SYSTEMIC AND OPPORTUNISTIC MYCOSES Flashcards
SYSTEMIC MYCOSES
● Blastomyces dermatitidis
● Paracoccidioides brasiliensis
● Coccidioides immitis
● Histoplasma capsulatum
Blastomyces dermatitidis causes
North American Blastomycosis
Gilchrists disease
Chicago disease
Human infection is initiated in the lungs
Blastomyces dermatitidis
Blastomyces dermatitidis can be acquired through
Inhalation of the conidia or hyphal fragments.
Blastomyces dermatitidis specimen
Specimens consist of sputum, pus, exudates, urine, and biopsies from lesions.
Blastomyces dermatitidis mold form
round or pyriform conidia
Resembling lollipops
Blastomyces dermatitidis yeast phase
Thick- walled, large yeast cells with single bud on
broad-base; broad isthmus at constriction
Show broadly attached buds on thick-walled yeast cells
Blastomyces dermatitidis wet mount
Blastomyces dermatitidis culture
Sabouraud’s agar or enriched blood agar
Treatment
○ Severe cases of blastomycosis are treated with
amphotericin B
Paracoccidioides brasiliensis
● Causes
South American Blastomycosis
Causes South American Blastomycosis
Paracoccidioides brasiliensis
Inhaled, and initial lesions occur in the lung
Paracoccidioides brasiliensis
Most patients are 30-60 years of age, and over 90% are men.
Paracoccidioides brasiliensis
Specimen for Paracoccidioides brasiliensis
Specimens consist sputum, exudates, biopsies or other material from lesions
Paracoccidioides brasiliensis
Mold phase
intercalary and terminal chlamydoconidia; few pyriform
microconidia
Paracoccidioides brasiliensis yeast phase
resembles a ship wheel or pilot wheel or mariner’s wheel
Most useful for diagnosis in Paracoccidioides brasiliensis
Serologic testing
KOH or calcofluor white
■ Yeasts are often apparent
Paracoccidioides brasiliensis
Causes Coccidioidomycosis
Coccidioides immitis
Coccidioides immitis
● Causes
Coccidioidomycosis
Coccidioides immitis acquire through
Inhalation of arthroconidia leads to a primary infection
Major biologic hazard among laboratory personnel
Coccidioides immitis
Specimen for Coccidiodes immitis
sputum
exudate from cutaneous lesions
spinal fluid
blood
urine
tissue biopsies.
Coccidioides immitis mold phase
thick-walled, barrel-shaped, rectangular arthroconidia
Coccidioides immitis yeast phase
thick-walled spherules with endospores
Coccidioides immitis
● Microscopic Examination
○ KOH or calcofluor white stain:
spherules and endospores
Coccidioides immitis culture media
Inhibitory mold agar
Sabouraud’s agar, or blood agar slants
‼️REMINDER‼️
Coccidioides immitis
Since arthroconidia are highly infectious, suspicious cultures are examined only in a biosafety cabinet.
Identification must be confirmed by detection of C. immitis
specific antigen
animal inoculation
use of a specific DNA probe
Causes Histoplasmosis
Histoplasma capsulatum
most prevalent pulmonary infection in
humans and animals
Histoplasmosis
Histoplasmosis begins at
primary and begins in the lung and eventually
invades the reticuloendothelial system.
Histoplasmosis causative agent
Histoplasma capsulatum
Histoplasma capsulatum can be acquired through
inhalation of the conidia
Histoplasma capsulatum mold form
round to pyriform microconidia
round,thick-walled knobby, tuberculated macroconidia forms
Histoplasma capsulatum Yeast phase
round to oval yeast cells; intracellular to mononuclear cells
Histoplasma capsulatum
● Microscopic Examination
Observe for small ovoid cells within macrophages
Histoplasma capsulatum fungal stains
Gomori methenamine silver, periodic
acid-Schiff or calcofluor white stain
Giemsa-stained smears of bone marrow or blood
Histoplasma capsulatum
Cultured in
rich media: glucose-cysteine blood agar at 37°C and on Sabouraud’s agar or inhibitory mold agar at 25–30°C
OPPORTUNISTIC MYCOSES
● Aspergillus spp.
● Fusarium
OPPORTUNISTIC MYCOSES YEASTS
● Candida spp.
● Cryptococcus spp.
● Geotrichum spp.
Most important group of opportunistic fungi pathogens
Candida spp.
Normal flora of the skin, mucous membranes and
gastrointestinal tract
Candida spp.
Capable of causing Candidiasis
Candida spp.
Candida spp. capable of causing
Candidiasis
exist as oval, yeastlike forms that produce buds
or blastoconidia
Candida spp.
Produce pseudohyphae and true hyphae
Candida spp. except glabrata
Specimens include swabs and scraping from superficial lesions, blood, spinal fluid, tissue biopsies, urine, exudates, and material from removed intravenous catheters
Candida spp
Culture media for Paracoccidioides brasiliensis
Sabouraud’s agar or yeast extract agar
Coccidioides immitis other names
San Joaquin Valley Fever/ valley fever
Histoplasma capsulatum also known as
Darling’s disease/Spelunker’s disease
Candida spp.
