2Mycoses are classified into the following categories: Mycosis: Any fungal disease. Tend to be chronic because fungi grow slowly.Mycoses are classified into the following categories:I. Systemic mycoses: Fungal infections deep within the body. Can affect a number if tissues and organs.Usually caused by fungi that live in the soil and are inhaled. Not contagious.Examples:Histoplasmosis (Histoplasma capsulatum): Initial infection in lungs. Later spreads through blood to most organs.Coccidiomycosis (Coccidioides immites): Resembles tuberculosis.
3COCCIDIOIDES IMMITIS Disease: Coccidioidomycosis. Reservior: desert areas of western US and Northern Mexico.Transmission: RespiratoryMorphology: Dimorphic fungus* mycelia forms with spores at 25°celsius.* yeast forms at 37° Celsius
4Disease: Coccidioidomycosis. * asymptomatic( in most patients)*pnuemonia* disseminated: can affect the lungs, bones, skin and meninges.A small percentage of individuals with this infection will develop painful erythematous nodular lesions called ERYTHEMA NODOSUM
6DIAGNOSIS BIOPSY OF AFFECTED TISSUE SEROLOGY SKIN TEST( TEST FOR EXPOSURE ONLY)TREATMENTAMPHOTERICIN B
7HISTOPLASMA CAPSULATUM RESERVIOUR: MISSISSIPI VALLLEYPRESENT IN BIRDS AND BAT DROPPINGSTRANSMISSION: RESPIRATORYMORPHOLOGY: H capsulatum is a dimorphic fungus that exists as a mold in soil and as a yeast in tissue
8HISTOPLASMA CAPSULATUM Disease: histoplasmosis.ASYMPTOMATIC*PNEUMONIA*DISSEMINATED: CAN OCCUR IN ANY ORGAN, ESPECIALLY IN THE LUNG,LIVER OR SPLEEN.
9DIAGNOSIS DIAGNOSIS: LUNG BIOPSY SEROLOGY SKIN TEST TREATMENT: ITRACONAZOLE
14BLASTOMYCES Disease: blastomycosis * ASYMPTOMATIC *PNEUMONIA *DISSEMINATED(MOST COMMON): PRESENT WITH WEIGHT LOSS, NIGHT SWEATS, LUNG INVOLVEMENTS AND SKIN ULCERS* CUTANEOUS: SKIN ULCERS
15Skin lesion following dissemination from the lungs.
16DIAGNOSIS BIOPSY OF AFFECTED TISSUE SEROLOGY SKIN TEST( TEST FOR EXPOSURE ONLY)TREATMENT:Itraconazole is the drug of choice for most patients.Amphotericin B should be used to treat severe disease.Surgical excision may be helpful.Prevention:There are no means of prevention.
17PARACOCCIDIOIDES BRASILIENSIS Disease: paracoccidioidomycosisP brasiliensis is a dimorphic fungus that exists as a mold in soil and as a yeast in tissue.The yeast is thick-walled with multiple buds (pilot wheel), in contrast to B. dermatitidis, which has a single bud
18Transmission: Inhalation of airborne asexual spores. Pathogenesis:The spores are inhaled, and early lesions occur in the lungs.Asymptomatic infection is common.Alternatively, oral mucous membrane lesions, lymph node enlargement, and sometimes dissemination to many organs develop.Laboratory Diagnosis:In pus or tissues, yeast cells with multiple buds (pilot’s wheel) are seen microscopically.A specimen cultured for 2—4 weeks may grow typical organisms.Skin tests are rarely helpful.Serologic testing shows that when significant antibody titers (by immunodiffusion or complement fixation) are found, active disease is present.Treatment: The drug of choice is itraconazole taken orally for several months.Prevention: There are no means of prevention.
19CRYPTOCOCCUS NEOFORMANS RESERVIOR: FOUND IN PIGEON DROPPINSTRANSMISSION: RESPIRATORYMORPHOLOGY: Oval, budding yeast surrounded by a wide polysaccharide capsule. Not dimorphic.
20DISEASE: Disease: Cryptococcosis, especially cryptococcal meningitis. * SUBACUTE OR CHRONIC MENINNGITISHEADACHEFEVERVOMITINGNEUROLOGICAL OR MENTAL STATUS CHANGES*PNEUMONIA*SKIN LESIONS: LOOK LIKE ACNE
21DIAGNOSISDIAGNOSIS* INDIA- INK STAIN OF CSF: OBSERVE ENCAPSULATED YEAST*CRYTOCOCCAL ANTIGEN TEST OF CSF DETECTS POLYSACCHARIDE ANTIGENS*FUNGAL CULTURE
22CUTANEOUS MYCOSES Dermatophytes Diseases: Dermatophytoses DermatophytesDiseases: DermatophytosesDermatophytes: are classified in three genera: Epidermophyton, Trichophyton, and Microsporum.
