CIULLA CHAPTER 7 - MYCOLOGY

A bulldozer operator became ill while working on a new C. Areas of the San Joaquin Valley are highly
1

highway in the San Joaquin Valley. He developed chest pain, endemic for Coccidioides immitis, and infectious
anorexia, headache and general malaise, and myalgia with arthroconidia of this fungus can be distrib- uted
fever. Chest X-ray showed pneumonic infiltrate and a single, in dust aerosols produced by construction and
well-defined nodule in the left lower lobe. His leukocyte count other disturbances. Symptomatic pulmonary
and sedimentation rate were slightly elevated. Although no disease patterns vary, but the signs and
fungus was seen in direct examination of a sputum symptoms given are found in many cases. The
specimen, processing included a culture on Sabouraud fungus grows more rapidly than do other
dextrose agar with chloramphenicol and cycloheximide. systemic fungal pathogens, and the aerial
Within 3 days at 30°C,this culture produced moist, grayish mycelium will typically produce the characteristic
growth, and white aerial mycelia began to develop (see Color barrel-shaped arthrospores.
Plate 30). A lactophenol cotton blue wet mount of this
organismis seen in Color Plate 31. What is the most likely
identification of this fungus?
A. Asperigillus fumigatus
B. Blastomyces dermatitidis
C. Coccidioides immitis
D. Histoplasma capsulatum

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2 A 38-year-old male from Ohio presented to his physician with D. The distribution of Histoplasma capsulatum is
a mild influenzalike illness that included headache and probably worldwide, but most clinical disease
occurs in the western hemisphere. Most cases
malaise. His chest X-ray showed no infiltrates. His past
in the U.S. occur in the Ohio and Mississippi
medical history was unremarkable. He had no history of River valleys. This organism is found in areas
travel but reported recently cleaning the bell tower at his contami- nated by large amounts of bird
excrement, such as starling and blackbird
church, which was littered with bird excrement. The most
roosts. Inhalation of the spores results in a
likely agent causing his disease is respiratory illness usually with clinical symptoms
A. Aspergillusfumigatus within 2 weeks of exposure. Disease ranges
B. Coccidioides immitis from a mild influenzalike illness to acute
C. Candida albicans fulminant lung infection resembling tuberculosis.
D. Histoplasma capsulatum

A 44-year-old gardener pricked herself with a rose thorn. A D. Sporothrix schenckii is the agent of
3

subcutaneous fungal infection characterized by the develop- sporotrichosis. It usually enters the skin by
ment of necrotic ulcers followed this direct inoculation of traumatic implantation. This fungus grows in
fungal spores into the skin. The causative fungus was vitro as small yeasts at 35°C and as a mould at
cultured as a small yeast form at 35°C (see Color Plate 32) room temperature (22-30°C) with delicate
and as a mould at room temperature with delicate hyphae hyphae and conidia.
and conidia. This disease is
A. Blastomycosis
B. Chromomycosis
C. Mycetoma
D. Sporotrichosis

A yeastlike fungus was isolated from a sputum sample. No C. All species listed may be urease positive, but
4

hyphae were produced on cornmeal agar with Tween 80. The C. terreus does not grow at 35°C and may
assimilate nitrate. C. krusei is inositol negative,
isolate was negative for nitrate assimilation and positive for
and these species of Candida and Trichosporon
inositol assimilation and produced urease at 37°C. These produce hyphae on morphology agar. C. neofor-
findings are typical of mans typically does not produce hyphae and is
nitrate negative, is inositol and urease positive,
A. Candida krusei
and grows at 37°C.
B. Cryptococcus terreus
C. Cryptococcus neoformans
D. Trichospown beigelii

