Veterinary Mycology
Veterinary Mycology
Veterinary Mycology
Veterinary
Mycology
Veterinary Mycology
Indranil Samanta
Veterinary Mycology
Indranil Samanta
Department of Veterinary Microbiology
West Bengal University of Animal & Fishery Sciences
Kolkata, West Bengal, India
Dr. Indranil Samanta is a young scientist who has gotten very important
scientific achievements in his short carrier: Bachelor of Veterinary Sciences
and Animal Husbandry, Master of Veterinary Sciences, Ph.D. in Veterinary
Microbiology, and now he is Assistant Professor in the Microbiology Depart-
ment of West Bengal University of Animal and Fishery Sciences, in India.
He was also Assistant Professor, Division of Microbiology and Immunology,
S. K. University of Agricultural Sciences and Technology of Kashmir, India,
and Veterinary Officer of West Bengal Government. He received four awards
and six research grants. His experience as publisher is wide, he belongs to
the Editorial Board of six journals and acts as reviewer in other four journals,
and he published 22 research articles in international journals. Last year he
published a book entitled Veterinary Bacteriology.
Dr. Samanta kindly invited me to write the foreword of Veterinary
Mycology and it is a great pleasure for me to present this book.
Medical and veterinary mycology have suffered very important
transformations in the last three decades. The introduction of molecular
biology techniques in taxonomy, epidemiology and diagnosis procedures,
not based on cultures, was probably the most significant of them. The
acquisition of more precise knowledge about pathogenesis of fungal
infections was also very important in the management of these diseases.
New antifungal drugs were incorporated to the therapeutic arsenal to fight
against these infections, including new presentations of classic drugs as lipid
formulations of amphotericin B and new compounds as echinocandins and
second generation triazoles. These advances, as well as the increasing mor-
bidity and mortality generated by the mycoses, attracted the attention of a
great number of animal health professionals to veterinary mycology.
Those who are interested in this discipline will find in Veterinary Mycol-
ogy an excellent guide book to increase their knowledge of fungal infections
and their etiologic agents. This book is divided in three main parts: in the first
one the history of veterinary mycology, general aspects of morphology,
taxonomy and biology of fungi are considered. In the second part, the
etiologic agents of superficial, deep, systemic and opportunistic mycoses
are described with great detail. Biological aspects of these fungi, epidemiol-
ogy of these infections, the immunity response of the hosts and the modern
diagnosis techniques such as those searching for fungal antigens in organic
vii
viii Foreword
fluid and those which applied molecular biology are extensively exposed.
Clinical manifestations and therapy of the mycoses are presented in a more
synthetic way, using tables containing comprehensive information. The third
part is related to laboratory diagnosis including clinical samples collection
and their processing for fungal isolation, special stains for fungal micro-
scopic visualization and culture media composition. There are also special
chapters about very infrequent fungal ‘infection’ and a glossary.
This book is written in concise and clear English, very easy to read. I think
the readers will enjoy it very much.
The study of fungi began during ancient times. Even in early Sanskrit
literature (Atharva Veda), scripts of Hippocrates and Lord Buddha and in
the Holy Bible, the importance of mycology was mentioned for prevention of
fungal diseases. Although it was little neglected both in medical and veteri-
nary sciences, studying mycology is gaining importance in recent times due
to emergence and re-emergence of fungal infection in human, animals and
birds. Emergence of black yeasts in poultry, Prototheca in pets, Laczia loboi
in human and marine animals, Lagenidium in pets, Emmonsia in human and
pets as well as re-emergence of brooder pneumonia in poultry, candidiasis in
human and animals, cryptococcosis in human and animals, and
dermatophytosis in animals is noted in recent times. The fungal infection
causes major economic loss in poultry and livestock related industry and it
poses zoonotic threat especially to the pet owners. Advancement of knowl-
edge helps in better understanding of the subject. Cumulation of the
advancements along with the conventional knowhow in the area of veterinary
mycology within the same cover was one of my best intentions. I have tried
to restructure the classification, genome characteristics, pathogenesis, immu-
nity, diagnosis and treatment of fungal diseases with the enlightened vision
of molecular biology and discovery of new antifungals. I hope the informa-
tion will be useful as reference text for undergraduate students, text for post-
graduate students, veterinary practitioners and in allied sectors. Any correc-
tion, modification and suggestion for improvement are most welcome by
the author.
