FUNGI

Name

Identification

Superficial fungal
Tinea
(Ringworm)

Murray p. 745
(+) KOH

Stages/Development

Transmission

Virulence factors

Diseases

Keynote Sx

Pathology

direct contact w
infected ppl or
animals

likes areas of heat

& moisture

Tinea
versicolor

non-itchy, hypo-pigmented lesions

n upper torso, arms, abd

colonize outer layers of skin,

hair, nails w NO host immune
response

Tinea nigra

well-demarcated macular lesions

on palms/soils

skin infx

papular/nodular --> eventually

abscess & ulcerate; osseous lesion
Asx in 90%; acute flu-like illness;
"millet seed" pattern in Lungs

(+) Wood's lamp

(flourencent)
Systemic fungal
Histoplasma
capsulatum

Murray p. 772
KOH (+)

Coccidioides

Blastomyces
dermatiditis

Murray p. 769
skin test Ag (+)
can culture on
Sabourad agar but
INFECTIOUS!
KOH (+)

Dimorphic - mold in
soil, yeast in body
oval budding yeast in
intracellular tissue

inhalation
hyphae or condia

strict pathogen

dimorphic
25C - soil,
filamentous mold w
"barrel shaped"
athrocondia

spread thru dust

storms

valley fever

Asx in 60%; mild, fibrile to

moderately severe resp; "eggshell"
lesions on CXR

dimorphic

inhale condia

skin infx

slowly expanding ulcerative or

verrucous lesions w gratulous bace
on face

dust clouds

lung infx
(Gilchrist's
Dz)

50% Asx; dry hacking or

mucopurulent cough,
DRENCHING SWEATS, NO
calcified lesions

lung infx

Murray p. 765
yeast has round
double refractive
wall w single broadbased bud on side
KOH (+)

inhale bug; phagocytosed by

pulm Macrophage --> converts
to YEAST form & replicates
inside Macrophage, carried to
rest of body by lymph
in LU, anthrospores congregate
to make spherules, can calcify;
dissemination cz
granulomatous lesions in
bone/CNS

Opportunistic
fungal
Candida spp.
C. albicans

Murray p. 779
KOH (+)

oval yeast w single

bud

Asperigillus spp
Aspergillus flavus

Culture (+) on
sabourad agar
Germ tube test
forms blastospores
after 2-3hrs
(**unique)
High titer of fungal
glycoprotein Abs
stains gram (+)
Murray p. 791
Fungus ball on CXR

No yeast form
only mold form

inhalation

Culture on sabourad
agar show
characterisitic
hyphae
KOH (+)
Murray p. 717
CSF KOH (+)
Capsular Ag
(**diff than other
mycosis)
Urease (+)

mold w V shaped
branching, septate
hyphae

invade wounds

MP dimorphism in
pathogenisis
Encapsulated yeast

inhalation

Cryptococcus spp
Cryptococcus
neoformans

Pneumocystis
Pneumocystis carinii

Dimorphic but only

hyphae in body****

Murray p. 799
Infiltrates - ground Features like
glass appearance
protozoans
Typical octonucleate
cysts

Not contagious,
but can transmit
yeast infections
like STD
endogenous

inhalation of resp
droplets

Dz assco w
defective Tcell,
disruption of

Aflatoxin potent
carcinogen,
neurotoxin

NO dimorphism
in pathogenisis
capsule antiphagocytic
phenoloxidase

Oral
candidiasis

Focal white patches on oral

mucosa, palate, tongue that bleed
when scrapped off

Vaginal
candidiasis
Chronic
mucocutaneou
s candidiasis

Thick white curdy discharge

Disseminated
candidiasis

Infect spread to other organs, esp

eye

allergic rxn

hemoptysis, granulomas, brown

flecked sputum, "fungus ball" on
CXR; massive eosinophilia

Aspergillus
systemic dz

thrombis; infarcts, hemorrhage,

CNS & HT damage; KI/LV failure

Cryptococosis
meningitis
(m/c fungal
meningitis)

typical sx; skin lesions or

osteolytic bone lesions

has prediliction for meninges,

thrives in CSF

PC
pneumonia

diffuse inflitrates w "ground glass

appearance"; progressive dry
nonproductive cough

bug inhaled, attaches to

alveolar C, induces inflam,
damages BM, cz leakage of
plasma into LU (frothy
exudate)

