CRYPTOCOCCOSIS PARACOCCIDIOIDOMYCOSIS COCCIDIOIDOMYCOSIS

CRYPTOCOCCOSIS It is also known as TORULOSIS Sub acute or chronic infection Caused by :- Cryptococcus neoformans HABITAT: soil saprophyte and particularly abundant in feces of pegeons

MORPHOLOGY Round or ovoid budding cell 4 – 20 µm in diameter Prominent polysaccharide capsule

PATHOGENICITY Source – dust containing basidiospores Route: mostly by inhalation and some times through skin or mucosa Most infections are asymptomatic Can produce disease in animals [mastitis in cattle]

Pulmonary cryptococcosis It may lead to mild pneumonitis No calcification occur Dissemination of infection may lead to : visceral , cutaneous and meningeal diseases

LABORATORY DIAGNOSIS Direct microscopy: Specimens –serum, CSF and other body fluid indian ink or 10%nigrosin with formalin wet mount shows round budding yeast cells with distinct halo A wide refractile gelatinous capsule surrounds the organism

diagram

CULTURE Grows readyly on Sabouraud’s Dextrose Agar. smooth, mucoid , cream coloured colonies are formed

SEROLOGY There are 4 serological types of Capsular polysaccharide – A, B, C, & D. Demonstration of Capsular antigen by precipitation is valuable in diagnosing some cases of Cryptococcal meningitis when the CSF is negative by smear or culture

TREATMENT Amphotericin B 5 –fluorocytosine Clotrimazole miconazole

EPIDEMIOLOGY World wide in distribution Known as European blastomycosis It is Only deep mycosis common in our country

COCCIDIOIDOMYCOSIS Caused by Coccidioides immitis Infection is usually self limited The disease is endemic in the dry and arid regions of Southwestern USA, where the fungus is present in soil and rodents.

MORPHOLOGY It is a dimorphic fungus at 37°C – Yeast form 25°C – Mould form

PATHOGENECITY Source: Dust containing Arthrospores Route: Inhalation After inhalation, these spores become spherical and enlarged forming SPHERULES.

Thick, double layered refractile wall is present SPHERULES 15-75µm in diameter Thick, double layered refractile wall is present Filled with endospores Spherules are the diagnostic features of C. immitis.

Possible sites of infection CNS & Bone

Contd.. In 60% of cases, the infection is assymptomatic This leads to immunization and is demonstrated by “positive” skin test with COCCIDIOIDIN The other 40% develops self limited influenza like illness with Fever, Malaise, Cough, Arthralgia and Headache. This condition is known as VALLEY FEVER or DESERT RHEUMATISM.

DIAGNOSIS Specimens: Sputum Exudate from cutaneous lesions Spinal fluid Blood and Urine

Microscopy Specimen stained with KOH or Calcoflour white stain Shows Spherules and endospores

Culture Culturing on SDA incubated at 37°C and at room temp. shows Mycelial form. The colonies are white to tan cottony colonies.

Serology With in 2-4 weeks after infection IgM Ab – Latex Agglutination IgG Ab – CFT or ID

Skin test After 24-48 of cutaneous injection with 0.1ml of standard dilute solution containing Coccidioidin Ag there is a formation of induration >5mm diameter. It is known as Positive skin test

Treatment Amphotericin B Itraconazole Fluconazole

PARACOCCIDIOIDO MYCOSIS It is a chronic granulomatous disease of skin, mucous membranes, lymphnodes and internal organs like spleen, liver.. Caused by Paracoccidioides brasiliensis South American Blastomycosis

Morphology Dimorphic fungi Mycelial form produces Chlamydiospores and Conidia

Pathogenesis & Clinical findings Source: Dust containing chlamydiospores and conidia Route: Inhalation Chronic, progressive pulmonary diseases occurs. Dissemination to other organs like skin, mucocutaneous tissue, spleen, liver, lymphnodes etc..

Contd.. Many patients present with painful sores involving the oral mucosa. The yeasts are generally observed in Giant cells or directly in exudate from mucocutaneous lesions.

DIAGNOSIS Microscopy Culture Serology Skin test

Treatment Itraconazole Ketoconazole Amphotericin - B