During this auspicious occasion, I heartily acknowledge the mycology
faculty members and scientists throughout the world who are stalwarts in this
subject for evaluation of my chapters and their contribution of fungal
photographs. I offer my sincere thanks to Professor Dr. Ricardo Negroni
for his encouraging words. I also acknowledge friends and senior colleagues
of my department and university for their valuable suggestions. All the
schematic diagrams drawn by my wife Jhuma are duly accredited.
ix
Contents
1 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Medical Mycology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Veterinary Mycology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 General Characteristics of Fungi . . . . . . . . . . . . . . . . . . . . . . . 3
2.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.1.1 Types of Hyphae . . . . . . . . . . . . . . . . . . . . . . . 4
2.1.2 Fungal Cell Structure . . . . . . . . . . . . . . . . . . . . 4
2.2 Nutrition and Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.3 Reproduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3 Classification of Fungi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4 Cutaneous, Subcutaneous and Systemic Mycology . . . . . . . . . 11
4.1 Trichophyton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
4.1.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
4.1.2 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . 13
4.1.3 Reproduction . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4.1.4 Susceptibility to Disinfectants . . . . . . . . . . . . . . 14
4.1.5 Natural Habitat and Distribution . . . . . . . . . . . . 14
4.1.6 Genome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4.1.7 Isolation, Growth and Colony
Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 15
4.1.8 Antigenic Characteristics . . . . . . . . . . . . . . . . . . 15
4.1.9 Virulence Factors . . . . . . . . . . . . . . . . . . . . . . . 16
4.1.10 Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4.1.11 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4.1.12 Disease Produced . . . . . . . . . . . . . . . . . . . . . . . 17
4.1.13 Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
4.1.14 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
4.1.15 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.1.16 Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.2 Microsporum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.2.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
4.2.2 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . 22
4.2.3 Reproduction . . . . . . . . . . . . . . . . . . . . . . . . . . 23
4.2.4 Susceptibility to Disinfectants . . . . . . . . . . . . . . 24
4.2.5 Natural Habitat and Distribution . . . . . . . . . . . . 24
xi
xii Contents
4.2.6 Genome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4.2.7 Isolation, Growth and Colony
Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 25
4.2.8 Antigenic Characteristics . . . . . . . . . . . . . . . . . . 25
4.2.9 Virulence Factors . . . . . . . . . . . . . . . . . . . . . . . 25
4.2.10 Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . 25
4.2.11 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
4.2.12 Disease Produced . . . . . . . . . . . . . . . . . . . . . . . 27
4.2.13 Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4.2.14 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4.2.15 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.3 Epidermophyton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.3.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.3.2 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.3.3 Susceptibility to Disinfectants . . . . . . . . . . . . . . 30
4.3.4 Natural Habitat and Distribution . . . . . . . . . . . . 30
4.3.5 Genome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
4.3.6 Isolation, Growth and Colony
Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 30
4.3.7 Antigenic Characteristics . . . . . . . . . . . . . . . . . . 31
4.3.8 Virulence Factors . . . . . . . . . . . . . . . . . . . . . . . 31
4.3.9 Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4.3.10 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4.3.11 Disease Produced . . . . . . . . . . . . . . . . . . . . . . . 31
4.3.12 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4.3.13 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.4 Aspergillus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.4.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.4.2 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . 34
4.4.3 Susceptibility to Disinfectants . . . . . . . . . . . . . . 34
4.4.4 Natural Habitat and Distribution . . . . . . . . . . . . 34
4.4.5 Genome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
4.4.6 Isolation, Growth and Colony
Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 35
4.4.7 Antigenic Characteristics . . . . . . . . . . . . . . . . . . 35
4.4.8 Toxins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4.4.9 Virulence Factors . . . . . . . . . . . . . . . . . . . . . . . 37
4.4.10 Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.4.11 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.4.12 Disease Produced . . . . . . . . . . . . . . . . . . . . . . . 40