Sup infect of skin, nails,

oropharynx; mult red pustular,
thick lesions, esp on face

Type I, III, IV hypersensitivity

rxn; increased resp distress w
continued exposure; plugs of
fungus block passages;
lesions w hyphae in BV

Environmental
molds
Stachybotris

Mucor spp

black slimy mold

grows only on wet
paper/wood
Murray p. 794
large fluffy white
colonies that turn
gray/brown w age

inhalation

toxin

zygomycete

systemic
poisoning
allergic rxn
opportunistic
infx

Penicillium

Rhizopus

Alternaria

Murray p. 777
"sausage" shaped
yeasts

Murray p. 794
colonies like "white
cotton candy" that
brown w age

dimorphic

zygomycete

Murray p. 797
"velvety" Colonies
dematiaceous fungi
dark green to brown;
rapidly growing

nosebleeds, cough, congestion,

pulmonary hemorrhage

inhalation,
ingestion,
contamination of
wounds

intracellular

allergic rxn

mycotoxin

Disseminated
infx

allergy to spores
infx of sinuses, skin, LU
spores contain mycotoxin that
some ppl are allergic to
infects skin, soft tissues, viscera;
F, cough, pulmonary infiltrates,
anemia, leukopenia; skin lesions

allergic rxn

allergic rxn

paranasal sinusitis

Pullalaria

Cladosprium

colonies white-pink,
blacken w age
Murray p. 798,
Merck p. 1225
colonies black,
brown or dark green
m/b powdery

worse w cigarette smoke

allergic rxn

allergic rxn

allergic rhinitis to asthma

opportunistic
infx

invasive sinusitis, subQ abscesses,

keratitis, LU masses, osteomylitis,
arthritis, endocarditis, chronic
meningitis

spores assoc w allergic rxn


VIRUSES
Family
Herpesviridae
double DNA

Virus
Murray p. 541
HSV-1

Test to identify

Virulence factors

Diseases

Keynote Sx
Dew drop on rose petal lesions that become pustules
w yellow crust

DNA polymerase (+)

Characteristic CPEs

Envelope fuses w host cell

mem
latent in sensory ganglion
cells of trigeminal ganglion
spread by syncytia (cell to
cell)

oral herpes

large, enveloped capsid

Tzanck smear (+) syncytia

(giant multi-nucleated cells)
Cowdry Type A inclusion bodies

HSV-2

PCR, ELISA
same as HSV-1

Varicella zoster
Diff than HSV b/c Smaller, replicate
slower, not released
from infected cells

Tzanck smear
FAMA Ab bond Ag
Cowdry Type A inclusion bodies
PCR
Culture diff, labile, often (-)

EBV
Gammavirus

Cytomegalovirus
contains both mRNA
& DNA** diff than
most viruses

latent in lumbar/sacral
genital herpes
ganglia
After infect, latent in dorsal chicken pox
root or cranial root ganglia
herpes zoster

Painful shallow ulcers; Regional lymphadenopathy;

Recurrent, prodrome
Blister lesions in diff sizes & stages, deep, painful,
scarring; F
Prodrome severe pain along dermatome; Small
red macules, closely spaced

Monospot (+)

B cell pathogen - NEEDS

CD21 receptor

Mononucleosis

High F, tonsils w white exudates, Lyphadenopathy

Heterophile (+) Ab recognize

Paul Bunnel Ag on farm animals
high IgM (acute infx); high IgG
(past infx)
Tissue biopsy: owls eye nucleus
enlarged cell w dense basophilic
inclusion in nucleus)