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5 A 24-year-old Vietnamese refugee was seen at a clinic in D. Infections due to Penicillium marneffei seem
Houston. His chief complaints were weight loss and fever. A to originate in eastern and southeastern Asia.
complete blood count confirmed he was suffering from This fungus was first isolated in 1959 from a
anemia as well. Multiple skin lesions were present on his hepatic lesion from a bamboo rat, a rodent
arms, some of them draining pus. Gram stain of the pus found throughout Southeast Asia. Clinical
revealed what appeared to be yeastlike cells. A culture of the disease includes fever, weight loss, anemia, and
pus grew a green mould at 22°C, which produced a red death if untreated. Skin lesions may be present
soluble pigment (see Color Plate 33). A lactophenol cotton and may drain pus. Diagnosis is made via
blue wet mount of this organism is seen in Color Plate 34. culture or histopathologic exam of lesions of
The causative agent in this case is skin, bone, or liver. The yeastlike cells of P.
A. Aspergillus fumigatus marneffei are oval (3-8 um) and scattered
B. Fusarium sp. throughout tissue. Elongated, sausage-shaped
C. Trichoderma sp. cells often contain cross-walls. At 22-30°C,
D. Penicillium marneffei structures typical of the genus Penicillium
develop. At 35-37°C, round or oval yeastlike
cells are seen.

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6 A section of a lymph node stained with the Gomori silver and C. Diagnostic features of H. capsulatum include
hematoxylin and eosin stains is shown in Color Plate 35 . A large, 8- to 14-um macroconidia with tuberculate
lactophenol cotton blue wet mount of a mould that grew from projections. Tuberculate and smooth
this specimen is shown in Color Plate 36 . Large, one-celled, macroconidia may be seen in the same colony.
smooth to tuberculate macroconidia and smooth or Microconidia are also produced.
echinulate microconidia are typical of mycelial phase growth
of
A. Blastomyces dermatitidis
B. Coccidioides immitis
C. Histoplasma capsulatum
D. Paracoccidioides brasiliensis

Which of the following types of Candida albicans infection is B. Neonatal thrush is the oral candidiasis most
7

commonly acquired from an exogenous source? commonly associated with mothers having
A. Diaper rash vaginal Candida, and the newborn acquires the
B. Neonatal thrush organism from the mother. Diaper rash due to C.
C. Perianal infection
albicans usually follows oral and perianal
D. Urinary tract infection
candidiasis of the infant. The other three
infections are associated with physiologic
changes in the host that permit proliferation of
C. albicans already present in the host's
micronflora.

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8 In a direct examination of a KOH wet mount of a nail A. KOH wet mounts should be used routinely for
specimen, Epidermophyton floccosum could be detected as direct examination of nails, skin, or hair for
A. Arthroconidia fungal elements. KOH digests the keratinous
B. Blastoconidia tissue and facilitates observation of any fungi
C. Macroconidia present. Epidermophyton floccosum and
D. Microconidia Trichophyton spp. invade nails, and the former
typically is found as chains of arthroconidia in
nail tissue.

The mould phase of the systemic fungus Blastomyces A. At 25-30°C, Blastomyces dermatitidis forms
9

dermatitidis can be confused with septate hyphae with delicate conidiophores of

A. Scedosporium apiospermum
various lengths that bear round or oval conidia.
B. Sporothrix schenckii
C. Aspergillus sp. It is important not to confuse the mould phase of
D. Penicillium notatum B. dermatitidis with either Scedosporium
apiospertnum or Chrysosporium sp. S.
apiospermum appears as septate hyphae with
simple conidiophores of various lengths that
bear oval conidia singly or in groups. S.
apiospermum is the causative agent of
mycetoma and can infect brain, bones, eyes,
lungs, etc. Chrysosporium sp. appears as
septate hyphae with simple to branched
conidiophores that bear oval conidia.
Chrysosporium sp. is commonly considered a
contaminant.

It is usually difficult or impossible to identify a fungal culture B. Conidiophores of Aspergillus arise from a foot
10

before it is mature. However, hyaline, septate hyphae, and a cell and terminate in a vesicle. The vesicle
young conidiophore with a foot cell (see Color Plate 37) and a
produces phialides; the phialides then produce
swollen vesicle are excellent clues to the identification of
A. Acremonium the conidia. Before the culture is mature, the
B. Aspergillus presence of a young conidiophore with a foot
C. Paecilomyces
cell and vesicle is a good clue to the identity of
D. Penicillium
the fungus.

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11 Zygomycetes are rapidly growing, airborne D. Although generally found as laboratory contaminants,
saprobes. In clinical specimens they the zygomycetes can be clinically significant.
A. Are common as normal, human microflora Zygomycosis (mucormycosis) is an acute disease that
B. Are found only as contaminants often results in death within a few days in acidotic
C. May be seen in a dimorphic tissue phase patients. Fungal agents of mucormycosis include
D. May be found as a cause of rapidly fatal Rhizopus, Mucor, and Absidia, which are common fungi
infection found in the environment.

