Lecture 14: Mycology 1 Flashcards
Direct examination for diagnosis of fungi
KOH
PAS
GMS
H&E
GRAM
INDIA INK
Culturing
KOH: easier identification/ cheap/ quick
PAS: contrast b/w yeast/hyphae; pink-red
GMS: Fungal cell wall black
H&E: Fungi cytoplasm stains pink w/ blue nuclei
GRAM: stains mostly everything (dark purple) -bacteria
INDIA INK: for seeing capsule (stains background instead of fungal)
CULTURING: TO ID A PATHOGEN; agar plates- size, texture, color, colony
Most common oral fungal infection in humans and cause various opportunistic infections
Candidiasis
Risk factor- immuno compromised
Transmitted- person- to- person, nosocomial, fomites
Which fungal infection would cause sudden tooth mobility, perforation of hard palate, necrotic ulcerations, gingival thickening and halitosis
Mucormycosis
opportunistic pathogens
-canidiasis
-mucormycosis
-asperigillus
Which fungal infection can be invade and affect the soft palate, tongue and Gingiva. And is also known as an allergic fungal sinusitis?
Aspergillosis
Which fungal infection would show a proliferation or ulcerated oral lesions on the hard palate, gingiva, tongue, or lips?
Blastomycosis
Which fungal infection presents as acute, chronic, pulmonary or progressive disseminated disease?
Histoplasmosis
true pathogen
-blastomycosis- acute pulmonary/chronic pneumonia… diss- idk
-histoplasmosis- acute/chronic pulmonary disease
… diss- acute/subacute
-cocciodiomycosis
Which fungal infection presents as oral lesions, which may be verrucous and present w/ ulceration, can result from either primary or secondary infection?
Coccidioidomycosis
Which fungal infections are considered opportunistic?
Which fungal infections are considered true viral infections?
Opportunistic
-candidiasis
-mucormycosis
-aspergillosis
True viral infection
-blastomycosis
-histoplasmosis
-Coccidioidomycosis
Which fungal infections are considered opportunistic?
Which fungal infections are considered true viral infections?
Opportunistic
-candidiasis
-mucormycosis
-aspergillosis
True viral infection
-blastomycosis
-histoplasmosis
-Coccidioidomycosis
Candida infections in oral and perioral tissue (10)
-pseudomembranous candidiasis (oral thrush)= lesions on the palate
-chronic erythematous candidiasis= palatal mucosa on denture wearing
-plaque like/nodular candidiasis= at the commissary of upper and lower lips (mucosal)
-angular cheilitis
-acute atrophic candidiasis: “antibiotic sore mouth”, “bald tongue”=diffuse loss of Filiform papillae
-median rhomboid glossitis: “central papillary atrophy” = “kissing lesion” - chronic
-denture stomatitis: mild inflammation of oral mucosa membranes= chronic
-circumoral dermatitis: topical steroid over-use around the mouth
-generalized cutaneous candidiasis: diffused popular rash (infants)
-Intertrigo: ass. W/ obesity (in folds of skins)
Which candidiasis infection is known as “kissing lesion” on soft palate and known as a chronic infection?
Median rhomboid glossitis
Aka central papillary atrophy
Which candidiasis infection is known as “bald tongue”?
Acute atrophic
“Antibiotic sore mouth”
Diffuse loss of Filiform papillae
Xerostomia
Which candidiasis is known as oral thrush ?
Pseudomembranous candidiasis
-lesions on the palate
What candidiasis is involved w/ obesity due to an infection in creases and folds of skin
Intertrigo
What infection is known to newborn and its involved in a diffused erythematous popular rash?
Generalized cutaneous candidiasis
What infection is known to be associated with topical steroids over-use around the mouth?
Circumoral dermatitis = CANDIDIASIS INFECTION
What infection is known to be associated with topical steroids over-use around the mouth?
Circumoral dermatitis = CANDIDIASIS INFECTION
What is the term for when a candidiasis infection becomes systemic?
Candidemia
=the most common form and may disseminate to nearly any organ in the body.
=signs of sepsis, tachycardia, altered mental status, hypotension
What strain of candidia is newly emerging, drug-resistant and causing serious outbreaks?
C. Auris
Diagnosis for candidiasis vs. candidemia
Candidiasis
-clinical evaluation + infected tissue/blood will have budding yeast cells and pseudohyphae w/ contstrictions at the septa
Candidemia (systemic- invasive)
-blood culture- GOLD STANDARD TO ID
-B-D-Glucan detection
T2 candida panel= identification of species
PCR= identification of species
What is the gold standard to ID Candidemia?
