vermicularis (pinworm) Simple cycle. Ingest eggs, mature in LI Females deposit eggs on perinanal skin Often asymptomatic carriage Eggs rarely in poop

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Extra-intestinal nematodes / roundworms Humans are incidental hosts, cause disease because they cannot complete their life cycle, from arthropod bite No fecal spread. Filariae do not lay eggs Disease is an allergic response to ?? Toxocara canis Creeping eruption: pruritic migratory skin infection Ingest eggs blood and stay as larvae Need to be in environment to be infective, so cannot get through direct contact with animal Ancylostoma brazilense Penetrate skin serpentine tunnels SC Cutaneous larvae migrans, vesicular reaction secondary bacterial infection Loftiers syndrome: transient pulmonary infiltrates with peripheral eosinophilia Trichnella spiralis In pork. Eat larvae adult in SI circulation skeletal muscle Males in feces, females penetrate intestinal mucosa Almost never find adults in tissue sections Most no stymptms Can invade through diaphragm heart, brain Most common parasitic cause of myocarditis Wucheria bancrofti Elephantiasis. Mosquito. Only in blood at night Onchocerca volvulus River blindness. Blackfly bite. SC fibrous nodules and moves to skin and eyes. Pruritc rash with darkened pigmentation. Ivermectin only works on microfilariae Loa Loa Mango fly. Calabar swellings. Blood at night Dracunulus meinesnsis Not filarial. Water has larvae female goes SC and aligns near skin. Drugs dont help Trematodes (flukeworms) Type of platyhelminthes Most hermaphrodite, need host to complete complicated cycle, no digestive tract, not segmented First host is mollusk, eggs with operculum Schistosomes Not hermaphrodites. No operculum. Snail intermediate host. Freshwater invade venous system. Eggs hatch in water so cannot multiply in humans Cercariae: mature larvae that penetrate skin. Veins of GI or bladder lay eggs in pee or poop Adults molecular mimicry Lay eggs that end up in pee or poop Eggs cause inflammation Dermatitis (swimmers itch) katayama fever (fever, hives, headache, weight loss, eosinophilia, from laying eggs) chronic fibrosis of organs and vessels Large gold eggs. Treatment does not help lesions

 Praziquantel. Granulomas around eggs Schistosoma hematobium Urinary. From fecally contaminated water bladder Shistosoma japonicum Eggs in feces Shistosoma mansoni Hepatic veins eggs in feces Liver flukes Fasciola hepatica Sheep liver fluke From watercress with cysts. In sheep as intermediate hosts Opsthorchis sinesis Chinese liver fluke Eggs in snail, cyst in fish Bile duct obstruction Lung fluke: paragonimus westermani Crabs and crayfish intermediate Stomach lungs Viscous brown and red sputum

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Cestodes (Tapeworms) Segmented, adults in humans, larvae usually intermediate host, proglottids with more distal ones gravid, no mouth or digestive tract, prazi and niclosamide See eggs and proglottids and stool Taenia solium Pork tapeworm Pig bladder to human SI through scolex Cysticerocosis: migrate to various organs Tissue infections from eggs, not larvae. Rupture cyst fluid causes inflammation Hooks on scolex Taenia sagintata Beef tapeworm No cysticerosis in humans no issues if you eat the eggs No hooks on scolex Diphyllobothrium latum Fish tapeworm Intermediate in freshwater crustaceans, fish Crustaceans eat fish eat human eats Pernicious anemia Echinoccus granuosus Hydatid disease Humans incidental end stage host Liver and other organs Fluid in cyst is toxic Pathognemoc: daughter cyst with hydatid cust