[Lec] MU6: Opportunistic Mycoses Flashcards
Infections in patients with immune deficiencies who would otherwise not be infected
Opportunistic Mycoses
Infections seen in those people with impaired host defenses
Opportunistic Mycoses
Odd One Out:
Impaired Host Defenses
a. AIDS
b. Alteration of normal flora
c. Diabetes mellitus
d. Immunosuppressive therapy
e. Presence of indigenous microbiota
f. Malignancy
e. Presence of indigenous microbiota
(normal flora)
Type of Opportunistic Mycoses:
part of a normal human flora
Endogenous
Type of Opportunistic Mycoses:
fungus does not normally live in/on human body
Exogenous
Endogenous species
Candida albicans and other spp.
Pneumocystis jirovecii
Exogenous species
Cryptococcus neoformans
Aspergillus spp.
Zygomycetes
Candidiasis / Moniliasis:
causative agent
Candida albicans and other Candida spp.
What disease:
caused by Candida albicans and other Candida spp.
Candidiasis / Moniliasis
What species:
Oval, budding yeast that produces pseudohyphae
Candida albicans
What species:
causes the most frequent opportunistic fungal infections
Candida albicans
What species:
Harmless inhabitants of the skin and mucous membranes (RT, GIT, female genital tract)
Candida albicans
T/F:
Compromised immune system keeps Candida on body surfaces
F; normal immune system
Odd One Out:
Risk Factors for Candidiasis/Moniliasis
a. Neutropenia
b. Diabetes mellitus
c. AIDS
d. SCID
e. Antineoplastic therapy
e. Antineoplastic therapy;
RF for Pneumocystis
Odd One Out:
Risk Factors for Candidiasis/Moniliasis
a. Myeloperoxidase defects
b. Broad-spectrum antibiotics
c. Corticosteroid therapy
d. Indwelling catheters
e. Major surgery
c. Corticosteroid therapy
RF for Pneumocystis, Cryptococcosis/Torulosis, & Aspergillosis
Odd One Out:
Risk Factors for Candidiasis/Moniliasis
a. Organ transplantation
b. Hematological malignancy
c. Neonates
d. Severity of any illness
e. Intravenous drug addicts
b. Hematological malignancy;
RF for Cryptococcosis/Torulosis & Aspergillosis
What disease:
Although it is endogenous in most cases, cross infections are described, especially in intensive care unit patients
Candidiasis/Moniliasis
What disease:
Oral thrush, Oezophagitis, Vulvovaginal infection, Onychomycosis
Candidiasis/Moniliasis
(Cutaneous and Mucosal Candidiasis)
Cutaneous candidiasis:
seen in what types of patients?
skin trauma, burn patients
Mucocutaneous candidiasis
seen in what types of patients?
SCID patients
Choose 3: Invasive Candidiasis
a. Systemic
b. Disseminated
c. Cutaneous
d. Hematogenous
a. Systemic
b. Disseminated
d. Hematogenous
Invasive Candidiasis:
Usually begins with __________
candidemia
Candidemia:
* Only about ____% of cases can be proven
* Mortality is ____%
50% proven
30-40% mortality
T/F:
In invasive candidiasis, invasive infection stops in compromised phagocytic system.
F;
normal phagocytic system
T/F:
In normal phagocytic system of invasive candidiasis, infection spreads to many organs and causes focal infection in these organs.
F;
In compromised phagocytic system
Choose 4:
Defense mechanism against Candidiasis/Moniliasis
a. Skin and mucous membranes integrity
b. Presence of normal bacterial flora
c. Phagocytosis
d. Immune suppression
e. T-cells (CD4)
a. Skin and mucous membranes integrity
b. Presence of normal bacterial flora
c. Phagocytosis
e. T-cells (CD4)
T/F:
Defense mechanisms against Candidiasis/Moniliasis include killing, mostly in macrophagses, less in polymorphonuclear cells.
