Hey Give me notes on Dimorphic Fungi, it should include Microbiological and Clinical Aspects along with the images.

Reading File

Finding Sources

Reading File

Loading Image

Finding Sources

Reading File

Loading Image

Reading File

Finding Sources

Reading File

Loading Image

Reading File

Loading Image

Reading File

I now have all the key content I need. Let me compile the comprehensive notes on Dimorphic Fungi:

Dimorphic Fungi - Comprehensive Notes

Definition & Core Concept

Dimorphic fungi are thermally dimorphic pathogens that exist in two distinct morphologic forms depending on temperature:

Environmental/Mold phase (25-30°C): Filamentous hyphal form producing conidia (infectious propagules)
Tissue/Yeast phase (37°C / body temperature): Converts to yeast forms within the host

Exception: Coccidioides spp. do not form yeasts in tissue - instead they produce spherules containing endospores. Emmonsia crescens produces diaspores.

This thermal conversion is the primary virulence mechanism - the yeast form enables replication and dissemination within host tissues.

Classification of Clinically Important Dimorphic Fungi

Organism	Disease	Geography	Entry Route	Tissue Form
Histoplasma capsulatum	Histoplasmosis	Ohio/Mississippi River valleys (USA), worldwide	Inhalation	Small intracellular yeasts (2-4 µm)
Blastomyces dermatitidis	Blastomycosis (North American)	SE/SC USA, Canada, Africa	Inhalation	Large broad-based budding yeasts (8-15 µm)
Coccidioides immitis / C. posadasii	Coccidioidomycosis (Valley fever)	SW USA, Mexico, Central/South America	Inhalation	Spherules (up to 100 µm) with endospores
Paracoccidioides brasiliensis	Paracoccidioidomycosis (South American blastomycosis)	South America (Brazil, Colombia)	Inhalation	"Mariner's wheel" - multiple peripheral buds
Sporothrix schenckii	Sporotrichosis	Worldwide (warm, humid climates)	Traumatic inoculation	Cigar-shaped yeasts (2-6 µm)
Talaromyces marneffei (formerly Penicillium marneffei)	Talaromycosis	Southeast Asia (Thailand, China, Vietnam)	Inhalation	Small oval yeasts with transverse septa
Emergomyces spp.	Emergomycosis	South Africa, globally	Inhalation	Yeast

Geographical Distribution

Geographic distribution of dimorphic fungal infections in the United States showing areas of greatest endemicity (dark shading) and lesser endemicity (light shading) for Histoplasmosis, Blastomycosis, and Coccidioidomycosis

Fig: Geographic distribution of the major endemic dimorphic fungi in the USA (Henry's Clinical Diagnosis and Management by Laboratory Methods)

Histoplasmosis - Ohio, Mississippi, St. Lawrence River valleys; Brazil; French Guiana; parts of Africa and Asia
Blastomycosis - SE/SC USA, Great Lakes, Africa, rare reports from India and Saudi Arabia
Coccidioidomycosis - SW USA (Arizona, California), northern Mexico, parts of Central/South America; expanding range now noted in Washington State
Paracoccidioidomycosis - Exclusively South and Central America; Brazil has highest incidence
Talaromycosis - Northern Thailand, SW China, Malaysia, Vietnam, northeast India
Sporotrichosis - Worldwide in warm, humid climates; major urban epidemic in Rio de Janeiro via cat transmission

Shared Characteristics of Endemic Dimorphic Fungi

Ability to cause disease in a healthy immunocompetent host
Association with a specific ecologic niche in soil/environment
Temperature dimorphism - mold at 25-30°C; yeast/spherules at body temperature
Most cause latent infections that may reactivate years later, especially in immunocompromised hosts
Clinical presentation may mimic other diseases (TB, malignancy) - travel/residence history is key

1. Histoplasmosis

Microbiology

Causative agent: Histoplasma capsulatum (recently reclassified into multiple species: H. mississippiense, H. ohiense, H. suramericanum, etc.)
Mold phase: Produces diagnostic tuberculate macroconidia (roughened, spiny projections) and microconidia; grows on enriched agar (brain-heart infusion) within 10-14 days; white to buff-brown fluffy colonies
Yeast phase: Small (2-4 µm), oval, intracellular yeasts within macrophages; multiply by narrow-based budding; NO true capsule (capsule-like artifact on staining)
Growth stimulated by bird and bat guano in soil; birds are not infected

Tuberculate macroconidia with microconidia of Histoplasma capsulatum in culture - characteristic environmental mold form (Lactophenol cotton blue stain, 400x)

Fig: Tuberculate macroconidia of H. capsulatum - the hallmark of its mold phase (Henry's Clinical Diagnosis and Management)

Clinical Aspects

Risk factors: Living in endemic areas; construction/excavation work; activities generating aerosols from soil (>90% of endemic area residents are seropositive)

Clinical spectrum:

Asymptomatic - most common in normal hosts exposed to low spore counts
Acute pulmonary - flu-like illness with fever, chills, cough, pleuritic chest pain after heavy exposure; self-limiting in immunocompetent; may leave calcified coin lesions
Granulomatous/fibrosing mediastinitis - enlarged mediastinal lymph nodes that can obstruct airways, pulmonary vessels, or esophagus; fistula formation
Chronic pulmonary - primarily in COPD patients; cavitation mimics TB
Disseminated histoplasmosis - in immunosuppressed (HIV/AIDS, TNF-α blockers, transplant) and extremes of age; reticuloendothelial involvement: lymphadenopathy, hepatosplenomegaly, thrombocytopenia; AIDS-defining illness

Yeast cells of Histoplasma capsulatum within macrophages - small, round-to-oval intracellular yeastlike cells (H&E stain, 1000x)

Fig: H. capsulatum yeasts inside macrophages - characteristic intracellular pathology (Henry's Clinical Diagnosis and Management)

Diagnosis:

Culture (gold standard) - mold form from respiratory specimens; AccuProbe nucleic acid hybridization for confirmation
Urine antigen detection: sensitivity up to 92% in disseminated disease, 75-80% in acute pulmonary
Serology (immunodiffusion, complement fixation): delayed by 2-6 weeks; cross-reacts with Blastomyces
Histopathology: intracellular small yeasts in macrophages (H&E, GMS, PAS)

2. Blastomycosis

Microbiology

Mold phase: Fluffy white to buff colonies; microconidia similar to Histoplasma; "lollipop" appearance of conidia on conidiophore at 25°C
Yeast phase: Large (8-15 µm), thick-walled yeasts with a characteristic broad-based (wide-neck) single bud - this is the key distinguishing feature

$Blastomyces dermatitidis in tissue showing characteristic large, broad-based, budding yeast cells with thick refractile double-contoured wall (H&E stain, 400x)$

Fig: B. dermatitidis in tissue - broad-based budding yeasts with double-contoured wall (Henry's Clinical Diagnosis and Management)

Mold form of Blastomyces dermatitidis in culture showing "lollipop" appearance of conidia on conidiophore (Lactophenol cotton blue stain, 400x)

Fig: B. dermatitidis mold form - "lollipop" conidia on conidiophores (Henry's Clinical Diagnosis and Management)

Clinical Aspects

Called "the great masquerader" due to protean clinical manifestations
Primarily affects men engaged in rural/outdoor activities
Lung: Pneumonia (most common); only 5% of pulmonary cases suspected at initial presentation
Skin: Most frequent extrapulmonary site; pseudoepitheliomatous hyperplasia; verrucous or ulcerated lesions
Bone and joints: Osteolytic lesions, arthritis
CNS: Rare but possible
Histopathology: Mixed suppurative and granulomatous inflammation; microabscesses; yeast cells in giant cells; PAS or GMS staining reveals the thick-walled yeasts; diagnosis often first made by surgical pathology/cytopathology

3. Coccidioidomycosis (Valley Fever)

Microbiology

Two species: C. immitis (California) and C. posadasii (Arizona and elsewhere) - phenotypically similar, genetically distinct
Environmental form: Arthroconidia (highly infectious barrel-shaped segments) in soil - BIOSAFETY LEVEL 3 PATHOGEN; arthroconidia easily aerosolized; lab cultures must be handled in BSC
Tissue form: Spherules (up to 100 µm diameter) containing endospores (2-5 µm); unique among dimorphic fungi - no yeast form
Grows rapidly in culture (within 1 week); can appear on routine bacteriology media (blood agar)

Spherules of Coccidioides spp. in tissue - large structures presumptive of coccidioidomycosis (H&E stain, 100x)

Fig: Coccidioides spherules in tissue - multiple sizes indicating varying maturity (Henry's Clinical Diagnosis and Management)

