1. 약품미생물학 생명산업과학대학 생물환경학과 김정호 http://bioenv.sunchon.ac.kr

2.  Fungi : Mycology Eucaryotic Yeast : unicellulr Mold : filamentous Dimorphic fungi Chytridiomycota Zygomycota Ascomycota Basidiomycota Deuteromycota Cell membrane : ergosterol Cell wall : chitin polysaccharide (glucan, mannan, cellulose) Heterotrophic Decomposer Fungi ( 진균 )

3.  Mycosis (Mycoses) Superficial ( 표재성 ) Cutaneous ( 피부 ) Subcutaneous ( 피하 ) Systemic (Deep, 전신성 ) Opportunistic ( 기회성 ) Dermatophyte ( 피부사상균 ) keratinase, acid proteinases, elastase Dermatophytosis a clinical condition caused by fungal infection of the skin Mycosis ( 진균증 )

5.  Superficial mycosis Black piedra ( 흑색 사모증 ) White piedra ( 백색 사모증 ) Pityriasis versicolor (Tinea versicolor, 어우러기 ) Tinea nigra ( 흑색 백선증 )  Piedra (Trichosporosis) "stone" in Spanish superficial fungal infection of the hair shaft  Tinea Any of a variety of skin mycoses Ringworm : the rash is circular, with a ring-like appearance Mostly caused by imperfect fungi Superficial Mycosis ( 표재성 진균증 )

6.  Black piedra ( 흑색 사모증 ) Small firm black nodule involving the hair shaft Piedraia hortae  White piedra ( 백색 사모증 ) Soft, friable, beige nodule of the distal ends of hair shafts Trichosporon asahii & 5 other species (T. beigelli)  Pityriasis versicolor (Tinea versicolor, 어우러기 ) versicolor : various color Hypo- or hyper-pigmentation of skin of the neck, shoulders, chest, and back (only the superficial keratin layer) Malassezia furfur, Malassezia globosa (yeast)  Tinea nigra ( 흑색 백선증 ) Dark brown to black painless patches on the palms of the hands and the soles of the feet Exophiala werneckii (Hortaea werneckii) (dimorphic fungus) Phaeoannellomyces werneckii Superficial Mycosis ( 표재성 진균증 )

7.  Diagnosis Microscopic test : after 10% KOH treatment, for hyphae Culture test : Bacto Trichohyton agar  Immunity Epidermopoiesis ( 표피형성 ) Delayed Hypersensitivity response ( 지연성 과민반응 ) increased lymphocytes, increased secretion of cytokines  Treatments Personal hygiene Topical antifungal medications benzoic acid & salicylic acid (keratin 용해제 ) selenium sulfide azoles : ketoconazole, miconazole, clotrimazole ciclopirox (Ciclopirox olamine), terbinafine Oral antifungal prescription-only medications ketoconazole, fluconazole, itraconazole Superficial Mycosis ( 표재성 진균증 )

8.  Cutaneous mycosis Dermatophytosis Dermatophytes : Trichophyton Microsporum Epeidermophyton Dermatomycosis Cutaneous mycosid due to fungi other than dermatophytes Mostly Candida spp.  Tinea pedis ( 족부백선, 무좀 ) Athlete's foot Ringworm of the foot, Tinea pedum, Moccasin foot itching, scaling, flaking & sometimes blistering Trichophyton mentagrophytes, Trichophyton ruburum, Epidermophyton floccosum Cutaneous mycosis ( 피부 진균증 )

9.  Cutaneous mycosis Dermatomycosis (dermatophytosis) Dermatophytes Trichophyton Microsporum Epeidermophyton  Tinea pedis ( 족부백선, 무좀 ) Athlete's foot ringworm of the foot, tinea pedum, moccasin foot itching, scaling, flaking & sometimes blistering Trichophyton mentagrophytes, Trichophyton ruburum, Epidermophyton floccosum Cutaneous mycosis ( 피부 진균증 )

10.  Tinea unguium (nails) 조갑백선  Tinea manuum (hand) 수부백선  Tinea cruris (groin) 고부백선 : 사타구니  Tinea corporis (body) 체부백선  Tinea capitis (scalp) : 두부백선  Tinea faciei (face)  Tinea barbae (beard) Cutaneous mycosis ( 피부 진균증 )

