SYSTEMIC MYCOSES

1. FUNGAL DISEASE SYSTEMIC MYCOSES

2. Mycosis:Any fungal disease. Tend to be chronic because fungi grow slowly. Mycoses are classified into the following categories: I. Systemicmycoses: Fungal infections deep within the body. Can affect a number if tissues and organs. • Usually caused by fungi that live in the soil and are inhaled. Not contagious. • Examples: • Histoplasmosis(Histoplasmacapsulatum): Initial infection in lungs. Later spreads through blood to most organs. • Coccidiomycosis(Coccidioidesimmites): Resembles tuberculosis.

3. COCCIDIOIDES IMMITIS • Disease:Coccidioidomycosis. • Reservior: desert areas of western US and Northern Mexico. • Transmission: Respiratory • Morphology: Dimorphic fungus • * mycelia forms with spores at 25°celsius. • * yeast forms at 37° Celsius

4. Disease:Coccidioidomycosis. • * asymptomatic( in most patients) • *pnuemonia • * disseminated: can affect the lungs, bones, skin and meninges. • A small percentage of individuals with this infection will develop painful erythematous nodular lesions called ERYTHEMA NODOSUM

6. DIAGNOSIS • BIOPSY OF AFFECTED TISSUE • SEROLOGY • SKIN TEST( TEST FOR EXPOSURE ONLY) • TREATMENT • AMPHOTERICIN B

7. HISTOPLASMA CAPSULATUM • RESERVIOUR: MISSISSIPI VALLLEY • PRESENT IN BIRDS AND BAT DROPPINGS • TRANSMISSION: RESPIRATORY • MORPHOLOGY: H capsulatumis adimorphic fungus that exists as a mold in soil and as a yeast in tissue

8. HISTOPLASMA CAPSULATUM Disease:histoplasmosis. • ASYMPTOMATIC • *PNEUMONIA • *DISSEMINATED: CAN OCCUR IN ANY ORGAN, ESPECIALLY IN THE LUNG,LIVER OR SPLEEN.

9. DIAGNOSIS • DIAGNOSIS: LUNG BIOPSY • SEROLOGY • SKIN TEST • TREATMENT: ITRACONAZOLE

11. BLASTOMYCES • RESERVIOUR: • * MISSISSIPI RIVER VALLEY EXTENDING NORTH TO THE GREAT LAKES • * RESIDES IN SOIL OR ROTTEN WOOD • TRANSMISSION: RESPIRATORY(Inhalation of airborne asexual spores).

12. MORPHOLOGY: • B. dermatitidisis adimorphicfungus that exists as a mold in soil and as a yeast in tissue. • The yeast is round with a doubly refractive wall and asingle broad-based bud.

14. BLASTOMYCES • Disease:blastomycosis • * ASYMPTOMATIC • *PNEUMONIA • *DISSEMINATED(MOST COMMON): PRESENT WITH WEIGHT LOSS, NIGHT SWEATS, LUNG INVOLVEMENTS AND SKIN ULCERS • * CUTANEOUS: SKIN ULCERS

15. Skin lesion following dissemination from the lungs.

16. DIAGNOSIS • BIOPSY OF AFFECTED TISSUE • SEROLOGY • SKIN TEST( TEST FOR EXPOSURE ONLY) • TREATMENT:Itraconazoleis the drug of choice for most patients. • Amphotericin Bshould be used to treat severe disease. • Surgical excision may be helpful. Prevention: There are no means of prevention.