Clinical Aspects

Risk populations: Military personnel (SW US bases), construction workers, outdoor workers, immunocompromised; genetic predisposition to dissemination in Blacks, Filipinos, Asians, Native Americans
Acute pulmonary (Valley Fever): Flu-like illness; self-limiting in most
Skin manifestations: Erythema nodosum, erythema multiforme ("desert rheumatism")
Disseminated disease (in immunocompromised, HIV): Skin, bone, joints, meninges
Meningitis: Indolent/chronic; most feared complication; requires lifelong azole therapy
Histopathology: Granulomatous with and without caseation; developing spherules in macrophages and giant cells; differential includes non-budding Blastomyces, Cryptococcus, adiaspiromycosis
Diagnosis: Calcofluor white stain of respiratory specimens; serology (IgM for acute, IgG for complement fixation); Coccidioides-specific PCR; culture (BSC required)

4. Paracoccidioidomycosis

Microbiology

Species: P. brasiliensis complex (P. brasiliensis, P. americana, P. restrepiensis, P. venezuelensis) and P. lutzii
Tissue form: Yeast cells with multiple peripheral buds arranged like a "mariner's wheel" or "pilot's wheel" (4-60 µm), highly characteristic
Female hormones (estrogens) provide protective effect - explains striking male:female ratio of 14:1 to 70:1 in chronic disease

Clinical Aspects

Acquired by inhalation; disease typically reactivates years after initial exposure
Acute/juvenile form (<10% of cases): Affects <30 year olds; disseminated reticuloendothelial involvement; peripheral eosinophilia; rapidly progressive
Chronic/adult form (~90% of cases): Older rural men; progressive pulmonary disease (lower lobes, fibrosis); ulcerative and nodular mucocutaneous lesions of upper respiratory tract (must distinguish from leishmaniasis and squamous cell carcinoma); CNS, skin, adrenal gland involvement (can cause adrenal insufficiency)
Predisposition from inborn errors affecting IL-12/IFN-γ signaling axis in severe/disseminated cases
Diagnosis: Culture of mold form at room temperature; presumptive by seeing mariner's wheel in biopsy

5. Sporotrichosis

Microbiology

Sporothrix schenckii complex - several species (S. brasiliensis, S. globosa, etc.) with differing geographic distributions and virulence
Mold phase at 25-30°C: Two types of conidia: thin-walled hyaline conidia in a "rosette/daisy head" arrangement at conidiophore tip; thick-walled dark (melanized) sessile conidia directly on hyphae - gives dematiaceous (dark) appearance in culture
Yeast phase at 37°C: Pleomorphic, small (2-6 µm), round to elongated cigar-shaped yeasts with narrow-based budding; rarely seen in tissue (unlike other dimorphic fungi)
Splendore-Hoeppli phenomenon (asteroid bodies): Radiating eosinophilic material around yeast cells in tissue - pathognomonic but uncommon
Culture on media with cycloheximide at 25-30°C; preferred specimen: aspirate, curetting, or biopsy of skin lesion

Clinical Aspects

Distinct from other dimorphics: Entry by traumatic inoculation (not inhalation); disease is typically localized (not pulmonary)
Classic presentation: Lymphocutaneous sporotrichosis - papule at entry site ulcerates, spreads via regional lymphatics producing a chain of ascending nodular lesions along the limb
Fixed cutaneous: Localized without lymphatic spread
Systemic dissemination: Rare; osteoarticular involvement, pulmonary (from inhalation); occurs in alcoholics, immunocompromised, AIDS
Zoonotic transmission: Growing cat-transmitted epidemic in Rio de Janeiro (S. brasiliensis)
Differential diagnosis: Mycobacterium marinum (swimming pool granuloma) in USA, cutaneous leishmaniasis in tropics

6. Talaromycosis (formerly Penicilliosis)

Microbiology

Talaromyces marneffei (formerly Penicillium marneffei) - the ONLY formerly Penicillium species with true thermal dimorphism
Natural reservoir: bamboo rats (Rhizomys sinensis)
Mold phase at 30°C: Typical Penicillium-like reproductive structures; produces a characteristic red/wine-colored soluble diffusible pigment
Yeast phase at 37°C: Small oval yeasts (2-5 µm) with transverse septa - reproduce by fission (not budding); key differentiating feature from Histoplasma which reproduces by budding
Commonly isolated from blood cultures in immunocompromised patients; fungemia seen in HIV+ patients

Clinical Aspects

Primarily opportunistic - major pathogen in HIV+ patients in SE Asia; AIDS-defining illness
Also reported in non-HIV immunocompromised (transplant, anti-IFN-γ autoantibodies)
Presentations: Fever, weight loss, anemia, lymphadenopathy, hepatosplenomegaly, pneumonia
Skin lesions: Characteristic cutaneous papules with central necrosis/umbilication resembling molluscum contagiosum - a clinical clue

Cutaneous papules showing central necrosis in a patient with disseminated Talaromyces marneffei infection

Fig: Skin lesions of disseminated talaromycosis - papules with central necrosis (Tietz Textbook of Laboratory Medicine, 7th Ed.)

7. Other Dimorphic Fungi

African Histoplasmosis (H. capsulatum var. duboisii)

Limited to equatorial Africa
Larger yeast cells (8-15 µm) with thicker walls resembling Blastomyces but WITHOUT broad-based buds
Emerging in HIV-infected African patients

Emergomycosis (Emergomyces spp.)

Newly described genus (5 species: E. africanus, E. canadensis, E. orientalis, E. europaeus, E. pasteurianus)
E. africanus: Most common endemic mycosis in South Africa; primarily in AIDS patients
Frequently misidentified as Blastomyces; sequencing necessary for differentiation
Symptoms: Fever, weight loss, elevated liver enzymes, TB-like chest findings, skin disease
Treatment: Amphotericin B initially, then itraconazole/voriconazole/posaconazole

Laboratory Diagnosis Summary

Method	Utility	Notes
Culture	Gold standard	Slow (weeks for most); AccuProbe nucleic acid probes for confirmation; BSL-3 precautions for Coccidioides
Direct microscopy	Rapid presumptive diagnosis	KOH/Calcofluor white; GMS; PAS; H&E - each organism has characteristic tissue morphology
Antigen detection	Best for disseminated disease	Urine/serum Histoplasma antigen (92% sensitivity in disseminated); cross-reactivity between fungi
Serology	Useful but limited	2-6 week delay; cross-reactions; poor sensitivity in immunocompromised
Nucleic acid probe (AccuProbe)	From culture isolates	Confirms Histoplasma, Blastomyces, Coccidioides
PCR/Molecular	Emerging	Direct detection from specimens; better sensitivity
Histopathology	Often diagnostic	Tissue biopsy with GMS or PAS staining

Key Stains:

H&E - routine; may miss small organisms (Histoplasma)
GMS (Gomori's methenamine silver) - preferred for fungi; highlights cell walls black
PAS - alternative silver stain
Calcofluor white - fluorescent; enhances detection; used on respiratory specimens

Treatment Overview

Organism	Mild-Moderate Disease	Severe/Disseminated Disease
Histoplasma	Itraconazole	Amphotericin B → Itraconazole
Blastomyces	Itraconazole	Amphotericin B → Itraconazole
Coccidioides	Fluconazole or Itraconazole	Amphotericin B; lifelong azole for meningitis
Paracoccidioides	Itraconazole	Amphotericin B → Itraconazole/TMP-SMX
Sporothrix	Itraconazole	Amphotericin B; then Itraconazole
Talaromyces	Itraconazole	Amphotericin B → Itraconazole

Itraconazole is the azole of choice for most dimorphic fungi
Posaconazole has activity against dimorphic fungi and mucorales
Disseminated Coccidioides, Histoplasma, and Talaromyces are AIDS-defining infections in HIV

Key Clinical Pearls

Travel/residence history is essential - most dimorphic fungi have restricted geographic distributions
Dimorphic fungi can mimic TB, sarcoidosis, and malignancy - always consider in endemic area patients
Most infections are asymptomatic in immunocompetent hosts - disease results from heavy exposure or immunosuppression
Latent infections can reactivate years later - question patients on past residence in endemic regions
Sporothrix is the odd one out: inoculation (not inhalation), lymphocutaneous pattern, cigar-shaped yeasts rarely seen in tissue
Coccidioides is the most infectious in the lab (BSL-3) - arthroconidia easily aerosolized from cultures
Paracoccidioides has a striking male predominance due to estrogen's protective effect (estrogens inhibit mold-to-yeast conversion)
T. marneffei yeast cells divide by fission (with transverse septa), not budding - distinguishes from Histoplasma

