Download - General Mycology
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2011 يناير 25ثورة الحرية
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Medical MycologyMedical Mycology
ByProf. Fikry El MorsyProfessor of medical
microbiology and immunologyHead of medical microbiology and immunology department
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Fungi were discovered earlier than
bacteria and viruses.
In the past, most fungi cause skin
infections or cosmetic infections,
where bacteria and viruses cause
serious fatal diseases, so there was
no interest of studying fungi.
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In 1980, when HIV infection was
discovered, increasing number of
immunocompromizing conditions,
they found that fungi produce fatal
diseases; from that time, fungi return
to be in focus again.
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It is the science that deals with the
study of pathogenic fungi that
produce diseases.
Fungi are eukaryotic organisms have
true nuclei with definite nuclear
membrane, nucleolus, cytoplasmic
organelles).
Medical MycologyMedical Mycology
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Cell membrane of fungi has sterols,
which is the target of action of
antifungal agents.
Ergosterol dominates in contrast to
cholesterol in mammalian membrane
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Cell wall of fungi lacks:
Peptidoglycan
Glycerol & ribitol teichoic acid of bacterial
cell wall
Lipopolysaccharide
Cell wall composed of:
Chitin.
Glycan (important for new antifungal
agent).
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Fungal metabolism
All fungi are heterotrophic organism
need to parasite or saprophyte (on
plant, animal or human) to obtain
organic source of carbon or nitrogen.
All fungi are aerobic.
Some are facultative anaerobes.
None are strict anaerobes.
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Optimum temperature of growth 25 – 30
ºC (because most are saprophyte live in
the environment).
Some are thermophilic and can grow at
higher temperature.
Fungi can tolerate a wide range of pH (2
– 9), but generally they prefer acidic
media.
Light inhibits the growth of fungi.
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Reproduction
1.Sexual reproduction: involve the
union of 2 nuclei or 2 sex cells or 2
sex organs.
2.Asexual reproduction:
It is the main method of reproduction.
N.B.: A single fungus may contain both mode of
reproduction.
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Asexual reproduction includes:
A.Fragmentation of hyphae & each
fragment grows into a new individual
fungus.
B.Fission of cell into 2 daughter cells
(similar to binary fission in bacteria).
C.Budding of cells, each bud produce new
individual (e.g. Candida).
D.Formation of asexual spores.
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Fungal SporesIt is an element of reproduction in fungi unlike
bacteria.
Two types:
1) Sexual:A. Zygospore (Two identical cells form the zygote).
B. Oospore (female cell fertilized by male cell).
C. Ascospore.
D. Basidiospore.
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Ascospores
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basidiospores
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2) Asexual:
A. Thallospore
B. Sporangiospore
C. Exogenous asexual spores
MacroconidiaMicroconidia
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Thallospore
Blastospores (by budding from thallus).
Arthrospores (forming within the lumen of
hyphae, can be cubical or round. Its size less than
the size of hyphal cell.
Chlamydospores (spores that arise from the
thallus by pulling or swelling of mycelium
filaments.
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Arthrospors Arthrospors (arise by fragmentation)(arise by fragmentation)
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BlastosporesBlastospores ((arise by budding then give sporesarise by budding then give spores))
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ChlamydiosporeChlamydiospore( ( thick spherical swellingthick spherical swelling))
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Sporangiospore
Some fungi during growth
form sac filled with spores
called sporangium.
Spores inside sporangium called sporangiospores.
Hyphae that carry this sporangium
are called sporangiophore.
This sporangium when gets ripping, its wall will be
broken and the spores disseminate.
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Exogenous asexual sporesConidia: These are spores formed at
the terminal part of a fertile hypha.
Conidophore: fertile hypha bearing
conidia.
e.g. Asperigillus, Penicillum.
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Microconidia:
Unicellular, asexual external spores.
Macroconidia:
Multicellular, asexual external spores.
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Pathogenesis of fungal infections
A- Source of infection:
Endogenous: Normal flora and it is the main nosocomial
infection (because those people in hospitals are
immunocompromized).
Exogenous: This is the main source of fungal infection
mainly from the environment.
Little fungal infections are communicable between human
or between animals.
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B-Mode of transmissionFungi can be transmitted by the following
methods:
1.Respiratory tract = air borne infection.
2.GIT = food & water borne infection.
3.Blood stream = injection.
4.Skin = contact.
Most fungal diseases are not communicable
between human or animals.