17. PARACOCCIDIOIDES BRASILIENSIS Disease:paracoccidioidomycosis • P brasiliensisis adimorphic fungusthat exists as a mold in soil and as a yeast in tissue. • The yeast is thick-walled withmultiple buds (pilot wheel),incontrast toB. dermatitidis, which has a single bud

18. Transmission:Inhalation of airborne asexual spores. Pathogenesis: • The spores are inhaled,and early lesions occur in the lungs. • Asymptomatic infection is common. • Alternatively, oral mucous membrane lesions, lymph node enlargement, and sometimes dissemination to many organs develop. Laboratory Diagnosis: • Inpus or tissues,yeast cells with multiple buds (pilot’s wheel)are seen microscopically. • A specimen cultured for 2—4 weeks may grow typical organisms. • Skin tests are rarely helpful. • Serologic testing shows that when significant antibody titers (by immunodiffusion or complement fixation) are found, active disease is present. Treatment:The drug ofchoice isitraconazoletaken orally for several months. Prevention:There are no means of prevention.

19. CRYPTOCOCCUS NEOFORMANS • RESERVIOR: FOUND IN PIGEON DROPPINS • TRANSMISSION: RESPIRATORY MORPHOLOGY: Oval, budding yeast surrounded by a wide polysaccharide capsule. Not dimorphic.

20. DISEASE: Disease: Cryptococcosis, especially cryptococcal meningitis. • * SUBACUTE OR CHRONIC MENINNGITIS • HEADACHE • FEVER • VOMITING • NEUROLOGICAL OR MENTAL STATUS CHANGES • *PNEUMONIA • *SKIN LESIONS: LOOK LIKE ACNE

21. DIAGNOSIS • DIAGNOSIS • * INDIA- INK STAIN OF CSF: OBSERVE ENCAPSULATED YEAST • *CRYTOCOCCAL ANTIGEN TEST OF CSF DETECTS POLYSACCHARIDE ANTIGENS • *FUNGAL CULTURE

22. CUTANEOUS MYCOSES Dermatophytes Diseases:Dermatophytoses Dermatophytes:are classified in three genera: Epidermophyton, Trichophyton, and Microsporum.

23. FUNGALDISEASES (Continued) II. Cutaneousmycoses: Fungal infections of the skin, hair, and nails. • Secrete keratinase, an enzyme that degrades keratin. • Infection is transmitted by direct contact or contact with infected hair (hair salon) or cells (nail files, shower floors).

24. RESERVIOR: DEPENDING ON THE PARTICULAR SPECIES • 1. SOIL • 2. ANIMALS • 3. HUMANS

25. Diseases:Dermatophytoses • 1. TINEA CORPORIS(BODY): RING WORM • 2. TINEA CRURIS (GROIN): JOCK ITCH • 3. TINEA PEDIS(FEET): ATHLETE’S FOOT • 4. TINEA CAPITIS ( SCALP) • 5. TINEA UNGUIUM ( NAIL): ONYCHOMYCOSIS

26. Dermatophytoses (Tinea- Ringworm) Characteristics: caused by fungi that infect only superficial keratinized structures(skin, hair, and nails), not deeper tissues. Transmission: spread from infected persons by direct contact. Microsporumis also spread from animals such as dogs and cats. This indicates that to prevent reinfection, the animal must be treated also. Pathogenesis:Dermatophytoses (tinea, ringworm) are chronic infections favored by heat and humidity, eg, athlete’s foot, moist skin and jock itch.Are characterized by broken hairs, and thickened, broken nails.

27. TENIA COPORIS

29. Tineacruris “Jock itch”

30. Tineacapitis

31. DIAGNOSIS • 10% KOH on a glass slideshow hyphae under microscopy. • Tineacapitislesions caused byMicrosporum speciescan be detected by seeing fluorescence when the lesions are exposed toultraviolet light from a Wood’s lamp. • TREATMENT: TOPICAL IMIDAZOLE • ORAL GRISEOFULVIN FOR TINEA UNGUIUM

32. SUBCUTANEOUS MYCOSES . Fungal infections beneath the skin. • Caused by saprophytic fungi that live in soil or on vegetation. • Infection occurs by implantation of spores or mycelial fragments into a skin wound. • Can spread to lymph vessels.

33. SUBCUTANEOUS MYCOSES Sporothrixschenckii These are caused by fungi that grow in soil and on vegetation and are introduced into subcutaneous tissue throughtrauma.