Sources: Henry's Clinical Diagnosis and Management by Laboratory Methods (Henry's); Tietz Textbook of Laboratory Medicine, 7th Edition; Harrison's Principles of Internal Medicine, 22nd Edition (2025); Current Surgical Therapy, 14th Edition

Make a PowerPoint presentation on dimorphic fungi clinical cases

Reading File

Running Command

mkdir -p /home/daytona/workspace/dimorphic-fungi-cases && node /home/daytona/ski…

Writing File

~/dimorphic-fungi-cases/make_pptx.js

const pptxgen = require("pptxgenjs");
const fs = require("fs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Dimorphic Fungi – Clinical Cases";
pres.author = "Medical Mycology";

// Load images
const imgs = [];
for (let i = 0; i <= 6; i++) {
  try { imgs[i] = fs.readFileSync(`/home/daytona/workspace/dimorphic-fungi-cases/img${i}.txt`, "utf8"); }
  catch(e) { imgs[i] = null; }
}

// ── COLORS ──────────────────────────────────────────────────────────────────
const C = {
  dark:    "0D1B2A",   // deep navy
  mid:     "1B3A5C",   // medium navy
  accent:  "2A9D8F",   // teal-green
  gold:    "E9C46A",   // warm amber
  alert:   "E76F51",   // coral/orange
  light:   "F4F1EC",   // off-white
  white:   "FFFFFF",
  gray:    "7A8FA6",
};

// ── HELPERS ──────────────────────────────────────────────────────────────────
function addDarkBg(slide, hex) {
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color: hex || C.dark }, line:{ type:"none" } });
}

function addLightBg(slide) {
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color: C.light }, line:{ type:"none" } });
}

function sectionTag(slide, label, color) {
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.42, fill:{ color: color || C.accent }, line:{ type:"none" } });
  slide.addText(label, { x:0.2, y:0, w:9.6, h:0.42, fontSize:9, bold:true, color:C.white, valign:"middle", margin:0 });
}

function caseLabel(slide, num, title, accent) {
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:0.42, w:10, h:1.1, fill:{ color: C.mid }, line:{ type:"none" } });
  slide.addText(`CASE ${num}`, { x:0.35, y:0.46, w:1.5, h:0.38, fontSize:9, bold:true, color:accent, margin:0 });
  slide.addText(title, { x:0.35, y:0.78, w:9.3, h:0.6, fontSize:22, bold:true, color:C.white, valign:"middle", margin:0 });
}

function keyBadge(slide, label, value, x, y, accent) {
  slide.addShape(pres.shapes.RECTANGLE, { x, y, w:2.9, h:0.72,
    fill:{ color: C.dark }, line:{ color: accent, pt:1.5 },
    shadow:{ type:"outer", color:"000000", blur:5, offset:2, angle:135, opacity:0.2 }
  });
  slide.addText([
    { text: label + "\n", options:{ bold:true, color:accent, fontSize:7.5 } },
    { text: value, options:{ color:C.white, fontSize:9.5 } }
  ], { x, y, w:2.9, h:0.72, align:"center", valign:"middle", margin:4 });
}

function diagBox(slide, items, x, y, w, h, accent) {
  slide.addShape(pres.shapes.RECTANGLE, { x, y, w, h, fill:{ color:"132940" }, line:{ color: accent, pt:1 } });
  slide.addText(items, { x:x+0.1, y, w:w-0.2, h, fontSize:10, color:C.white, valign:"middle", margin:6 });
}

function addSectionDivider(slide, title, subText, accent) {
  addDarkBg(slide, C.dark);
  slide.addShape(pres.shapes.RECTANGLE, { x:0, y:2.2, w:10, h:1.25, fill:{ color: accent }, line:{ type:"none" } });
  slide.addText(title, { x:0.5, y:2.22, w:9, h:0.75, fontSize:32, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
  slide.addText(subText, { x:0.5, y:3.0, w:9, h:0.4, fontSize:13, color:C.light, align:"center", valign:"middle", margin:0 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.dark);
  // Teal bar left accent
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:0.18, h:5.625, fill:{ color:C.accent }, line:{ type:"none" } });
  // Gold bottom stripe
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.1, w:10, h:0.525, fill:{ color:C.gold }, line:{ type:"none" } });
  s.addText("DIMORPHIC FUNGI", { x:0.4, y:0.9, w:9.2, h:0.7, fontSize:13, bold:true, color:C.accent, charSpacing:6, margin:0 });
  s.addText("Clinical Cases", { x:0.4, y:1.5, w:9.2, h:1.4, fontSize:44, bold:true, color:C.white, margin:0 });
  s.addText("Microbiological & Clinical Perspectives", { x:0.4, y:3.0, w:9.2, h:0.5, fontSize:16, color:C.gold, margin:0 });
  s.addText("Histoplasmosis  ·  Blastomycosis  ·  Coccidioidomycosis  ·  Sporotrichosis  ·  Talaromycosis", {
    x:0.4, y:3.6, w:9.2, h:0.38, fontSize:10, color:C.gray, margin:0 });
  s.addText("Case-based Learning Series", { x:0.4, y:5.1, w:9.2, h:0.45, fontSize:11, color:C.dark, align:"center", valign:"middle", bold:true, margin:0 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OVERVIEW: What are Dimorphic Fungi?
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addLightBg(s);
  sectionTag(s, "OVERVIEW");
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.42, w:10, h:0.95, fill:{ color:C.mid }, line:{ type:"none" } });
  s.addText("What Are Dimorphic Fungi?", { x:0.35, y:0.42, w:9.3, h:0.95, fontSize:24, bold:true, color:C.white, valign:"middle", margin:0 });

  // Central concept box
  s.addShape(pres.shapes.RECTANGLE, { x:0.3, y:1.55, w:4.1, h:1.5, fill:{ color:C.accent }, line:{ type:"none" },
    shadow:{ type:"outer", color:"000000", blur:8, offset:3, angle:135, opacity:0.2 } });
  s.addText([
    { text:"MOLD PHASE (25–30°C)\n", options:{ bold:true, fontSize:10 } },
    { text:"Filamentous, produces infectious conidia\nFound in soil/environment", options:{ fontSize:9.5 } }
  ], { x:0.3, y:1.55, w:4.1, h:1.5, color:C.white, align:"center", valign:"middle", margin:8 });

  // Arrow
  s.addShape(pres.shapes.RIGHT_ARROW, { x:4.6, y:2.05, w:0.9, h:0.5, fill:{ color:C.gold }, line:{ type:"none" } });
  s.addText("37°C\n(body)", { x:4.55, y:2.6, w:1.0, h:0.45, fontSize:8, color:C.dark, align:"center", margin:0 });

  s.addShape(pres.shapes.RECTANGLE, { x:5.6, y:1.55, w:4.1, h:1.5, fill:{ color:C.mid }, line:{ type:"none" },
    shadow:{ type:"outer", color:"000000", blur:8, offset:3, angle:135, opacity:0.2 } });
  s.addText([
    { text:"YEAST PHASE (37°C)\n", options:{ bold:true, fontSize:10 } },
    { text:"Single cells / spherules in tissue\nReplication & dissemination", options:{ fontSize:9.5 } }
  ], { x:5.6, y:1.55, w:4.1, h:1.5, color:C.white, align:"center", valign:"middle", margin:8 });

  // Bullets
  s.addText([
    { text: "Key shared features:  ", options:{ bold:true, color:C.dark, fontSize:10.5 } },
    { text: "Infect immunocompetent hosts  ·  Geographically restricted  ·  Latent reactivation  ·  Mimic TB/malignancy", options:{ color:"333333", fontSize:10 } }
  ], { x:0.3, y:3.25, w:9.4, h:0.45, margin:0 });