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C- Most fungi are opportunist:
Produce diseases in immunocompromized
patients.
Little is primary pathogen (cause disease
in person with intact immune system).
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D- Steps of infection
1.Adherence
2.Invasion
3.Phagocytic interactions
4.Tissue injury
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i. Adherence:
• By adhesions, e.g. Candida, but
filamentous fungi have no adhesions.
• Fibrinonectin of epithelial cell is the
receptors.
• Virulence usually associated with
adherence.
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ii. Invasion:
• Mechanical trauma to skin or mucosal surface
is an essential step in fungal infection,
because most of the infective element in fungi
is the spore and it is non-invasive.
• Some fungi have invasive power like Candida
by the formation of hyphae and
pseudohyphae.
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iii. Phagocytic interactions:
• Some fungi especially dimorphic fungi
show resistance to phagocytic killing.
iv. Tissue injury:
• No classical endotoxins and exotoxin of
bacteria.
• Disease is due to prolonged presence of
fungus, inflammatory & immunological
responses to get rid of this fungus.
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Immunity to fungal infections
Innate immunity: Non-specific works
against all microorganisms.
Acquired immunity:
• The main immunity is cellular immunity
because fungi stay inside the host cell.
• Antibodies have limited role in some
fungal diseases.
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Fungal Classification
According to morphology:
Moulds (Filamentous fungi):
Yeasts
Yeast-like
Dimorphic fungi
According to nature of their sexual spores
Phycomycetes:
Ascomycetes:
Basidiospores
Fungi imperfecti
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A- According to morphology
1- Moulds (Filamentous fungi):
Grow with formation of hyphae, which may
be septated or non-septated.
Vegetative mycelium: hyphae that penetrate
the media.
Aerial mycelium hyphae present at the
surface of the media.
Some hyphae may be directed upward &
carry the spores that produced by this
fungus.
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mycelium: septate mycelium: non septate
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2- Yeasts:• Unicellular fungi (rounded or oval in
shape).
• Reproduce by budding.
• The only example of pathogenic yeasts
is Cryptococcus neoformans.
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3- Yeast-like:• Unicellular fungi (rounded or oval in shape).
• Reproduce by budding.
• during infection it produces pseudohyphae.
• Example: Candida.
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4- Dimorphic fungi:
Can grow as yeast during infection in the
body & on incubating culture at 37 ºC.
Can grow as moulds or filaments when
inoculated at room temperature.
Example: Histoplasma capsulatum.
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B- According to nature of their sexual
spores:
1-Phycomycetes:
Sexual spores are of 2 types: zygospores &
oospores.
Non-pathogens.
2-Ascomycetes:
Sexual ascospors.
Non-pathogens.
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3-Basidiospores:
Sexual basidiospores.
Non-pathogens.
4-Fungi imperfecti:
Imperfect or sexual state not present or not
discovered, so can't be placed with one of the above
three classes.
Most of pathogenic moulds, yeasts, yeast-like and
dimorphic fungi belong to the group fungi imperfecti.
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Human mycosis terminology:
A. Anatomical terminology (According to the
site of infection):
Dermatomycosis: Fungal infection of the skin.
Pulmonary mycosis: Fungal infection of the lung.
Cardiovascular mycosis: Fungal infection of the
cardiovascular system.
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B. Mycological terminology (According to the
etiology):
Candidiasis (=Candidiosis): Fungal infection by
Candida.
Aspergillosis: Fungal infection by Aspergillus.
Cryptococcosis: Fungal infection by Cryptococcus.
Histoplasmosis: Fungal infection by Histoplasma.
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Types of human mycosis
1- Superficial mycosis:
Infection restricted to upper most horny layer
of skin, hair and nails.
e.g. Tinea versicolor.
2. Cutaneous mycosis:
Ringworm fungi.
e.g. Candidiasis of skin, mucosal surfaces.
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3. Subcutaneous mycosis (Implantation
mycosis):
Most of fungi are non invasive because the
infection element is the spores.
Occur by implantation of spores into wounds.
e.g. Mycetoma (madura foot), thorn pricks
mycosis.
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4. Systemic mycosis
Multi organs affected.
Mode of infection:
Inhalation of spores of saprophytic fungi.
Extension of local mycosis.
Examples:Cryptococcosis.
Histoplasmosis.
Candidiasis.
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5. Opportunistic mycosis:
Fungal infection by:
Fungal flora (Candida).
