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The clinical features, diagnosis, and biology of the fungal pathogen , which causes pneumonia in immunocompromised patients and can colonize healthy individuals with an intact immune system.

Citation: Cushion M. 2015. , p 2015-2029. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch118
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Image of FIGURE 1

Major developmental forms of (A) Single trophic form; (B) sporocyte (precyst); (C) cyst with four visible spores (intracystic bodies); (D) cyst with three intracystic spores and a spore that has apparently excysted (arrow); (E) cyst with localized thickening of the cell wall (arrow) and eight visible spores. Nomarski Interference Contrast microscopy; magnification ×1,000. doi:10.1128/9781555817381.ch118.f1

Citation: Cushion M. 2015. , p 2015-2029. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch118
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Image of FIGURE 2

Proposed life cycle of (A) The primary site of infection is the lung alveoli. Three clusters of alveoli are illustrated. An expanded schematic of an alveolus (box) is shown in panel B. (B) Single alveolus with organisms depicted as a hatched shape attached to the cells lining the alveoli in some areas (type I pneumocytes) and unattached to other alveolar cells (type II pneumocytes). (C) Putative sexual cycle of in the lung alveoli: ( ) opposite mating types fuse and undergo karyogamy resulting in a diploid zygote; ( ) the zygote then undergoes meiosis resulting in four nuclei; ( ) additional postmeiotic mitosis increases the number of nuclei to eight; ( ) the nuclei and mitochondria (not shown) are compartmentalized by invagination of the inner plasma membrane, resulting in eight spores. Spores are released from the ascus (cyst) and presumably enter into the vegetative phase of the cycle. (D) Asexual replication cycle of Trophic forms undergo binary fission after mitotic replication of the nucleus. (Drawn with SmartDraw Suite, ed. 7.3.) doi:10.1128/9781555817381.ch118.f2

Citation: Cushion M. 2015. , p 2015-2029. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch118
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Image of FIGURE 3

Morphology and tinctorial characteristics of in clinical samples stained with various stains (magnification, × 960, unless stated otherwise). (A) Calcofluor stain of BAL fluid. Cyst walls with internal thickenings (double comma) are highly fluorescent (color varies with barrier filter used). (B) Rapid Giemsa-like (Diff-Quick) stain of BALF. Thick cluster of mostly trophic forms (2 to 3 μm) with small reddish-purple nuclei and light blue to red-violet cytoplasm. Boundaries of trophic forms are rarely discernible with this stain. Trophic forms overlay each other to produce darker staining blue cytoplasm. Large dark purple host nuclei are admixed in the cluster. (C) Gomori methenamine silver stain (Grocott) of organisms from BALF. Cyst walls and thickenings (double comma) can be observed as well as collapsed, cup shapes and crinkled raisin-like appearance. Note the lack of budding. Trophic forms are not stained with silver-based stains. (D) Papanicolaou’s stain of BALF. Note the distinctive alveolar cast morphology; magnification, ×400. (E) Toluidine blue O stain of in BALF. Cyst walls are stained light purple. The crinkled appearance of the cysts is illustrated with this stain, as well as darker central staining body. Note the lack of budding with this and other cyst wall stains. Trophic forms are not stained. (F) Direct fluorescent antibody stain of organism cluster from BAL. Note apple-green fluorescence distributed unevenly over the cluster, with accumulation on a cyst wall (lower left of cluster). Structures within the cysts are unstained and appear black. doi:10.1128/9781555817381.ch118.f3

Citation: Cushion M. 2015. , p 2015-2029. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch118
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Generic image for table

Comparison of stains used to detect

Citation: Cushion M. 2015. , p 2015-2029. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch118
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PCR detection of : suggested primers and conditions

Citation: Cushion M. 2015. , p 2015-2029. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch118

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