23FUNGAL DISEASES (Continued) II. Cutaneous mycoses: Fungal infections of the skin, hair, and nails.Secrete keratinase, an enzyme that degrades keratin.Infection is transmitted by direct contact or contact with infected hair (hair salon) or cells (nail files, shower floors).
24RESERVIOR: DEPENDING ON THE PARTICULAR SPECIES 1. SOIL2. ANIMALS3. HUMANS
26Dermatophytoses (Tinea- Ringworm) Characteristics: caused by fungi that infect only superficial keratinized structures (skin, hair, and nails), not deeper tissues.Transmission: spread from infected persons by direct contact. Microsporum is also spread from animals such as dogs and cats. This indicates that to prevent reinfection, the animal must be treated also.Pathogenesis: Dermatophytoses (tinea, ringworm) are chronic infections favored by heat and humidity, eg, athlete’s foot, moist skin and jock itch. Are characterized by broken hairs, and thickened, broken nails.
31DIAGNOSIS 10% KOH on a glass slide show hyphae under microscopy. Tinea capitis lesions caused by Microsporum species can be detected by seeing fluorescence when the lesions are exposed to ultraviolet light from a Wood’s lamp.TREATMENT: TOPICAL IMIDAZOLEORAL GRISEOFULVIN FOR TINEA UNGUIUM
32SUBCUTANEOUS MYCOSES . Fungal infections beneath the skin. Caused by saprophytic fungi that live in soil or on vegetation.Infection occurs by implantation of spores or mycelial fragments into a skin wound.Can spread to lymph vessels.
33SUBCUTANEOUS MYCOSES Sporothrix schenckii These are caused by fungi that grow in soil and on vegetation and are introduced into subcutaneous tissue through trauma.
34Sporothrix schenckiiDiseases: Sporotrichosis Characteristics: Sporothrix schenckii is a dimorphic fungus that lives on vegetation. Trauma to the skin, typically by a thorn. Pathogenesis: local pustule or ulcer with nodules along the draining lymphatics Laboratory Diagnosis: round or cigar-shaped budding yeasts are seen in tissue specimens. In culture, hyphae occur bearing oval conidia. Treatment: with itraconazole. Prevention: protecting skin when touching plants, moss, and
36SUPERFICIAL TINA VERSICOLOR (Malssenzia furfur) MORPHOLOGY: SPAGHETTI AND MEAT BALLSCLINICAL: HYPO OR HYPERPIGMENTED PATCHES ON THE SKIN; SURROUNDING SKIN DARKENS WITH SUNLIGHT WHILE THE PATCHES REMAIN WHITE
39DIAGNOSISPotassium hydroxide(KOH) prep: reveals short, curved, unbranched hyphae with spherical yeast cells( looks like “ sphagetti and meat balls”)Treatment:1. dandruff shampoo( containing selenium sulfide)2. topical imidazole
40OPPORTUNISTIC MYCOSES Opportunistic mycoses: Caused by organisms that are generally harmless unless individual has weakened defenses:AIDS and cancer patientsIndividuals treated with broad spectrum antibioticsVery old or very young individuals (newborns).Examples:Aspergillosis: Inhalation of Aspergillus spores.Yeast Infections or Candidiasis: Caused mainly by Candida albicans. Part of normal mouth, esophagus, and vaginal flora.
41Mucor & Rhizopus species Disease: Mucormycosis.Characteristics: Molds with nonseptate hyphae with right angle branching. Not dimorphic.Habitat: is the soil.Transmission: Inhalation of airborne sporangiospores.
42Disease: Mucormycosis 1. rhinocerebral ( associated with diabetes): starts on nasal mucosa and invades the sinus and orbit2. pulmonary mucormycosisDiagnosis: biopsy and black nasal discharge
43Aspergillus fumigatus Diseases:infections of the skin, eyes, ears and other organs;“fungus ball” in the lung and allergic bronchopulmonary aspergillosis.Exist only as mold with septate hyphae that branch at a V-shaped angle.Habitat: is the soil. Transmission: Inhalation of airborne condidia.
44Clinical1. allergic bronchopulmonary aspergillosis( shortness of breath and high fever)2. aspergilloma( fungus ball) associated with hemoptysis(bloody cough)3. invasive aspergilossis4. aflatoxin consumption( produced by aspergillus flavus) can cause liver damage and liver cancer
50Laboratory Diagnosis: yeasts and pseudohyphae.colonies of yeasts on Sabouraud’s agar.The yeast form produces germ tubes when incubated in serum at 37 0C: distinguish C albicans from other candida species.Treatment:1- Skin and mucous membrane disease can be treated with oral or topical antifungal agents such as miconazole.2- Disseminated disease requires amphotericin B.3- Chronic mucocutaneous candidiasis: ketoconazole.4- The drug of choice for oropharyngeal or esophageal thrush is fluconazole Prevention: Predisposing factors should be reduced. Oral thrush can be prevented by using clotrimazole.