Saprophytic fungi in the environment
(Aspergillus).
occurs in immunocompromized host
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Superficial mycosesSuperficial mycoses
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Subcutaneous mycosesSubcutaneous mycoses
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Systemic MycosesSystemic Mycoses
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Systemic MycosesSystemic Mycoses
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Opportunistic conditions like:
•Diabetic patients.
•Cancer patients.
•Corticosteroid therapy.
•Cytotoxic drugs.
•Prolonged antibiotic therapy.
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Diagnosis of fungal infections
1. Direct Microscopic Preparation:
a)Unstained preparation:
a) rapid method of diagnosis.
Scraping of lesion or exudates (e.g. sputum, pus).
Put on clear slide, add drop of KOH (10 – 30%).
Gentle heating.
Examined by high power lens of the microscope.
Find diagnostic fungal elements.
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b) Stained preparation:Rapid, easy and cheep.
KOH preparation may be stained with
Lactophenol cotton blue stain.
It is used for demonstration of
Cryptococcus neoformans.
Its positivity not more than 30%.
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2. Culture for isolation of fungi:
Sabouraud`s dextrose agar (SDA):
Disadvantage: Bacteria can grow on it.
SDA + Chloramphenicol (0.05%):
Chloramphenicol is added to inhibit bacterial
growth.
SDA + Chloramphenicol + Cyclohexamide
(0.5%):
Cyclohexamide is added to inhibit the growth of
saprophytic fungal contaminants.
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Blood agar:
Some fungi as yeast and yeast like (Candida and
Cryptococcus) grow rapidly as bacteria after 4
weeks from incubation.
Growth is identified by:
Macroscopic characters: e.g. colour from both
sides (recto – verso examination), shape, size
and texture of the colony.
Microscopic stained preparation.
Biochemical reaction: Sugar fermentation and
assimilation.
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Colony MorphologyColony Morphology
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Yeast coloniesYeast colonies
Mucoid colonies
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3. Microculture
Used to:
See whole morphological details of fungi especially
in yeasts.
Prevent disturbing the fungal morphology.
It has 2 types: Direct evaluation of a culture in an open petri dish under the
microscope.
Slide culture technique.
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4. HistopathologyFungi occur in tissue as one of the following:
Yeast cells:
They may be intracellular small yeast: e.g. Histoplasma
capsulatum.
They may have a large distinguishing capsule: e.g. Cryptococcus.
Sporangia:
Intact sporangia are large sac-like structure filled with
sporangiospores.
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Hyphae:
May be brown or non-colour, septated or non-septated.
Granules:
Tightly packed masses of hyphae or filaments
Combination of yeast cells and hyphae:
As in Candida.
5. Woods light:Long wave ultraviolet rays which when come in contact with
mycotic areas of skin and hair produce fluorescence
Disadvantage: it occurs in some mycotic infections only.
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6. Indirect method of diagnosis:Detection of circulating antibodies (Serological diagnosis):
Used in diagnosis of Cryptococcus and Candida with
limits.
Tests used for detecting fungal antibodies:
A- Precipitation reaction, Agglutination, Electrophoretic
tests, Complement fixation, Indirect fluorescent
antibody,and ELISA.
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B- Fungal skin tests:
It has no value in diagnosis.
It does not differentiate between active and past
infection.
Mainly used for epidemiological study.
It is observed by formation of induration and
swelling due to reaction between injected antigen
and T cells.
e.g. Histoplasmin, Candidin, Tricophytin tests.
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Antifungal therapy
A- Topical antifungal:Polyenes e.g. nystatin, fungizone
Azoles (e.g. miconazole, Ketoconazole, econazole,
clotrimazole).
Miscellaneous e.g tolanftate, allylamine.
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B- Systemic antifungals:Polyenes (e.g Amphotericin-B).
5- flucytosine.
Azoles (e.g itraconazole, fluconazole).
Terbinafine.
Griseofulvin
Iodine.
New antifungal Echino candins e.g caspofungin
New triazole e.g voriconazole and posaconazole
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Mechanism of action of antifungal drugs
1- Drugs act on cell membrane:
e.g. Polyenes and Azoles
2-Drugs act on Nucleic acid synthesis
e.g. 5-flucytosin and griseofulvin
3- Drugs act on cell wall
e.g. Caspofungin
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Drugs act on cell wall
•Echinocandine e.g. Caspofungin
•Inhibite glucan synthetase
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1) Polynes
Bind to ergosterol in the fungal cell membrane
altered permeability leakage of K+, Mg++,
Sugar Cell death
Fungicidal and broad Spectrum
Hepatotoxic and nephrotoxic,
lipid preparations (as liposomal amphotericin-B)
are more tolerable and less toxic.
