FUNGI

SYSTEMIC MYCOSES

Histoplasma capsulatum

1
Historian
1
Histoplasma capsulatum (a dimorphic fungus)
2
Bat
2
Histoplasma capsulatum thrives in environments contaminated with bat and bird feces,
such as caves and poultry houses
3
Ohio and Mississippi River valley map
3
Histoplasma capsulatum is endemic to the midwestern and east central regions of the
United States, particularly around the Ohio and Mississippi River valleys
4
Coughing
4
Transmission of Histoplasma capsulatum occurs through the inhalation of airborne
spores from mold
 5
Birdcage
5
Histoplasma capsulatum transforms into a yeast form that is ingested by
macrophages, where it can be identified as small oval bodies within these cells under
microscopy
6
Red stalactite
6
Detection of Histoplasma capsulatum serum and urine antigen (SAg, UAg) aid in the
diagnosis of histoplasmosis
7
Yellow stalactite
7
Detection of Histoplasma capsulatum serum and urine antigen (SAg, UAg) aid in the
diagnosis of histoplasmosis
8
Small spots in macrophage puddle
8
Histoplasma capsulatum yeast cells, intracellular oval bodies smaller than red blood
cells, are seen within macrophages on microscopy
9
Dimorphic butterfly
9
Histoplasma capsulatum exhibits dimorphism, growing as mold in cooler environments
(25-30°C) and as yeast at human body temperature (35-37°C)
10
White stalactites in lung rocks
10
Histoplasma capsulatum infection can result in lung calcifications, such as calcified
mediastinal and hilar lymph nodes; this is a part of the healing and containment
process following the inflammatory response to the infection
11
Tuberculosis cactus
11
Chronic histoplasmosis may present with symptoms like cough, fatigue, weight loss,
and lung cavitations, resembling tuberculosis
12
Spotted leg rocks
12
Histoplasma capsulatum infection is associated with erythema nodosum,
characterized by painful red nodules typically found symmetrically on the shins
13
Liver + spleen spots
13
The most common physical findings of disseminated histoplasmosis
include splenomegaly, hepatomegaly, and lymphadenopathy
14
Immunocompromised cane
14
Disseminated histoplasmosis is more common in individuals with weakened immune
systems
15
Pinecones
15
Azoles are the treatment of choice for mild histoplasmosis or as stepdown therapy from
amphotericin B in severe or disseminated disease; itraconazole is the preferred azole
for treatment
16
Amphibians
16
Amphotericin B is the drug of choice for severe or disseminated cases of
histoplasmosis
Blastomyces dermatitidis

1
Cannon blast
1
Blastomyces dermatitidis (a dimorphic fungus)
2
Ohio and Mississippi River valleys + Great Lakes map
2
Blastomyces dermatitidis is predominantly found in the eastern and central regions of
the United States, particularly around the Ohio and Mississippi River valleys and
the Great Lakes region
3
Dimorphic butterfly
3
Blastomyces dermatitidis exhibits dimorphism, growing as mold in cooler environments
(25-30°C) and as yeast at human body temperature (35-37°C)
4
Breathing in dust
4
Infection with Blastomyces dermatitidis occurs through the inhalation of airborne mold
spores
5
Doubled cannonballs
 5
The yeast form of Blastomyces dermatitidis is characterized by its broad-based
budding and a double refractile cell wall, generally similar in size to an RBC
6
Dust clouds in lungs
6
CXR findings in blastomycosis are highly variable, including patchy infiltrates, mass-
like lesions, or cavitations
7
Cannonballs in lungs
7
Blastomyces dermatitidis can cause granulomatous infection, with the lungs being the
most commonly affected organ
8
Immunocompromised cane
8
Immunocompromised individuals are at higher risk of disseminated blastomycosis,
affecting skin, bones, and the genitourinary system
9
Statue erosion
9
Disseminated blastomycosis can present as various skin lesions, including papules,
pustules, ulcers, and verrucous growths
10
Exposed bone
10
Bone involvement in disseminated blastomycosis can manifest as painful lytic
lesions
11
Yellow river
11
Detection of Blastomyces dermatitidis antigen in urine can assist in diagnosis, though
culture or histopathology remains definitive
12
Pinecones
12
Itraconazole or fluconazole is recommended for treating mild to moderate cases of
blastomycosis
13
Amphibians
13
Amphotericin B is the treatment of choice for severe blastomycosis
Coccidioides immitis

