Deep mycoses /systemic Mycoses Meaning: Originate in the lungs but disseminate to other organs (especially in immunocomprommised individuals

Agents of Systemic infection Most agents are dimorphic fungi Exist as filamentous fungi in soil (sapbroic phase) or as Yeast spherules in tissue (parasite phase)

In health individuals, many systemic mycoses are asymptomatic or manifest as a relatively mild, self limiting pulmonary infection. In immunocompromised individuals systemic mycoses generally exhibit more serious lung involvement and often disseminate to other organs.

Blastomyces dermtitidis Are dimorphic , large yeast with broad based buds seen in tissue sample Endemic in portions of the Midwestern united state. Blastomycosis is marked by tuberclosis –like pneumonia with possible skin, bone, or prostate involvement.

Laboratory diagnosis, disease and Transmission Diagnosed by: yeast cells in sputum or skin lesion, Culture on SDA Causes: Blastomycosis Transmission is by inhalation of airborne spores

Pathogenesis and treatment Pathogenesis: infection can be confused with tuberculoses, can produce abscesses. Treatment: ketoconazole,

Coccidiodes characteristics Dimorphic , growing as hyphae in the soil but yeast like endospores within capsule (spherules) in tissue.

Laboratory Identification In sputum or tissue . Culture on Sabouraud Dextrose Aga (SDA) Serology

Transmission and Pathogenesis Transmission by inhalation of the airborne stage (Arthoconidia) Pathogenesis: Lung infection give mild , influenza like condition, but serious illness may fellow dissemination. Coccidiodomycosis is mostly affecting Americans.

Treatment and Prevention Amphotericin B, Ketoconazole

Cryptococcus neoformans Non dimorphic encapsulated yeast visible in Indian ink preparations of CSF, found worldwide commonly in pigeon dropping and nests. Primary Cryptococcus often is discovered accidentally as a solitary pulmonary nodule that may mimic carcinoma Granumatous meningitis is most common form of systemic disease. Invade lungs and can spread to CNS.

Laboratory identification, disease & Transmission Using Encapsulated yeast cells in sputum or in cerebral spinal fluid Culture on SDA Serology Transmit Cyrptococcosis. Transmitted by inhalation of airborne cells

Pathogenesis, treatment and prevention Pathogenesis: lung infection may result like influenza like, condition pneumonia. In imunocompremised patients, CNS involvement leads to meningitis. Treated by Amphotericin B and flucytosine.

Histoplasma capsulatum Dimorphic, small budding yeast seen within macrophages , sometimes is endemic especially in abundant in bird and bat droppings. Histoplasmosis is marked by pulmonary granuloma, which may be seen on radiograph. Invade lungs and grow as a yeast cells which can survive intracellular other phagocytes. Widely disseminated in the body.

Lab. Identification, disease, transmission and pathogenesis Identification: yeast cell in sputum Transmits : Histoplasmosis Transmission : inhalation of airborne spores. Pathogenesis: Can produce acute and chronic pulmonary disease, serious illness result from dissemination into other organs.

Treatment Amphotericin B, ketoconazole

Paracoccidiodes brasilliensis Are dimorphic Captains wheel morphology of yeast cells in tissues due to multiple budding, Endemic in different parts of the world especially Central and South America Paracoccidiomycoses is marked by ulcerative lessions of the oral and nasal mucosa..

Paracoccidiodes brasilliensis cont…. Diagnosis By double diffusion in agar plate and complement fixation test, culture method. Pathogenesis: Causes ulceration of mouth, nose with spreading through the lymphatic system. Affected area are lung, lymph nodes and mucous membrane of the mouth.

Paracoccidiodes brasilliensis cont… Treatment Use Triazoles ( itraconazole, voriconazole and posaconazole)

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