34. Sporothrixschenckii Diseases:Sporotrichosis Characteristics:Sporothrixschenckiiis adimorphicfungus that lives on vegetation. Trauma to the skin, typically by athorn. Pathogenesis:local pustule or ulcer with nodules along the draining lymphatics Laboratory Diagnosis:round or cigar-shaped budding yeastsare seen in tissue specimens. In culture, hyphae occur bearing oval conidia. Treatment:with itraconazole. Prevention:protecting skin when touching plants, moss, and

35. Sporothrix skin lesions

36. SUPERFICIAL • TINA VERSICOLOR (Malssenziafurfur) • MORPHOLOGY: SPAGHETTI AND MEAT BALLS • CLINICAL: HYPO OR HYPERPIGMENTED PATCHES ON THE SKIN; SURROUNDING SKIN DARKENS WITH SUNLIGHT WHILE THE PATCHES REMAIN WHITE

37. TINA VERSICOLOR

39. DIAGNOSIS • Potassium hydroxide(KOH) prep: reveals short, curved, unbranchedhyphae with spherical yeast cells( looks like “ sphagetti and meat balls”) • Treatment: • 1. dandruff shampoo( containing selenium sulfide) • 2. topical imidazole

40. OPPORTUNISTIC MYCOSES Opportunistic mycoses: Caused by organisms that are generally harmless unless individual has weakened defenses: • AIDS and cancer patients • Individuals treated with broad spectrum antibiotics • Very old or very young individuals (newborns). • Examples: • Aspergillosis: Inhalation of Aspergillus spores. • Yeast Infections or Candidiasis: Caused mainly by Candida albicans. Part of normal mouth, esophagus, and vaginal flora.

41. Mucor & Rhizopus species Disease:Mucormycosis. Characteristics: Molds with nonseptatehyphae with right angle branching. Not dimorphic. Habitat: is the soil. Transmission:Inhalation of airborne sporangiospores.

42. Disease: Mucormycosis • 1. rhinocerebral ( associated with diabetes): starts on nasal mucosa and invades the sinus and orbit • 2. pulmonary mucormycosis • Diagnosis: biopsy and black nasal discharge

43. Aspergillusfumigatus Diseases: • infections of the skin, eyes, ears and other organs; • “fungus ball” in the lung and allergic bronchopulmonaryaspergillosis. • Exist only as mold with septatehyphae that branch at a V-shaped angle. Habitat: is the soil.  Transmission: Inhalation of airborne condidia.

44. Clinical • 1. allergic bronchopulmonaryaspergillosis( shortness of breath and high fever) • 2. aspergilloma( fungus ball) associated with hemoptysis(bloody cough) • 3. invasive aspergilossis • 4. aflatoxin consumption( produced by aspergillusflavus) can cause liver damage and liver cancer

45. Treatment: • Corticosteroids • Surgery • Amphoteric b

46. CANDIDA ALBICANS • Reserviour : normal inhabitant of the skin, mouth and gastrointestinal tract • Morphology: Pseudohyphae and yeast

47. CLINICAL • Candidiasis in a normal Host • 1. oral thrush • 2. vulvovaginalcandidiasis • 3. cutaneous *diaper rash * rash in the skin folds of obese individuals

48. Oral thrush

50. Laboratory Diagnosis: • yeasts and pseudohyphae. • colonies of yeasts on Sabouraud’s agar. • The yeast form produces germ tubes when incubated in serum at 37 0C: distinguish C albicans from other candida species. Treatment: 1- Skin and mucous membrane disease can be treated with oral or topical antifungal agents such as miconazole. 2- Disseminated disease requires amphotericin B. 3- Chronic mucocutaneouscandidiasis: ketoconazole. 4- The drug of choice for oropharyngeal or esophageal thrush is fluconazole Prevention:Predisposing factors should be reduced. Oral thrush can be prevented by using clotrimazole.