Fungal Infections

1. Fungal Infections

2. Histoplasmosis • Systemic infection by Primary pathogen • Causative agent: Histoplasmosiscapsulatum • Most common true pathogen • Typically dimorphic • H. capsulatum grows in soil and material contaminated with bat or bird droppings. (droppings from chickens, pigeons, blackbirds also support its growth) • The microscopic fungal spores can become airborne when the soil is disturbed, and breathing in the spores can cause infection in the lungs • Most prevalent in eastern & central regions of the US

3. Histoplasmosis • H. capsulatum thrives in moderate temperatures & moist environment • Cannot be transmitted from person to person • Many people who are infected with the fungus do not show any symptoms • If symptoms occur, they usually start within 3 to 17 days after being exposed to the fungus • In people who develop disease, the most common symptoms are similar to those of pneumonia, and include: fever, chest pains, and a dry or nonproductive cough

4. Histoplasmosis • Multiple tests available to diagnose Histoplasmosis • Blood • Sputum • Bone marrow • Liver, or skin • By looking at a small sample of infected tissue under a microscope • The mild pulmonary (lung) form of histoplasmosis will generally resolve within about a month without treatment. • Prescription antifungal medications are needed to treat severe cases of acute histoplasmosis, and all cases of chronic or disseminated disease

6. Coccidioidomycosis: Valley Fever • Systemic infection by Primary pathogen • Causative agent: coccidioidesimmitis • The most virulent of all fungal pathogens • Distinctive morphology • Blocklikearthroconidia in the free living stage & spherules containing endospores in the lungs • Lives in the soil of dry, low rainfall areas

7. Coccidioidomycosis: Valley Fever • The disease is found mainly in the southwestern United States, Mexico and Central and South America • Dry weather coupled with sparse foliage and high winds provides the ideal condition for the spores to be airborne • Transmission is generally by inhalation of spores found in the soil in endemic areas

8. Coccidioidomycosis: Valley Fever • In 60% of cases infection is asymptomatic • In 40% of cases include • flu-like symptoms (cough, fever, sore throat, chills, headache, and in some cases itchy rash) that go away on their own • Rare (5/1000), advanced coccidioidomycosis includes: skin lesions, chronic pneumonia, bone or joint infection • Imaging tests- CT scans, x-rays of the lungs • In many cases, treatment is not necessary • Prescription of antifungal medications, such as amphotericin B & fluconazole, to prevent a more severe infection from developing

10. Dermatophytes • Pathogens with Intermediate virulence • Derma “skin” and plant “phyte” • Common fungal infections that may occur anywhere on the skin, hair, and nail infections. • All are communicable diseases • Among humans, animals, and soil • Many different species of dermatophytes that can cause infection in humans. Two of the most common types are Trichophytonrubrum and Trichophytontonsurans, which are usually transmitted from person to person. T. rubrum T. tonsurans

11. Dermatophytes • Dermatophytes like to live on moist areas of the skin, such as places where there are skin folds. • They can also live on household items, such as clothing, towels, and bedding. • Most diseases are termed “ringworm” or tinea because they develop in circular scaly patches

12. Dermatophytes • The work tinea followed by the Latin term for the part of the body infected, is often used. • Tineacapitis(head) Tineacorporis(body) • Tineapedis(foot) Tineamanuum(hand) • Tineaunguium(nail)

13. Tineacapitis • Sometimes called “ringworm of the scalp” • Primarily affects school-aged children • More common in large cities and overcrowded conditions • Reservoir for most organisms is humans , some have animal hosts • Incubation is 10 to 14 days

14. Tineacapitis Transmission Symptoms By direct or indirect contact Backs of theater seats Barber clippers Combs/hairbrushes Clothes Animals can also transmit the infection and sometimes are carriers If the infection involves the scalp or beard, hair may fall out Begin as small papules and spread across the head Hair in the infection area become brittle and break off easily

15. Tineacapitis • Diagnosis is through physical examination • Particular medication and duration of treatment depends on the location of the infection • Topical treatment alone usually is ineffective and is not recommended for the management of tineacapitis • Scalp infections usually require treatment with an oral antifungal medication(for at least 4 weeks)

16. Tineapedis • Fungus infection of the foot especially between the toes • Commonly called “athlete’s foot” • Most common of all fungal skin diseases • Infects adults more often than children, and males more often than females • More often and more severe in hot weather • Warm, moist conditions (between sweaty toes)

17. Symptoms Tineapedis Transmission By direct or indirect contact with skin of an infected individual or lesion of infected animals Floors, shower stalls, benches, and similar location can also be a source of infection Scaling or cracking between the toes and watery blisters In severe cases- lesions may appear on other parts of the body particularly the hands Itching can be severe