  // Table of organisms
  const rows = [
    [{ text:"Organism", options:{ bold:true, color:C.white } }, { text:"Disease", options:{ bold:true, color:C.white } }, { text:"Geography", options:{ bold:true, color:C.white } }, { text:"Entry", options:{ bold:true, color:C.white } }],
    ["Histoplasma capsulatum","Histoplasmosis","Ohio/Mississippi valleys, Worldwide","Inhalation"],
    ["Blastomyces dermatitidis","Blastomycosis","SE/SC USA, Africa","Inhalation"],
    ["Coccidioides spp.","Coccidioidomycosis (Valley Fever)","SW USA, Mexico","Inhalation"],
    ["Sporothrix schenckii","Sporotrichosis","Worldwide (warm, humid)","Traumatic inoculation"],
    ["Talaromyces marneffei","Talaromycosis","SE Asia","Inhalation"],
  ];
  s.addTable(rows, {
    x:0.3, y:3.78, w:9.4, h:1.7,
    fontSize:9, color:"222222", valign:"middle",
    rowH:0.28,
    border:{ type:"solid", color:"CCCCCC", pt:0.5 },
    fill:"F4F1EC",
    colW:[2.6, 2.3, 2.7, 1.8],
  });
  // Override header row fill
  // pptxgenjs doesn't support per-row fill in addTable without per-cell opts
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – GEOGRAPHIC DISTRIBUTION (IMAGE)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.mid);
  sectionTag(s, "EPIDEMIOLOGY", C.accent);
  s.addText("Geographic Distribution of Endemic Dimorphic Fungi", {
    x:0.3, y:0.5, w:9.4, h:0.65, fontSize:20, bold:true, color:C.white, margin:0 });
  if (imgs[0]) s.addImage({ data:imgs[0], x:0.2, y:1.25, w:4.0, h:4.0 });
  // Right side bullets
  const pts = [
    ["Histoplasmosis", "Ohio & Mississippi River valleys; extends into Caribbean, South America, Asia"],
    ["Blastomycosis", "SE/SC USA, Great Lakes, Canada; also sub-Saharan Africa"],
    ["Coccidioidomycosis", "SW USA (Arizona, California), Mexico, Central/South America"],
    ["Paracoccidioidomycosis", "Exclusively South & Central America; Brazil highest burden"],
    ["Talaromycosis", "SE Asia: Thailand, S China, Vietnam, NE India"],
    ["Sporotrichosis", "Worldwide; Brazil epidemic via cat transmission"],
  ];
  let yy = 1.28;
  pts.forEach(([org, desc]) => {
    s.addShape(pres.shapes.RECTANGLE, { x:4.5, y:yy, w:5.25, h:0.62, fill:{ color:"132940" }, line:{ color:C.accent, pt:0.8 } });
    s.addText([
      { text:org + "  ", options:{ bold:true, color:C.accent, fontSize:9 } },
      { text:desc, options:{ color:C.light, fontSize:8.5 } }
    ], { x:4.6, y:yy, w:5.05, h:0.62, valign:"middle", margin:4 });
    yy += 0.68;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – CASE 1: HISTOPLASMOSIS  (Presentation)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.dark);
  sectionTag(s, "CASE 1 – HISTOPLASMOSIS", C.accent);
  caseLabel(s, "01", "Histoplasmosis – The Cave Explorer", C.accent);

  // Left panel: case scenario
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:1.62, w:5.5, h:3.8, fill:{ color:"0F2535" }, line:{ color:C.accent, pt:1 } });
  s.addText("CLINICAL PRESENTATION", { x:0.35, y:1.68, w:5.3, h:0.32, fontSize:8.5, bold:true, color:C.accent, margin:0 });
  s.addText([
    { text:"• ", options:{ color:C.gold } }, { text:"32-year-old male, spelunker (caver) from Ohio\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"3-week history of fever, dry cough, fatigue, night sweats\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Severe headache and weight loss (4 kg)\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Explored bat caves 3–4 weeks ago\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"EXAMINATION\n", options:{ bold:true, color:C.gold, fontSize:9 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Temp 38.8°C, HR 102, SpO₂ 94% on room air\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Hepatosplenomegaly, cervical lymphadenopathy\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"CXR: bilateral diffuse interstitial infiltrates\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"LABS\n", options:{ bold:true, color:C.gold, fontSize:9 } },
    { text:"• WBC 3.2 × 10⁹/L  •  LDH elevated  •  Ferritin 2400 ng/mL\n", options:{ color:C.white, fontSize:10 } },
    { text:"• HIV negative  •  No immunosuppressive medications", options:{ color:C.white, fontSize:10 } },
  ], { x:0.35, y:2.05, w:5.3, h:3.25, valign:"top", margin:4 });

  // Right panel: key clues
  s.addText("KEY DIAGNOSTIC CLUES", { x:6.0, y:1.68, w:3.7, h:0.32, fontSize:8.5, bold:true, color:C.gold, margin:0 });
  const clues = [
    ["🦇", "Bat Cave Exposure", "Primary epidemiologic risk"],
    ["🌡️", "Flu-like Syndrome", "Fever, cough, fatigue"],
    ["🫁", "Bilateral Infiltrates", "CXR / CT finding"],
    ["🔬", "Intracellular Yeasts", "In macrophages (2–4 µm)"],
    ["📍", "Ohio River Valley", "Classic endemic area"],
  ];
  let cy = 2.05;
  clues.forEach(([icon, hd, sub]) => {
    s.addShape(pres.shapes.RECTANGLE, { x:6.0, y:cy, w:3.72, h:0.64, fill:{ color:"0F2535" }, line:{ color:C.gold, pt:0.6 } });
    s.addText([
      { text:icon + "  ", options:{ fontSize:13 } },
      { text:hd + "\n", options:{ bold:true, color:C.gold, fontSize:9.5 } },
      { text:"      " + sub, options:{ color:C.gray, fontSize:8.5 } }
    ], { x:6.05, y:cy, w:3.62, h:0.64, valign:"middle", margin:4 });
    cy += 0.7;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – CASE 1: HISTOPLASMOSIS (Micro + Diagnosis + Treatment)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addLightBg(s);
  sectionTag(s, "CASE 1 – HISTOPLASMOSIS: MICROBIOLOGY & MANAGEMENT", C.accent);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.42, w:10, h:0.75, fill:{ color:C.mid }, line:{ type:"none" } });
  s.addText("Histoplasma capsulatum – Microbiological Features & Workup", {
    x:0.3, y:0.42, w:9.4, h:0.75, fontSize:17, bold:true, color:C.white, valign:"middle", margin:0 });

  // Image: macroconidia
  if (imgs[2]) s.addImage({ data:imgs[2], x:0.25, y:1.28, w:3.2, h:2.4 });
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:3.68, w:3.2, h:0.35, fill:{ color:C.accent }, line:{ type:"none" } });
  s.addText("Tuberculate macroconidia — mold phase (LPCB 400×)", { x:0.25, y:3.68, w:3.2, h:0.35, fontSize:7.5, color:C.white, align:"center", valign:"middle", margin:0 });

  // Image: yeasts in macrophage
  if (imgs[1]) s.addImage({ data:imgs[1], x:3.65, y:1.28, w:3.2, h:2.4 });
  s.addShape(pres.shapes.RECTANGLE, { x:3.65, y:3.68, w:3.2, h:0.35, fill:{ color:C.accent }, line:{ type:"none" } });
  s.addText("H. capsulatum yeasts inside macrophages (H&E 1000×)", { x:3.65, y:3.68, w:3.2, h:0.35, fontSize:7.5, color:C.white, align:"center", valign:"middle", margin:0 });

  // Right panel: diagnosis + treatment
  s.addShape(pres.shapes.RECTANGLE, { x:7.1, y:1.28, w:2.65, h:4.1, fill:{ color:C.dark }, line:{ color:C.accent, pt:1 } });
  s.addText([
    { text:"DIAGNOSIS\n", options:{ bold:true, color:C.accent, fontSize:9.5, breakLine:true } },
    { text:"✓ Urine antigen\n  (92% sensitivity, disseminated)\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"✓ Bronchoalveolar lavage\n  + GMS stain\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"✓ Culture: BHI agar 25°C\n  (10–28 days); AccuProbe\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"✓ Serology: complement\n  fixation / immunodiffusion\n\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"TREATMENT\n", options:{ bold:true, color:C.gold, fontSize:9.5, breakLine:true } },
    { text:"Mild-moderate:\n  Itraconazole 200 mg TID\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"Severe/disseminated:\n  Amphotericin B → Itraconazole\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"Duration: 12 weeks\n  (disseminated: 12 months)", options:{ color:C.white, fontSize:8.5 } },
  ], { x:7.15, y:1.33, w:2.55, h:4.0, valign:"top", margin:6 });

  s.addText("Answer: Disseminated Histoplasmosis  |  Confirmed by urine antigen + bone marrow biopsy",
    { x:0.25, y:4.12, w:6.7, h:0.38, fontSize:8.5, bold:true, color:C.dark,
      fill:{ color:C.gold }, align:"center", valign:"middle", margin:4 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 6 – CASE 2: BLASTOMYCOSIS (Presentation)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.dark);
  sectionTag(s, "CASE 2 – BLASTOMYCOSIS", C.gold);
  caseLabel(s, "02", "Blastomycosis – The Great Masquerader", C.gold);

