Medical Mycology Opportunistic Mycoses

1. Medical MycologyOpportunistic Mycoses Hugh B. Fackrell Filename: Fungi_opport.ppt

2. Mycoses & Mytoxicosis • Mycoses fungal infections • Mycotoxicosis- intoxicaton

3. Fungal Diseases • Mycoses -Colonization of the host • Mycotoxicosis • Hypersensitivity

4. Fungal Infections • Opportunistic Infections • Superficial fungal infections • Cutaneous Mycoses • Subcutaneous Mycoses • Systemic Mycoses

5. Intact skin long chain fatty acids pH Bacterial antagonism stratum corneum desiccated epithelial cell turnover rate (0.5 kg/yr) Mucous membranes ciliated antimicrobials Immunological competence Host Defense Factors

6. Fungal Entry • Rarely cause disease in healthy person • many host defenses • Commensal • Candida albicans • Malasseza fufur • Underlying disorder • trauma • immunological deficiency • debilitating conditions

7. Endogenous Opportunistic Iatrogenic ( indwelling lines catheters) Exogenous Opportunistic inhalation Superficial Trauma hygiene Cutaneous trauma Subcutaneous trauma Systemic inhalation Disease Mechanisms of Fungi

8. Fungal Dissemination • Breach in host defenses • endocrinopathies • immune disorders • iatrogenic Must repair defect

9. Opportunistic Mycoses • Pneumocystosis • Candidiasis • Aspergillosis • Zygomycosis • Mucormycosis • Phycomycosis

10. Pneumocystosis Pneumocystis carinii - Thought to be a protozoan but recent RNA analysis shows it is a fungus. • Infections occur world wide, if symptoms occur - mild respiratory. Childhood. • Respiratory Infection • interstitial pneumonitis with plasma cell infiltrates

11. Pneumocystosis Occurence • Primarily AIDS • Hospitalized infants who were premature and malnourished • Elderly • Cancer and organ transplant patients who are being treated with immunosuppressive drugs.

12. Pneumocystosis Treatment • Trimethoprim - sulfamethoxazole • Aerosolized pentamidine (particularly for AIDS patients)

13. Pneumocystosis Laboratory Diagnosis • Sputum, lavage, Transbronchial aspirate, Brush biopsy, Open biopsy • Microscopic - Stain appearance, Fluorescent antibody

14. Pneumocystis microscopy CDC Website

15. Pneumocystosis Microscopy CDC Website

16. Pneumocystis microscopyFluorescent antibody CDC Website

17. Candidiasis • Candida albicans - normal flora of the mouth, gut, vagina. • Acute purulent inflammation with white patches. • Heavy discharge in the mouth, vulvo-vaginal area, or glans penis. • chronic mucocutaneous candidiasis • in skin- moist areas axilla,perineum,nails. • Disseminated candidiasis • Systemically in gut, renal, pulmonary.

18. Candidiasis • Usually indigenous flora (endogenous) but can be infectious (exogenous) . • Typical opportunist: • normal flora disruption • Birth control pills - vaginitis. • Pregnancy • Diabetes • malignancy • drugs corticosteroids Immunosuppressive drugs. Broad spectrum oral antibiotics(gut)

20. Chronic Mucocutaneous Candidiasis

22. Disseminated Candidiasis: Kidney

23. Disseminated Candidiasis

24. CandidiasisLaboratory Diagnosis

25. Treatment, Prevention & Control • Oral: nystatin, amphotericin B, gentian violet • Enteritis:Ketoconazole • Vaginitis:nystatin amphotericin B • suppositories • Systemic: amphotericin B + 5 fluorocytosine

26. Aspergillosis • Granulomatous lesions • Secondary to other chronic diseases • tuberculosis, • malignancy, steroid therapy, immuno-compromised.

27. Aspergillus

28. Aspergillus

29. Diseases caused by Aspergillus • Mycotoxicoses • contaminated food • Hypersensitivity pneumonitis • (allergic bronchopulmonary disease) • Secondary colonization • no invasion of surrounding tissue • Systemic mycoses • invasion of multiple organs

30. AspergillosisLaboratory Diagnosis • Tissue specimens directional branching of septate hyphae • Confirmation Difficult • repeated specimens • hard to isolate • ubiquitous

31. Zygomycosis • Mucormycosis • Phycomycosis