4.4.13 Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4.4.14 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
4.4.15 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4.5 Blastomyces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4.5.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4.5.2 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4.5.3 Reproduction . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4.5.4 Susceptibility to Disinfectants . . . . . . . . . . . . . . 45
Contents xiii
4.11 Penicillium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
4.11.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4.11.2 Life Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4.11.3 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.11.4 Reproduction . . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.11.5 Natural Habitat and Distribution . . . . . . . . . . . . 87
4.11.6 Genome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
4.11.7 Isolation, Growth and Colony
Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 87
4.11.8 Antigenic Characteristics . . . . . . . . . . . . . . . . . . 88
4.11.9 Toxins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
4.11.10 Virulence Factors . . . . . . . . . . . . . . . . . . . . . . . 88
4.11.11 Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . 88
4.11.12 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
4.11.13 Disease Produced . . . . . . . . . . . . . . . . . . . . . . . 89
4.11.14 Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
4.11.15 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
4.11.16 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
4.12 Cryptococcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.12.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.12.2 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . 92
4.12.3 Reproduction . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.12.4 Susceptibility to Disinfectants . . . . . . . . . . . . . . 93
4.12.5 Natural Habitat and Distribution . . . . . . . . . . . . 93
4.12.6 Genome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
4.12.7 Isolation, Growth and Colony
Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.12.8 Biochemical Characteristics . . . . . . . . . . . . . . . . 95
4.12.9 Antigenic Characteristics . . . . . . . . . . . . . . . . . . 95
4.12.10 Virulence Factors . . . . . . . . . . . . . . . . . . . . . . . 96
4.12.11 Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . 96
4.12.12 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
4.12.13 Disease Produced . . . . . . . . . . . . . . . . . . . . . . . 99
4.12.14 Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
4.12.15 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
4.12.16 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
4.13 Candida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
4.13.1 Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
4.13.2 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . 104
4.13.3 Reproduction . . . . . . . . . . . . . . . . . . . . . . . . . . 104
4.13.4 Susceptibility to Disinfectants . . . . . . . . . . . . . . 105
4.13.5 Natural Habitat and Distribution . . . . . . . . . . . . 105
4.13.6 Genome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
4.13.7 Isolation, Growth and Colony
Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 106
4.13.8 Biochemical Characteristics . . . . . . . . . . . . . . . . 106
4.13.9 Antigenic Characteristics . . . . . . . . . . . . . . . . . . 106
xvi Contents
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Composition of Commonly Used Mounting Fluids/Stains . . . . . . 165
Composition of Commonly Used Media in Diagnostic
Mycology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
About the Author
xix
History
1
1.1 Medical Mycology of rice and sugarcane which can decrease their
production. In the Bible (Amos 4, 19)
The term ‘mycology’ was coined by instructions were provided to the priests for treat-
H.S. Berkley (1834) as a study of fungi. Medical ment of fungal infection such as dry rot.
or veterinary mycology is the study of medically The first description of dermatophytosis was
or veterinary important fungi and fungal diseases recorded by Celsus, a Roman encyclopaedist
in human and animals, respectively. The term who described a suppurative infection of the
‘mycosis’ (mykes ¼ mushroom) is used to scalp (‘porrigo’ or ‘kerion of Celsus’) in De Re
describe the infection of human, animal, birds Medicina (30 AD). Throughout the middle ages
and plants which is caused by numerous patho- several descriptions of dermatophytosis are pro-
genic fungi. The ‘mycotoxicosis’ describes the duced where it was described as ‘tinea’ (Latin
diseased condition produced by the ingestion of term). Micheli (1729) published Nova genera
mycotoxins (intoxication) present in the feed. Plantarum (written in copper plate) in which he
When the fungi produce the pathogenesis due to established several genera of fungi such as
in vivo toxin production after entry within the Aspergillus, Mucor, etc. However, the patho-
host, it is known as ‘mycetism’. genic potentiality of fungi in human or animals
In ancient Sanskrit writing of India (Atharva remained uncertain.
