A 27-year-old intravenous drug user presents with difficulty swallowing. Examination of the oropharynx reveals white plaques along the tongue and the oral mucosa. Which of the following best describes the microscopic appearance of the microorganism responsible for this patient's illness?
This patient has Candida esophagitis. Any time a patient presents with dysphagia or odynophagia and you note white plaques in the oropharynx (thrush), you can assume that the Candida is affecting the esophagus as well. The fact that the patient is an IV drug user makes an oppounistic infection such as Candida more likely. Candida appears as budding yeast with pseudohyphae in vivo. The other answer choices represent the morphology of other impoant oppounistic fungi: Cryptococcus are encapsulated yeast. You should think about Cryptococcus neoformans when you're presented with an immunocompromised patient with neurological symptoms. The classic clue is the presence of encapsulated organisms observable in an India ink preparation. Mucor and Rhizopus are molds with nonseptate hyphae. You should think about Mucor when you are presented with a diabetic (especially ketoacidosis) or a leukemic patient with a severe sinus infection. Aspergillus is a mold with septate hyphae. In immunocompromised patients, aspergillosis can present with acute pneumonia, often with cavitation (aspergillomas = fungus balls in the lungs). Ref: McQuaid K.R. (2013). Chapter 15. Gastrointestinal Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013.
Budding yeast and pseudohyphae
Encapsulated yeast
Mold with nonseptate hyphae
Mold with septate hyphae