viral capsid Ag

Burkitt;s
Lymphoma

Lymphocyte tumour cells contain virus DNA

Latent in Tcells; prevents

cell from expressing MHC
I & interferes w CK
expression of MHC II
Infx is ISsupp

infantile
meningitis

Pneumonia, hepatitis, microcephaly

opportunistic infx

Pizza pie retinitis, Esophagitis, colitis, pneumonia

latent in Tcells

roseola infantum

abrupt onset High F, then 3-5 d later macularpapular

rash on trunk; slapped cheek

Cell culture: charact. CPE in

diploid fibroblast cells
heterophile (-) Ab
Anti-CMV IgM Ab
HHV-6

Latent or lytic infections

lifelong infx

Adenovirus
Linear dsDNA

Murray p. 533
Adenovirus
Hemagglutin (+)
** capsid has fibres at
vertices

Binds glycoprotein Ig
family receptor

respiratory infx

Acute: F, cough, pharyngitis; Atypical pneumonia:

pertussis-like illness w prolonged course

Lytic, latent infections

produces protein that bind
MHC-1

pharyngitis

Mild URT infection, F, rhinorrhea, cough

conjuctivitis
Shipyard eye
gastroenteritis

Inflame of palpebral and bulbar conjuctiva, pebbled

mucosa
Severe cramping, N/V, NO F

comman/plantar
warts
condyloma
acuminata
cervical cancer

Painless (m/c) wart on hands/feet

DNA polymerase (+)

Naked capsid (isohedral
shape)

resist drying,
detergents, ST acid,
mild Cl

Vector for gene therapy

Owl eye inclusion body w no

cytomegaly
C-reactive protein
Culture: characteristic CPE

Papillomaoviridae
dsDNA circular

Murray p. 523
HPV

Non-enveloped

PAP smear (presence of

koilocytes)
topical 5% acetic acid (tuns white
in areas w high DNA)

Local persistant infection

Dx on sx

Form sycytia

measles

Cough, coryza, conjunctivitis, photophobia,

Koplicks spots, maculopapular descending rash, F

Culture: difficult

Replicate in cell cytoplasm

subacute
sclerosing
panencephalitis

changes in memory, behavious, movement, etc

4x in measle specific IgM

hemagglutin protein - for

viral attachment

Naked capsid (isohedral)

Paramyxoviridae
ssRNA
Enveloped
helical capsid
replicate in cell
cytoplasm ** strange!
form syncytia

Murray p. 597
Morbillovirus (
Rubeola = Measles)

Lytic, chronic, latent or

transforming infections
Proteins inactivate tumour
suppressing genes p53

Genital warts; plaque-like, circumscribed, fleshcoloured

All ppl get infx

pathognomonic sx
ONLY 1 serotype
complete resistance to
re-infx
Severity depends of
SEC

fusion protein - for fusing

membranes

Mumps virus

Saliva/urine/CSF 4x in IgM in
blood

mumps

m/c aSx; sudden bilat parotitis, F, swelling of other

glands; 50% have CNS involvm

orchitis

swelling of testis

NO longterm immunity

severe pharyngitis

infx of upper/lower resp tract; rhinorrhea,

brochiolitis (infants), OM

CXR: Steeple sign

Infects URT epith cells

croup

Laryngeotrachebronchitis; sound worse than they

look - Seal bark, harsh brassy cough, mild resp
distress, low F, inspire stridor

Syncia
Hemabsorb guinea pig RBC
hemagglutinin (+)

Rarely systemic
Only partial immunity
giant cell formation, cell
lysis

Hemabsorb hemagglutinin (+)

Infects URT epith cells -->

viremia --> testes/ovaries,
paraotid gland (via
Stensons duct) -->
parotitis
lytic infx
Lifelong resistance

RSV
Smaller capsid more
fragile
Susceptible to freezing

hemagglutinin (-)

syncitia
4x in anti-RSV in blood
Direct ELIZA not reliable in
adults
Parainfluenza

Anti-viral Ag

Hepatitis viruses
grouped together b/c all
cz LV damage

Murray p. 675
HAV picornavirus

increased LV enzymes

acute hepatitis A

abrupt onset, mild sx, F, fatigue, N followed by

jaundice (80%)

insiduous onset; 75% aSx: F, malaise, N/V,

followed by jaundice

ssRNA
Naked capsid
(isohedral) extremely
stabile
ONLY 1 serotype
Not stable to Cl

Acute anti-HAV IgM

Life anti-HAV IgG
Direct ELIZA Ag in feces

HBV hepdnavirus
dsDNA, circular
Enveloped unusually
stable
reverse transcriptase
(+)

