Ma. Rosario L. Lacandula, MD, MPH Department of Microbiology & Parasitology College of Medicine Our...
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Ma. Rosario L. Lacandula, MD, MPH
Department of Microbiology & Parasitology
College of Medicine
Our Lady of Fatima University
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General Characteristics:
True Pathogenic fungi- causes infection in normal host
Highly virulent organism
MOT: Inhalation; Respiratory droplet
Primary site of infection- LUNGS, 90% of infection is asymptomatic or they resolved spontaneously accompanied by high degree of specific resistance to infections
Causes dissemination to other sites
Geographically restricted
Dimorphic
25 C- grows as filamentous mold
37C- yeast cell
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HISTOPLASMOSISDarling’s disease, Reticuloendothelial cytomycosis,
Cave disease & Spelunker’s disease
Thin branching hyphae that produce microconidia and tuberculate macroconidia
Small budding yeast 2-5 um in diameter and found inside
macrophages
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Histoplasmosis
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Histoplasmosis
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Histoplasmosis
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Histoplasmosis Etiologic agent: H. capsulatum var. capsulatum, H. capsulatum var
duboisii Natural reservoir: grows in soil with high nitrogen content especially
areas contaminated by excreta of bats and birds( starlings & chicken)
High endemicity- Ohio & Mississippi Valley regions of the United States Southern provinces of Ontario & Quebec in Canada Scattered areas of Central & South America Cases- Europe & Asia Africa- H. capsulatum var. duboisii
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HISTOPLASMOSIS
CLINICAL SYNDROMES: Normal Host
Asymptomatic or mild flu like illness N exposure
Acute Pulmonary Histoplasmosis H exposure
Rare complications Pericarditis,mediastinal fibrosis
Opportunistic infection Disseminated histoplasmosis
Chronic Pulmonary histoplasmosis
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HISTOPLASMOSIS
Laboratory Diagnosis: Serologic Test- complement fixation- standard test – (+) later in
the disease 6 weeks or longer after symptoms, fourfold rise Immunodiffusion- detects H & M antigens, more specific but less
sensitive Microscopic examination of infected tissue Skin test- Histoplasmin test- ( +) after 2 weeks of exposure, no
diagnostic value
Treatment: Amphotericin B
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BlastomycosisChicago Disease,Gilchrist’s disease, North American blastomycosis
Mold phase – typical pyriform microconidia 2-4 um in
diameter
Tissue phase – 8-15 um in diameter; buds are produced
singly & attached to parent cell by a broad base
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Blastomycosis
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Blastomycosis
Etiologic Agent: Blastomyces dermatitidis North America Continent & parts of Africa Endemicity overlaps with histoplasmosis Other endemic areas: Minnesota, Southern Manitoba, & Southwest
Ontario Epidemics- Wisconsin, Minnesota, Illinois, Eastern State of Virginia
& North Carolina Natural reservoir : not known, rarely cultured from soil of endemic
areas Infection can also occur among dogs and horses
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Blastomycosis
Clinical Syndromes: Primary infection in the lungs- Inapparent Ulcerative lesions of the skin & lytic bone lesion
Laboratory Diagnosis: Serology Microscopic findings
Treatment: Amphoterecin B
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Blastomycosis
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Blastomycosis
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ParacoccidiodomycosisSouth American blastomycosis, Lutz Splendore-
Almeida’s disease
No typical pattern of sporulation
Yeast with several budding cells attached to a parent cell;
“pilot’s wheel”; 2-3 um in diameter
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Paracoccidiodomycosis
Etiologic Agent: P. brazieliensis Central & South America & has high incidence in Brazil, Venezuela
& Colombia Natural reservoir: isolated in soil that have high humidity & average
temperature of 23 C Equal distribution among males & females, but clinical disease is
about 9X higher in males Transition of fungi from mold to yeast can be induced in vitro by
raising the temperature of 25 C to 37 C M-17-beta- estradiol inhibits transformation of the fungi Testosterone,corticosterone & 17 alpha estradiol had NO inhibitory
on the transformation
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Paracoccidiodomycosis
Clinical Syndromes: Primary lung infection- asymptomatic Ulcerative lesions of the buccal, nasal & occasionally GIT
mucosa
Laboratory Diagnosis: Serology Microscopic findings
Treatment : Amphotericin B
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CoccidiodomycosisPosada’s Disease, San Joaquin Valley fever &
Desert rheumatism
Mycelia fragment to produce cylindrical arthroconidia
Spherule; multinucleated structure that undergoes internal cleavage to produce endospore
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Coccidioidomycosis
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Coccidioidomycosis
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Coccidioidomycosis
Etiologic Agent: Coccidiodes immitis “ New World”- North, Central & South American Continents Highest endemicity- San Joaquin Valley in California, Maricopa &
Pima Countries in Arizona, Texas Endemic- Northern states of Mexico, parts of Venezuela, Paraquay