  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:1.62, w:5.5, h:3.8, fill:{ color:"0F2535" }, line:{ color:C.gold, pt:1 } });
  s.addText("CLINICAL PRESENTATION", { x:0.35, y:1.68, w:5.3, h:0.32, fontSize:8.5, bold:true, color:C.gold, margin:0 });
  s.addText([
    { text:"• ", options:{ color:C.accent } }, { text:"45-year-old male logger from Wisconsin\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"6-week history of productive cough, fever, pleuritic chest pain\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"3 courses of antibiotics — no improvement\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"New raised, verrucous skin lesions on face and arms\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"EXAMINATION\n", options:{ bold:true, color:C.accent, fontSize:9 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Temp 38.2°C, decreased breath sounds at right base\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Verrucous crusted plaques with irregular borders\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"CXR: right lower lobe mass-like consolidation\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"LABS\n", options:{ bold:true, color:C.accent, fontSize:9 } },
    { text:"• WBC 14 × 10⁹/L  •  CRP 85 mg/L  •  HIV negative\n", options:{ color:C.white, fontSize:10 } },
    { text:"• CT chest: consolidation + cavitation (mimics lung cancer)", options:{ color:C.white, fontSize:10 } },
  ], { x:0.35, y:2.05, w:5.3, h:3.25, valign:"top", margin:4 });

  // Right clues
  s.addText("THE GREAT MASQUERADER", { x:6.0, y:1.68, w:3.7, h:0.32, fontSize:8.5, bold:true, color:C.gold, margin:0 });
  const clues = [
    ["🌲", "Rural/Outdoor Worker", "Logging, farming — soil exposure"],
    ["🩹", "Antibiotic Failure", "Key red flag for fungal etiology"],
    ["🩺", "Skin Lesions", "Verrucous, ulcerated plaques"],
    ["🔬", "Broad-based Buds", "8–15 µm thick-walled yeasts"],
    ["📍", "Ohio/Mississippi", "Great Lakes endemic region"],
  ];
  let cy = 2.05;
  clues.forEach(([icon, hd, sub]) => {
    s.addShape(pres.shapes.RECTANGLE, { x:6.0, y:cy, w:3.72, h:0.64, fill:{ color:"0F2535" }, line:{ color:C.gold, pt:0.6 } });
    s.addText([
      { text:icon + "  ", options:{ fontSize:13 } },
      { text:hd + "\n", options:{ bold:true, color:C.gold, fontSize:9.5 } },
      { text:"      " + sub, options:{ color:C.gray, fontSize:8.5 } }
    ], { x:6.05, y:cy, w:3.62, h:0.64, valign:"middle", margin:4 });
    cy += 0.7;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 7 – CASE 2: BLASTOMYCOSIS (Micro + Diagnosis)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addLightBg(s);
  sectionTag(s, "CASE 2 – BLASTOMYCOSIS: MICROBIOLOGY & MANAGEMENT", C.gold);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.42, w:10, h:0.75, fill:{ color:C.mid }, line:{ type:"none" } });
  s.addText("Blastomyces dermatitidis – Microbiological Features & Workup", {
    x:0.3, y:0.42, w:9.4, h:0.75, fontSize:17, bold:true, color:C.white, valign:"middle", margin:0 });

  // Image: Blastomyces yeast in tissue
  if (imgs[3]) s.addImage({ data:imgs[3], x:0.25, y:1.28, w:3.2, h:2.4 });
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:3.68, w:3.2, h:0.4, fill:{ color:"B8860B" }, line:{ type:"none" } });
  s.addText("B. dermatitidis — broad-based budding yeasts in tissue (H&E 400×)", { x:0.25, y:3.68, w:3.2, h:0.4, fontSize:7.5, color:C.white, align:"center", valign:"middle", margin:0 });

  // Image: mold form
  if (imgs[6]) s.addImage({ data:imgs[6], x:3.65, y:1.28, w:3.2, h:2.4 });
  s.addShape(pres.shapes.RECTANGLE, { x:3.65, y:3.68, w:3.2, h:0.4, fill:{ color:"B8860B" }, line:{ type:"none" } });
  s.addText("Mold form — \"lollipop\" conidia on conidiophore (LPCB 400×)", { x:3.65, y:3.68, w:3.2, h:0.4, fontSize:7.5, color:C.white, align:"center", valign:"middle", margin:0 });

  // Right: diagnosis + treatment
  s.addShape(pres.shapes.RECTANGLE, { x:7.1, y:1.28, w:2.65, h:4.1, fill:{ color:C.dark }, line:{ color:C.gold, pt:1 } });
  s.addText([
    { text:"DIAGNOSIS\n", options:{ bold:true, color:C.gold, fontSize:9.5, breakLine:true } },
    { text:"✓ Wet prep / KOH of sputum\n  or skin scraping\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"✓ Culture: BHI agar\n  White fluffy colonies\n  AccuProbe confirmation\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"✓ Urine antigen\n  (cross-reacts w/ Histoplasma)\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"✓ Biopsy: GMS/PAS stain\n\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"TREATMENT\n", options:{ bold:true, color:C.accent, fontSize:9.5, breakLine:true } },
    { text:"Mild-moderate:\n  Itraconazole 200 mg BID\n  × 6 months\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
    { text:"Severe/CNS:\n  Amphotericin B\n  → Itraconazole\n", options:{ color:C.white, fontSize:8.5, breakLine:true } },
  ], { x:7.15, y:1.33, w:2.55, h:4.0, valign:"top", margin:6 });

  s.addText("Answer: Pulmonary + Cutaneous Blastomycosis  |  Confirmed by culture + broad-based budding yeasts",
    { x:0.25, y:4.12, w:6.7, h:0.38, fontSize:8.5, bold:true, color:C.dark,
      fill:{ color:C.gold }, align:"center", valign:"middle", margin:4 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 8 – CASE 3: COCCIDIOIDOMYCOSIS (Presentation)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.dark);
  sectionTag(s, "CASE 3 – COCCIDIOIDOMYCOSIS (VALLEY FEVER)", C.alert);
  caseLabel(s, "03", "Coccidioidomycosis – Valley Fever", C.alert);

  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:1.62, w:5.5, h:3.8, fill:{ color:"0F2535" }, line:{ color:C.alert, pt:1 } });
  s.addText("CLINICAL PRESENTATION", { x:0.35, y:1.68, w:5.3, h:0.32, fontSize:8.5, bold:true, color:C.alert, margin:0 });
  s.addText([
    { text:"• ", options:{ color:C.gold } }, { text:"28-year-old Filipino male, military recruit training in Arizona\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"2-week fever, dry cough, chest tightness\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Painful red nodules on shins (erythema nodosum)\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Joint aches, myalgia — called \"desert rheumatism\"\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"EXAMINATION\n", options:{ bold:true, color:C.accent, fontSize:9 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Temp 38.5°C, tender anterior tibial nodules\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Reduced air entry at right apex\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"CXR: right upper lobe infiltrate with hilar adenopathy\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"LABS\n", options:{ bold:true, color:C.accent, fontSize:9 } },
    { text:"• WBC 11.2 × 10⁹/L  •  Eosinophilia (8%)\n", options:{ color:C.white, fontSize:10 } },
    { text:"• HIV negative  •  IgM coccidioides serology positive", options:{ color:C.white, fontSize:10 } },
  ], { x:0.35, y:2.05, w:5.3, h:3.25, valign:"top", margin:4 });

  s.addText("KEY DIAGNOSTIC CLUES", { x:6.0, y:1.68, w:3.7, h:0.32, fontSize:8.5, bold:true, color:C.alert, margin:0 });
  const clues = [
    ["🏜️", "Desert Exposure", "SW USA military base/construction"],
    ["🦶", "Erythema Nodosum", "\"Desert rheumatism\" triad"],
    ["⚠️", "Filipino Ethnicity", "Genetic risk for dissemination"],
    ["🔬", "Spherules", "Up to 100 µm, filled with endospores"],
    ["⚗️", "BSL-3 Pathogen", "Most infectious dimorphic fungus"],
  ];
  let cy = 2.05;
  clues.forEach(([icon, hd, sub]) => {
    s.addShape(pres.shapes.RECTANGLE, { x:6.0, y:cy, w:3.72, h:0.64, fill:{ color:"0F2535" }, line:{ color:C.alert, pt:0.6 } });
    s.addText([
      { text:icon + "  ", options:{ fontSize:13 } },
      { text:hd + "\n", options:{ bold:true, color:C.alert, fontSize:9.5 } },
      { text:"      " + sub, options:{ color:C.gray, fontSize:8.5 } }
    ], { x:6.05, y:cy, w:3.62, h:0.64, valign:"middle", margin:4 });
    cy += 0.7;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 9 – CASE 3: COCCIDIOIDOMYCOSIS (Micro + Diagnosis)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addLightBg(s);
  sectionTag(s, "CASE 3 – COCCIDIOIDOMYCOSIS: MICROBIOLOGY & MANAGEMENT", C.alert);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.42, w:10, h:0.75, fill:{ color:C.mid }, line:{ type:"none" } });
  s.addText("Coccidioides spp. – Unique Tissue Form & Workup", {
    x:0.3, y:0.42, w:9.4, h:0.75, fontSize:17, bold:true, color:C.white, valign:"middle", margin:0 });

