1. Clinical
   1. general characteristics
      1. cell structure
         1. nucleus, organelles
         2. cell membrane w/sterols
         3. cell wall w/chitin
      2. metabolism
         1. obligate aerobes, require carbon
      3. reproduction
         1. asexual
            1. haploid nucleus
            2. budding, hyphae separation
         2. sexual
            1. forms spores after mating
      4. morphology
         1. moulds
            1. septate hyphae
            2. contain septa (transverse walls)
            3. nonseptate hyphae
            4. single continuous cell
            5. mycelium
            6. mat of hyphae
         2. single cell
            1. yeast
         3. dimorphic
   2. Classification
      1. superficial mycoses
         1. outer skin, hair (dermatophytes)
      2. cutaneous mycoses
         1. epidermis, hair, nails (dermatophytes)
      3. subcutaneous
         1. deeper layers of dermis, subcut, & bone
      4. deep mycoses
         1. systemic
            1. internal organs
            2. by dimorphic fungi
         2. opportunistic
            1. internal organs
            2. by less virulent fungi
   3. Lab Diagnosis
      1. Direct microscopy
         1. KOH, stains, etc
      2. Ag detection
      3. culture
      4. molecular techniques
      5. serology
   4. Transmission
      1. inhalation
      2. direct contact
      3. traumatic implant
   5. Pathology
      1. tissue damage due to inflam, immune response, granulomas
      2. allergies
      3. toxins
         1. hepatotoxins (mushrooms)
         2. alkaloids
         3. aflatoxins
   6. Host Defenses
      1. cell-mediated immunity
   7. Therapy
      1. NOT Abx
      2. most are subclinical or self-limiting
      3. antifungals
         1. azoles (ketoconazole, etc)
            1. inhibit cell membrane
         2. polyenes (amphotericin)
            1. damage cell membrane
         3. flucytosin & grisofulvin
            1. inhibit NA synthesis
2. Yeast
   1. Candida
      1. mucocutaneous
         1. diaper rash, skin & nails, oral, vulvar
      2. systemic/invasive
   2. Cryptococcus
      1. environmental sources
      2. C. neoformans (opportunistic)
         1. soil
      3. C. gattii
         1. CGB agar turns blue
         2. decaying wood, eucalyptus
3. Moulds
   1. hyphae: filamentous structures
   2. Aspergillus
      1. soil
      2. septated hyphae
      3. secondary opportunistic
         1. cause disease in presence of underlying condition
      4. aspergillosis
         1. allergic bronchopulmonary aspergillosis
         2. pulmonary aspergilloma
         3. invasive
   3. Zygomycetes
      1. non-septate hyphae
      2. common contaminent
      3. fatal in immunocompromised
   4. Dimorphics
      1. characteristics
         1. yeast @ 35 deg, mould @25
         2. spores inhaled in lung, then infects skin & bones, LN, CNS
      2. histoplasma
         1. bird droppings
         2. resides in RES
         3. infects healthy, but more fatal in immunocompromised
      3. coccidioides immitus
         1. mostly self-limited RI
         2. can be chronic or fatal
      4. blastomyces dermatitidis
         1. pulmonary infection
      5. paracoccidioides
         1. P. brasiliensis
            1. wide spectrum of disease
            2. RES, skin, mucous membranes
      6. sporothrix schenckii (different)
         1. entry through skin, spreads through lymph
   5. Dermatophytes
      1. disease of skin, hair, nails
      2. epidermophyton, trichophyton, microsporum
         1. athlete's foot, ringworm