MEDICAL MYCOLOGY Arthur F. Di Salvo, MD Reno, Nevada

1. MEDICAL MYCOLOGY Arthur F. Di Salvo, MD Reno, Nevada

4. Medical Mycology Outline HOUR SUBJECT • Introduction, Actinomycetes • Yeasts, Dermatophytes • Filamentous Fungi, Dimorphic Fungi • Dimorphic Fungi • Opportunistic Fungi

5. OBJECTIVES • To impart sufficient basic science of the medically important fungi to assist you in diagnosing mycotic diseases. • To impart sufficient clinical knowledge to raise your index of suspicion for mycotic diseases.

6. What is SAID is not HEARD • What is HEARD is not UNDERSTOOD • What is UNDERSTOOD is not RETAINED • What is RETAINED is not IMPLEMENTED

7. ASK QUESTIONS ANYTIME • During or after lecture

8. INTRODUCTION

13. Fairy Ring Mushrooms

14. What is Mycology?

15. Mycology is the study of • Beer • Wine • Bread • Cheese • Gourmet mushrooms • Environmental toxins • Biodegradation • Disease

23. BIOREMEDIATION • Clean up oil spills • Remove cyanide in mining operations • Neutralize dioxins and pesticides • Produce organic acids, sugars • Manufacture other commercial products

25. A. Classification

26. What is a Fungus ? • Eukaryotic – a true nucleus • Do not contain chlorophyll • Have cell walls • Produce filamentous structures • Produce spores

27. Species of Fungi • 100,000 – 200,000 species • About 300 pathogenic for man

28. Kingdom FungiEukaryocytes Ascomycota Basidiomycota Zygomycota Mitosporic Fungi (Fungi Imperfecti)

29. KINGDOM CHARACTERISTIC EXAMPLE Monera Prokaryocyte Bacteria Actinomyces Protista Eukaryocyte Protozoa Fungi Eukaryocyte * Fungi Plants Eukaryocyte Plants Moss Animals Eukaryocyte * Arthropods Mammals Man

30. KINGDOM CHARACTERISTIC EXAMPLE Monera Prokaryocyte Bacteria Actinomyces Protista Eukaryocyte Protozoa Fungi Eukaryocyte * Fungi Plants Eukaryocyte Plants Moss Animals Eukaryocyte * Arthropods Mammals Man

31. SIZE COMPARISON OF PATHOGENS

32. Actinomyces(True Bacteria) • Tradition • Clinical infection resembles mycoses • Actinomyces grow on mycotic media • Actinomyces grow slowly (24-48 h) • Gross colonies resemble fungi • (rough,heaped, short aerial filaments) • Resemble mycelia microscopically, with branched mycelia in tissue and smears.

33. HANDOUT Page 2

34. What is Medical Mycology ?

35. MYCOTIC DISEASES(Four Types) • Hypersensitivity • Allergy • Mycotoxicosis • Production of toxin • Mycetismus (mushroom poisoning) • Pre-formed toxin • Infection

36. Hypersensitivity • FARMER’S LUNG – Moldy hay • MALT WORKER’S DISEASE – Moldy barley • CHEESE WASHER’S LUNG – Moldy cheese • WOOD TRIMMER’S DISEASE – Moldy wood

38. PATHOGENIC FUNGI • NORMAL HOST • Systemic pathogens - 25 species • Cutaneous pathogens - 33 species • Subcutaneous pathogens - 10 species • IMMUNOCOMPROMISED HOST Opportunistic fungi - 300 species

39. PARASITIC STATE • Increased metabolic state • Modified metabolic pathways • Modified cell wall structure • Carbohydrate content • Lipid structure • RNA aggregates

40. PATHOGENICITY OF FUNGI • Thermotolerance • Ability to survive in tissue environment • Ability to withstand host defenses

41. REVIVED INTEREST IN MYCOLOGY • Increased frequency of mycotic diseases • Increased awareness by physicians • Better trained laboratory personnel • More invasive procedures used on patients • Increased use of immunosuppressive drugs • Increase in immunosuppressive disease 7. Better laboratory diagnostic tools

43. B. MORPHOLOGY

44. MORPHOLGY • Yeasts • Hyphae (filamentous fungi, mycelium) • Septate • Coenocytic (non-septate) • Dimorphic • Yeast • Mycelium

48. Dimorphic Fungi • Yeast Form • Parasitic form • Tissue form • Cultured at 37 C • Mycelial Form • Saprophytic form • Cultured at 25 C

49. SPORES • SEXUAL • ASEXUAL • Arthrospore • Blastospore • Chamydospore • Conidia • Microconidia • Macroconidia