11.  Diagnosis Microscopic test Culture test : Sabouraud’s dextrose agar (SDA)  Immunity  Treatment Topical antifungal medications azoles : miconazole, clotrimazole, econazole griseofulvin (for hair) naftifine (an allylamine) Oral antifungal prescription-only medications terbinafine Cutaneous mycosis ( 피부 진균증 )

12.  Subcutaneous mycosis Caused by traumatic inoculation of the etiological fungi into the subcutaneous tissue ( 외상으로 인한 피부 손상 ) Mycetoma (Madura foot, Eumycotic mycetoma) 진균성 균종 Chromoblastomycosis (Chromomycosis) 색소모세포진균증 Sporotrichosis (Lymphocutanoeous sporotrichosis) Subcutaneous mycosis ( 피하 진균증 )

13.  Mycetoma ( 진균성 균종 ) suppurative and granulomatous ( 화농성, 종양성 ) fungal tumor ( 진균종 ) destructive of contiguous bone, tendon, and skeletal muscle Eumycotic mycetoma : Pseudallescheria boydii Actinomycotic mycetoma : Actinomadura madurae, Madurella griesea, Nocardia brasiliensis Dematiaceous (melanized) fungi ( 유색진균 ) pigmented brown to black may produce a range of infections from superficial to subcutaneous to deep (visceral) infection Fungal Dimorphism

14.  Chromoblastomycosis ( 색소모세포진균증 ) Caused by only certain fungi Cladosporium carionii, Phialophora verrucosa, Fonsecaea pedrosoi, Fonsecaea compacta, Verrucoid lesions of the skin ( 사마귀, lower extremities) Generally limited to the subcutaneous tissue with no involvement of bone, tendon, or muscle muriform cells (perpendicular septations) or so-called “copper pennies” that are characteristic of this infection  Sporotrichosis ( 스포로트리쿰증 ) Sporothrix schenckii (dimorphic ) involves the subcutaneous tissue at the point of traumatic inoculation infection usually spreads along cutaneous lymphatic channels of the extremity involved

15.  Systemic mycoses Primary mycoses Primary pathogen : able to establish infection in normal hosts usually via the respiratory tract Opportunistic mycoses Opportunistic pathogen : require a compromised host in order to establish infection via the respiratory tract, alimentary tract, or intravascular devices  Primary systemic mycoses Coccidiodomycosis : Coccidioides immitis Histoplasmosis : Histoplasma capsulatum Blastomycosis : Blastomyces dermatitidis Paracoccidioidomycosis : Paracoccidioides brasiliensis Cryptococosis : Cryptococcus neoformans (opportunistic?) Systemic (Deep) mycoses

16.  Opportunistic systemic mycoses Candudiasus : Candida albicans, Aspergillosis : Aspergillus fumigatus, A. flavas, … Zygomycosis : Rhizopus oryzae, Absidia corymbifera, Rhizomucor pusillus Pneumocystis pneumonia (PJP) : Pneumocystis jiroveci Cryptococosis : Cryptococcus neoformans …

17.  Coccidiodomycosis : 콕시디오이드 진균증 inhalation of arthroconidia of Coccidioides immitis progressive pulmonary infection may disseminate to brain, bone, and other sites coccidioides meningitis : life-threatening  Histoplasmosis : 히스토플라스마증 inhalation of conidia of Histoplasma capsulatum conidia convert in vivo into budding yeast for m dissemination to the mediastinal lymph nodes, spleen, liver, bone marrow, and brain may be life-threatening intracellular growth of the pathogen in macrophage and a granulomatous reaction in tissue Primary systemic mycoses

18.  Blastomycosis : 분아진균증 inhalation of blastoconidia from the mycelial phase of Blastomyces dermatitidis conidia conver into the parasitic yeast phase chronic pneumonia dissemination to skin, bone, and in males, prostate  Paracoccidioidomycosis : South American blastomycosis, Brazilian blastomycosis, paracoccidioidal granuloma Endemic to South and Central America (Brazil, Argentina, …) Paracoccidioides brasiliensis Primary systemic mycoses