Acute: anti-HBcAg IgM,

HB(e,c,s)-Ag; cant find free Ab

makes antigenic decoy

proteins (HBsAg)

hepatitis B

Chronic active: HB(e,s)-Ag (+)

Chronic carrier: HBs-Ag (+) on
2+ occasions, HBV DNA(+)
Resolved: anti-HB(c,e,s)Ab
Elevated AST, ALT, etc
Ground glass hepatocytes

LV cell trophism

Cirrhosis
Liver Cancer
Carrier State

Acute: indirect ELIZA anti-HCV

Ab

High viral heterogeneity

hepatitis C

Acute m/c aSx, intermittant fatigue, arthralgia,

NO jaundice

PCR

Partial immunity

cirrhosis

15% rapid onset cirrhosis; 20% chronic cirrhosis

** unique RNA
replication
HCV flavavirus
ssRNA
enveloped

HDV
Viral parasite
Circular ssRNA
*unusual
*** Requires co-infx w
Hep B!!!
Double envelope (outer
is HBV)

ALT 8x normal
bilirubin
Ag to HDV and HBV

***REQUIRES HBV

Co-infection = HBV&
HBC at same time
Super-infection = HBV
first (more severe dz)

liver cancer
4% w chronic hep C
carrier state
40% aSx carrers
fulminant hepatitis Sx often severe; Fulminant hepatitis, hepatic
encephalopathy

Rhinovirus

Orthomyxoviridae
enveloped

Murray p. 588
Rhinovirus
icosahedral capsid
naked, small
mRNA
> 100 serotypes

Influenzae A

unique 8 segments Linear

ssRNA **facilitates
rearrangement
hemagglutinin &
neuroamidase spikes

Labile at acidic pH cant grow

in ST

m/c cause of common cold

Optimal growth at 33C

Resistant to drying/detergents
CPE in human fibroblast cells

transient immunity
gradual antigenic drift

Hemagglutin (+)

Antigenic Shift small

mutations every 2-3y

Neuroamidase (+)

Antigenic Drift major

recombination every 10y

sneezing, rhinorrhea

Influenzae A

Abrupt onset of F for 1-5 days; Non-productive

cough, severe myalgia

No antigenic drift

Influenzae B
Influenzae C

stomach flu, milder, GI sx

Damage d/t virus!

Polio

1) aSx; 2) abortive (mild febrile illness); 3) nonparalytic poliomyelitis (aseptic meningitis, HA,
back pain, etc); 4) paralytic: spinal asymmetric
flaccid paralysis in limbs, no sensory loss; bulbar
affects CN or medullary resp center

Binds glycoprotein Ig
family receptor

myocarditis

febrile illness, sudden HT failure; cyanosis,

tachycardia, cardiomegaly, hepatomegaly
MI sx w F
complication of mild aseptic meningitis; permanent
N damage, paralysis
range from common-cold sx to sore throat w
vesicular lesions
Mild F dz, w vesiculat lesions on hands, feet

Ant-HA abs protect against that

strain
Influenzae B
Influenzae C

Picornaviridae
icosahedral capsid
naked, small
mRNA
Stable pH, detergents,
heat

common cold

Murray p. 581
Polio virus
(enterovirus)

CPE on monkey tissue

CSF fluid test

Coxsackie

CPE on monkey tissue

4x increase in IgM Ab

Other enterovirus

pericarditis
encephalitis &
Paralytic dz
upper resp tract
infx
hand-foot-mouth
dz
gastroenteritis

Rhabdovirus
ssRNA

Murray p. 619
Rabies virus

bullet shape, enveloped

**not very cytolytic (usual

for an encephalitis dz)

rabies

aSx incube phase prodrome (2-10d) fever

malaise, HA, paresthesia at wound site
neurological (2-10d) hydrophobia, aerophobia,
aggressiveness, foaming at mouth; furious rabies
(death aka tetanus for a weak) or dumb rabies (death
aka symmetrical ascending paralysis in 2-3wks)