Trichophyton rubrum and T. mentagrophytes may D. When speciation of T. mentagrophytes or T. rubrum is

12

be differentiated by the not certain on morphology alone, the in vitro hair

A. Consistently different appearance of their perforation test is useful; T. men- tagrophytes is positive
colonies and T. rubrum is negative. Urease production by T.
B. Endothrix hair infection produced by T. rubrum mentagrophytes is less reliable. Neither species produces
C. Fluorescence of hairs infected with T. rubrum endothrix infection, and T. rubrum rarely infects hair.
D. In vitro hair penetration by T. mentagrophytes

Broad, coenocytic hyphae found in tissue would be D. Rhizopus and other fungal agents of mucormycosis are
13

most typical of infection with characterized by having coenocytic (nonseptate) hyphae.

A. Aspergillus The finding of broad, nonseptate hyphal elements in
B. Blastomyces sterile body fluids or tissue can provide rapid confirmation
C. Microsporum of a clinical diagnosis of mucormycosis. The other moulds
D. Rhizopus listed have septate hyphae.

A fungus infecting only skin and nails typically D. Epidermophyton floccosum infects skin and nails. This
14

produces in culture dermatophyte produces thin-walled macroconidia, usually

A. Spindle-shaped, hyaline, echinulate in clusters, but no micro- conidia. Microsporum spp.
macroconidia and microconidia produce infections in hair and skin. Trichophyton spp. may
B. Cylindrical or club-shaped, smooth, thin-walled produce infection of the nails, hair, and skin.
macroconidia and microconidia
C. Many microconidia in clusters or along the
hyphae
D. Large, thin-walled, club-shaped macroconidia
without microconidia

The most useful finding for prompt, presumptive D. Essentially all strains of Candida albicans produce
15

identification of C. albicans is its germ tubes within 2 hours of incubation at 37°C in serum.
A. Failure to assimilate sucrose Chlamydospores are produced by most strains of C.
B. "Feathering" on EMB albicans after 24-48 hours at 22-26°C on cornmeal Tween
C. Production of chlamydospores 80 agar or a similar substrate. Use of eosin methylene
D. Production of germ tubes blue medium to screen for C. albicans may require 24-48
hours of incubation.

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16 Identify the dimorphic fungus that typically has a D. The dimorphic pathogenic fungi include the species
tissue phase in which the large mother cells have listed. The parasitic or tissue phase of P. brasiliensis
one to a dozen narrow-necked buds and a slowly produces large, multiple-budding yeasts, 20-60 um long.
growing mycelial form with intercalary chlamydo- The saprophytic or mycelial phase colonies resemble B.
conidia and coiled hyphae. dermatitidis, but all cultures produce intercalary
A. Blastomyces dermatitidis chlamydoconidia and coiled hyphae, and conidia develop-
B. Coccidioides immitis ment is delayed or absent. Clinical types of
C. Histoplasma capsulatum paracoccidioidomycosis include relatively benign primary
D. Paracoccidioides brasiliensis pulmonary infection; progressive pulmonary disease;
disseminated disease; or an acute, fulminant, juvenile
infection. The disease is endemic in certain areas of
Central and South America.

Which of the following stains greatly enhances the C. The calcofluor white stain requires the use of a
17

visibility of fungi by binding to the cell walls, fluorescence microscope. It is a rapidly staining method,
causing the fungi to fluoresce blue-white or apple requiring only one minute to complete. Stain binds to
green? chitin in the cell wall of fungi.
A. Rhodamine-auramine
B. Warthin-Starry
C. Calcofluor white
D. Periodic acid-Schiff

The formation of arthroconidia is not an important D. Barrel-shaped arthroconidia, alternating with empty
18

characteristic in the identification of cells, are typical of the mature mycelial phase of
A. Coccidioides Coccidioides immitis. Species of Geot- richum produce
B. Geotrichum chains of hyaline arthroconidia, and Trichosporon is
C. Trichosporon characterized by production of hyaline arthroconidia,
D. Sporothrix blastoconidia, hyphae, and pseudohyphae.
Aureobasidium produces dematiaceous arthroconidia.
Sporothrix is the sole member of the list that does not
produce arthroconidia.