& Argentina Isolated in soil samples during summer Inhibited by P. jantheniluem & B.subtilis during rainy season
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Coccidioidomycosis
Clinical Syndromes 60 % asymptomatic 40 % develop symptomatic pulmonary infection.Most common
symptoms of primary disease are cough, fever, and chest pain. Night sweats and joint pains are not unusual
Primary infections usually self limited Dissemination mainly in the meninges and/or skin
HLA A9, Type B blood, do not develop toxic erythemas Blacks/ Asian are susceptible
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Coccidioidomycosis
Laboratory Diagnosis Complement fixation and tube precepitin Latex agglutination and agar immunodiffusion- two lines of
precipitation appear to be significant 2 sources of antigen, both cell-free culture filtrates
Coccidiodin Spherulin
Treatment: Amphotericin B, ketoconazole
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Coccidioidomycosis
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Ma. Rosario L. Lacandula, MD, MPH
Department of Microbiology & Parasitology
College of Medicine
Our Lady of Fatima University
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Opportunistic mycoses
General Characteristic:
Low virulent fungi
Monomorphic
Causes infection in immunocompromised host
Healthy individual develop high degree of innate resistance to fungal colonization
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CrytococcosisBusse-Buschke’s disease, torulosis, and European
Blastomycosis
Etiologic agent: Crytococcus neoformans Monomorphic Encapsulated- inhibits phagocytosis Phenoloxidase- converts phenolic compounds to melanin Lungs- Primary site of infection High predilection for systemic spread to the brain- leading cause of
fungal meningitis
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Cryptococcosis
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Cryptococcosis
Survive well in dessicated, alkaline, nitrogen rich, and hypertonic environment- recovered from excreta and debris of pigeons
Organism that not cause infection of pigeons Worldwide distribution
Clinical Syndromes: Primary pulmonary infection-asymptomatic detected as an
incidental finding on routine chest X ray- solitary nodule Symptomatic pneumonia-diffuse pulmonary infiltrates Skin cryptococcosis, Cryptococcal meningitis, osteolytic bone
lesions
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Cryptococcosis
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Cryptococcosis
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Cryptococcosis
Laboratory Diagnosis Detection based on the presence of antigen Latex agglutination test for detection of the capsule Rapid test- use of India Ink preparation of CSF- seen as clear
halo
Treatment: Amphotericin B
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Candidiasis
Etiologic agent: Specie of Candida Endogenous normal flora Major disease problem of immunocompromised host Clinical disease ranges from superficial skin infection to systemic
life threatening disease Rarely isolated from the surface of human skin except from certain
intertrigenous areas Organs involved- lungs, spleen,kidney,liver,heart and brain Pseudohyphae & septate hyphae
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Candidiasis
Clinical Syndromes CMC Chronic mucocutaneous candidiasis- heterogenous group
of clinical syndromes characterized by chronic, treatment resistant superficial Candida infections of the skin, nails and oropharynx
No dissemination seen in visceral organs Defect in CMI
Laboratory Diagnosis Rapid diagnosis- germ tube test Budding yeast cells, pseudohyphae and septate hyphae
Treatment: Amphotericin B , 5-fluorocytosine, ketoconazole and fluconazole
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Development of germ tubes by Candida albicans yeast cells after incubation in serum x 2 hours @ 37oC
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Candidiasis (Moniliasis)
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Candidiasis (Moniliasis)
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Aspergillosis
Etiologic agent: A. fumigatus; A. niger; A. flavus Common in the environment Exogenous source Normal individual not susceptible to systemic aspergillosis
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Aspergillosis
Clinical syndromes Mycotoxicosis- ingestion of contaminated peanuts Allergic aspergillosis- allergic bronchopulmonary disease Secondary Colonization- fungal colonization of pre existing
cavity ( e.g. pulmonary abscess) w/o invasion. Fungus ball- spherical mass of intertwined septate branching
hyphal elements Systemic disease- Invasive disease involving multiple organs
Laboratory Diagnosis: septate hyphae that branch at regular intervals seen in clinical specimens
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Mucormycosis
Susceptibility to the fungi- metabolic acidosis, DM, leukopenis and hyperglycemia
Grows rapidly on all laboratory media Form coenocytic hyphae Ubiquitous in the environment and encountered as contaminants
Clinical Syndromes Rhinocerebral zygomycosis-most common-originate in the
paranasal sinuses can involve the ocular orbit and palate with extension to the brain
Lungs, GIT, subcutaneous tissue
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Mucormycosis
In severely burned patients- colonize the damaged tissues and tend to become invasive.
In disseminated disease- predilection for invading major bood vessel. Clot that result can cause ischemia and necrosis of adjacent tissues.
Laboratory Diagnosis: Microscopic findings
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Mucormycosis
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Mucormycosis