Resp tropism, not cytolytic

german measles

Regional LN, viremia, mild URTI, low F,

rhinorrhea small erythematous nodules gone
in 3 days

** heterologous
interference (protects you
from other viruses)

congenital rubella
syn = HELEN
KELLAR

Classic triad: eyes, ears, heart damage, and

microencephaly

Culture: difficult to grow

cytolytic infx

yellow fever

Titer often false (+)

viral RNA blocks mRNA

translation --> changes cell
permeability to favour viral
mRNA
Ab response: limits
viremia, some X-reactivity
but in subsequent infection
uptake of virus
CMI reponse: DTH, ag/ab
complexes can weaken
vaculature
replication in target tissues
--> express Fc receptors -> infectivity

dengue fever

Flu-like syndrome Hepatitis, hemorrhagic F,

Black Vomit, severe jaundice, F, shock, arthritis
Flu-like syndrome bone pain, high fever,
enlarged LN, maculopapular rash

ELIZA

Post mortem: Negri bodies

helical nucleocapsid
Togavirus
ssRNA

Murray p. 645
Rubivirus
hemagglutinin (+)
One serotype life
immunity
Always Sx

Enveloped
*replicate in cytoplasm
alpha & flavi virus

PCR of blood

ELIZA for WNV-IgM in serum

or CSF w/in 8d

encephalitis

many types - mild to severe

Retroviridae
Delicate outer envelope,
spherical
2 copies of ssRNA

encodes RNA-dep DNA

polymerase =
REVERSE
TRANSCRIPTASE

Murray p. 657
HIV-1
HIV-2

Initial screen indirect ELIZA for

gp120 or gp41
Western blot for gp120, p24,
p31
Active viral replication direct
ELIZA for p24
PCR viral load/RT in blood
Culture difficult!

trophism for CD4+ Tcells

& Macrophages
uses reverse transcriptase
to convert mRNA to
dsDNA --> error prone -->
many mutations
integrase - helps integrate
new copy of viral DNA
into host genome
protease - helps complete
viral proteins into new
virion
gp120 attaches to CD4
receptor on macrophage,
then Th cell & CCR5
chemokine receptors
(**vital to cz infect)
gp41 -- facilitates fusion of
viral envelope w host cell
membrane
host DNA pol 11
transcribes viral DNA,
enhancer/promoter region
viral protease makes
infectious virions --> lytic
infect or syncytia
Evades by: 1) inactivates T
cells, mac
2) hypervariable regions
Ag drift of gp120
3) latent infection unique
promoter/enhancer regions
4) direct/indirect
suppression of IS

AIDS

DEFINED AS: 1) anti-HIV gp120 Abs

2) CD4 cell count (<200)

3) wasting syndrome

4) presence of opportunistic infection

Poxviridae
very large, double layer
envelope

* envelop formed in
golgi
ovoid to brick shape
DNA virus
* replicate in cytoplasm
**contain all own
DNA/RNA for synthesis
(unusual!!)
Reoviridae
double layer capsid
10-12 segment dsRNA
non-enveloped
*but has glycoproteins
Parvovirus
Smallest DNA virus

Naked capsid (isohedral)

*assembles & replicates
in nucleus in S phase

Murray p. 565
Variola

Dx on sx

Life immunity if natural

exposure

smallpox

aSx stage, not contagious prodrome intense

viremia, high F, myalgia skin rash (most
contagious) thick opaque flued filled centre w
belly button like depression in center; Lesion at
same stage @ same time (diff than chicken pox)

molluscum
contagiosum

Genital tumors or benign warts form at contact pt,

fleshy, pearl-like umbilicated nodules w central
caseous plug, painless

infantile diarrhea

Projectile vomiting, water diarrhea, F, dehydration

erythema
infectiosum =
fifth dz

50% aSx: Non-specific URI, slapped cheek rash that

spreads to trunk lacy reticulate appearance; 2nd
stage - intense viremia, flu-like illness

PCR, CPE

mulluscipoxvirus

Murray p. 631
Rotavirus
can survive ST acid

Stool samples

**antigenic shift!
Immunity from mom for
6mon

Murray p. 573
Parvovirus B-19
VERY Resistant to
drying, acid/base, salt
1 serotype

ELIZA for B-19 specific Ag

PCR

bind P Ag on RBC,
vascular endoth --> anemia