3/28/2017 Disclosure of Relevant The Differentiation of Yeast Financial Relationships USCAP requires that all planners (Education Committee) in a position to and Yeast-Like Fungi influence or control the content of CME disclose any relevant financial relationship WITH COMMERCIAL INTERESTS which they or their Gary W. Procop, MD, MS spouse/partner have, or have had, within the past 12 months, which relates to the content of this educational activity and creates a conflict of interest. Dr. Gary W. Procop declares he/she has no conflict(s) of interest to disclose. What are the Possibilities? The Inflammatory Response How to Limit the Differential? • Neutrophilic • Candida species • These may be: • Allergic Reaction • Bronchopulmonary Aspergillosis and Allergic Fungal Sinusitis • Yeast • Granulomas • With/without necrosis • Dimorphic Fungi • Coccidioides, Histoplasma, Cryptococcus • With eosinophils • Dematiaceous Fungi • Coccidioides • Pyogranulomatous • Sporothrix, Blastomyces, Agents of Chromoblastomycosis • Chronic • Differentiate Morphologically • Blastomyces • Based on size, morphology, special features • Immunosupression • Truncated Responses • Poorly formed granulomas • Lack of typical cellular elements • Culture Definitively Differentiates • Example: Histoplasma in histiocytes rather than granulomas. • Reaction to injury • Necrosis, hyaline membrane disease, etcetera. Small Yeast Forms (2-4 microns) • Histoplasma capsulatum • Sporothrix schenckii complex • C. glabrata, • Malassezia species • Pneumocystis jirovecii • Endospores of C. immitis • “Acapsular variants of C. neoformans. • Talaromyces (Penicillium) marneffei 1 3/28/2017 Histoplasma capsulatum Sporothrix schenckii complex C. glabrata, C. tropicalis and a Zygomycete Malassezia species 2 3/28/2017 Pneumocystis jirovecii Talaromyces (Penicillium) marneffei Moderate and Large Yeast Forms • Moderate (4-10 microns) • Candida species other than C. glabrata. • Cryptococcus • Immature spherules of C. immitis • Dematiaceous Fungi • Exophiala species • Agents of Chromoblastomycosis • Large (>10 microns) • Blastomyces dermatitidis • Spherule of C. immitis 3 3/28/2017 Exophiala - Young Exophiala with Age Chromoblastomycosis • Chronic fungal disease that involves the skin and subcutaneous tissues. • Causes pyogranulomatous inflammatory response, pseudoepitheliomatous hyperplasia, and the Splendore-Hoeppli phenomenon may be observed. • Fungal elements (sclerotic bodies) appear as “copper pennies” • Common causes: Cladosporium (Cladophialophora), Phialophora, Fonsecaea. 4 3/28/2017 5 3/28/2017 Optimal Use of Molecular Tools ** Engage a Pathologist ** • 17 month compared 100 patient specimens • Broad Range Fungal PCR • Direct Examination (KOH/Calcofluor White) • Fungal Culture • Histopathology 6 3/28/2017 Important Information Regarding CME/SAMs The Online CME/Evaluations/SAMs claim process will only be available on the USCAP website until September 30, 2017. No claims can be processed after that date! After September 30, 2017 you will NOT be able to obtain any CME or SAMs credits for attending this meeting. 7.