A black pigment produced by colonies growing on B. Phenol oxidase breaks down the substrate found in
19

bird seed agar is due to niger seeds producing melanin. This result is
A. Urease characteristic of C. neoformans. C. neo- formans is
B. Phenol oxidase urease positive, but that reaction is not detected on this
C. Sucrose assimilation medium.
D. Arthroconidiaproduction

Which of the following fungi is not considered an C. Absidia and Mucor can cause the uncommon disease
20

opportunistic pathogen? mucormycosis in debilitated patients. Rhinocerebral

A. Absidia syndrome is the form of this infection most often seen in
B. Aspergillus the U.S. Species of Aspergillus are ubiquitous and
C. Coccidioides opportunis- tic and cause a variety of human infections.
D. Fusarium Fusarium is one of the saprobic fungi most often found in
external mycotic keratitis following corneal trauma.
Coccidioides is considered a true pathogen that can infect
healthy people.

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21 Observation of hyaline or dematiaceous hyphae is A. Observation of dark pigmented hyphae in a culture is
an early clue in the identification of common, evidence that the fungus is in one of the dematiaceous
airborne fungi. Which of the following genera genera. Typically, the reverse of a plate will be black.
contains species found as dematiaceous Alternaria is a common dematiaceous contaminant.
contaminants?
A. Alternaria
B. Aspergillus
C. Fusarium
D. Penicillium

Which of the following fungi is most likely to be C. Mycotic keratitis due to Fusarium has been reported
22

found as a common saprobe and as an agent of following injury or cortisone treatment. An ulcerative lesion
keratitis? develops on the cornea. Corneal scrapings may be
A. Exophiala received for direct exam and culture.
B. Phialophora
C. Fusarium
D. Wamgiella

The microscopic identification of Pneumocystis B. Pneumocystis jirovecii produces cysts and trophozoites
23

jirovecii is based on the detection of that can be found in respiratory tract specimens. The
A. Arthroconidia in subcutaneous tissue biopsies fungus primarily infects the lungs, so specimens from the
B. Cysts and trophozoites in respiratory specimens lower respiratory tract are most productive (e.g.,
C. Yeasts in respiratory specimens brochoalveolar lavage). Specimens can be stained with a
D. Tuberculate macroconidia in lung biopsies silver stain or Giemsa stain.

Fungi that undergo asexual reproduction are termed A. Fungi with only an asexual stage of reproduction are
24

A. Imperfect referred to as the imperfect fungi. Fungi able to reproduce

B. Perfect sexually are called the perfect fungi. "Septate" and
C. Aseptate "aseptate" refer to the presence or absence (respectively)
D. Septate of crosswalls in hyphae.

Hyaline septate hyphae, branched or unbranched A. Diagnostic features of Fusarium spp. include hyaline
25

conidiophores, and multicelled banana-shaped septate hyphae and sickle- or banana- shaped
conidia are characteristic of which of the following? macroconidia. Macroconidia are multi-septate with long or
A. Fusarium short branched or unbranched conidiophores.
B. Curvularia Microconidia (one or two celled) are also produced.
C. Acremonium
D. Trichophyton

Which of the following does not correctly describe B. Rhodotorula rubra has been isolated from soil, water,
26

the yeast Rhodotorula rubra? and a number of food sources, especially daily products
A. It has been isolated from dairy products, soil, and as a contaminant of skin, lung, urine, or feces.
and water. Rhodotorula fungemia has been caused by contaminated
B. It is the most common fungal cause of diaper catheters, intravenous solutions, and dialysis machines.
rash. C. albicans is a more common cause of diaper rash.
C. It has been identified as a nosocomial pathogen.
D. It has been found as a contaminant or
commensal in specimens of urine, sputum, and
feces.