Veda, 2000–1000 BC), the first description of a Robert Hook (1665) first illustrated the patho-
fungal infection, i.e. mycetoma (Pada genic role of rose rust (Phragmidium
Valmikan), was documented. In seventeenth cen- mucronatum) in his book ‘Micrographia’. In
tury, a German physician (Engelbert Kaempfer) 1835, Agostino Bassi, an Italian lawyer and
working in India first reported clinical human farmer, first reported a fungal infection
cases of mycetoma which was followed by case (muscardine) of silkworm and illustrated that a
reports of French missionaries in Pondicherry, microbe can cause an infection. Robert Remak
India (ant-hill of worms, 1714). The fungal (1837–1841), a Polish physician, described the
plant diseases (smut, rust) were noted in other first human mycosis (tinea favosa). Gruby (1844)
Veda (1200 BC) also. In Rigveda crushing of first described the aetiologic agent of tinea
mushroom (an edible fungus) with the feet was endothrix, later became known as Trichophyton
illustrated as a punishment. Hippocrates tonsurans. The work of Remak and Gruby
(460–377 BC) first documented oral established the mycology as a separate branch
pseudomembranous candidiasis and he described of medical science. In 1892, Alejandro Posadas,
it with the name of ‘aphthae albae’ which was a medical student, and Robert Wernicke, a
later supported by Galen (130–200 BC). Lord pathologist, first described Coccidioides from a
Buddha (400 BC) observed the fungal diseases soldier with recurrent skin tumours in Argentina.
The histoplasmosis in human was first notified by Edwin John Butler (1901) started the systemic
Darling (1906), an American pathologist who study of fungi (Pythium, Phytopthora) and he is
observed it during an autopsy of a Martinique known as the ‘Father of Indian mycology’.
native person who died with tuberculosis-like
syndrome in Panama. Raymond Jacques Adrien
Sabouraud (France) compiled the description of 1.2 Veterinary Mycology
dermatophytes (Trichophyton) in his book Les
Teignes (1910) which was based on his observa- In 1749, Reaumur first described avian aspergil-
tion in artificial culture. This authentic book losis in birds which was followed by the report of
initiated the development of medical mycology. similar syndrome in a duck (Montagu, 1813).
Gomori (1946) first developed a stain for the Aspergillus fumigatus was first detected in the
microscopic observation of fungal cells in tissue lung of a great bustard (Otis tardaga) in 1863
which was later modified by Grocott in 1955. by Fresenius. He was also the first to use the term
Kligman (1951) used the periodic acid Schiff ‘aspergillosis’ for this respiratory disease.
stain for histological demonstration of fungi. The causative agent of Epizootic
Gridley (1953) later modified PAS stain by lymphangitis in horses (Histoplasma capsulatum
replacing periodic acid with chromic acid var. farciminosum) was first demonstrated in the
which can reveal both hyphae and yeast cells pus by Rivolta (1873). However, it was success-
in tissues. fully isolated in 1896 by Tokishiga in Japan.
In India, Lt. Col. Kirtikar (1885) established Smith (1884), a Veterinarian working in India,
the mycology with his collection and identifica- first described a chronic cutaneous granuloma-
tion of mushrooms from West Bengal. tous disease in horses known as ‘bursattee’ in
Cunningham (1872) exposed the grease covered local Indian language. Later the aetiology of the
slides to the air and collected spores of Rhizopus disease was correlated with the fungi (Pythium)
and rusts along with the cholera bacteria. Sir based on histology.
General Characteristics of Fungi
2
Fig. 2.2 Types of dermatophyte hyphae (schematic); a, spiral; b, pectinate body; c, favic chandelier; d, nodular organ;
e, racquet hyphae
mannan, chitosan (polymer of glucosamine) and also present in the cytoplasm. The microtubules
galactans. Among the glucans, polymers with are composed of tubulin protein and they help in
(β1, 3) and (β1,6) linked glucosyl units, known as the movement of chromosomes (during mitosis or
β glucan, is common. The β glucans are potent meiosis), nuclei, golgi vesicles, vacuoles and
immunomodulator and are used in poultry mitochondria. Disruption of tubulin synthesis by
industry. antifungal (griseofulvin) can prevent the fungal
In yeast form of dimorphic fungi (Histoplasma, mitosis. The cytoplasm contains membrane-
Blastomyces dermatitidis), α glucan makes the bound nucleus composed of chromatin and nucle-
cell layer, whereas the β glucan predominantly olus. The chromatin is composed of DNA and
make the cell wall of mycelium. The presence of associated proteins. The number, shape and size
α glucan is associated with virulence of the yeast of nuclei vary between the fungi. Majority of
cells than the mycelial form. Another major con- genetic material (80 %) is present in the chromatin
stituent of yeast cell wall is peptidomannan (man- and the rest (20 %) is associated with mitochon-
nan, galactomannans, rhamnomannans) which drial genome (Fig. 2.3).
helps in serological identification of the fungi.