1
"Presidio San Joaquin"
1
Coccidioides immitis (a dimorphic fungus that causes San Joaquin Valley fever)
2
Southwest US map
2
Coccidioides immitis is endemic to the arid regions of the southwestern United
States and northern Mexico, thriving in desert soils
3
Breathing in dust
3
Infection occurs through the inhalation of airborne arthroconidia (mold spores)
4
Cracks in earth
4
Coccidioides immitis arthroconidia (mold spores) can become aerosolized when soil is
disturbed by activities like construction, farming, or natural events such
as earthquakes and dust storms
5
Dimorphic butterfly
5
Coccidioides immitis exhibits dimorphism, growing as mold in cooler environments (25-
30°C) and as yeast at human body temperature (35-37°C)
6
Tumbleweeds
6
in tissue sample, Coccidioides immitis can be seen as large, yeast-like
spherules containing endospores
7
Small red hat next to tumbleweed
7
Coccidioides immitis spherules, large yeast-like structures containing endospores,
are significantly larger than RBCs
8
Coughing + sweating + knee pain
8
The clinical presentation of coccidioidomycosis can range from asymptomatic to severe
pneumonia, with common symptoms including cough, fever, and chest pain, often
accompanied by arthralgia
9
Protruding bricks and holes in lung wall
9
CXR in patients with primary coccidioidomycosis might reveal unilateral infiltrates,
hilar lymphadenopathy, or nodules; however, imaging can be normal in many cases
10
Spotted leg wall
10
Coccidioidomycosis can manifest as erythema nodosum, an inflammatory condition
characterized by painful, red nodules on the lower extremities
11
Immunocompromised cane
11
Extrapulmonary coccidioidomycosis (most commonly skin, bone, joint, and CNS
involvement) primarily occurs in patients who are immunocompromised patients
12
Statue erosion
12
Disseminated coccidioidomycosis may present with skin lesions, osteolytic bone
lesions causing pain, and meningitis
13
Exposed bone
13
Disseminated coccidioidomycosis may present with skin lesions, osteolytic bone
lesions causing pain, and meningitis
 14
Neck brace
14
Disseminated coccidioidomycosis may present with skin lesions, osteolytic bone lesions
causing pain, and meningitis
15
Pinecones
15
Azoles like itraconazole or fluconazole are recommended for mild to moderate
coccidioidomycosis
16
Amphibians
16
Amphotericin B is the treatment of choice for severe or disseminated
coccidioidomycosis
Paracoccidioides brasiliensis

1
Brazilian pirate
1
Paracoccidioides brasiliensis (a dimorphic fungus)
2
Central and South America map
2
Paracoccidioides brasiliensis is endemic to Central and South America
3
Captain's wheel
3
The yeast form of Paracoccidioides brasiliensis, characterized by multipolar budding,
resembles a captain’s wheel
4
Butterfly
4
Paracoccidioides brasiliensis exhibits dimorphism, growing as mold in cooler
environments (25-30°C) and as yeast at human body temperature (35-37°C)
5
Small red center of captain's wheel
5
The multipolar budding yeast form of Paracoccidioides brasiliensis is typically much
larger than an RBC
 6
Water droplets
6
Paracoccidioides brasiliensis is primarily transmitted via inhalation of mold spores
7
Medallions over chest
7
Paracoccidioidomycosis can lead to granuloma formation in the lungs and other
organs, particularly in disseminated disease
8
Beads by neck
8
Disseminated paracoccidioidomycosis frequently manifests
as lymphadenopathy, particularly in the cervical region
9
Unhealthy mouth
9
Chronic paracoccidioidomycosis often presents with granulomatous oral ulcers,
characterized by a granular appearance and potential mucosal destruction
10
Pinecones
10
Azoles, particularly itraconazole, are the treatment of choice for mild to moderate
paracoccidioidomycosis
11
Amphibians
11
Amphotericin B is the treatment of choice for severe cases of paracoccidioidomycosis
CUTANEOUS MYCOSES