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27 A 21-year-old male member of a university track D. Malassezia furfur is the causative agent of tinea or
team presents to student health services with a light pityriasis versicolor—a superficial skin infection that
brown circular lesion on his upper back. The agent occurs commonly on the upper back, chest, shoulders,
most likely responsible for this condition is upper arms, and abdomen. Initially lesions are discrete
A. Candida albicans but in time may coalesce. Lesions may be hyper- or
B. Fusarium spp. hypopigmented. M. furfur is part of the normal skin flora of
C. Geotrichum candidum over 90% of adults. There may be an association between
D. Malasseziafurfur the disease and excessive sweating. The disease is more
common in tropical and subtropical areas.

Which of the following is likely to be found in clinical D. C.albicans is an endogenous species causing a variety
28

specimens as normal microflora and as clinically of opportunistic infections. Infection is usually secondary
significant isolates? to a predisposing debility. Aspergillus spp. are common
A. Aspergillus niger saprophytic con- taminants. Paracoccidioides brasiliensis
B. Paracoccidioides brasiliensis and Penicillium marneffei are dimorphic fungi that cause
C. Penicillium marneffei systemic mycoses.
D. Candida albicans

A 4-year-old child's hair is falling out in patches. The A. Microsporum audouinii most commonly affects
29

hair fluoresces when subjected to the UV light from children. Only rarely are adults infected. Colonies are flat,
a Wood's lamp. When the hair is cultured, a white downy to silky, and gray to white in color. Colony reverse
cottony mould grows at 25°C on potato dextrose is salmon to brown with a reddish-brown center.
agar. Microscopically, rare microconidia, septate Microscopic examination reveals septate hyphae, terminal
hyphae, and terminal chlamydospores are seen. chlamydoconidia, and occasional microconidia (borne
Macroconidia are absent. The mould fails to grow on singly). Macroconidia are very rare or absent. Infected
polished rice grains. The causative agent is hair fluoresces. Growth on polished rice grains aids in
A. Microsporum audouinii differentiating M. audouinii from other Microsporum
B. Microsporum gypseum species that grow well on rice grains.
C. Trichophyton mentagrophytes
D. Trichophyton rubrum

In tissues infected with Histoplasma capsulatum D. Histoplasma capsulatum is found primarily within
30

A. The hyphae usually invade blood vessels histiocytes and in macrophages or monocytes in
B. Encapsulated yeast cells are typical specimens from bone marrow aspirates, biopsies, or the
C. Tuberculatemacroconidiaaretypical buffy coat of centrifuged blood. Unstained cell wall of the
D. The fungus is usually intracellular tissue (yeast) form of H. capsulatum may be mistaken for
a capsular halo in stained preparations. Only the mould
phase would exhibit hyphae and macroconidia.

For each numbered mycosis below, choose the B. Blastomyces dermatitidis is rarely found in the
31

letter of the environment most commonly associated environment, and there is no reliable skin test for
with an increased incidence of that infection. screening for past or subclinical blastomyco- sis.
Outbreaks occur most frequently following exposures to
Blastomycosis moist environments like streams and rivers. The incidence
of clinical cases in the U.S. is highest in the Mississippi
A. Lower Sonoran Life Zone and Ohio River basins and part of the Missouri River
B. Mississippi and Ohio River basins drainage.
C. Pigeon roosts
D. Bat roosts

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32 Coccidioidomycosis A. The most highly endemic regions of
coccidioidomycosis are semiarid, with dry, hot seasons
A. Lower Sonoran Life Zone and wetter, cooler seasons above freezing. The areas of
B. Mississippi and Ohio River basins the southwestern U.S. and northern Mexico with this
C. Pigeon roosts typical Lower Sonoran Life Zone climate have the highest
D. Bat roosts incidence of coccidioidomycosis. The peak endemic
period is fall, when the fungus becomes airborne from the
desert surface.

Cryptococcosis C. Although Cryptococcus neoformans does not appear to

33

infect pigeons, it apparently passes unharmed through

A. Lower Sonoran Life Zone their gut. It has been found in large numbers, even as the
B. Mississippi and Ohio River basins predominant microorganism, from the debris of old pigeon
C. Pigeon roosts roosts. Viable, virulent, desiccated cells, small enough to
D. Bat roosts be inhaled into the alveoli, can be present in the dust of
these roosts.