The capsule is observed in Cryptococcus like
prokaryotes. The capsule consists primarily of two 2.2 Nutrition and Growth
polysaccharides, glucuronoxylomannan (GXM)
and glucuronoxylomannogalactan (GXMGal), The fungi are chemoorganoheterotrophic
along with smaller amounts of mannoproteins. It organisms. They use chemical compounds as a
is antiphagocytic and it protects the yeast cells. source of energy and organic compounds as elec-
Plasma membrane: The plasma membrane is tron and carbon source. They obtain their nutrition
present beneath the cell wall. Like other by absorption (osmotrophic) either from the envi-
mammalian cells, it is a phospholipid and ronment (saprophyte) or the host (parasite). Most
sphingolipid bilayer in which the proteins of the saprophytic moulds grow aerobically in
(peripheral and integral) are interspersed. The artificial culture medium at 20–30 C. The patho-
hydrophilic heads of phospholipids are towards genic yeasts and yeast phase of dimorphic fungi
the surface, and the hydrophobic tails are present prefer to grow at 37 C. High humidity, acidic pH
in the interior of the membrane. Major sterol of (3.8–5.6), high sugar concentration (4–5 %), car-
fungal plasma membrane is ergosterol. In con- bon, phosphorus, sulphur and traces of potassium,
trast, mammalian plasma membrane contains magnesium, iron and calcium are required for
cholesterol. The antifungals act on ergosterol optimum fungal growth. The peptone in the
(polyene) or biosynthetic pathway of ergosterol media and keratin in the skin act as a nitrogen
(imidazole, triazole) to inhibit the fungal growth. source. The nitrogen is required for synthesis of
Cytoplasm: The cell cytoplasm contains amino acids for building proteins, purines and
nucleus and organelles such as mitochondria, pyrimidines for nucleic acids, glucosamine for
endoplasmic reticulum, golgi vesicles, lysosomes, chitin and various vitamins. Most of the fungi use
vacuoles, etc. Long, hollow cylindrical structures nitrogen as nitrate which is reduced to nitrite and
(25 nm in diameter), known as microtubules, are further to ammonia. None of them can directly fix
6 2 General Characteristics of Fungi
nitrogen. The growth is not dependent on light and reproduction of fungi produces spores which
ultraviolet and X-ray are mild inhibitory. The are considered as dispersal and survival unit of
growth rate of fungi is slower than bacteria and fungi without an embryo. The spores separate
the medium is easily contaminated with bacteria. from their mother fungi and develop into an
Antibiotics (e.g. chloramphenicol) and antifungal individual progeny.
(e.g. cycloheximide) are added in the media to In asexual reproduction, union of sex organ or
prevent the bacterial and saprophytic fungi con- nuclei does not occur. Instead, the following
tamination. The cycloheximide is inhibitory processes are observed:
against the growth of certain pathogenic fungi 1. Fission of mother cell: It produces two similar
and yeasts such as Aspergillus fumigatus, Candida daughter cells.
albicans and Cryptococcus. 2. Budding: The budding has three steps:
Inoculation of culture medium is done by a (i) Bud emergence: The outer cell wall of the
transfer needle with flattened tip which helps in parent cell thins and new inner cell wall
cutting of mycelium. The bacteriological inocu- and plasma membrane are synthesised at
lation loop is sufficient for inoculation of yeasts the site of bud emergence. The bud emer-
(Table 2.1). gence is regulated by the activation of the
polysaccharide synthetase (zymogen) for
the synthesis of new cell wall and turgor
2.3 Reproduction pressure of the parent cell.
(ii) Bud growth: Mitosis occurs and the
The fungi reproduce by two major ways, conidium (spore) possesses the daughter
i.e. asexual and sexual reproduction. The nucleus.