Malassezia furfur

1
"Ristorante Italiano di Malassezia"
1
Malassezia furfur (a fungus that causes pityriasis versicolor and seborrheic dermatitis)
2
"Versi di calore sauce"
2
Pityriasis versicolor presents as variably pigmented macules predominantly on the
trunk and upper limbs
3
KOH salt on spaghetti and meatballs
3
On potassium hydroxide (KOH) examination of skin scrapings, Malassezia
furfur exhibits a distinctive "spaghetti and meatballs" morphology
4
Heat lamp
4
The transition of Malassezia furfur yeast cells to the pathogenic mycelial form is
associated with heat and humidity
5
Sauce on chest and back
5
Pityriasis versicolor is characterized by distinct, oval patches or plaques with fine
scaling that can be hypopigmented, hyperpigmented, or erythematous and may
merge over large areas
6
Olive oil
6
Malassezia furfur thrives on the lipid composition of sebum
7
Corn on lasagna
7
Infections by Malassezia furfur are typically superficial, involving only the stratum
corneum of the epidermis
8
Baby slurping noodle
8
Malassezia furfur fungemia is a rare complication seen in neonates receiving total
parenteral nutrition (TPN) via central venous catheters
9
Blue sun
9
Topical application of selenium sulfide is an effective treatment for skin infections
caused by Malassezia furfur
Epidermophyton spp., Trichophyton spp., Microsporum spp. (Dermatophytes)

1
"E," "T," and "M" munchkins
1
Epidermophyton spp., Trichophyton spp., Microsporum spp. (dermatophytes that
cause tinea, aka ringworm)
2
Tin man
2
The dermatophytes cause tinea, a fungal infection of the skin, nails, or scalp
3
Naked munchkins
3
The dermatophyte are responsible for skin infections and are not part of the normal
skin flora
4
Rings on hat
4
The dermatophytes cause tinea capitis, an infection of the scalp and hair
5
Rings on groin
5
The dermatophytes cause tinea cruris, also known as jock itch, a fungal infection of
the groin
6
Rings on feet
6
The dermatophytes cause tinea pedis, commonly known as athlete's foot, a fungal
infection of the feet
7
Dog
7
Dermatophyte infections can be transmitted through direct contact with infected
animals or indirectly through shared environments
8
Scratching
8
Dermatophyte infections typically present with a red, itchy rash
9
Rings on body
9
The dermatophytes cause tinea corporis, a fungal infection of the body
10
KOH salt
10
Potassium hydroxide (KOH) microscopy is used to visualize the hyphae of
dermatophytes to confirm diagnosis
11
Lamps + "M" munchkin
11
A specialized UV light called a Wood's lamp can be used to detect the presence of
dermatophytes of the Microsporum genus
12
Pinecones
12
Topical azoles are commonly used to treat tinea infections caused by dermatophytes
13
Biting nails
13
The dermatophytes cause onychomycosis, otherwise known as tinea unguium, a
fungal infection of the nail
14
Turban
14
The most commonly used drugs for onychomycosis are terbinafine, griseofulvin, and
azoles
15
Grease
15
The most commonly used drugs for onychomycosis are terbinafine, griseofulvin, and
azoles
Sporothrix schenckii

1
Shanked by a thorn
1
Sporothrix schenckii (a dimorphic fungus that causes cutaneous mycosis)
2
Garden
2
Sporothrix schenckii thrives in soil and on plant debris
3
Dimorphic butterfly
3
Sporothrix schenckii exhibits dimorphism, growing as mold in cooler environments (25-
30°C) and as yeast at human body temperature (35-37°C)
4
Roses
4
Sporotrichosis is sometimes referred to as “rose gardener’s disease” because
infection can result from being pricked by thorns and other plant material
contaminated with Sporothrix schenckii
5
Cigar
5
In its yeast phase, Sporothrix schenckii can be identified microscopically by its
distinctive cigar-shaped cells
6
Roses around arm
6
Sporotrichosis is generally caused by traumatic inoculation of plant matter or soil
contaminated with Sporothrix schenckii fungi, often resulting in the formation
of subcutaneous nodules and ulcers
7
Ascending vines
7
In lymphocutaneous sporotrichosis, Sporothrix schenckii ascends along the
lymphatics from the site of inoculation, forming subcutaneous nodules and ulcers
8
Pinecones
8
Oral itraconazole is the preferred treatment for both cutaneous and lymphocutaneous
forms of sporotrichosis
9
Potassium iodide pesticide
9
While saturated solution of potassium iodide (SSKI) has been a historical remedy for
sporotrichosis, modern antifungal medications are now more commonly used
OPPORTUNISTIC FUNGAL INFECTIONS

