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Jawetz, Melnick, & Adelberg’s Medical Microbiology, 27e

Chapter 45: Medical Mycology

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Which statement regarding fungi is correct?

(A) All fungi are able to grow as yeasts and molds.

(B) Although fungi are eukaryotes, they lack mitochondria.

(C) Fungi are photosynthetic.

(D) Fungi have one or more nuclei and chromosomes.

(E) Few fungi possess cell membranes.

Which statement regarding fungal growth and morphology is correct?

(A) Pseudohyphae are produced by all yeasts.

(B) Molds produce hyphae that may or may not be partitioned with cross-walls or septa.

(C) Conidia are produced by sexual reproduction.

(D) Most yeasts reproduce by budding and lack cell walls.

(E) Most pathogenic dimorphic molds produce hyphae in the host and yeasts at 30°C.

Which statement regarding fungal cell walls is correct?

(A) The major components of fungal cell walls are proteins such as chitin, glucans, and mannans.

(B) The cell wall is not essential for fungal viability or survival.

(C) Ligands associated with the cell walls of certain fungi mediate attachment to host cells.

(D) Fungal cell wall components are the targets for the major classes of antifungal antibiotics, such as the polyenes and azoles.

(E) Fungal cell wall components rarely stimulate an immune response.

A 54-year-old man developed a slowly worsening headache followed by gradual, progressive weakness in his right arm. A brain scan revealed a left cerebral lesion. At surgery an abscess surrounded by granulomatous material was found. Sections of the tissue and subsequent culture showed darkly pigmented septate hyphae indicating phaeohyphomycosis. This infection may be caused by species of which genus below?

(A) Aspergillus

(B) Cladophialophora

(C) Coccidioides

(D) Malassezia

(E) Sporothrix

A 35-year-old man is a farmer in a tropical area of West Africa. He developed a persistent scaly papule on his leg. Ten months later a new crop of wart-like purplish scaly lesions appeared. These lesions slowly progressed to a cauliflower-like appearance. Chromoblastomycosis (chromomycosis) was diagnosed. Which statement regarding this disease is most correct?

(A) In tissue, the organisms convert to spherical cells that reproduce by fission and exhibit transverse septations.

(B) The etiologic agents are endogenous members of the mammalian flora and possess melanized cell walls.

(C) The disease is caused by a single species.

(D) Most infections are systemic.

(E) Most infections are acute and clear spontaneously.

A 42-year-old HIV-positive male, originally from Vietnam but now residing in Tucson, Arizona, presents with a painful ulcerative lesion on his upper lip (cheilitis). A biopsy was obtained, and the histopathologic slide (hematoxylin and eosin stain) revealed spherical structures (20–50 μm in diameter) with thick refractory cell walls. What is the likely disease consistent with this finding?

(A) Infection with Penicillium marneffei

(B) Cryptococcosis

(C) Blastomycosis

(D) Coccidioidomycosis

(E) No diagnostic significance

A 47-year-old man with poorly controlled diabetes mellitus developed a bloody nasal discharge, facial edema, and necrosis of his nasal septum. Culture of his cloudy nasal secretions yielded Rhizopus species. What is the most important implication of this finding?

(A) No diagnostic value because this mold is an airborne contaminant.

(B) Consider treatment for rhinocerebral mucormycosis (zygomycosis).

(C) Strongly suggestive of ketoacidosis.

(D) Strongly suggestive of HIV infection.

(E) The patient has been exposed to indoor mold contamination.

An 8-year-old boy develops a circular dry, scaly, and pruritic lesion on his leg. What is the diagnostic significance of observing branching, septate, nonpigmented hyphae in a potassium hydroxide/calcofluor white preparation of a scraping from this skin lesion?

(A) Chromomycosis

(B) Dermatophytosis

(C) Phaeohyphomycosis

(D) Sporotrichosis

(E) No diagnostic significance

Which statement regarding the epidemiology of candidiasis is correct?

(A) Patients receiving bone marrow transplants are not at risk for systemic candidiasis.