19.  Candidiasis Most common opportunistic fungal infection Candida albicans : most common cause of candidiasis Candida spp. Superficial candidiasis : epidermal & mucosal surfaces (oral cavity, pharynx, esophagus, intestines, urinary bladder, vagina) Cutaneous (Oral, Vulvovaginal, Chronic mucocutaneous, Ocular) Candidiasis Deep (Visceral) candidiasis alimentary tract & intravascular catheters kidney, liver, spleen, brain, eyes, heart, and other tissues At high risk : AIDS, Cancer, Neurtropenia ( 호중구 감소증 ) broad spectrum antibiotics, cytotoxic chemotherapy, corticosteroids, vascular catheters Candidiasis

20.  Aspergillosis Genus Aspergillus Septated hyphae, conidiospore (conidium) Aspergillus fumigatus, Aspergillus flavus Inhalation of conidiospores : lung & paranasal sinuses (injuries to skin) Disseminate from lungs to brain, kidneys, liver, heart, bones Key risk factor : Immunocompromised (defects in circulating neutrophils) Neurtropenia ( 호중구 감소증 ), cytotoxic chemotherapy for leukemia or AIDS systemic corticosteroids tuberculosis chronic obstructive pulmonary disease (COPD) hematopoietic stem cell transplantation Aspergillosis

21.  Allergic bronchopulmonary aspergillosis (ABPA): inflammation in the lungs allergy symptoms such as coughing and wheezing  Allergic Aspergillus sinusitis inflammation in the sinuses drainage, stuffiness, headache  Aspergilloma (fungus ball, 진균공 ) Aspergillus that grows in the lungs or sinuses  Chronic pulmonary aspergillosis long-term (3 months or more) can cause cavities in the lungs fungal balls (aspergillomas) may also be present in the lungs  Invasive aspergillosis ( 침투성 ) weakened immune systems commonly affect lungs, can spread to other parts of the body  Cutaneous (skin) aspergillosis through a break in the skin (after surgery or a burn wound)

22.  Treatments Fluconazole and other azoles : not effective For aggressive invasive aspergillosis voriconazole & liposomal amphotericin B in combination with surgical debridement For less aggressive allergic bronchopulmonary aspergillosis oral steroids for a prolonged period of time (for 6~9 months) itraconazole is given with steroids Aspergillosis

23.  Zygomycosis Phylum Zygomycota : no septum (coenocytic hyphae) sporangiospore Rhizopus oryzae, Rhizopus arrhizus, Rhizomucor pusillus, Absidia corymbifera, Mucor Inhalation of sporangiospores Usually begins in the nose and paranasal sinuses Usually affect face or oropharyngeal cavity (nose & mouth) Brain, Lung, Gastrointestinal tract, Skin Rare yet serious & potentially life-threatening Rhinocerebral syndrome ( 비대뇌 접합균증 ) diabetics with ketoacidosis, leukemia, burn, Treatment prompt & intensive antifungal drug therapy (amphotecicin B) surgery to remove the infected tissue Zygomycosis

24.  Cryptococosis Cryptococcus (Greek for "hidden sphere") Basidiomycota Cryptococcus : yeast state Filobasidiella : telemorph (sexual form), filamentous Cryptococcus neoformans, Cryptococcus gattii Encapsulated yeast Potentially fatal fungal disease pneumonia and/or meningitis a major life-threatening fungal infection in patients with severe HIV infection may complicate organ transplantation, reticuloendothelial malignancy, corticosteroid treatment, or sarcoidosis. Cryptococosis

25.  Pneumocystis jiroveci peneumonia (PJP) pneumonia caused by Pneumocystis jirovecii Pneumocystis jirovecii cannot be cultured ex vivo ascus-like cysts : Ascomycota protozoa? No ergosterol in cell membrane : Amphotericin B and azoles are not effective not commonly found in the lungs of healthy people immunocompromised people cancer patients undergoing chemotherapy HIV/AIDS medications that suppress the immune system Treatment trimethoprim-sulfamethoxazole (TMP-SMX) Without treatment, PCP can be fatal Pneumocystis pneumonia (PCP)