Candida albicans

1
Canada
1
Candida albicans (an opportunistic dimorphic fungus)
2
Dimorphic butterfly
2
Candida albicans is a dimorphic fungus, but differs from other dimorphic fungi in that it
exists in its yeast-form at 23–25 °C and a multicellular hyphal form at 37°C
3
"37 flavors" + germ tube straw
3
Candida albicans forms germ tubes (a precursor to hyphal growth) at 37°C
4
"20°C" + yeast snowballs
4
At 23–25 °C, Candida albicans exists in its yeast form that reproduces by budding
5
Catalase cat
5
Candida albicans produces catalase, an enzyme that converts hydrogen peroxide into
water and oxygen
6
Baby in red swing
6
Candida albicans is a common cause of cutaneous candidiasis, thriving in warm,
moist areas such as the diaper region in infants
7
Immunocompromised cane
7
Immunocompromised individuals, particularly those with neutropenia, are at
heightened risk for disseminated Candida albicans infections
8
Snow on tongue + inhaler
8
Candida albicans causes oral thrush, which characterized by white, scrapable lesions
in the mouth; oral thrush is frequently seen in individuals using inhaled steroids and in
immunocompromised patients
9
Shoveling snow
9
Oral thrush, characterized by white, scrapable lesions in the mouth, is frequently
seen in individuals using inhaled steroids and in immunocompromised patients
10
KOH salt
10
The presence of Candida albicans can be confirmed through KOH mount of scrapings
from oral, vaginal, or skin lesions, revealing budding yeast and pseudohyphae
11
Snow inside tube slide
11
Candida albicans is a causative agent of esophagitis in immunocompromised
individuals, notably those with HIV/AIDS, presenting with grey-white
pseudomembranes
12
"Max 200 LBS"
12
Esophageal candidiasis is an AIDS-defining illness and is most often observed in
patients with CD4+ count <200
13
Snowball thrown in crotch
13
Vulvovaginal candidiasis often presents with pruritus and a thick white vaginal
discharge
14
Candy + medication bottles + birth control pills
14
Vulvovaginal candidiasis can be precipitated by uncontrolled diabetes, antibiotic
use, and hormonal changes (e.g., birth control pills)
15
"Playground open until 4pH"
15
In vulvovaginal candidiasis, the vaginal pH typically remains within the normal range
of 3.8-4.5
16
3 heart roofs
16
Candida endocarditis predominantly affects the tricuspid valve in IV drug users and
individuals with prosthetic heart valves and indwelling catheters
17
Pinecone
17
Fluconazole is the antifungal of choice for a broad spectrum of Candida
albicans infections
18
Amphibians
18
Amphotericin B can be used in cases of severe or fluconazole-
resistant Candida infections
19
"Play NYCE"
19
Nystatin is effective for cutaneous and oral Candida infections
20
Cap
20
Echinocandins, such as caspofungin and micafungin, are options for treating severe or
refractory cases of candidiasis, including esophageal and systemic infections
Aspergillus fumigatus