(B) Patients with impaired or low numbers of neutrophils and monocytes are not at risk for systemic candidiasis.

(C) Patients with any form of diabetes have enhanced resistance to candidiasis.

(D) Patients with AIDS frequently develop mucocutaneous candidiasis, such as thrush.

(E) Pregnancy lowers the risk of candidal vaginitis.

Which statement regarding dermatophytosis is correct?

(A) Chronic infections are associated with zoophilic dermatophytes, such as Microsporum canis.

(B) Acute infections are associated with zoophilic dermatophytes, such as Microsporum canis.

(C) Chronic infections are associated with anthropophilic dermatophytes, such as Microsporum canis.

(D) Acute infections are associated with anthropophilic dermatophytes, such as Microsporum canis.

Which statement regarding the laboratory identification of fungi is correct?

(A) Histoplasma capsulatum typically requires less than 48 hours of incubation to yield positive cultures from clinical specimens.

(B) Since many saprobic (nonpathogenic) molds resemble dimorphic mycotic agents in culture at 30°C, the identification of putative dimorphic pathogenic fungi must be confirmed by conversion to the tissue form in vitro or by the detection of species-specific antigens or DNA sequence analysis.

(C) Molds are routinely speciated by a battery of physiologic tests, such as the ability to assimilate various sugars.

(D) A positive germ tube test provides a rapid presumptive identification of Candida glabrata.

(E) Budding yeast cells and abundant pseudohyphae are typical of Pneumocystis jiroveci.

A 28-year-old female sex worker from southern California complained of headaches, dizziness, and occasional episodes of “spacing out” during the past 2 weeks. A lumbar puncture revealed reduced sugar, elevated protein, and 450 mononuclear leukocytes per milliliter. She was seropositive for HIV. Her history is compatible with fungal meningitis due to Cryptococcus neoformans, Coccidioides posadasii, or a species of Candida. Which one of the following tests is confirmatory?

(A) Meningitis due to Coccidioides posadasii would be confirmed by a positive test of the CSF for cryptococcal capsular antigen.

(B) Meningitis due to Cryptococcus neoformans would be confirmed by a positive test of the CSF for complement fixation antibodies to coccidioidin.

(C) Meningitis due to a species of Candida would be confirmed by the microscopic observation of oval yeast cells and pseudohyphae in the CSF.

(D) Meningitis due to Coccidioides posadasii would be confirmed by a positive skin test to coccidioidin.

Which statement about phaeohyphomycosis is correct?

(A) The infection only occurs in immunocompetent patients.

(B) Infected tissue reveals branching, septate nonpigmented hyphae.

(C) The causative agents are members of the normal microbial flora and can be isolated readily from the skin and mucosa of healthy persons.

(D) Phaeohyphomycosis may exhibit several clinical manifestations, including subcutaneous or systemic disease, as well as sinusitis.

(E) Cases rarely respond to treatment with itraconazole.

A 37-year-old man with AIDS, currently living in Indianapolis, Indiana, presented with osteomyelitis of the left hip. A needle biopsy of the bone marrow was obtained, and the calcofluor white smear revealed a variety of myelogenous cells, monocytes, and macrophages containing numerous intracellular yeast cells that were elliptical and approximately 2 × 4 μm. What is the most likely diagnosis?

(A) Blastomycosis

(B) Candidiasis

(C) Cryptococcosis

(D) Histoplasmosis

(E) No diagnostic significance

The potassium hydroxide examination of sputum from a heart transplant patient with fever and pulmonary infiltrates contains oval budding yeast cells and pseudohyphae. What is the diagnostic significance?