BLOOD CULTURES
Treatment for candiadiasis
-Amphotericin B
-Echinocandins
-fuconazole - (cocco-mycoses)
-nystatin
Mucormycosis Is part of what species
Rhizopus
Risk factors for Mucormycosis
DIABETES, LUNGS, GI, SKIN
-uncontrolled diabetes & severe COVID-19= Rhinocerebral Mucormycosis (most revenant to dentist)
-Immunocompromised = pulmonary Mucormycosis
-extreme malnutrition =GI Mucormycosis
-burn patients, wounds, and IV drug users = cutaneous Mucormycosis
different infection based on its localized
Rhinocerebral Mucormycosis
-what is it?
-initial symptoms
-late symptoms
-severe infection of the facial sinuses extending into the brain (prevelenat in dentistry)
Initial symptoms: headache, facial pain, fever, hyposmia (smell decrease) nasal congestion/obstruction… BLACK DISCHARGE
Late: vision pobzzz, necrotic on nasal, palate face. Reduced level of consciousness
Pulmonary mucormycosis
-risk factor
-symptoms
-immunocompromised
-bloody cough, fever, labored breathing
>70% death
Gastrointestinal Mucormycosis
-risk factor
-symptoms
Extreme malnutrition
>70% mortality
Distension
Bloody stool
Abdominal pain
Bowel obstruction*
Vomiting/nausea
Cutaneous mucormycosis
-risk factor
-symptoms
Burn patients
Cellulitis and progresses to dermal necrosis and black Escher formation
Mucormycosis Pathogenesis
What type of WBC?
-hyphae invade vasculature and neuronal structures
NEUTROPHILS ARE KEY DEFENSE
-Innate immunity
Diagnosis of Mucormycosis
-combo of observed symtoms and microscopic identification in tissue biopsy
-“twisted” “ribbon-like” appearance of broad, coenocytic hyphae
Treatment Mucormycosis
Treatment of rhinocerebral disease
-Amphotericin B
-excision of orbital contents and involved brain
Aspergillosis
-transmission
-inhalation transmission
-ubiquitous in air, soil, decaying matter
we breathe it in everyday
Inhalation of conidia (aspergillus) with a lung disease patient
ASPERGILLOMA
Inhalation of conidia In a asthma/cystic fibrosis patient
ALLERGIC BRONCHO-PULMONARY ASPERGILLOSIS
Inhalation of conidia with chronic lung disease or mildly immunocompromised patient
Chronic pulmonary aspergillosis
Inhalation of conidia in a immunocompromised host (severe) patients
Invasive pulmonary aspergillosis (increase mortality rate)
ASPERGILLOMA
-occurs when?
You have to have a lung disease (like TB)
-mycetoma (fungus ball) forms in the cavity
Asymptomatic, caugh +fever
ABPA allergic bronchopulmonary aspergillosis
-patients w/ asthma, and/or cystic fibrosis
-allergic reaction
-cough, wheezing, produce mucus plugs, shortness of breath
-bronchial casts
-little fungus in plugs
Chronic pulmonary aspergillosis (CPA)
IN PATIENTS who are mildly immunocompromised w/ steroid-dependent COPD, or have chronic lung disease
-manifests as subacute pneumonia = fever, night sweats, cough, fever
Invasive pulmonary aspergillosis (IPA)
PATIENTS that are severely immunocompromised host
-w/ or w/o blood cough, chest pain
-mortality increase even w/ treatment
-often disseminates (spleen most commonly infected)
Pathogenesis for CPA & IPA
CPA= chronic pulmonary aspergillosis
IPA= invasive pulmonary aspergillosis
-inhaled conidia
-lack of innate immunity.. aspergillus will cause infection
NEUTROPENIA = BIGGEST RISK FACTOR
Biggest risk factor for aspergillus
NEUTROPENIA
Diagnosis of aspergillus
-ELISA = galactomannan
-B-D-GLUCAN
ASPERGILLOMA diagnosis
Radiology and positive serology (IgG, IgE)
ABPA diagnosis
Elevated total and aspergillus-specific IgE
CPA diagnosis
Anti-aspergillus antibody testing (IgG or IgE) combined with/ radiology
IPA diagnosis
Positive histology from affected organ = Hyphae have frequent septa
Positive culture from a normally sterile site
CPA/IPA TREATMENT
Voriconazole
ABPA TREATMENT
Itraconazole and
Oral corticosteroids
ASPERGILLOMA treatment
Surgery
Yet 10% will spontaneously cough the fungus ball out
Mucormycosis vs. aspergillosis identification differences
Aspergillosis = septa
Mucormycosis = no septa, irregular branching