  // Coccidioides spherules image
  if (imgs[4]) s.addImage({ data:imgs[4], x:0.25, y:1.28, w:4.5, h:2.8 });
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:4.08, w:4.5, h:0.4, fill:{ color:C.alert }, line:{ type:"none" } });
  s.addText("Coccidioides spherules of varying size in tissue (H&E 100×)", { x:0.25, y:4.08, w:4.5, h:0.4, fontSize:7.5, color:C.white, align:"center", valign:"middle", margin:0 });

  // Right panel: micro + treatment
  s.addShape(pres.shapes.RECTANGLE, { x:5.0, y:1.28, w:4.75, h:3.2, fill:{ color:C.dark }, line:{ color:C.alert, pt:1 } });
  s.addText([
    { text:"UNIQUE MICROBIOLOGICAL FEATURES\n", options:{ bold:true, color:C.alert, fontSize:9.5, breakLine:true } },
    { text:"• Spherules (up to 100 µm) — NOT yeasts\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Endospores (2–5 µm) — disseminate on rupture\n", options:{ color:C.white, fontSize:9 } },
    { text:"• BSL-3 biohazard — arthroconidia infectious in lab\n", options:{ color:C.white, fontSize:9 } },
    { text:"• C. immitis (CA) vs. C. posadasii (AZ/elsewhere)\n\n", options:{ color:C.white, fontSize:9 } },
    { text:"DIAGNOSIS\n", options:{ bold:true, color:C.gold, fontSize:9.5, breakLine:true } },
    { text:"• Serology: IgM (acute), IgG/complement fixation\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Culture in BSC — rapid growth (1 week)\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Calcofluor white stain on BAL/sputum\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Urine/serum antigen (less sensitive)\n\n", options:{ color:C.white, fontSize:9 } },
    { text:"TREATMENT\n", options:{ bold:true, color:C.accent, fontSize:9.5, breakLine:true } },
    { text:"Mild: Fluconazole 400 mg/day or Itraconazole\n", options:{ color:C.white, fontSize:9 } },
    { text:"Severe: Amphotericin B then azole maintenance\n", options:{ color:C.white, fontSize:9 } },
    { text:"Meningitis: Fluconazole LIFELONG", options:{ color:C.alert, fontSize:9, bold:true } },
  ], { x:5.05, y:1.33, w:4.65, h:3.1, valign:"top", margin:6 });

  s.addText("Answer: Acute Pulmonary Coccidioidomycosis (Valley Fever)  |  Monitor for dissemination (Filipino ethnicity = high risk)",
    { x:0.25, y:4.58, w:9.5, h:0.42, fontSize:8.5, bold:true, color:C.dark,
      fill:{ color:C.gold }, align:"center", valign:"middle", margin:4 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 10 – CASE 4: SPOROTRICHOSIS (Presentation)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.dark);
  sectionTag(s, "CASE 4 – SPOROTRICHOSIS", C.accent);
  caseLabel(s, "04", "Sporotrichosis – The Rose Thorn Infection", C.accent);

  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:1.62, w:5.5, h:3.8, fill:{ color:"0F2535" }, line:{ color:C.accent, pt:1 } });
  s.addText("CLINICAL PRESENTATION", { x:0.35, y:1.68, w:5.3, h:0.32, fontSize:8.5, bold:true, color:C.accent, margin:0 });
  s.addText([
    { text:"• ", options:{ color:C.gold } }, { text:"38-year-old female florist from Brazil\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Initially: small painless papule on right index finger\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Over 4 weeks: ulcerated, then new nodules appeared\n  extending up the forearm\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Works with roses and potted plants daily\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"EXAMINATION\n", options:{ bold:true, color:C.accent, fontSize:9 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Afebrile, no systemic symptoms\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Chain of 5 nodular lesions tracking along lymphatics\n  from finger to elbow — classical sporotrichoid spread\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"No hepatosplenomegaly, normal CXR\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"LABS\n", options:{ bold:true, color:C.accent, fontSize:9 } },
    { text:"• Normal CBC, ESR mildly elevated\n", options:{ color:C.white, fontSize:10 } },
    { text:"• HIV negative  •  Culture: moist colony, turns dark", options:{ color:C.white, fontSize:10 } },
  ], { x:0.35, y:2.05, w:5.3, h:3.25, valign:"top", margin:4 });

  s.addText("KEY DIAGNOSTIC CLUES", { x:6.0, y:1.68, w:3.7, h:0.32, fontSize:8.5, bold:true, color:C.accent, margin:0 });
  const clues = [
    ["🌹", "Rose / Plant Thorn", "Traumatic inoculation — NOT inhalation"],
    ["📈", "Lymphocutaneous", "Ascending chain of nodules"],
    ["🔬", "Cigar-shaped Yeasts", "Rarely seen in tissue (2–6 µm)"],
    ["⭐", "Asteroid Bodies", "Splendore-Hoeppli phenomenon"],
    ["🌍", "Worldwide", "Warm, humid environments"],
  ];
  let cy = 2.05;
  clues.forEach(([icon, hd, sub]) => {
    s.addShape(pres.shapes.RECTANGLE, { x:6.0, y:cy, w:3.72, h:0.64, fill:{ color:"0F2535" }, line:{ color:C.accent, pt:0.6 } });
    s.addText([
      { text:icon + "  ", options:{ fontSize:13 } },
      { text:hd + "\n", options:{ bold:true, color:C.accent, fontSize:9.5 } },
      { text:"      " + sub, options:{ color:C.gray, fontSize:8.5 } }
    ], { x:6.05, y:cy, w:3.62, h:0.64, valign:"middle", margin:4 });
    cy += 0.7;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 11 – CASE 4: SPOROTRICHOSIS (Micro + Treatment)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addLightBg(s);
  sectionTag(s, "CASE 4 – SPOROTRICHOSIS: MICROBIOLOGY & MANAGEMENT", C.accent);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.42, w:10, h:0.75, fill:{ color:C.mid }, line:{ type:"none" } });
  s.addText("Sporothrix schenckii – Features & Treatment", {
    x:0.3, y:0.42, w:9.4, h:0.75, fontSize:17, bold:true, color:C.white, valign:"middle", margin:0 });

  // Content boxes
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:1.3, w:4.7, h:2.2, fill:{ color:C.dark }, line:{ color:C.accent, pt:1 } });
  s.addText([
    { text:"MOLD PHASE (25–30°C)\n", options:{ bold:true, color:C.accent, fontSize:10, breakLine:true } },
    { text:"• Two conidial types:\n", options:{ color:C.white, fontSize:9.5 } },
    { text:"  - Thin-walled hyaline: rosette/daisy-head arrangement\n", options:{ color:C.white, fontSize:9 } },
    { text:"  - Thick-walled dark (melanized) sessile on hyphae\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Colonies: initially cream, turn dark brown/black\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Dematiaceous (melanized) appearance in culture\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Cycloheximide: grows well (selective advantage)", options:{ color:C.white, fontSize:9 } },
  ], { x:0.35, y:1.35, w:4.5, h:2.1, valign:"top", margin:4 });

  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:3.58, w:4.7, h:1.75, fill:{ color:C.dark }, line:{ color:C.gold, pt:1 } });
  s.addText([
    { text:"YEAST PHASE (37°C in tissue)\n", options:{ bold:true, color:C.gold, fontSize:10, breakLine:true } },
    { text:"• Cigar-shaped or pleomorphic (2–6 µm)\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Narrow-based budding — rarely seen in tissue\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Asteroid bodies (Splendore-Hoeppli): eosinophilic\n  radiating material around yeast — pathognomonic\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Differential: M. marinum, cutaneous leishmaniasis", options:{ color:C.white, fontSize:9 } },
  ], { x:0.35, y:3.63, w:4.5, h:1.65, valign:"top", margin:4 });

