Question

Q1. Explain/Discuss and give the reasons, as presented in the case history, the most likely fungal agent associated with this patient. Q2. Ilustrate, label and describe the microscopic finds of the culture of the suspect organism at 37 C and 25 C. Q3. Is this organism considered to be dimorphic? Explain, in details, the reasons for your response. Q4. Identify the antifungal agents which may possibly be used to treat the fungal infection Case A A 33-year-old male taxi driver with past medical history significant only for alcoholism presented to his family physician's office with the chief complaint of left knee pain and swelling for nine months. He denied any specific injury, puncture wound, or any systemic symptoms. He denied contact with animals. Examination of his left knee demonstrated a moderate-to-severe effusion. He was not tender to palpation across his bony prominences. He had no medial or lateral joint line tenderness. He had a range of motion that was full and symmetric with that of the contralateral side. He had a negative McMurray's sign. His knee was stable to ligamentous examination. There was no erythema or lymphadenopathy. X-ray of the left knee showed a joint effusion. MRI of his left knee also demonstrated a joint effusion with a popliteal cyst and synovial thickening He subsequently underwent aspiration of the effusion in the office. Synovial fluid was cloudy yellow and blood-tinged. Fluid analysis showed the following: RBC 50,200 cells/mcL, WBC: 4900 cells/mcL (ref range < 150/mcL), PMN: 34% (ref range 0- 0 25%), lymphocytes: 54%, and monocyte: 10%; no crystals were observed, and pathological exam was consistent with hemorrhagic fluid with acute and chronic inflammation. Bacterial culture did not demonstrate any growth, but fungal cultures grew

Answer 1

Q1. Explain or discuss and give the reasons as presented in the case history ,the most likely fungal agent associated with this agent.

One of the risk factor for the infection is alcoholism .First symptom of the fungi is appearance of nodule in joints without pain and can take upto 17 months to diagnose. This fungi commonly infects knee joint and lead to tenderness & stiffness of joints and a cause arthritis in joints especially knee joints. This infection mostly affect males and adults. Sporothrix schenckii is the fungal agent causing these symptoms in this 33 year old male.

Q2. Ilustrate, label and describe the microscopic finds of the culture of the suspect organism at 37 C and 25 C.

At 25°C, Sporothrix schenckii colonies grow moderately rapid. Appears leathery to velvety and moist. At 37 C it appears like yeast

$spr2_l-300x199.jpg$At 37 C ( Used from 2000 doctor fungus corporation)

At 25 C it appears in velvety form

(Used from Rippon (1988),Medical mycology pathogenic fungi and the pathogenic actinomyces)

The fungi takes a transition phase between hyphae and yeast forms .As it has two morphological forms it is said to be dimorphic.

Q4. Identify the antifungal agents which may possibly be used to treat the fungal infection.

Itraconazole is the only fungal agent to treat this infection.