2.3 Reproduction 7
(iii) Conidium separation: The septum (c) Arthrospores (oidia): Disjoining of hyphal
between the developing conidium and cells produces single-celled arthrospores.
its parent cell is formed from a chitin (d) Chlamydospores: Thick-walled, single-
ring. The septum helps in the separation celled spores produced by aerial hyphae and
of conidia which leaves a bud scar on the they are highly resistant to adverse environ-
parent cell wall. Sometimes the conidia ment. Some fungi (Histoplasma) produce
are not separated and released from the chlamydospores with small spine-like
parent cells. Consequently, pseudohypha projections in their wall (tuberculate).
consisting of a filament of attached (e) Blastoconidia: The spores produced by bud-
conidia is produced (Fig. 2.4). ding are known as blastoconidia (Fig. 2.5).
Sexual reproduction occurs by the union of
3. Fragmentation of hyphae. two compatible thalli (homothallic or heterothal-
4. Spore formation. lic).In heterothallic fungi the male and female
Many kinds of fungal asexual spores are mating types exist in nature, designated as
detected. A and a (or + and ). The homothallic fungi do
(a) Sporangiospores: A specialised reproductive not require separate mating types. The sex organ-
hypha (sporangiophore) bears a sac-like struc- elle of fungi is called gametangium. Male and
ture known as sporangium. Each of the spo- female gametangia are known as ‘antheridium’
rangium contains numerous single-celled and ‘oogonium’, respectively. The union of com-
sporangiospores. Non-motile sporangiospores patible thalli is followed by fusion of gametangia
are called ‘aplanospore’ and motile (plasmogamy). In some fungi, ‘trichogyne’
sporangiospores are called ‘zoospore’. (a specialised hyphae) is present surrounding
(b) Conidia: Conidia are small asexual spores the female gametangium and it receives
attached directly with reproductive hyphae the male gamete. The male gamete is uninucleate
(conidiophore). Small single-celled spores spermatium (microconidium) or multinucleate
are called microconidia and large multicellu- macroconidium, formed either directly on
lar spores are called macroconidia. the male mycelium (+ type) or in a specialised
structure called ‘spermogonia’. The trichogyne
recruits a fertilising nucleus from the male gam-
ete which enters the female gametangium and
fusion of two haploid nuclei (karyogamy) occurs.
The karyogamy produces a diploid nucleus
which undergoes meiosis to reduce the chromo-
some number into haploid again. Some of the
progeny nuclei degenerate and in some fungal
Fig. 2.4 Steps of yeast budding (schematic); a, bud species post-meiotic mitosis occurs. Sexual
emergence; b, bud growth; c, conidium separation reproduction is typically controlled by genes
that reside in the mating-type locus. The sexual the female gametes (oospheres) to produce
spores occur less frequently and in smaller num- oospores (Fig. 2.6).
bers than the asexual spores. Different types of The sexual and asexual spores are protected
sexual spores are described below. from the environment by a highly organised
(a) Ascospores: These meiospores are single structure, known as ‘fruiting body’ or ‘sporo-
celled and are produced within a sac-like carp’. The fruiting bodies for sexual spores
structure, known as ascus (meiosporangium). include cleistothecia, perithecia, apothecia and
Each ascus contains eight ascospores. pseudothecia. The cleistothecium is a completely
(b) Basidiospores: These spores are also like closed fruiting body. In perithecium, a pore (osti-
ascospores but are produced within a club- ole) is present through which the spores can
shaped structure known as basidium. escape. The apothecium is a cup or saucer-like
(c) Zygospores: Zygospores are produced by the fruiting body. In addition to spores, some fruiting
fusion of two compatible thalli or their bodies contain sterile hyphae.
gametangia. The fruiting bodies such as pycnidium and
(d) Oospores: These special sexual spores are acervulus can protect asexual spores. Pycnidium
produced within female gametangium (oogo- is a spherical structure with a pore (ostiole) at the
nium). After fusion of two compatible top and it is arranged as separate or aggregate.
hyphae, the male gametes (produced in The acervulus is an open, saucer-shaped asexual
antheridium) enter the oogonium and fertilise fruiting body.
Classification of Fungi
3
The classification of fungi relies mostly on mor- proposal for classification of fungi is published
phological criteria such as the pigmentation, in official journal of International Association for
shape of hyphae, presence or absence of septa Plant Taxonomy (Taxon) and is discussed in
and types of spores. The taxonomy of mould annual meeting before acceptance. The classifi-
and yeasts is governed by International Code of cation of clinically relevant fungi is described in
Botanical Nomenclature (ICBN). Any new Table 3.1.