  // Right: diagnosis + treatment
  s.addShape(pres.shapes.RECTANGLE, { x:5.2, y:1.3, w:4.55, h:4.03, fill:{ color:C.dark }, line:{ color:C.accent, pt:1 } });
  s.addText([
    { text:"DIAGNOSIS\n", options:{ bold:true, color:C.accent, fontSize:9.5, breakLine:true } },
    { text:"✓ Culture (preferred)\n  Aspirate / biopsy of skin lesion\n  BHI or Sabouraud's agar at 25–30°C\n", options:{ color:C.white, fontSize:9, breakLine:true } },
    { text:"✓ Histopathology\n  PAS/GMS stain (yeasts rarely visible)\n", options:{ color:C.white, fontSize:9, breakLine:true } },
    { text:"✓ Sporotrichin skin test\n  (epidemiologic surveys only)\n\n", options:{ color:C.white, fontSize:9, breakLine:true } },
    { text:"TREATMENT\n", options:{ bold:true, color:C.gold, fontSize:9.5, breakLine:true } },
    { text:"Lymphocutaneous/Fixed cutaneous:\n  Itraconazole 200 mg/day × 3–6 months\n  OR Saturated KI (SSKI) drops\n", options:{ color:C.white, fontSize:9, breakLine:true } },
    { text:"Disseminated/Pulmonary:\n  Amphotericin B → Itraconazole\n", options:{ color:C.white, fontSize:9, breakLine:true } },
    { text:"Heat therapy: local heat application\n  (yeast sensitive to temperature)\n\n", options:{ color:C.white, fontSize:9, breakLine:true } },
    { text:"⚠️  Terbinafine may be used for\n  cutaneous disease (S. brasiliensis)", options:{ color:C.alert, fontSize:9 } },
  ], { x:5.3, y:1.35, w:4.35, h:3.93, valign:"top", margin:6 });

  s.addText("Answer: Lymphocutaneous Sporotrichosis  |  Confirmed by culture of skin aspirate",
    { x:0.25, y:5.1, w:9.5, h:0.38, fontSize:8.5, bold:true, color:C.dark,
      fill:{ color:C.gold }, align:"center", valign:"middle", margin:4 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 12 – CASE 5: TALAROMYCOSIS (Presentation)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.dark);
  sectionTag(s, "CASE 5 – TALAROMYCOSIS (formerly Penicilliosis)", C.alert);
  caseLabel(s, "05", "Talaromycosis – The AIDS-Defining Mycosis", C.alert);

  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:1.62, w:5.5, h:3.8, fill:{ color:"0F2535" }, line:{ color:C.alert, pt:1 } });
  s.addText("CLINICAL PRESENTATION", { x:0.35, y:1.68, w:5.3, h:0.32, fontSize:8.5, bold:true, color:C.alert, margin:0 });
  s.addText([
    { text:"• ", options:{ color:C.gold } }, { text:"35-year-old HIV-positive male, CD4 count 45 cells/µL\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Resident of Chiang Mai, northern Thailand\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"3 weeks of fever, productive cough, weight loss (6 kg)\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.gold } }, { text:"Multiple skin lesions on face resembling molluscum\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"EXAMINATION\n", options:{ bold:true, color:C.accent, fontSize:9 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Temp 39.4°C, tachycardic, pallor\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Papules with central umbilication on face/trunk\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Massive hepatosplenomegaly, lymphadenopathy\n", options:{ color:C.white, fontSize:10 } },
    { text:"• ", options:{ color:C.accent } }, { text:"Bilateral crackles, diffuse infiltrates on CXR\n\n", options:{ color:C.white, fontSize:10 } },
    { text:"LABS\n", options:{ bold:true, color:C.accent, fontSize:9 } },
    { text:"• Hb 7.2 g/dL  •  WBC 2.1 × 10⁹/L  •  Platelets 58 × 10⁹/L\n", options:{ color:C.white, fontSize:10 } },
    { text:"• LDH markedly elevated  •  Blood cultures × 2 POSITIVE", options:{ color:C.alert, fontSize:10, bold:true } },
  ], { x:0.35, y:2.05, w:5.3, h:3.25, valign:"top", margin:4 });

  s.addText("KEY DIAGNOSTIC CLUES", { x:6.0, y:1.68, w:3.7, h:0.32, fontSize:8.5, bold:true, color:C.alert, margin:0 });
  const clues = [
    ["🌏", "SE Asia + HIV", "CD4 <100 — opportunistic pathogen"],
    ["🐀", "Bamboo Rat", "Environmental reservoir"],
    ["🩺", "Skin Lesions", "Umbilicated papules = molluscum-like"],
    ["🔬", "Transverse Septa", "Fission (NOT budding) — unique feature"],
    ["🎨", "Red Pigment", "Soluble pigment in culture = diagnostic"],
  ];
  let cy = 2.05;
  clues.forEach(([icon, hd, sub]) => {
    s.addShape(pres.shapes.RECTANGLE, { x:6.0, y:cy, w:3.72, h:0.64, fill:{ color:"0F2535" }, line:{ color:C.alert, pt:0.6 } });
    s.addText([
      { text:icon + "  ", options:{ fontSize:13 } },
      { text:hd + "\n", options:{ bold:true, color:C.alert, fontSize:9.5 } },
      { text:"      " + sub, options:{ color:C.gray, fontSize:8.5 } }
    ], { x:6.05, y:cy, w:3.62, h:0.64, valign:"middle", margin:4 });
    cy += 0.7;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 13 – CASE 5: TALAROMYCOSIS (Micro + Diagnosis + Skin image)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addLightBg(s);
  sectionTag(s, "CASE 5 – TALAROMYCOSIS: MICROBIOLOGY & MANAGEMENT", C.alert);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.42, w:10, h:0.75, fill:{ color:C.mid }, line:{ type:"none" } });
  s.addText("Talaromyces marneffei – Unique Features & Workup", {
    x:0.3, y:0.42, w:9.4, h:0.75, fontSize:17, bold:true, color:C.white, valign:"middle", margin:0 });

  // Skin image
  if (imgs[5]) s.addImage({ data:imgs[5], x:0.25, y:1.28, w:4.0, h:2.8 });
  s.addShape(pres.shapes.RECTANGLE, { x:0.25, y:4.08, w:4.0, h:0.4, fill:{ color:C.alert }, line:{ type:"none" } });
  s.addText("Disseminated talaromycosis — umbilicated papules (Tietz Textbook)", { x:0.25, y:4.08, w:4.0, h:0.4, fontSize:7.5, color:C.white, align:"center", valign:"middle", margin:0 });

  // Right panels
  s.addShape(pres.shapes.RECTANGLE, { x:4.5, y:1.28, w:5.25, h:1.6, fill:{ color:C.dark }, line:{ color:C.alert, pt:1 } });
  s.addText([
    { text:"UNIQUE MICROBIOLOGICAL FEATURES\n", options:{ bold:true, color:C.alert, fontSize:9.5, breakLine:true } },
    { text:"• Only dimorphic member of former Penicillium genus\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Yeast divides by FISSION (transverse septa) — NOT budding\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Soluble red/wine pigment diffuses into agar\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Mold: Penicillium-like structures (biseriate phialides)\n", options:{ color:C.white, fontSize:9 } },
    { text:"• Natural host: Rhizomys sinensis (bamboo rat)\n", options:{ color:C.white, fontSize:9 } },
  ], { x:4.6, y:1.33, w:5.05, h:1.5, valign:"top", margin:5 });

  s.addShape(pres.shapes.RECTANGLE, { x:4.5, y:3.0, w:5.25, h:1.4, fill:{ color:C.dark }, line:{ color:C.gold, pt:1 } });
  s.addText([
    { text:"DIAGNOSIS\n", options:{ bold:true, color:C.gold, fontSize:9.5, breakLine:true } },
    { text:"✓ Blood / bone marrow culture (fungemia in ~50%)\n", options:{ color:C.white, fontSize:9 } },
    { text:"✓ Skin scraping / biopsy: Wright/Giemsa stain\n", options:{ color:C.white, fontSize:9 } },
    { text:"✓ Serology and antigen: not widely available\n", options:{ color:C.white, fontSize:9 } },
    { text:"✓ Molecular: ITS sequencing for confirmation", options:{ color:C.white, fontSize:9 } },
  ], { x:4.6, y:3.05, w:5.05, h:1.3, valign:"top", margin:5 });

  s.addShape(pres.shapes.RECTANGLE, { x:4.5, y:4.5, w:5.25, h:0.85, fill:{ color:C.dark }, line:{ color:C.accent, pt:1 } });
  s.addText([
    { text:"TREATMENT\n", options:{ bold:true, color:C.accent, fontSize:9.5, breakLine:true } },
    { text:"Induction: Amphotericin B × 2 weeks  →  Itraconazole × 10 weeks\n", options:{ color:C.white, fontSize:9 } },
    { text:"Secondary prophylaxis: Itraconazole until CD4 >100 cells/µL", options:{ color:C.white, fontSize:9 } },
  ], { x:4.6, y:4.55, w:5.05, h:0.75, valign:"top", margin:5 });