For each numbered mycosis below, choose the B. The most highly endemic areas of histoplasmosis
34

letter of the environment most commonly associated (Missouri, Kentucky, southern Illinois, Indiana, and Ohio)
with an increased incidence of that infection. also have the most starlings, whose flocks produce large
accumulations of guano. Histoplasma capsulatum has
Histoplasmosis been found growing in almost pure culture in accumulated
starling guano. Exposure to aerosols containing many
A. Sphagnum moss spores of this fungus has been associated with a number
B. Starling roosts of "common source" outbreaks of histoplasmosis.
C. Stagnant fresh water
D. Colorado River Valley

Sporotrichosis A. In temperate countries, including the U.S.,

35

sporotrichosis is an occupational hazard of gardeners and

A. Sphagnum moss nursery workers and is frequently associated with contact
B. Starling roosts with sphagnum moss. In Mexico, it has been associated
C. Stagnant fresh water with working with grass, and a well-known epidemic in
D. Colorado River Valley South Africa involved gold mine workers in contact with
untreated mine poles. Sporothrix schenckii pro- duces
subcutaneous infections that begin at the site of traumatic
implantation.

For each numbered incomplete statement, select the B. White piedra is frequently caused by Trichosporon
36

letter of the most appropriate species. ovoides and T. inkin. T. beigelii was the name formerly
used for the species infecting humans. The disease is
The cause of white piedra characterized by soft, white to light brown nodules around
and in the hair shaft. The nodules are composed of
A. Hortaea werneckii hyphae, yeastlike arthroconidia, and sometimes blasto-
B. Trichosporon sp. conidia. The beard and body hair are more often affected
C. Piedraia hortae than scalp hair.
D. Fonsecaea compacta

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37 The cause of black piedra C. Black piedra is caused by Piedra hortae, which
produces brown to black, gritty nodules on the outside
A. Hortaea werneckii and under the cuticle of the hair shaft. Scalp hair is the
B. Trichosporon sp. site most often involved. Direct microscopic examination
C. Piedraia hortae of portions of these nodules in KOH wet mounts can show
D. Fonsecaea compacta septate dematiaceous hyphae and ascospores.

The cause of tinea nigra A. Tinea nigra is a superficial skin infection caused by
38

Hortaea wemeckii. The pigmented, painless lesion, which

A. Hortaea werneckii usually occurs on the palms or ringers, may be mistaken
B. Trichosporon sp. for melanoma. Accu- rate laboratory findings in a KOH
C. Piedraia hortae preparation of a skin scraping are important in preventing
D. Fonsecaea compacta surgical mutilation of the patient. Microscopic examination
of skin scrapings from tinea nigra shows dematiaceous,
septate hyphae and budding cells.

For each numbered incomplete statement, select the B. Tinea versicolor is a chronic, mild, superfi- cial skin
39

letter of the most appropriate species. infection caused by Malassesia furfur, which may also be
found on normal skin. Despite the name "tinea versicolor,"
The cause of tinea versicolor the causative fungus is not a dermatophyte. Skin
scrapings from the lesions demonstrate characteristic
A. Aspergillus niger yeastlike cells and hyphae.
B. Malassesiafurfur
C. Microsporum gypseum
D. Geotrichum Candida

A keratinophilic saprophyte C. Microsporum gypseum is a keratinophilic fungus

40

(dermatophyte). It has a geophilic species that has been

A. Aspergillus niger isolated from human infections. It is a moderately rapid
B. Malassesiafurfur grower, producing numerous thick-walled rough
C. Microsporum gypseum macroconidia.
D. Geotrichum Candida

A cause of otomycosis A. Aspergillus niger causes approximately 90% of the

41

otomycoses and external ear infections due to fungi.

A. Aspergillus niger Aspergillus fumigatus also causes otomycosis. Other
B. Malassesiafurfur fungi, far less often involved, include Scopulariopsis,
C. Microsporum gypseum Penicillium, Rhizomucor, Candida, and other species of
D. Geotrichum Candida Aspergillus.

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42 The incomplete statements below describe the B. Geotrichum spp. typically produce numerous hyphae
appearance of growth of yeast or yeastlike fungi in and arthroconidia. Germinating arthroconidia of
morphology agar, such as rice agar or cornmeal Geotrichum, however, may be mistaken
agar with Tween 80, a finding helpful in the presum for blastoconidia production. This may cause confusion
ptive identification of these organisms. For each between Geotrichum and Trichosporon.
numbered description, select the letter of the most
appropriate species.