18. Tineapedis • Based on symptoms and physical examinations • Can be treated with topical antifungal medications. • Fungicide in salve or powder form should be applied after every bath or shower

19. Candidiasis- “yeast infections” • Infection by Secondary pathogen • Causative agent: most common is Candida albicans • Infections can be short-lived, superficial skin irritations to overwhelming, fatal systemic diseases • Budding cells of varying size that may form both elongate pseudohyphae and true hyphae

20. Candidiasis • Candida yeasts normally live on the skin and mucous membranes without causing infection • Overgrowth of these organisms can cause symptoms to develop • Candidiasis is usually endogenous • Can also be communicable

21. Oropharyngeal Candidiasis • Candidiasis that develops in the mouth or throat is called “thrush” or oropharyngeal candidiasis • The most common symptom is white patches or plaques on the tongue and other oral mucous membranes • Other symptoms include: • Redness or soreness in the affected areas • Difficulty swallowing • Cracking at the corners of the mouth (angular cheilitis)

22. Oropharyngeal Candidiasis-Symptoms • Uncommon in adults who are otherwise healthy • Can affect normal newborns • Newborns can develop thrush from mothers with a vaginal “yeast infection” at delivery • Symptoms begin 7-10 days after birth • Diagnoses based on symptoms • Taking a scraping of the affected areas to examine under a microscope • Candida infections of the mouth and throat must be treated with prescription antifungal medication • The type and duration of treatment depends on the severity of the infection

23. Candidiasis-Genital/Vulvovaginal • Genital / vulvovaginal candidiasis (VVC) is also sometimes called a "yeast infection.” • Occurs when there is overgrowth of Candida • Imbalances • Normal acidity of the vagina changes or when hormonal balance changes • Transmission: endogenous infection or contact with excretions or secretions of infected individuals • Women with VVC usually experience genital itching, burning, and sometimes a "cottage cheese-like" vaginal discharge • Men with genital candidiasis may experience an itchy rash on the penis

24. Candidiasis-Genital/Vulvovaginal • Nearly 75% of all adult women have had at least one "yeast infection" in their lifetime • Wearing cotton underwear may help to reduce the risk of developing a yeast infection. • Symptoms are similar to those of many other genital infections • can be difficult to diagnose a yeast infection by physical examination only • Usually the diagnosis is made by taking a sample of the vaginal secretions and looking at the sample under a microscope to see if an abnormal number of Candida organisms are present

25. Candidiasis-Genital/Vulvovaginal • Treatment • Antifungal vaginal suppositories or creams are commonly used • Duration of the treatment course of creams and suppositories can range from one day to seven days of therapy • Mild or moderate infections can sometimes be treated with a single dose of oral antifungal medication • Over-the-counter treatments for VVC are available

26. Aspergillosis • Infection by a secondary pathogen • Causative agent: Aspergillus • Distinguished by septate mycelium with characteristic conidial heads • Common fungus that can be found in indoor and outdoor environments • Found in soil, on plants, and on decaying organic matter • Also found on household dust, and building material Aspergillusflavus

27. Aspergillosis Aspergillusflavus • There are many different species of Aspergillus • 8 involved in human disease • Most common species are Aspergillusfumigatus and Aspergillusflavus • Different kinds of aspergillosis • allergic bronchopulmonaryaspergillosis (also called ABPA) • aspergilloma • invasive aspergillosis • Transmission: through inhalation of spores • Most people breathe in Aspergillus spores every day without being affected • Inhalation of spores causes fungus balls in lungs and invasive disease in the eyes, heart, & brain

28. Aspergillosis • The different kinds of aspergillosis can cause different symptoms • Symptoms of allergic bronchopulmonaryaspergillosis (ABPA) may include: • Wheezing • Coughing • Fever (in rare cases) • Aspergilloma • “fungus ball” • Symptoms of invasive aspergillosis may include: • Fever • Chest pain • Coughing • Shortness of breath

30. Aspergillosis • ABPA can affect people who are otherwise healthy, but it is most common in people with asthma or cystic fibrosis • Invasive aspergillosis generally affects people who have weakened immune systems • Those who have had a bone marrow transplant or solid organ transplant, people who are taking high doses of corticosteroids, and people who are getting chemotherapy for cancer. • Healthcare providers consider symptoms • Further testing may include imaging tests such as x-rays or CT scans of the lungs, biopsies of affected tissue and samples may be analyzed for evidence of the fungus • Requires treatment with antifungal medication prescribed by a doctor