เอกสารบรรยาย pathology of fungal infection

FMS 2_Fungus_2015

1 Pathology of common fungal infections

Fundamental Medical Sciences 2 Pathology of common fungal infections ..

1. 2. 3. 4.

FMS 2_Fungus_2015


FUNGAL COLONIZATION AND DISEASES

protective barriers

- Dermatophytes ( )

keratinase - Yeasts genus Candida

pseudohyphae - dimorphic fungi yeast

form mold form - Cryptococcus neoformans mucopolysaccharide capsule

virulence factor subcutaneous

layer superficial mycoses subcutaneous mycoses systemic mycosis

FMS 2_Fungus_2015


SUPERFICIAL MYCOSES

epidermis, ,

:- - (anthropophilic) - (zoophilic) - (geophilic) dermatophytes (), pityriasis versicolor (

), onychomycosis () superficial candidiasis tinea nigra, black white piedra Onychomycosis

dermatophyte, non-dermatophyte fungi, yeasts dermatophyte Tinea unguium

, , , , (peripheral vascular diseases) , ,

1. Distal subungual onychomycosis

(hyponychium) (subungueal area)

2. White superficial onychomycosis

3. Proximal subungual onychomycosis (proximal nail fold)

4. Total dystrophic onychomycosis epidermis minimal dermal inflammatory response

FMS 2_Fungus_2015


Superficial Candidiasis (Candidosis)

Candida spp normal flora Candida albicans host tissue, secretory aspartyl proteases phospholipase enzymes yeast hyphae

Predisposing factors superficial candidiasis 1. (primarily T cell phagocytosis)

- Primary immunological disease chronic granulomatous disease - Secondary immunodefects 2.

2. 3. , , hypoadrenalism 4. Physiological changes , , 5.

1 onychomycosis

FMS 2_Fungus_2015


2 () oropharyngeal candidiasis () Candida budding yeast pseudohyphae Candida budding yeast cells (blastoconidia), pseudohyphae septate hyphae Tinea nigra rare superficial fungal infection Hortaea werneckii epidermis (tinea nigra palmaris) (tinea nigra plantaris) Central South America, Africa, Asia, North America. direct inoculation 1 1.5 .. (hyperkeratosis) stratum lucidum elongated budding cells 3 X 10 m dark hyphae

FMS 2_Fungus_2015


3 () tinea nigra Palmaris () yeast Hortaea werneckii Piedra

2 1. Black Piedra Piedraia hortae

spores

2. White Piedra Trichosporon beigelii , hyphae, arthrospores (spores hyphae) blastospores (budding yeast cells) 4 () Black Piedra () White Piedra

FMS 2_Fungus_2015


SUBCUTANEOUS MYCOSES

subcutaneous tissue dermis, subcutaneous tissues, muscle, fascia

Chromoblastomycosis (or Chromomycosis)

cutaneous suppurative granulomas sclerotic cells muriform cells hypha formation (dematiaceous fungi) Fonsecaea pedrosoi Exophiala dermatitidis microabscesses epidermis 5-12 m cross septum neutrophil

5 () chromoblastomycosis verrucoid lesion () histopathology chromoblastomycosis granulomatous inflammation Langhans giant cell yeasts

FMS 2_Fungus_2015


Mycetoma (or Madura foot) subcutaneous tissue

colonies ( granules grains) dematiaceous non-dematiaceous fungi

sinus tract grains (granules) mononuclear cell fibrosis

Sporotrichosis

Subcutaneous sporotrichosis dimorphic fungus; Sporothrix schenckii,

1. Fixed type (solitary cutaneous ulcer) (nodule) 2-4 cm

6 eumycotic mycetoma (1) (tumorous lesion) (2) sinus opening (3) grains granules

FMS 2_Fungus_2015


2. Lymphocutaneous disease (lymphangitis) (lymphadenopathy)

granulomatous inflammation cental suppuration

Periodic acid-Schiff staining cigar-shaped yeast forms, subglobose ovoid 3-5 m hyphal forms stellate eosinophilic material asteroid bodies asteroid bodies 10 m 7 sporotrichosis histopathology PAS budding yeast cells

FMS 2_Fungus_2015


SYSTEMIC MYCOSES

1. Endemic mycoses (opportunistic infection) 2. Opportunistic mycoses normal flora normal flora Systemic mycoses

- hosts immune system , AIDS - steroid, ,

, -

8 systemic mycosis

FMS 2_Fungus_2015


Histoplasmosis dimorphic fungi, Histoplasma capsulatum

North South America North American Histoplasmosis ( small-form histoplasmosis).

Histoplasmosis true systemic mycosis severe case chronic cavitary histoplasmosis

conidia

1. Asymptomatic infection endemic areas skin test

2. Primary pulmonary histoplasmosis 12-21 diffuse reticulonodular infiltrates mediastinum calcification

3. Chronic pulmonary histoplasmosis

4. Disseminated histoplasmosis histoplasmosis reticuloendothelial system diffuse reticuloendothelial involvement shock, respiratory distress, , yeast macrophage reticuloendothelial system intracellular budding yeasts 3 m well-developed granuloma

FMS 2_Fungus_2015


central area caseation tuberculosis. Solitary pulmonary nodules ("coin lesion")

9 macrophage Histoplasma capsulatum H&E GMS (Gomoris-Methenamine Silver) stain Cryptococcosis

encapsulated yeast Cryptococcus neoformans virulence factor polysaccharide capsule phenol oxidase

systemic T-cell lineages AIDS steroid

cryptococcosis 1. Pulmonary cryptococcosis

pulmonary infiltration

2. Cryptococcal meningoencephalitis subacute chronic

FMS 2_Fungus_2015


lymphocytes neutrophils glucose protein India ink capsule yeast cell

Cryptococci

yeast cell mucoid capsule yeast 4-6 m capsule 1-30 m yeast mucicarmine capsule

10 Cryptococcus neoformans budding yeast cells () mucicarmine Systemic candidiasis (or candidosis)

Candida transient candidemia disseminated invasive disease body cavity

C. albicans 1. Disseminated candidiasis

2.

FMS 2_Fungus_2015


- -

(chronic disseminated candidiasis) - -

superficial candidiasis Aspergillosis

Aspergillus

1. Aspergilloma fungal ball cavity

2. Invasive aspergillosis A. fumigatus, A. Flavus (hyaline, septate, dichotomously branched hyphae of uniform diameter) conidial head purulent, necrotizing inflammation

11 Aspergillus Hyaline septated hyphae with dichotomous branching GMS stain

FMS 2_Fungus_2015


Zygomycosis Zygomycosis class Zygomycetes

Mucorales, Mortierellales Entomophthorales mucormycosis AIDS (angioinvasive)

1. Rhinocerebral zygomycosis involvement

2. Cutaneous zygomycosis

3. Pulmonary zygomycosis neutrophil segmental consolidation

4. Gastrointestinal zygomycosis ileum acute suppurative inflammation granulomatous inflammation (broad, thin-walled, hyaline, often aseptate or sparsely septate hyphae) 6-15 m

FMS 2_Fungus_2015


Penicilliosis

P. marneffei Penicillium dimorphic fungi AIDS (bamboo rat) cell-mediated immunity

Penicilliosis marneffei

necrotizing granulomas microabscess formation slide Wrights stain biopsy H&E macrophages internal septation binary fission P. marneffei H. capsulatum internal septation Gomoris Methenamine Silver stain (GMS stain) 13 internal cross septation Penicillium ()

12 zygomycosis hyaline nonseptated hyphae with perpendicular branching

เอกสารบรรยาย pathology of fungal infection

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