True hyphae and arthroconidia only

A. Candida albicans
B. Geotrichum
C. Trichosporon
D. Aspergillus fumigatus

True hyphae, arthroconidia, and blastoconidia C. Trichosporon spp. produce hyphae and arthroconidia.
43

They may also produce blastoconidia, although these may

A. Candida albicans be rare. If present, blastoconidia can differentiate
B. Geotrichum Trichosporon from Geotrichum.
C. Trichosporon
D. Aspergillus fumigatus

Pseudohyphae, blastoconidia, and chlamydospores A. Candida albicans and C. dubliniensis both produce
44

pseudohyphae and are germ tube positive. Both are

A. Candida albicans capable of producing chlamydospores and blastoconidia.
B. Geotrichum These two species are difficult to differentiate.
C. Trichosporon
D. Aspergillus fumigatus

The incomplete statements below describe the B. Candida tropicalis typically produces long- branched
45

appearance of growth of yeast or yeastlike fungi on pseudohyphae. Blastoconidia are pro- duced singly or in
morphology agar, such as rice agar or cornmeal short chains. This species does not produce
agar with Tween 80, a finding helpful in the chlamydospores. The carbon assimilation pattern of C.
presumptive identification of these organisms. For tropicalis resembles that of C. albicans, and some strains
each numbered description, select the letter of the of C. tropicalis may produce a positive germ tube test if
most appropriate species. incubated more than 3 hours.

Pseudohyphae and blastospores only

A. Mucor sp.
B. Candida tropicalis
C. Cryptococcus neoformans
D. Candida albicans

Blastospores only, without hyphae or C. Cryptococcus neoformans produces only blastoconidia

46

pseudohyphae when growing on morphology agar (e.g., cornmeal agar

with Tween 80). This species is usually identified by its
A. Mucor sp. encapsulated cells, production of urease, failure to
E. Candida tropicalis assimilate nitrate, and production of brown pigment on
F. Cryptococcus neoformans bird seed agar. Cryptococcosis can lead to systemic
G. Candida albicans infections in immunocompromised patients.

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47 Select the letter of the most appropriate specimen B. The most frequently diagnosed form of cryptococcosis
source for isolation of each numbered species is central nervous system infection. Few or many
description. organisms may be in the cere- brospinal fluid, but a
clinical diagnosis of menin- gitis can often be confirmed by
Cryptococcus neoformans the cryptococcal antigen test. In the past, the use of a
microscopic examination of a spun specimen with India
A. Bone marrow ink has been used. The cryptococcal antigen test is much
B. Cerebrospinal fluid more sensitive and is the recommended test.
C. Chronic draining sinus tract of foot
D. Chronic interdigital lesion of foot

Histoplasma capsulatum A. Histoplasma capsulatum is a parasite of the

48

reticuloendothelial system and is seldom extra- cellular.

A. Bone marrow Specimens such as sternal bone marrow, lymph node,
B. Cerebrospinal fluid liver and spleen biopsies, or buffy coat of blood should be
C. Chronic draining sinus tract of foot stained with Giemsa or Wright's stain and examined for
D. Chronic interdigital lesion of foot small, intracellular yeast cells.

Pseudallescheria boydii C. Pseudoallescheria boydii is the most common cause of

49

eumycotic mycetoma in the U.S. Mycetoma is a clinical

A. Bone marrow syndrome of localized abscesses, granulomas, and
B. Cerebrospinal fluid draining sinuses that develops over months or years. It
C. Chronic draining sinus tract of foot usually occurs on the foot or hand after traumatic
D. Chronic interdigital lesion of foot implantation of soil organisms.

Trichophyton mentagrophytes D. Trichophyton mentagrophytes is a common cause of

50

intertriginous tinea pedis or athlete's foot. This is a chronic

A. Bone marrow dermatitis most often affecting the areas between the
B. Cerebrospinal fluid fourth and fifth and third and fourth toes. The acute
C. Chronic draining sinus tract of foot inflammation often subsides, but recurrences are
D. Chronic interdigital lesion of foot common.

CIULLA: CHAPTER 7 – MYCOLOGY [COMPILED BY: SRYB3] 13