Table 4.1 Teleomorphic species complex, anamorph species and hosts of Trichophyton
Teleomorphic species
complex Anamorph Host
Trichophyton rubrum T. rubrum of Africa (including the old taxa of T. raubitschekii, Human
complex T. soudanense, T. gourvilii, T. megninii)
T. rubrum (including the old taxa of T. fischeri, T. kanei, T. raubitschekii) Human
T. violaceum (including the old taxa of T. yaoundei, T. glabrum) Human
Arthroderma simii T. simii Monkey
complex T. mentagrophytes (including the old taxa T. mentagrophytes var. Mice, camels
quinckeanum, T. langeronii, T. sarkisovii)
T. schoenleinii Human
Arthroderma benhamiae T. verrucosum Cattle
complex T. erinacei Hedgehogs
Trichophyton species of A. benhamiae (including T. mentagrophytes var. Rabbits, guinea
granulosum) pigs, rodents
T. concentricum Human
T. bullosum Horses
T. eriotrephon –
Arthroderma T. tonsurans Human
vanbreuseghemii complex T. equinum Horses
T. interdigitale (including zoophilic species as T. mentagrophytes var. –
mentagrophytes, var. granulosum, T. verrucosum var. autotrophicum)
T. mentagrophytes var. goetzii, interdigitale, nodulare, T. krajdenii Human
14 4 Cutaneous, Subcutaneous and Systemic Mycology
invade the skin epithelial cells. The spores, after different because the fungi can invade and grow
transmission through the skin trauma, can germi- in the moist living tissues. The trauma causing
nate in the non-living keratinised layer of the the breakage in the epidermis is a prerequisite for
skin (stratum corneum). The fungal metabolites the establishment of the infection in the dermis.
induce inflammatory reaction at the site of infec- During trauma, follicular disruption occurs
tion. The inflammation causes the pathogen to which causes the introduction of keratin and
move away from the site of infection in a circular necrosed materials into the dermis. The keratin
way with healing at the centre and papules at the and necrosed materials act as substrate for sur-
periphery which is responsible for classical ring vival of the organism. The growth of the organ-
shaped lesion. ism causes cellular destruction and inflammation
The invasion of stratum corneum is associated which raises the level of stromal acid mucopoly-
with the production of different virulence factors saccharides, lowering the dermal pH to make it
such as sulphite, keratinase and proteases as suitable for the fungal survival. The neutrophils
described in Table 4.3. The keratinous tissues and monocytes can ingest and kill the conidia of
are composed of insoluble proteinaceous com- T. rubrum. However during immunosuppression
plex made of a network of different cross-linked these neutrophils and monocyte mediated killing
proteins such as loricrin- and proline-rich is hampered and the infection may progress into
proteins which contain numerous cysteine the deeper part of the tissues.
residues to form disulphide bridges. The secreted
sulphite can break these disulphide bridges
and make the reduced proteins accessible by
different proteases and keratinases for further 4.1.12 Disease Produced
digestion.
The pathogenesis of anthropophilic T. rubrum The major animal and human diseases produced
causing Majocchi’s granuloma in human is little by Trichophyton are enlisted in Table 4.4.
Table 4.5 Different species of Trichophyton associated atrophic epidermis. Inflammation with round-
with hair invasion cell infiltrate is seen in the adjacent dermis. In
Ectothrix invasion Endothrix invasion Noninvasion comparison to direct microscopy histopatho-
T. verrucosum T. schoenleinii T. rubrum logical investigation is much reliable,
T. equinum T. violaceum T. simii although it cannot detect the species of der-
T. mentagrophytes T. tonsurans T. concentricum matophyte. The diagnostic sensitivity can be
increased with biopsy which is not always
diagnosis without heating and the specimens possible to conduct especially in human
can be preserved for long time. The hyphae patients suffering with diabetes.
