Last-minute revision program | DIMORPHIC FUNGUS | eGurukul | DBMCI

Last-minute revision program | DIMORPHIC FUNGUS by Dr. Neetu Shree | eGurukul | DBMCI
LMRP is a short duration revision program focused on last-minute revision before NEET PG/ AIIMS/JIPMER/ PGI examination. The duration of the entire content will be around 250 to 300 hours.
Now Talking about the anesthetist for Rapid revision in LMRP, it is covered by Dr. Neetu Shree.
Dr. Neetushree has completed her MBBS from Govt. Stanley Medical College, Chennai, and MD from VMMC, New Delhi. She got Gold medal and Award of Excellence for the MD Microbiology exam, 2013. She has also done a Diploma in Hospital Management from the National Institute of Health and Family Welfare, New Delhi in 2013-14. She has published 12 research papers in various journals of national and international repute and is on reviewer’s panel of various scientific journals apart from being involved in many research projects in the field of clinical microbiology.
Now talking about Dimorphic Fungus.
The term dimorphic is commonly used for fungi that can grow both as yeast and filamentous cells, however many of these dimorphic fungi actually can grow in more than these two forms. Dimorphic is thus often used as a general reference for fungi being able to switch between yeast and filamentous cells, but not necessarily limiting more shapes.
Checkout More LMRP Videos
Basics of Radiography by Dr.Rajat Jain
www.youtube.com/watch?v=5M4mi...
Neuro Ophthal by Dr. Niha Aggarwal
www.youtube.com/watch?v=ShU9A...
Renal System by Dr. Praveen Kumar Gupta
www.youtube.com/watch?v=DGH52...
Deformity, Metabolic Disorders & Skeletal Dysplasia by Dr. Sushil Vijay
www.youtube.com/watch?v=mauoW...
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[@hudanoor6009]

Ma'am why candida do not follow these temprature it grow as yeast at 20degree and filamentous at 37degree ....please reply

[@putzigetajwanu]

What fungi could this be: looks like a Tinea infection from a glance, they start from a dome shape that is highly hyperpigmented relative to caucasian population, round lesion 1-2cm in diametre; easily confused for ringworm. They spread outwards like a disc except borders can be palpated but invisible. The edges form almost a perfect circle with small 1-3mm lesions forming their own disc-like ring around it, and these are locations where branching starts. The fungi starts from the proximal lateral side of 3cm of the knee cap. It then accelerates in growth like the creeping buttercup weed where a small piece can star growing, I assume they derive their energy from here and also act as new point of growth if the fungi around is severed.
They form multiple smaller strands ventrally and dorsally with the skull being the target and are meshed together. The only exception is two main tubules that run to and from the original 'disc' lesion to the back of the skill where it forms a bag, these are stretched to at least 1.5mm - 3mm giving impression of a closed loop system after the system 'bled out', the 'tubule' deflated back to no more than 0.8mm. Breaking the bag releases mould like smell and cutting the big tubules leaks a clear fluid that darkens due to oxidation. The 'bag' also eats away at the skull. The smaller strands look super straight and smooth, no budding, and also circulates the fluid. It is resistant to OTC Terbinafine 1%, Cicloprirox Olamine 1% (both topicals), Ketoconazole 5% (shampoo/bodywash), Still unaware it was pretending to be an Azole, Itraconazole 200mg po bid, was prescribed it worked: the disc turned black and died, the PT was having a small rash as the fungal mechanism disabling proper functioning of the immune system was back in action; the tubules broke like mush. Some doctor decided its a brilliant idea and a quote 'a flash of inspiration from God to switch to Fluconazole 150mg q1week'; I thought it was qd or typo initially. The symptoms returned and even a loading dose of Itraconazole 600mg x3 days then back to maintenance x 14 days did little. Had that doctor's 'divine intervention' happened, it would likely have healed.
The first time time tubes extend up, it acted like a Tunnel Boring Machine, then if the tubule was severed and pushed back to origin (very easy to do), it doesnt waste time, but 'grows' a new one as if spores of some form were laid. Disturbing the 'tubes' too much will cause it to create an extremely low melting point foam around to protect it. If near a crease like by the meeting point of ear it will hide there.
The scary thing is this fungi can form fistulas thru bones, a few were found in the right maxillofacial region and the chin to protect the tubules. As far as I know, any form of Tinea should not be able to drill holes thru the PT (all painless and unknown).
Given all the above information, what might the fungi be?

[@putzigetajwanu]

forgot to mention the 'tinia impersonator'comes in a pair not only the origin to 'bag' one; doctors were fooled for 6 months since impersonal was perfectly done. Tinea unguium softens nails and white filaments come out in between. the pair feeding all 5 fingers before splitting could stretch and wrap around a 10cm - 12cm portion of the Ulna + Radius before it breaks which requires quite a bit of force.
Hyphae coming out of finger tips look like white 0.1mm wool strands. Take a smallpiece of your pillow's polyester filling, thats what it look like.
Some longer pieces removed look braided and tears easily; perhaps its the stretching while still under the epithelium that gives it strength. No pain, only sometime feeling of movement and some pruitis.
If you palpated along any part of the body, you will feel an horrific amount of invisible pitting; Im guessing those made it down to the spinous layer only of the epidermis so theres no injury to the melanocytes; unknown if normal layers will grow back as im guessing it's possible the fungi could have harmed the basel cells in between the sparse melanocytes.
Doctors initially diagnosed PT with insect bites, but he managed to video the fungi poking up and out, with the sides turning white as blood is cut off. It is rarely seen and usually occurs during sleep and usually near the 'Tunnel Boring Machine' analogy mentioned earlier as if it is creating an air shaft; one was so well aligned like a 6 pack of beer it looked like a machine did it!
I hope that gives enough clues to eliminate.
Hope it is not secondry infection of any kind fungi or bacterial involved. Im calling it "False Tinea (Dimorphic) Osteomyelitis". Very General but can be life threatening. Dam thing even knows how to repair itself!

[@dr.selfimprover5329]

2 questions came in neet pg from penicilliosis