(A) Aspergillosis

(B) Candidiasis

(C) Hyalohyphomycosis

(D) Phaeohyphomycosis

(E) No diagnostic significance

A middle-aged male resident of southern California received a liver transplant. During the following months, he gradually developed fatigue, weight loss, cough, night sweats, dyspnea, and a nonhealing subcutaneous nodule on his nose. The chest radiograph revealed hilar lymphadenopathy and diffuse infiltrates. Direct examination and culture of a respiratory specimen were negative. Skin tests with PPD, blastomycin, coccidioidin, and histoplasmin were negative. Serologic test results were as follows: Negative serum test for cryptococcal capsular antigen in blood, positive immunodiffusion test for serum precipitins to fungal antigen F, and negative immunodiffusion tests for precipitins to antigens h, m, and A. Serum tests for fungal complement fixation antibodies were negative for Blastomyces dermatitidis, as well as both the mycelial and yeast antigens of Histoplasma capsulatum but yielded a titer of 1:32 to coccidioidin. Which interpretation of these data is the most tenable?

(A) Clinical and serologic findings are inconclusive.

(B) Clinical and serologic findings are most consistent with active disseminated histoplasmosis.

(C) Clinical and serologic findings are most consistent with active disseminated blastomycosis.

(D) Clinical and serologic findings are consistent with active disseminated coccidioidomycosis.

(E) Clinical and serologic findings exclude a diagnosis of blastomycosis, histoplasmosis, and coccidioidomycosis.

Which statement regarding aspergillosis is correct?

(A) Patients with allergic bronchopulmonary aspergillosis rarely have eosinophilia.

(B) Patients receiving parenteral corticosteroids are not at risk for invasive aspergillosis.

(C) The diagnosis of pulmonary aspergillosis is frequently established by culturing Aspergillus from the sputum and blood.

(D) The clinical manifestations of aspergillosis include local infections of the ear, cornea, nails, and sinuses.

(E) Bone marrow transplant recipients are not at risk for invasive aspergillosis.

Which statement regarding sporotrichosis is correct?

(A) The most common etiologic agent is Pseudallescheria boydii (Scedosporium apiospermum).

(B) The etiologic agent is a dimorphic fungus.

(C) The ecology of the etiologic agent is unknown.

(D) Most cases are subcutaneous and nonlymphangitic.

(E) Most patients are immunocompromised.

A 24-year-old, HIV-negative migrant worker from Colombia presented with a painful ulcerative lesion on the tongue. The edge of the lesion was gently scraped and a calcofluor white-potassium hydroxide smear revealed tissue cells, debris, and several large, spherical, multiply budding yeast cells. Based on this observation, what is the most likely diagnosis?

(A) Blastomycosis

(B) Candidiasis

(C) Coccidioidomycosis

(D) Histoplasmosis

(E) Paracoccidioidomycosis

Which statement about blastomycosis is correct?

(A) Similar to other endemic mycoses, this infection occurs equally in men and women.

(B) Infection starts in the skin, and the organisms commonly disseminate to the lungs, bone, genitourinary tract, or other sites.

(C) The disease is endemic to certain areas of South America.

(D) In tissue, one finds large, thick-walled, single budding yeast cells with broad connections between the parent yeast and bud.

(E) All cases require treatment with amphotericin B.

Which statement regarding dermatophytosis is correct?

(A) Chronic infections are associated with zoophilic dermatophytes, such as Trichophyton rubrum.

(B) Acute infections are associated with zoophilic dermatophytes, such as Trichophyton rubrum.

(C) Chronic infections are associated with anthropophilic dermatophytes, such as Trichophyton rubrum.

(D) Acute infections are associated with anthropophilic dermatophytes, such as Trichophyton rubrum.

Which statement regarding paracoccidiomycosis is not correct?

(A) The etiologic agent is a dimorphic fungus.

(B) Most patients acquired their infections in South America.

(C) Although the infection is acquired by inhalation and is initiated in the lungs, many patients develop cutaneous and mucocutaneous lesions.

(D) The vast majority of patients with active disease are males.

(E) The etiologic agent is inherently resistant to amphotericin B.

Your kidney transplant patient has developed nosocomial systemic candidiasis, but the patient’s isolate of Candida glabrata is resistant to fluconazole. A reasonable alternative would be oral administration of: