Systemic mycosis  Dimorphs  Internal organs  Cutaneous Primary Primary Secondary Secondary  Saprophytes

Systemic mycosis  Tissue staining PAS, H&E, GMS( Gomory Methenamine Silver) PAS, H&E, GMS( Gomory Methenamine Silver)  Blastomyces dermatitidis Yeast, thick wall, linier Yeast, thick wall, linier  Histoplasma capsulatum Yeast, point, blood or bone marrow, wright Yeast, point, blood or bone marrow, wright  Paracoccidioides brasiliensis Multiple budding Multiple budding  Coccidioides immitis Sphrule Sphrule

Systemic mycosis  PCR  SABHI  Blood agar  12 week  Slide culture  Mask, gloves, hood

Blastomycosis  Blastomyces dermatitidis  Canada, South America, Africa  Inhalation of conidia  Chronic disease in lung Disseminated Skin Bone Nose Skin Bone Nose Mouth Mouth

Blastomycosis  Culture SABHI SABHI Round or oval conidiaRound or oval conidia Unicellular & smoothUnicellular & smooth Shortly conidiophore Shortly conidiophore BHI, Blood agar BHI, Blood agar YeastYeast linier bud linier bud RoundRound BigBig

Histoplasmosis  Histoplasma capsulatum  America  Bird & bat  Wind  Inhalation  Skin

Histoplasmosis  90-95% without symptom self limitation  Clinical manifestation Fever, cough, loose weight, sweat Fever, cough, loose weight, sweat Lung, spleen, kidney, liver, skin, eye, CNS Lung, spleen, kidney, liver, skin, eye, CNS Blood culture is positive Blood culture is positive  Amphotricin-B

Histoplasmosis  Culture SABHI SABHI Hyphae, macro conidiaHyphae, macro conidia BHI, Blood agar BHI, Blood agar YeastYeast Point bud Point bud

Coccidioidomycosis  SW America desert  Arthroconidia Tolerant to dry & salt Tolerant to dry & salt  60% without symptoms  40% mild Bone  Lung blood Skin Brain Brain lymph nod lymph nod

Coccidioidomycosis  Amphotricin-B  Culture SABHI SABHI Rectangular arthroconidiaRectangular arthroconidia  Spherule Endospore Endospore Blastomyces - C.i Blastomyces - C.i Vaseline germtube + B.d Vaseline germtube + B.d

Paracoccidioidomycosis  South America, Brazil  Saprophyte  Water, soil, plant  Inhalation  Lung  Eating  Mouth & gum disseminated systemic Enlargement of lymph nod Enlargement of lymph nod

paracoccidioidomycosis  Co trimaxazol  Culture SABHI SABHI ChlamydioconidiaChlamydioconidia BHI, Blood agar BHI, Blood agar Multiple buddingMultiple budding ship's wheel ship's wheel