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2) Azole
Inhibits ergosterol biosynthesis via binding to
cytochrome p- 450 dependent enzyme 14α
demethylase accumulation of 14 α sterol
depletes sterols.
Hepatotxic and spermatogenesis inhibitor
Fluconazole crosses BBB so used in treatment
of cryptococcal meningitis.
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3) Criseofulvin
Exact mechanism is unknown
Inhibit synthesis of cell wall chitin.
Inhibit nucleic acid synthesis
Have antimitotic activity by inhibiting
microtubules assembly
![Page 74: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/74.jpg)
4) 5- Flucytosin
Deaminated in cell to 5- fluorouracil, which
replace uracil base in RNA disruption of
protein synthesis.
How to select proper antifungal drug?
By susceptibility testing methods e.g
• Broth dilution method
• Agar diffusion method
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I. Superficial fungal infection
A. Ring worm fungi
(Tinea =dermatophytosis)
![Page 78: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/78.jpg)
Dermatophytosis: Fungal infection by dermatophytes of keratinous structures (skin, hair, nails).
Common clinical types:
1. Tinea Corporus:Dermatophyte infection of the gollaporous skin
(trunk, back, dorsum of the hand).
2. Tinea Capitis:Fungal infection of the skin of the scalp and hair.
![Page 79: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/79.jpg)
Tinea Corporis
![Page 80: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/80.jpg)
![Page 81: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/81.jpg)
Tinea capitis
![Page 82: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/82.jpg)
This takes 3 forms:a) Endothrix:
There is abundant fungus growth inside the hair shaft.
b) Ectothrix:The spores surround the hair shaft from
outside lead to weakness and falling of the hair.
c) Favic type: Some fungal mycelia are present inside the
shaft with air space.
![Page 83: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/83.jpg)
Hair affection
![Page 84: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/84.jpg)
3. Tinea Barbae:Fungal infection of the bird and
moustache skin area in male.
4. Tinea Pedis (Athlete's foot):Ring worm of the foot.
It is infection of the feet or toes with
dermatophyte fungus (include soles,
nails and inter-digital peeling).
![Page 85: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/85.jpg)
Tinea Barbae
![Page 86: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/86.jpg)
Tinea pedis
![Page 87: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/87.jpg)
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5. Tinea Manum:
Fungal infection of the palm of the hand
and inter-digital areas.
6. Tinea Cruris:
Fungal infection of the crural area and
perineum.
7. Tinea Unguim:
Fungal infection of the nail of the hand.
![Page 90: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/90.jpg)
Tinea manum
![Page 91: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/91.jpg)
Tinea cruris
![Page 92: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/92.jpg)
Epidemiology
According to the source of infection
1- Anthroprophilic:From human to human.
e.g. Epidermophyton flocosum.
2- Zoophilic:
From animal to human.
e.g. Microsporum canis.
3- Geophilic:
Spores found in soil.
e.g. Microsporum gypseum.
![Page 93: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/93.jpg)
Pathogenesis
1. Infective stage is arthrospore of fungus or
keratinous material containing fungus
2. Need direct or indirect contact.
3. Need slight trauma.
4. Active infection restricted to the basal
keratinocytes of the epidermis.
![Page 94: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/94.jpg)
Causative fungus
Dermatophytes include 3 genera:
1. Epidermophyton e.g. E. flocosum.
2. Trichophyton e.g. T. rubrum.
3. Microsporum e.g. M. canis.
![Page 95: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/95.jpg)
Diagnosis of dermatophyte infection
1. Clinical picture.
2. Wood's light (negative result doesn't exclude
fungal infection).
3. Direct examination by KOH preparation:
Diagnostic element in skin & nail is the
septated hyphae.
Diagnostic element in hair is the endothrix,
ectothrix or favic.
![Page 96: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/96.jpg)
4. Culture:On SDA with chloramphenicol & actidion.
Dermatophyte test medium that is yellow in
colour (if turned red, this indicate positive
test).
Macroscopic examination.