F;
killing mostly in polymorphonuclear cells, less in macrophages
Candidiasis/Moniliasis:
Specimen for lab diagnosis
CESS:
CSF
Exudates
Sputum
Swabs or Scrappings from lesions
What species:
Microscopic morphology: Gram (+) oval, budding yeast/ elongated budding cells in chain (pseudohyphae)
Candida spp
Candida spp:
appearance in SDA
soft, cream-colored colonies with a yeasty odor, surface growth consists of oval budding cells
Candidiasis/Moniliasis:
Ferments _______ and _______ producing acid and gas for lab diagnosis
glucose
maltose
Candidiasis/Moniliasis:
Serological test
Precipitation tests
Candidiasis/Moniliasis:
Treatment
FANC:
Fluconazole
Amphotericin B
Nystatin
Caspofungin
Candidiasis/Moniliasis:
Treatment for neutropenic patients
Amphotericin B
Candidiasis/Moniliasis:
Treatment for nonneutropenic patients
Fluconazole
Candidiasis/Moniliasis:
Treatment that suppresses intestinal and vaginal candidiasis
Nystatin
Pneumocystis Pneumonia:
causative agent
Pneumocystis jirovecii
What disease:
caused by Pneumocystis jirovecii
Pneumocystis Pneumonia
What species:
was formerly carinii and was previously classified as a protozoa but now considered a fungus based on nucleic acid and biochemical analysis
Pneumocystis jirovecii
What species:
Present in lungs of many mammals, including humans in persistent but harmless infection
Pneumocystis jirovecii
Odd One Out:
Risk Factors for Pneumocystis Pneumonia
a. Myeloperoxidase defects
b. AIDS
c. Transplantation
d. Corticosteroid
e. Antineoplastic therapy
a. Myeloperoxidase defects
RF for Candidiasis/Moniliasis
Pneumocystis:
Clinical manifestation
Interstitial pneumonitis (in compromised patients)
Pneumocystis:
Defense Mechanism
T-cell mediated
Pneumocystis Pneumonia:
Treatment
Co-trimoxazole
Pentamidine
Cryptococcosis/Torulosis:
causative agent
Cryptococcus neoformans
What disease:
caused by Cryptococcus neoformans
Cryptococcosis/Torulosis
What species:
Causes an acute or chronic infection that involves the brain
Cryptococcus neoformans
What species:
Occurs worldwide in soil and in bird droppings
Cryptococcus neoformans
What species:
Prominent feature is thick polysaccharide capsule, which causes evasion from phagocytosis
Cryptococcus neoformans
Odd One Out:
Risk Factors for Cryptococcosis/Torulosis
a. T-cell deficiency (AIDS patients)
b. Bone marrow transplantation
c. Corticosteroid therapy
d. Organ transplantation
e. Hematological malignancy
b. Bone marrow transplantation
RF for Aspergillosis
T/F:
Cryptococcosis/Torulosis is transmitted from human to human.
F
What disease:
A slowly developing chronic meningitis that resembles a brain tumor
Cryptococcosis/Torulosis
What disease:
Brain abscess
Cryptococcosis/Torulosis
What disease:
Degenerative CNS disease
Cryptococcosis/Torulosis
Cryptococcosis/Torulosis:
Infection is via ___________
respiratory tract
What disease:
Symptoms associated with nonspecific pulmonary signs and symptoms
Cryptococcosis/Torulosis
What disease:
May disseminate in other organs like the brain
Cryptococcosis/Torulosis
(most common is cryptococcal meningitis)
Cryptococcosis/Torulosis:
most common manifestation when it disseminates in other organs like the brain
Cryptococcal Meningitis
Cryptococcosis/Torulosis:
Defense mechanism
________ responsible for defense
T-cells
Cryptococcosis/Torulosis:
Cryptococcus reaches humans by?
inhalation of aerosolized yeast cells
Cryptococcosis/Torulosis:
Specimen for lab diagnosis
SUCE:
Sputum
Urine
CSF
Exudate
What species:
Microscopic morphology:
round or ovoid, often budding with thick capsule
Cryptococcus neoformans
Cryptococcus neoformans:
appearance in SDA
cream, shiny, mucoid colonies
Cryptococcosis/Torulosis:
serological tests
CoPy-CAT LAT:
Cryptococcal polysaccharide capsular antigen test
Latex agglutination test
Cryptococcosis/Torulosis:
Treatment
Combination of chemotherapy of:
Amphotericin B
Flucytosine
Cryptococcosis/Torulosis:
Recurrence Prevention
Fluconazole
Aspergillosis:
causative agent
Aspergillus spp.