  s.addText("Answer: Disseminated Talaromycosis (AIDS-defining illness)  |  Confirmed by blood cultures + skin biopsy",
    { x:0.25, y:5.1, w:9.5, h:0.38, fontSize:8.5, bold:true, color:C.dark,
      fill:{ color:C.gold }, align:"center", valign:"middle", margin:4 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 14 – COMPARISON TABLE
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addLightBg(s);
  sectionTag(s, "SUMMARY COMPARISON", C.mid);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0.42, w:10, h:0.75, fill:{ color:C.mid }, line:{ type:"none" } });
  s.addText("Dimorphic Fungi at a Glance", { x:0.3, y:0.42, w:9.4, h:0.75, fontSize:22, bold:true, color:C.white, valign:"middle", margin:0 });

  const rows = [
    [
      { text:"Organism", options:{ bold:true, color:C.white, fill:"1B3A5C" } },
      { text:"Mold Features", options:{ bold:true, color:C.white, fill:"1B3A5C" } },
      { text:"Tissue Form", options:{ bold:true, color:C.white, fill:"1B3A5C" } },
      { text:"Classic Presentation", options:{ bold:true, color:C.white, fill:"1B3A5C" } },
      { text:"Key Test", options:{ bold:true, color:C.white, fill:"1B3A5C" } },
      { text:"1st-Line Rx", options:{ bold:true, color:C.white, fill:"1B3A5C" } },
    ],
    ["H. capsulatum","Tuberculate macroconidia","Small yeasts 2–4 µm intracellular","Flu + hepatosplenomegaly (bat cave)","Urine antigen","Itraconazole"],
    ["B. dermatitidis","Lollipop conidia","Broad-based budding yeasts 8–15 µm","Pneumonia + verrucous skin lesions","KOH / culture","Itraconazole"],
    ["Coccidioides spp.","Barrel arthroconidia (BSL-3)","Spherules up to 100 µm","Valley fever; erythema nodosum","IgM serology","Fluconazole / Itraz"],
    ["Sporothrix spp.","Rosette & melanized conidia","Cigar yeasts 2–6 µm (rare in tissue)","Lymphocutaneous nodules (thorn)","Culture of aspirate","Itraconazole"],
    ["T. marneffei","Penicillium-like; red pigment","Small yeasts w/ transverse septa","Disseminated in HIV; molluscum-like","Blood culture","AmB → Itraconazole"],
  ];
  s.addTable(rows, {
    x:0.2, y:1.28, w:9.6, h:4.1,
    fontSize:8.5, color:"1A1A1A", valign:"middle",
    rowH:0.68,
    border:{ type:"solid", color:"CCCCCC", pt:0.5 },
    fill:"FFFFFF",
    colW:[1.9, 1.95, 1.95, 1.95, 1.5, 1.35],
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 15 – KEY PEARLS / TAKE-HOME MESSAGES
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.dark);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.42, fill:{ color:C.accent }, line:{ type:"none" } });
  s.addText("CLINICAL PEARLS", { x:0.2, y:0, w:9.6, h:0.42, fontSize:9, bold:true, color:C.white, valign:"middle", margin:0 });
  s.addText("Take-Home Messages", { x:0.3, y:0.48, w:9.4, h:0.65, fontSize:24, bold:true, color:C.white, margin:0 });

  const pearls = [
    ["1", C.accent, "Travel History is Diagnostic", "Always ask about residence or recent travel to endemic regions — most dimorphic fungi are geographically restricted."],
    ["2", C.gold, "Antibiotic Failure = Think Fungi", "Blastomycosis, histoplasmosis, and coccidioidomycosis all mimic bacterial pneumonia. Failure of antibiotics is a key red flag."],
    ["3", C.alert, "Immunocompromised = High Risk", "HIV (CD4 <100), TNF-α inhibitors, transplant recipients are at risk for severe/disseminated disease."],
    ["4", C.accent, "Lab Safety for Coccidioides", "BSL-3 pathogen — arthroconidia are highly infectious. All cultures must be handled in a biosafety cabinet."],
    ["5", C.gold, "Sporothrix is the Odd One Out", "Traumatic inoculation (not inhalation), lymphocutaneous disease, worldwide distribution, yeast rarely seen in tissue."],
    ["6", C.alert, "Talaromyces Divides by Fission", "Unlike all other dimorphic fungi that bud, T. marneffei divides by fission — transverse septa on yeast cells."],
  ];

  let xPos = 0.25, yPos = 1.25;
  pearls.forEach(([ num, col, title, body ], i) => {
    if (i === 3) { xPos = 5.15; yPos = 1.25; }
    s.addShape(pres.shapes.RECTANGLE, { x:xPos, y:yPos, w:4.65, h:1.25,
      fill:{ color:"0F2535" }, line:{ color:col, pt:1 },
      shadow:{ type:"outer", color:"000000", blur:6, offset:2, angle:135, opacity:0.25 }
    });
    s.addShape(pres.shapes.RECTANGLE, { x:xPos, y:yPos, w:0.35, h:1.25, fill:{ color:col }, line:{ type:"none" } });
    s.addText(num, { x:xPos, y:yPos, w:0.35, h:1.25, fontSize:14, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    s.addText([
      { text:title + "\n", options:{ bold:true, color:col, fontSize:9.5 } },
      { text:body, options:{ color:C.light, fontSize:8.5 } }
    ], { x:xPos+0.42, y:yPos+0.08, w:4.15, h:1.1, valign:"top", margin:4 });
    yPos += 1.38;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 16 – CLOSING
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addDarkBg(s, C.dark);
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.18, fill:{ color:C.accent }, line:{ type:"none" } });
  s.addShape(pres.shapes.RECTANGLE, { x:0, y:5.42, w:10, h:0.2, fill:{ color:C.gold }, line:{ type:"none" } });
  s.addText("DIMORPHIC FUNGI", { x:0.5, y:1.3, w:9, h:0.5, fontSize:11, bold:true, color:C.accent, align:"center", charSpacing:8, margin:0 });
  s.addText("Clinical Cases", { x:0.5, y:1.85, w:9, h:1.0, fontSize:38, bold:true, color:C.white, align:"center", margin:0 });
  s.addText("Thank You", { x:0.5, y:2.85, w:9, h:0.55, fontSize:22, color:C.gold, align:"center", margin:0 });
  s.addText("Histoplasmosis  ·  Blastomycosis  ·  Coccidioidomycosis  ·  Sporotrichosis  ·  Talaromycosis", {
    x:0.5, y:3.6, w:9, h:0.38, fontSize:9.5, color:C.gray, align:"center", margin:0 });
  s.addText("Sources: Henry's Clinical Diagnosis & Management | Tietz Textbook of Laboratory Medicine 7e | Harrison's Internal Medicine 22e",
    { x:0.5, y:4.9, w:9, h:0.38, fontSize:7.5, color:C.gray, align:"center", margin:0 });
}

// ── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/dimorphic-fungi-cases/Dimorphic_Fungi_Clinical_Cases.pptx" })
  .then(() => console.log("✅  Saved: Dimorphic_Fungi_Clinical_Cases.pptx"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

Running Command

cd /home/daytona/workspace/dimorphic-fungi-cases && node make_pptx.js

Running Command

ls -lh /home/daytona/workspace/dimorphic-fungi-cases/Dimorphic_Fungi_Clinical_Ca…

Your presentation is ready! Here's the download link:

Dimorphic Fungi Clinical Cases

Presentation · PPTX

3.7 MB · 16 slides · Deep navy + teal-green color scheme

Here's what's inside:

Slide	Content
1	Title slide
2	Overview — What are dimorphic fungi? (mold vs. yeast phase, comparison table)
3	Geographic distribution map (with real textbook image)
4-5	Case 1: Histoplasmosis — The Cave Explorer (32M, Ohio, bat cave exposure) — clinical + microbiology (tuberculate macroconidia + yeast-in-macrophage images)
6-7	Case 2: Blastomycosis — The Great Masquerader (45M, Wisconsin logger, antibiotic failure + verrucous skin) — broad-based buds + lollipop mold images
8-9	Case 3: Coccidioidomycosis — Valley Fever (28M, Filipino military recruit in Arizona, erythema nodosum) — spherule images, BSL-3 warning
10-11	Case 4: Sporotrichosis — The Rose Thorn (38F, Brazilian florist, lymphocutaneous nodular chain)
12-13	Case 5: Talaromycosis — AIDS-defining mycosis (35M, HIV+, CD4 45, Thailand) — skin papule image, fission vs. budding
14	Summary comparison table (all 5 fungi side-by-side)
15	6 clinical pearls / take-home messages
16	Closing slide

Each case slide pair has: a clinical scenario + key diagnostic clues panel, followed by microbiology images + diagnosis & treatment details.

This is a shared conversation. Sign in to Orris to start your own chat.