Microscopic examination: to differentiate
between the three genera of dermatophytes
according to the type of macroconidia
![Page 97: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/97.jpg)
MicrosporumSpindle shape, multicellular with rough
surface.
![Page 98: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/98.jpg)
EpidermophytonClup shape (racket) with smooth surface.
![Page 99: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/99.jpg)
Trichophytonpencil shape with smooth surface.
![Page 100: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/100.jpg)
Microsporum: Spindle shape, multicellular
with rough surface.
Epidermophyton: Clup shape (racket) with
smooth surface.
Trichophyton: pencil shape with smooth
surface.
5. No role of serology.
![Page 101: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/101.jpg)
Treatment
A. Systemic agents (oral): Griseofolvin (drug of choice).
Itraconazole.
Allylamine (Lamisil).
Ketoconazole (not used now).
B. Topical agents: White field.
Clotrimazole (Canesten).
Miconazole (Daktarin).
![Page 102: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/102.jpg)
Prohylaxis against Tinea pedis
Keep the feet dry.
Rub between toes by dry piece of
gauze & alcohol.
![Page 103: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/103.jpg)
B. Pityriasis versicolor (Tinea versicolor)
Definition:◦Chronic superficial fungal infection of the upper most horny layer of the epidermis.
◦Main area affected is the trunk but it can appear in any site of the skin
◦Infection may result in hypo- or hyper-pigmentation
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Etiology:
Pityrosporum orbicular.
Diagnosis:Direct microscopic examination of skin
scrapping by KOH preparation.
Diagnostic element is short angular
hyphae & yeast cells (spaghetti & meat
ball appearance).
![Page 107: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/107.jpg)
Yeast with angular hyphae (spaghetti and meat ball)
![Page 108: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/108.jpg)
TreatmentAny topical azole is effective (e.g.
Miconazole, Clotrimazole).
If the infection is recurrent or widely
diffused in the trunk: Shampoo Selnum
blue (1% selenium sulfide).
![Page 109: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/109.jpg)
Candidal infection
It is fungal infection caused by one member of genus Candida.
Source of infection: Endogenous: (autoinfection): Present as
normal flora in oral cavity, GIT, female genital tract and skin.
Exogenous: By sexual intercourse.
![Page 110: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/110.jpg)
Pathogenesis and virulence factors1. Adhesin: Colonization on the mucosal surface.
2. Pseudohyphae: inflammation and tissue distraction.
3. Protease enzyme: invasion.
4. Endotoxin like: Releasing of histamine leading to clinical reaction.
5. Resistance to intracellular killing of phagocytes.
![Page 111: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/111.jpg)
Predisposing factors
1. Extreme of age.
2. Pregnancy and diabetes.
3. Prolonged use of antibiotics,
steroids or immunosuppressive
drugs.
4. Traumatic conditions such as
catheter or IV lines.
![Page 112: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/112.jpg)
Immunity T-cell mediated.
Humoral immunity has a limited role.
Non-albicans Candida
1. Candida tropicalis.
2. Candida glaborata (doesn’t cause
pseudohyphae).
![Page 113: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/113.jpg)
Clinical manifestation of diseases
caused by Candida
A- Mucocutaneous infection:
1. Oral thrush: In the mouth (cheesy
covering layer), mouth angles:
(stomatitis), at the lips (cheilitis).
2. Vaginitis: White-milky discharge and
itching.
![Page 114: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/114.jpg)
B- Cutaneous infections:
1. Skin: Napkin area in baby, axilla, groin,
submammary folds, characterized by redness,
itching and red follicles.
2. Nail: Paronychia.
C- Systemic infections:
1. . Urinary tract infection.
2. Endocarditis.
3. Meningitis.
4. Septicemia, fungemia
![Page 115: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/115.jpg)
Oral thrush
![Page 116: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/116.jpg)
Napkin dermatitis
![Page 117: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/117.jpg)
Paronychia
![Page 118: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/118.jpg)
Laboratory diagnosis of Candidiasis
A. Direct:
1. Microscopic examination:Unstained preparation or stained
preparation (KOH) lactophenol-cotton
blue stains.
For detection of yeast cells and
pseudohyphae.
![Page 119: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/119.jpg)
Candida albicansCandida albicans
SEM
![Page 120: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/120.jpg)
2. Culture: On SDA medium.
Growth is identified by:
a. Macroscopic appearance: the colonies after 24 –
48 hours are white, smooth, creamy and have
characteristic yeast odour.
b. Microscopic appearance: Spherical or oval cells.