What disease:
caused by Aspergillus spp.
Aspergillosis
What species:
worldwide occurring saprophytes, living in soil and on plants
Aspergilli
What species:
have small conidia that form aerosols
Aspergilli
Odd One Out:
Risk Factors for Aspergillosis
a. Hematological malignancy
b. Bone marrow transplantation
c. Indwelling catheters
d. Corticosteroid therapy
c. Indwelling catheters
RF for Candidiasis/Moniliasis
Aspergillosis:
defense mechanism
Phagocytosis
Aspergillosis:
specimen for lab diagnosis
Tissue Biopsy
Aspergillus spp:
microscopic morphology using what stain
hyphal fragments (methenamine silver)
Aspergillus spp:
apperance in SDA
gray to green colonies
Aspergillus spp:
treatment
FASI:
Flucytosine
Amphotericin B
Surgery
Itraconazole
T/F:
Prevention of Aspergillosis includes avoiding exposure to conidia (new buildings).
T
Zygomycosis:
Causative agents
Rhizopus
Mucor
Absidia
Rhizomucor
Zygomycosis:
Also called as?
Mucormycosis
Phycomycosis
What disease:
caused by zygomycetes, principally by the species of Rhizopus, Mucor, Rhizomucor, Absidia
Zygomycosis/ Mucormycosis/ Phycomycosis
What species:
These fungi are ubiquitous thermotolerant saprophyte; spores are present in air and dust
Zygomycetes
(Rhizopus, Mucor, Rhizomucor, Absidia)
What Class:
an obsolete polyphyletic taxon that form coenocytic hyphae and reproduce asexually by producing sporangiophores within which develops sporangiospores
Class Phycomycetes
T/F:
Class Phycomycetes form coenocytic hyphae and reproduce sexually by producing sporangiophores within which develops sporangiospores.
F;
reproduce asexually
Rhizopus:
Mycelium is differentiated
into 3 types of hyphae, which are?
- Stolon
- Rhizoid
- Sporangiophores
What species:
Mycelium is differentiated
into 3 types of hyphae, which are:
1. Stolon
2. Rhizoid
3. Sporangiophores
Rhizopus
What species:
Mycelium has only one type of hyphae → Sporangiophores
Mucor
What species:
Rhizoids are present
Rhizopus
What species:
Food materials are absorbed
mainly by rhizoids.
Rhizopus
What species:
Sporangiophores occurs in tufts from the stolons opposite the rhizoids.
Rhizopus
What species:
Spores easily disseminated by the wind.
Rhizopus
What species:
Rhizoids are absent.
Mucor
What species:
Sporangiophores usually occur singly from any point on the mycelium
Mucor
What species:
Food is absorbed by the
entire mycelial surface
Mucor
What species:
Spores remain adhered to
the columella thus not easily
disseminated
Mucor
What species:
Difference from Mucor:
Mucor have no rhizoids
Absidia
What species:
Difference from Rhizopus:
Rhizoids in between Sporangiophores
Absidia
What species:
Difference from Mucor:
Have rhizoids and stolons;
grows at 50- 55°C
Rhizomucor
What species:
Difference from Rhizopus:
Have branched sporangiophores
Rhizomucor
What species:
Difference from Absidia:
Have globose sporangia and sporangiophores are not swollen where they merge with the columellae
Rhizomucor
Odd One Out:
Zygomycosis Risk Factors
a. Acidosis
b. Severity of any illness
c. Leukemias
d. Leukemias
b. Severity of any illness
RF for Candidiasis / Moniliasis
Odd One Out:
Zygomycosis Risk Factors
a. Corticosteroid treatment
b. Severe burns
c. Immunodeficiencies
d. Antineoplastic therapy
d. Antineoplastic therapy
RF for Pneumocystic Pneumonia
What disease:
Clinical manifestations include Rhinocerebral Mucormycosis.