1
Asparagus farm
1
Aspergillus spp. (opportunistic fungi)
2
Catalase cat
2
Aspergillus spp. produce catalase, an enzyme that converts hydrogen peroxide into
water and oxygen
3
Peanut plant
3
Aflatoxins, potent carcinogens produced by Aspergillus flavus, are contaminants in
nuts, grains, and other foods
4
Liver spot + crab
4
Exposure to aflatoxins from Aspergillus flavus is a risk factor for hepatocellular
carcinoma
5
Acute angle branches
5
Aspergillus spp. exhibit characteristic septate hyphae with acute branching angles,
often around 45 degrees
6
Fruiting body flowers
6
Inhalation of airborne spores from the fruiting bodies of Aspergillus spp. (found in
various environmental sources) is the primary route of transmission for infections
7
ABPA plane + running farmer + sweat
7
Allergic bronchopulmonary aspergillosis (ABPA), a type I hypersensitivity reaction
to Aspergillus spp., is characterized by migratory pulmonary infiltrates, fever,
wheezing, and elevated serum IgE levels, and it most commonly affects individuals with
cystic fibrosis or asthma
8
IgE inhaler
8
Allergic bronchopulmonary aspergillosis (ABPA), a type I hypersensitivity reaction
to Aspergillus spp., is characterized by migratory pulmonary infiltrates, fever, wheezing,
and elevated serum IgE levels, and it most commonly affects individuals with cystic
fibrosis or asthma
9
Sweating + coughing into red napkin
9
Aspergillomas, or "fungus balls," typically form in lung cavities from conditions like
tuberculosis, leading to symptoms such as cough and hemoptysis
10
Tuberculosis cactus
10
Aspergillomas, or "fungus balls," typically form in lung cavities from conditions like
tuberculosis, leading to symptoms such as cough and hemoptysis
11
Peanuts at bottom of cavities
11
On radiographs, aspergillomas frequently manifest as mass-like lesions that
are gravity-dependent and may shift with changes in the patient's position
12
Immunocompromised cane
12
Invasive aspergillosis, which can be life-threatening, primarily affects individuals
with weakened immune systems; invasive aspergillosis most commonly affects the
lungs, but can also spread to other organs and systems
13
Red sprinkler system
13
Invasive aspergillosis can lead to widespread organ involvement
through hematogenous spread, affecting the kidneys, heart, brain, and sinuses,
particularly in individuals with compromised immunity
14
Red pipes + sweating + coughing into red napkin
14
Symptoms of invasive pulmonary aspergillosis can include fever, cough, hemoptysis,
chest pain, and shortness of breath
15
Straw kidneys
15
Hematogenous spread of Aspergillus to the kidneys can cause renal infarction and
failure in immunocompromised patients
16
Straw heart
16
Aspergillus endocarditis, a rare but serious condition, can occur when the fungus
invades the heart valves in immunocompromised patients
17
Head holes
17
In immunocompromised individuals, CNS involvement by Aspergillus can lead to brain
abscesses, often seen as ring-enhancing lesions on imaging
18
Nose hole
18
In immunocompromised individuals, invasion of the paranasal
sinuses by Aspergillus can cause extensive tissue damage and necrosis
19
Pinecones in vortex
19
Voriconazole is the preferred antifungal for treating most forms of aspergillosis
20
Amphibians
20
Amphotericin B can be used to treat invasive aspergillosis; however, IV or oral
voriconazole is the primary treatment for most patients with invasive aspergillosis
Cryptococcus neoformans

1
Crypt
1
Cryptococcus neoformans (an opportunistic fungi)
2
Thick-walled sarcophagus
2
Cryptococcus neoformans has a thick polysaccharide capsule that inhibits
phagocytosis
3
Hexagon design
3
Cryptococcus neoformans has a thick polysaccharide capsule that inhibits
phagocytosis
4
Pigeon poop
4
Cryptococcus neoformans is commonly associated with pigeon droppings, and
humans can become infected by breathing in the dust created when cleaning droppings
5
Ammonia bottle
5
Cryptococcus neoformans produces urease, an enzyme that hydrolyzes urea into
carbon dioxide and ammonia
6
Immunocompromised cane
6
Cryptococcus neoformans is an opportunistic fungus and predominantly
infects immunocompromised individuals, such as those with HIV/AIDS
7
Coughing
7
Cryptococcal pulmonary infections can be asymptomatic; however, approximately half
of patients have a cough or chest pain; in immunocompromised individuals, the onset
may be more severe
8
Neck brace + sweat
8
Meningoencephalitis is the most common manifestation of Cryptococcus infection,
typically presenting with fever, malaise, headache, neck stiffness, nausea, vomiting,
and sensitivity to light
9
Soap bubbles on chest
9
Mucicarmine or methenamine staining of bronchoalveolar lavage samples can be
done to diagnose pulmonary cryptococcosis
10
Red and silver
10
Bronchoalveolar lavage samples can be prepared with mucicarmine
(red) or methenamine (silver) stain for diagnosis of pulmonary cryptococcosis
11
Light circles in black tar
11
India ink staining of CSF reveals encapsulated Cryptococcus neoformans cells,
characterized by clear haloes against a dark background
12
Latex gloves
12
The latex agglutination test detects the polysaccharide capsule antigen
of Cryptococcus neoformans in the serum and CSF
13
Soap bubbles on head
13
Cryptococcal meningoencephalitis may present with “soap bubble” brain lesions on
MRI
14
Frogs and flute
14
Initial treatment of cryptococcal meningitis involves a combination of amphotericin
B and flucytosine, followed by long-term therapy of fluconazole
15
Pinecones
15
Initial treatment of cryptococcal meningitis involves a combination of amphotericin B and
flucytosine, followed by long-term therapy of fluconazole
Mucor spp. & Rhizopus spp. (Mucormycetes)