Gram film shows Gram-positive yeast.
c. Microculture: Rice agar plates for demonstration
of chlamydospores.
![Page 121: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/121.jpg)
Candida Candida ColoniesColonies
![Page 122: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/122.jpg)
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d. Biochemical reactions: Sugar fermentation
and assimilation.
e. Germ tube formation: The ability of Candida
albicans to form filamentous growth after 2 –
4 hours when cultivated on human serum at
37ºC
(rapid sure diagnosis).
f. Chlamydospores formation on Potato Carrot
Bile medium.
![Page 124: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/124.jpg)
![Page 125: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/125.jpg)
Chlamydiospore
![Page 126: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/126.jpg)
B. Indirect:
1. Skin test:No value in diagnosis.
2. Serological test:Ag detection: Important in immunocompromized
patients.
3. Histopathology:Diagnostic element is Yeast cell &
Pseudohyphae.
![Page 127: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/127.jpg)
4. New tests for diagnosis:Detection of ß-glucan antigen.
D-arabinitol marker.
PCR.
Biofilm by scanning electron
microscope.
![Page 128: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/128.jpg)
Treatment1. Superficial:
Topical polyene, nystatin & amphotericin B.
Topical imidazole as micnazole, clotrimazole.
2. Deep systemic infection:Amphotericin B.
Fluconazole.
Itraconazole.
Caspofungin.
Lipid preparation; liposomal Amphotericin B.
![Page 129: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/129.jpg)
II. Subcutaneous Mycosis
A. Mycetoma (Madura foot = Maduromycosis)
Definition:Chronic granulomatous infection, which produce tumour-like lesion and sinus tract formation, with the presence of granules affecting foot, SC tissue, fascia and bone.
![Page 130: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/130.jpg)
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Large coarse Branched septated hyphae with spores
![Page 134: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/134.jpg)
Etiology
(1) Bacteial:
◦ Actinomycotic (Actinomadura, Nocardia, Streptomyces).
◦ The granules contain very fine delicate filaments.
(2) Fungal (Eumycotic):
◦ Most saprophytic fungi e.g. Madurella.
◦ The granules contain large coarse septated hyphae.
◦ Usually the lesion has many openings.
![Page 135: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/135.jpg)
DiagnosisKOH preparation.
Bacterial: Fine branching filament.
Eumycotic: Coarse septated hyphae.
TreatmentBacterial (Actinomycotic): Antibiotic.
Eumycotic:
◦Amputation of the affected part.
◦Antifungal agents e.g. Itraconazole, Amphotericin B.
![Page 136: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/136.jpg)
B. Sporotrichosis
(rose gardner disease)
Subcutaneous fungal infection,
Characterized by mobile tender nodules forming
ulcer,
May be followed by chronic sporotrichosis in the
form of multiple hard nodules along lymphatic
channels.
![Page 137: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/137.jpg)
![Page 138: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/138.jpg)
Etiology:
Sporothrix schenckii (A dimorphic fungus).
Diagnosis:
1. Sample: Exudates from lesion or LN aspirate.
2. Direct film:
In pus: Cigar shaped yeast.
In tissue: Asteroid body (fungus surrounded by
eosinophilic infiltration).
![Page 139: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/139.jpg)
![Page 140: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/140.jpg)
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3. Culture:At 37 ºC on enriched media giving gray
colonies. Identified microscopically as Gram-
positive cigar shaped budding yeast.
At 27 ºC on Sabouraud`s dextrose agar:
wrinkled white creamy varies to black
colonies. Identified microscopically as
branching septated hyphae carry pyriform
conidia.
![Page 143: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/143.jpg)
III. Systemic Mycosis
A. Histoplasma capsulatum
The organism is misnamed because
infection is not in the plasma cells but in
the macrophages, and it is not
capsulated.
![Page 144: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/144.jpg)
Microbiological characters1. Dimorphic fungi: i.e. two morphological
forms:Yeast during infection and cultures at 37 ºC
Mould cultures at 25 ºC produce microconidia and macroconidia with septated hyphae.
2. Smallest yeast cell, reproduce by budding.
3. Non-capsulated.
![Page 145: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/145.jpg)
Pathogenesis
Infection of reticuloendothelial system
and growth in phagocytic macrophage. Primary lesion is in the lung, which
leads to calcified node and positive
Histoplasmin skin test. Immunity: Cell-mediated immunity.