Zygomycosis/ Mucormycosis/ Phycomycosis
What disease:
Clinical manifestations include Thoracic Mucormycosis.
Zygomycosis/ Mucormycosis/ Phycomycosis
What disease:
Clinical manifestations include other sites of invasion
Zygomycosis/ Mucormycosis/ Phycomycosis
What clinical manifestation (Zygomycosis):
Results from germination of the sporangiospores in the nasal passages and invasion of the hyphae into the blood vessels, causing thrombosis, infarction and necrosis
Rhinocerebral Mucormycosis
What clinical manifestation (Zygomycosis):
The disease can progress rapidly with invasion of the sinuses, eyes, cranial bones and brain
Rhinocerebral Mucormycosis
What clinical manifestation (Zygomycosis):
Blood vessels and nerves are damaged, and patients develop edema of the involved facial area, a bloody nasal exudate, and orbital cellulitis
Rhinocerebral Mucormycosis
What clinical manifestation (Zygomycosis):
It is almost invariably associated with acute diabetes mellitus or with debilitating diseases such as leukemia or lymphoma.
Rhinocerebral Mucormycosis
What clinical manifestation (Zygomycosis):
This follows inhalation of the sporangiospores with invasion
of the lung parenchyma and vasculature
Thoracic Mucormycosis
What clinical manifestation (Zygomycosis):
In both locations, ischemic necrosis causes massive tissue
destruction
Thoracic Mucormycosis
T/F:
Other sites of invasion of aspergillosis include primary cutaneous infections such as skin infections following burns or surgery have also been reported.
F;
Zygomycosis
T/F:
Subcutaneous zygomycosis cases are also reported.
T
Zygomycosis:
Specimen for lab diagnosis
Nasal discharge
Sputum
Biopsy
Zygomycetes:
microscopic morphology using what stain
Using KOH:
Broad and aseptate
Branched mycelium (sometimes distorted hyphae)
stained by Methenamine silver stain
Zygomycetes:
appearance in SDA
abundant and cottony
Zygomycosis:
Treatment
Amphotericin B
Penicilliosis / Talaromycosis:
causative agent
Talaromyces marneffei
(formerly Penicillium)
What disease:
caused by Talaromyces marneffei (formerly Penicillium)
Penicilliosis / Talaromycosis
What species:
There are more than 150 Penicillium species; when it was still classified as Penicillium it was the only most medically important species
Talaromyces marneffei
(formerly Penicillium)
What species:
Thermally dimorphic fungi
Talaromyces marneffei
(formerly Penicillium)
What species:
saprophytes, present in the environment and grow on various substrates such as bread, jam, fruit and cheese
Talaromyces marneffei
(formerly Penicillium)
What species:
has been reported to be an important
opportunistic pathogen in the HIV
infected
Talaromyces marneffei
(formerly Penicillium)
What species:
It causes disseminated infection with
multiple organ involvement.
Talaromyces marneffei
(formerly Penicillium)
Odd One Out:
Risk Factors for Penicilliosis / Talaromycosis
a. Adult-onset immunodeficiency syndrome
b. Diabetic Ketoacidosis
c. Cancer
d. HIV/AIDS
e. Organ transplant
b. Diabetic Ketoacidosis
RF for Zygomycosis
What species:
Common in Southeast Asia
Talaromyces marneffei
(formerly Penicillium)
What disease:
Bamboo rats can also get ___________.
Talaromycosis
T/F:
In Penicilliosis / Talaromycosis, infection can be spread from Bamboo rats to people and from person to person.
F;
No evidence of spread from Bamboo rats to people
No person to person spread
Penicilliosis / Talaromycosis:
specimen for lab diagnosis
Bone Marrow
Blood
Lung Fluids
Lymph
Nodes
Skin
Talaromyces marneffei:
microscopic morphology
yeast are small, oval, 2-4 µm in diameter
Talaromyces marneffei:
appearance in SDA
yellow green colonies with characteristic soluble red pigment
Talaromyces marneffei:
molecular technique
PCR
Penicilliosis / Talaromycosis:
treatment
Amphotericin B
Oral Itraconazole