1. Fungal infections 400 out of 75,000 Primary infections Opportunistic infections Myco-toxins Allergy

2. Mycoses Superficial and cutaneous Subcutaneous Deep (systemic)

3. Superficial and Cutaneous Mycoses Skin, hair, nail, mucus membranes Most common World-wide Ringworm infections Yeast infections

4. Subcutaneous Mycoses Skin, subcutaneous tissues, fascia and bone Localized Trauma More in tropics Mycetoma, chromomycosis and sporotrichosis

5. Systemic Mycoses Deep-seated Inhalation Primary (restricted) Opportunistic (world-wide)

6. GIT Mycoses

7. DANGEROUS ORGANISMS AROUND US

8. Source of microbes Food Drinks Spices Dishes Cutlery

10. Dishwashers! Found in 40% of homes in UK They are perfect breeding niche for fungi associated with potentially deadly illnesses Study on 189 dishwashers in 101 different cities around the world: – 62 % of dishwashers contained fungi on the rubber band in the door – More than half of these included the black yeasts: – Exophiala dermatitidis – Exophiala phaeomuriformis – Scedosporium apiospermum

11. Source of many fungi Food, drinks and spices (Aspergillus, Peinicillim And human own microflora (e.g. Candida)

16. Could these microbes pass through intestinal barriers and reach our internal organs ?

17. Microbial translocation Microbial translocation is defined as the passage of viable microbes from the gastrointestinal tract to extra-intestinal sites, such as the mesenteric lymph node, spleen, liver, kidneys, and blood

18. Systemic mycoses due to opportunistic pathogens Immune deficiencies: – AIDS – Alteration of normal flora by antibiotics – Immunosuppressive therapy – Cancer Examples: – Candidiasis, Cryptococcosis, Zygomycosis and Aspergillosis

19. Candida albicans translocation J Infect Dis. 1993 Nov;168(5):1314-8. Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces species

20. Systemic mycoses due to primary pathogens AgentinfectionDissemination Blastomyces dermatitidis BlastomycosisSkin and bone Later nervous system and visceral organs Coccidioides immitisCoccidioidomycosisSkin, bones, joints, subcutaneous tissues, and visceral organs Paracoccidioidoes brasiliensis ParacoccidioidomycosisOro-nasal mucosa latter spleen, liver, intestine and skin Histoplasma capsulatum Histoplasmosis Acute pneumonia (cave disease) Chronic pneumonia (smoker) Disseminated (immunocompromised) Primary cutaneous (lab accidents)

21. Treatment of invasive intestinal infections Depending on causative agent: – Amphotericin B Posaconazole or Voriconazole (filamentous fungi) – Fluconazole, Caspofungin, Amphotericin B or Voriconazole (yeast infection) – Amphotericin B (dimorphic and zygomycetes)

22. Polyene antifungal agents Amphotericin B Nystatin

23. Azoles antifungal agents Clotrimazole Econazole Ketoconazole Miconazole Fluconazole Itraconazole Posaconazole Voriconazole

24. Other antifungal agents Echinocandins – Anidulafungin – Caspofungin – Micafungin Terbinafine 5-fluorocytosine