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  #1  
Old 08-08-2013
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Smile Histoplasmosis Coccidioidomycosis and Blastomycosis

I always find these Fungus questions - Blastomycosis , Coccidiidomycosis,
Histoplasmosis questons very difficult.
I dont know whats the trick with all the overlapping clinical features
and Geographic distribution.
A few points i remember so far

Blastomycosis- missisipi, ohio , highest infection rate wisconsin
clinically resembles TB and Histopl.........lol confusion again
charecteristic skin lesion
Broad based budding yeast

Aspergillosis - is a good one
easy to answer if question says solid fungus ball in cavity
but whats the geographu, cant remember

IS there a trick to remember these??
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  #2  
Old 08-08-2013
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im not american so whenever they say 'a 45yr old pt from mississipi' i say UGH when im sure americans are like hell yes, and know the answer already lol
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Old 08-09-2013
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Quote:
Originally Posted by rg99 View Post
I always find these Fungus questions - Blastomycosis , Coccidiidomycosis,
Histoplasmosis questons very difficult.
I dont know whats the trick with all the overlapping clinical features
and Geographic distribution.
A few points i remember so far

Blastomycosis- missisipi, ohio , highest infection rate wisconsin
clinically resembles TB and Histopl.........lol confusion again
charecteristic skin lesion
Broad based budding yeast

Aspergillosis - is a good one
easy to answer if question says solid fungus ball in cavity
but whats the geographu, cant remember

IS there a trick to remember these??
They are not hard at all you just need a few tricks..

Histoplasmosis and Blastomycosis share the exact same geographical distribution however..
Histoplasmosis clues:
Cave explorer, bat exposition--> bat took a **** and patient inhaled that ****, either that or a bird **** can work as well.!
Clinical presentation of Histplasmosis will be a pneumonia like syndrome with general symptoms like fever, fatigue and so on.
Pathological clue will be either dimorphic yeast OR macrophages full of yeasts!

Blastomycosis: same geographical distribution.
Also has pulmonary involvement, however it will be given with skin and bone lesions as well!
Blasto wont have a description of bat or bird **** so it is easy to distinguish them
BROAD BASED YEASTS will ALWAYS BE GIVEN (I have never seen a question that does not say at least this).

Aspergillus: Doesnt have a geographical area.. The pt has to be immunocompromised and they have to say cavitation in the lung. They can also describe the fungus as septate branched hyphae.
Inhalation of spores is the most common method of infection
The lung infection is characterized by hemoptysis (when I mean this it is really a bad hemoptysis.. some say it is even worse than TB hemoptysis)!

As you see no confusion at all.. Just gotta know the clues.
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Old 08-09-2013
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I struggled with this for the longest but from what I know and have read from Uworld so far.

blasto- lung, skin, bone (osteolytic lesion) PROSTATE (maj diff feature)

Histo- Palatal Ulcers (most imp) also they have pancytopenia and hepatospleenomegaly as they infect the RE system

coccidioides- they have erythema nodosum and the same lung features as blasto

Also know the area of distribution

Hope this helps!
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Old 08-10-2013
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@xpaezx

I saw one q on UW where blasto was without mentioning broad base yeast lol,
But you could easily narrow down to histo or blasto and the key to the answer were - skin lesions
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Quote:
Originally Posted by DocSikorski View Post
@xpaezx

I saw one q on UW where blasto was without mentioning broad base yeast lol,
But you could easily narrow down to histo or blasto and the key to the answer were - skin lesions
Probably yeah.. I dont remember ever having a question without them mentioning the broad base yeast.. and as you said If they dont mention that they will have to mention skin/soft tissue/bone lesions.

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Old 08-11-2013
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Thanks everyone! this is a thorny area for me as well but your explanations have been very helpful.Good job!
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Old 08-11-2013
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can someone explain to me histo vs aspergillus? i always confuse those two.
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Old 08-11-2013
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Quote:
Originally Posted by Dr.NickRiviera View Post
can someone explain to me histo vs aspergillus? i always confuse those two.
Histo - Lobar infiltrate , mediastinal lymadenopathy, calcified nodes CXR
Asper- solid fungal ball in cavity is classic
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Old 08-15-2013
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Quote:
Originally Posted by rg99 View Post
Histo - Lobar infiltrate , mediastinal lymadenopathy, calcified nodes CXR
Asper- solid fungal ball in cavity is classic
ahhh i got another question on these two wrong in UW. ughh
which one is in immunocompromised/AIDS?
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Old 08-15-2013
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Default Broad-based concept

Broad-based in Blastomycosis is not a characteristic skin lesion ,, it describes the relationship between two particles of a budding that they are not meeting in a single point but they meet a long a broad area


Histoplasmosis Coccidioidomycosis and Blastomycosis-broad-base-budding-yeast.png
click image to enlarge
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Quote:
Originally Posted by dr-ahmed View Post
Broad-based in Blastomycosis is not a characteristic skin lesion ,, it describes the relationship between two particles of a budding that they are not meeting in a single point but they meet a long a broad area
Thanks for the image but you have serious reading problems...no one said that broad based was a skin lesion, everybody here has said BROAD BASED YEASTS

Nice input though
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@dr ahmed
Thanks a lot for the nice image ,
but r u kidding man, we all r here bcoz we know broad based yeast is not a skin lesion.....
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Old 08-15-2013
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Also histo has pancytopenia, unlike blasto. And blasto has violaceous skin lesions which on biopsy contain the broad based yeast and is acquired from decaying wood and vegetation. Coccidio on the other hand has erythema nodosum.
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Quote:
Originally Posted by Dr.NickRiviera View Post
ahhh i got another question on these two wrong in UW. ughh
which one is in immunocompromised/AIDS?
Disseminated histo and invasive aspergillosis both occur in immunocompromised, so thats not much of a differentiating point.
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Old 08-16-2013
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Default Sorry for the confusion

Quote:
Originally Posted by rg99 View Post
@dr ahmed
Thanks a lot for the nice image ,
but r u kidding man, we all r here bcoz we know broad based yeast is not a skin lesion.....
Your mentioning them in your first post in 2 subsequent lines made me think that you thought it a skin lesion so I just wanted to make it clear.

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Old 08-16-2013
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Originally Posted by rohit39 View Post
Disseminated histo and invasive aspergillosis both occur in immunocompromised, so thats not much of a differentiating point.
I don't know how reliable is this hint, but:
- [Histo: HIV]: Histo is outside (bird droppings), so HIV+ who wanders around get it.
- [Aspergillus:leukemia]. Aspergillus is ubiquitous, so even neutropenic guy with leukemia who sits in hos room cannot be safe. (Heard that Aspergillus inf. increased in hospital when they were building a neighbooring pavilon -> more dust from soil.)
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Originally Posted by rohit39 View Post
Disseminated histo and invasive aspergillosis both occur in immunocompromised, so thats not much of a differentiating point.
ok but one causes mouth ulcers right?
ah i have so much trouble between these two buggers.
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Quote:
Originally Posted by Dr.NickRiviera View Post
ok but one causes mouth ulcers right?
ah i have so much trouble between these two buggers.
Histo:
(+- Birds hint)
+- mouth ulcers
macrophages -> RE system -> Lymphadenopathy, H-Smegaly
+- pancytopenia

Aspergillus:
- pulmonary imaging: ball, septate branched hyphae, "halo lesion", cavitation
+- hemoptysis

I hope at least one of these will be in the stem to differentiate these two.
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