● Microscopic Examination
Gram-stained smears or histopathological slides for tissue biopsies, centrifuged spinal fluid, and other specimens
Candida spp.
Gram-stained smears or histopathological slides for tissuebiopsies, centrifuged spinal fluid, and other specimens shows?
Pseudohyphae and budding cells
Candida spp.
Skin or nail scrapings are first placed in a drop of
10% KOH
calcofluor white
Special agar for Candida spp
CHROM AGAR
Candida spp.
○ All specimens are cultured on fungal or bacteriologic media at
37°C
Most isolated species from clinical material
Candida albicans
Can be saprophytic in oral cavities, Gi or vaginal tract
Candida albicans
Causes candidiasis
Candida albicans
moniliasis infection
Candida albicans
Candida albicans causes
candidiasis or moniliasis infection
Oral moniliasis
Vaginal moniliasis
Onchomycosis( nail infection)
Paronychomycosis (cuticle infections)
Hyphae-like extensions of young yeast cells showing parallel sides, aseptate and will not constrict at their point of origin
Germ-tube in Candida albicans
look like germ tubes but are aseptate and constricted at their point of origin.
Pseudohyphae in Candida albicans
This usually causes meningitis in patients with AIDS
Cryptococcus neoformans
Encapsulated yeast cell in bird and bat droppings
Cryptococcus neoformans
pigeon droppings
Cryptococcus neoformans
Causes Cryptococcosis or Torulosis/Torulopsis or European Blastomycosis
Cryptococcus neoformans
Torulosis/Torulopsis
Cryptococcus neoformans
European Blastomycosis
Cryptococcus neoformans
Specimen for Cryptococcus neoformans
cerebrospinal fluid
tissue, exudates
sputum
blood
cutaneous scrapings
urine.
Cryptococcus neoforman
Microscopic examination
wet mounts, both directly and after mixing with India ink.
Grow at room temperature
Cryptococcus neoformans alternative
Phenol oxidase
C. neoformans produces melanin in the cell walls and colonies develop a
Brown colonies
Often initially appears as a white to cream-colored, yeastlike colony; some isolates may appear as white, powdery molds.
Geotrichum candidum
Hyphae are septate and produce numerous rectangular to cylindrical to barrel-shaped arthroconidia.
Geotrichum candidum
OPPORTUNISTIC MYCOSES
● Aspergillus spp.
● Fusarium spp.
Causes Aspergillosis
Aspergillus spp.
Can cause disease by ingestion of mycotoxins, traumatic inoculation, or inhalation.
Aspergillus spp.
Also capable of causing disseminated infection in immunocompromised patients, pulmonary or sinus fungus ball, allergic bronchopulmonary aspergillosis, external otomycosis, mycotic keratitis, onychomycosis, sinusitis, endocarditis and central nervous system infection
Aspergillus spp.
The species are identified according to morphologic differences in their structures.
Aspergillus spp.
Specimen for Aspergillus
sputum
other respiratory tract specimens
lung biopsy tissue
Rapidly growing mold that produces a fluffy to granular, white to blue-green colony
Aspergillus fumigatus
● Characterized by the presence of septate hyphae and short or long conidiophores with a characteristic “foot cell” at their base.
Aspergillus fumigatus
Cultures are thermotolerant and able to withstand temperatures up to 45°C
Aspergillus fumigatus
Somewhat more rapidly growing species that produces
yellow-green colony.
Aspergillus flavus
Conidiophore is coarsely roughened near the vesicle.
Aspergillus flavus
Produces darkly pigmented, roughened spores
macroscopically, but microscopically its hyphae are hyaline and septate
Aspergillus niger
Growth begins initially as yellow colony
Aspergillus niger
With age, the colony becomes jet black and powdery, but
the reverse remains buff or cream colores.
Aspergillus niger
Less commonly seen in the clinical laboratory
Aspergillus terreus
Produces tan colonies that resembles cinnamon.
Aspergillus terreus
Produces larger cells, aleurioconidia, which are found on submerged hyphae.
Aspergillus terreus
Fusarium spp.
● Most commonly isolated organisms within this group are within the
Fusarium solani species complex
Long been known to cause mycotic keratitis.
Fusarium spp.
Oftentimes infections are associated with the consumption of grains contaminated with trichothecene mycotoxins
Fusarium spp.
● Oftentimes infections are associated with the consumption of grains contaminated with trichothecene mycotoxins produced by
F. sporotrichiodes or F. poae
Capable of causing sinusitis, wound (burn) infection, allergic fungal sinusitis, endopthalmitis, and disseminated fusariosis.
Fusarium spp.
Colonies grow rapidly, within 2 to 5 days, and are fluffy to
cottony and may be pink, purple, yellow, green or other
colors, depending on the species.
Fusarium spp.
Fusarium spp.
Most common medium used to induce sporulation is
corneal agar.
Fusarium spp.
Keys to identification are based on growth on
Dextrose agar