1
"Mu Car Auto Shop - Rides’R’Us"
1
Mucor spp. and Rhizopus spp. (opportunistic fungi that cause mucormycosis)
2
Immunocompromised cane
2
Mucormycosis primarily affects immunocompromised individuals, with a notable
prevalence among patients with uncontrolled diabetes mellitus, especially during
diabetic ketoacidosis
3
Candy
3
Mucormycosis primarily affects immunocompromised individuals, with a notable
prevalence among patients with uncontrolled diabetes mellitus, especially
during diabetic ketoacidosis
4
Bread
4
Certain Rhizopus species are known as common bread molds
5
Coughing
 5
Infection by Mucor spp. and Rhizopus spp. typically occurs through the inhalation of
fungal spores from the environment
6
"Ketone auto parts"
6
Mucormycosis caused by Rhizopus spp. is strongly associated with diabetic
ketoacidosis
7
Right angle lug wrenches
7
Mucor spp. and Rhizopus spp. are characterized by nonseptate hyphae that branch at
right angles
8
Red jumper cables
8
The proliferation of Mucor spp. and Rhizopus spp. within blood vessel walls leads to
the characteristic invasive disease process seen in mucormycosis
9
Holes in oil plate
9
Rhinocerebral mucormycosis involves the invasion of the brain by through
the cribriform plate
10
Oil on face
10
Necrosis of the nasal cavity, presenting as a black eschar on the palate or
turbinates, is a hallmark of rhinocerebral mucormycosis
11
Amphibian car
11
The management of mucormycosis involves the administration of amphotericin B and
surgical debridement to remove necrotic tissues
Pneumocystis jirovecii

1
PCP pingpong
1
Pneumocystis jirovecii (an opportunistic fungus)
2
"AID for AIDS"
2
Pneumocystis pneumonia (PCP) is a significant opportunistic infection in patients
with HIV, and is classified as an AIDS-defining illness
3
Immunocompromised cane
3
Pneumocystis jirovecii predominantly affects those with weakened immune systems
4
Healthy player
4
Disease caused by Pneumocystis jirovecii in immunocompetent patients is
extremely rare (immunocompetent individuals may be asymptomatic carriers of P.
jirovecii)
5
"20-0"
5
Patients with a CD4+ count <200 are at risk of developing Pneumocystis
jirovecii pneumonia
6
Cracked glass table
6
Characteristic "ground glass" opacities on CXR are indicative of PCP
7
BAL bottle
7
Diagnosis of PCP can be established through PCR or microscopic analysis
of bronchoalveolar lavage or induced sputum
8
Silver discs
8
Methenamine silver stain of lung biopsy or bronchoalveolar lavage fluid shows disc-
shaped yeast-like Pneumocystis jirovecii cells
9
Crushed ping pong balls
9
Cyst forms of Pneumocystis jirovecii exhibit a distinctive "crushed ping pong ball"
morphology on methenamine silver-stained samples
10
Backhand
10
Bactrim (trimethoprim-sulfamethoxazole) is used in HIV patients for prophylaxis and
treatment of PCP
11
Egg-shaped ping pong balls
11
Bactrim (trimethoprim-sulfamethoxazole) is used in HIV patients for prophylaxis and
treatment of PCP
12
Pentagon paddles
12
For patients intolerant to trimethoprim-sulfamethoxazole, pentamidine can be given as
an alternative for PCP prophylaxis and treatment