![Page 146: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/146.jpg)
Epidemiology
◦ Source of infection: Soil containing bird or bat droppings.
◦ No case-to-case transmission.
![Page 147: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/147.jpg)
Clinical picture1. Asymptomatic or respiratory infection
giving flue like symptoms in immunocompetent patient.
2. Chronic lesion in lungs leads to tuberculosis like picture.
3. Disseminated infection: appears as febrile illness and enlargement of reticuloendothelial organs.
![Page 148: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/148.jpg)
Diagnosis:1. Direct examination of sputum.2. Histological examination of bone marrow
to demonstrate intracellular yeast in macrophages.
3. Culture.4. Serology.5. Skin test: Histoplasmin test
Treatment:Amphotericin B, followed by itraconazole.
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HHiissttooppllaass
mmaa
ccaappssuullaattuumm
3377oocc
![Page 151: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/151.jpg)
Histoplasma capsulatumHistoplasma capsulatum 27oC27oC
![Page 152: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/152.jpg)
B. Cryptococcus neoformans
Morphology:Capsulated yeast.
Urease positive.
![Page 153: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/153.jpg)
Pathogenesis:
Infection occurs by inhalation of spores which lead to
pulmonary infection.
Most infection is unrecognized and self-limiting.
Capsule is the determinant of virulence.
Immunity
1.Cell-mediated immunity.
2.Humoral (opsonizing antibodies against capsule).
![Page 154: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/154.jpg)
Epidemiology:
• Source of infection: Pigeon or birds droppings and soil
contaminated with them.
• Human infection mostly by inhalation.
• No case-to-case transmission.
Clinical picture:
• Pneumonia followed by meningitis.
• In heavy infection disseminated skin and bone infections
occur.
![Page 155: General Mycology](https://reader036.vdocuments.pub/reader036/viewer/2022081720/554b270fb4c905ce088b47b8/html5/thumbnails/155.jpg)
Diagnosis:• In Cryptococcus meningitis: CSF shows
1.Increased pressure of CSF.
2.Decreased glucose and increased protein.
3.Increased cell count > 100, mostly lymphocytes.
4.Indea ink preparation: yeast cell surrounded by huge capsule.
• Culture and identification of growth.
• Detection of Cryptococcus antigen in CSF by latex
agglutination.
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Cryptococcus Cryptococcus neoformansneoformans
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Treatment:
Amphotericin B. Followed by
fluconazole (Can cross blood brain
barrier).
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C. Aspergillosis
• It is the fungal infection by Aspergillus.
• It is a saprophytic organism.
• Produces spores carried by air.
• Aspergillosis can produced in immunocompromized
patients as well as immunocompetent persons.
Causes:
A. fumigatus, A. niger, and A. flavus.
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Clinical forms
1.Granulomatous lesion: Chronic infection in the lung.
2.Fungal ball in old TB cavity: mass formation in the
lung, which mistake by bronchogenic carcinoma.
3.Allergic type: Asthma and farmer's lung.
4.Acute pneumonia in immunocompromized patients.
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Mode of transmissionEnvironmentally by inhalation of spores.
Diagnosis1.KOH preparation of sputum: Hyaline, septated
hyphae or dichotomously branched hyphae.
2.Culture on SDA and examination of growth by:
A. Macroscopically: Black (A. niger), green-
orange or white colonies.
B. Microscopically: aspergillus head
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Treatment
Antifungal drugs in disseminated lesions
like: Amphotericin B, Itraconazole,
Voriconazole.
Surgical removal of fungal ball.
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Mycotoxicosis
Fungi can generate substances with
direct toxicity for humans and animals.
Ingestion of these toxins leads to
mycotoxicosis, the severity depends on
the amount and type of ingested
mycotoxin.
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General criteria of mycotoxicosis
1.Non-transmissible.
2.No effect of antifungal drugs.
3.Seasonal.
4.Associated with food ingestion.
5.The degree of toxicity depends on many host
factors.
6.Examination of the food reveals fungal growth.
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Types of mycotoxins:
• There is large number of mycotoxins
according to the fungus produce it. e.g.
aflatoxin, ochratoxin, amatoxin and
phallotoxin.
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Aflatoxin
• Produced by Aspergillus flavus.
Effects of aflatoxins on man:
1.Initiate liver cell carcinoma
2.Immunosuppression.
3.Gastroenteritis.
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