are observed under the microscope invading 4. Molecular biology: The conventional PCR
the hair and producing arthrospores. There have developed for identification of different
are two types of hair invasion by the Trichophyton species using nuclear ribosomal
dermatophytes, known as ectothrix and DNA (rDNA), mitochondrial DNA (mtDNA),
endothrix invasion. In ectothrix invasion, the chitin synthase 1 (chs1), topoisomerase II
arthrospores are observed on the surface of (TOP2) genes, small (18S rRNA) and large
the hair, whereas in endothrix invasion, the subunit (28S rRNA) of ribosomal RNA as
spores are found within the hair. There are major target genes. Further, randomly
some Trichophyton species also which cannot amplified polymorphic DNA (RAPD), PCR
attack the hair. The different Trichophyton fingerprinting, amplified fragment length poly-
species associated with hair invasion are morphism (AFLP) and sequencing of microsat-
enlisted in Table 4.5. ellite markers, have been successfully applied
The specimens can be stained with to species identification in dermatophytes but
chlorazol black or Parkers blue ink. Chlorazol were mostly unable to discriminate between the
helps in identification of hyphae by staining the strains. The sequencing of the internal-
carbohydrate rich cell wall without staining the transcribed spacer (ITS) region is commonly
contaminants such as cotton or elastic fibres. used for phylogenetic analysis and identifica-
The fine needle aspirates can be stained with tion of dermatophyte species. Although, the
the May–Grunwald–Giemsa method. ITS region shows high sequence similarities
Majority of Trichophyton species (except between the species of Trichophyton
T. schoenleinii) do not produce fluorescence (90–100 %), the discriminating polymorphisms
under Wood’s lamp. However, fluorescence (barcode sequence) exists in ITS1 and ITS2
microscopy (UVA, 365 nm) produces better region of the members of T. tonsurans and
resolution than wet mount with KOH. The T. equinum. In addition, non-transcribed spacer
fluorescent substance (calcofluor, acridinium (NTS) region of the rRNA genes is also consid-
orange or Blankophor) is added to the KOH. It ered suitable for strain typing of some
binds fungal cell wall and increases the visi- Trichophyton species, such as T. rubrum,
bility of fungal hyphae and spores. T. interdigitale and T. tonsurans.
2. Isolation and identification: Media and incu- Recent progress includes the use of
bation condition as described earlier will PCR-ELISA which can specifically identify
serve the purpose. the PCR amplified product with the help of
3. Histopathology: The histopathological slides enzyme labelled probe producing colour reac-
are prepared with periodic acid–Schiff (PAS), tion in positive cases. The uniplex-PCR-ELISA
Grocott methenamine silver and calcofluor can identify T. rubrum, T. interdigitale,
white (CFW) stains. The histopathological T. tonsurans and T. violaceum individually.
section shows the dead and degenerating The matrix-assisted laser desorption/ionisation
mycelium with cellular debris at the centre time-of-flight mass spectrometry (MALDI-
of the lesion with well preserved hyphae at TOF-MS) can identify the species of
the periphery of the lesion. In T. schoenleinii Trichophyton from the grown cultures which
infection, the ‘scutulum’ (concave, is very fast and specific method and the result
cup-shaped yellow crust) is observed on the shows 98–99 % similarity with PCR.
4.2 Microsporum 21
October 1895 to July 1898. Of the 279 cases, 1962; Gupta et al. 1970), pets (Pal et al. 1990)
139 (50 %) were caused by Microsporum and wild animal (Pal 1988) was also reported
audouinii in children. The existence of the sexual from India.
phase of certain dermatophytes was first
recognised by Nannizzi (1927) in Italy. He also
described the sexual form of Microsporum 4.2.1 Morphology
gypseum as Gymnoascus gypseum. Griffin
validated the Nannizzi’s investigations and con- The septate, branching hyphae are produced
firmed the existence of the sexual phase of by Microsporum in the artificial culture and
Microsporum. This sexual stage was renamed nonparasitic (environmental) state. Like other
as Nannizzia in the name of Nannizzi. In1934, dermatophytes, Microsporum also produce asex-
Emmons first classified the dermatophytes into ual spores known as conidia. Two types of
three genera, i.e. Trichophyton, Microsporum conidia, i.e. macroconidia (macroaleuriospores)
and Epidermophyton. This description is till and microconidia (microaleuriospores), are
date considered as the standard system of classi- detected. The size of macroconidia varies from
fication for dermatophytes. Bodin first described 6 to 160 μm 6–25 μm. The macroconidia are
two species of Microsporum such as M. canis and rough walled, spindle shaped, fusiform
M. gypseum. Kligman (1952) described the (M. vanbreuseghemii) or ovoid (M. nanum).
epidemics of tinea capitis due to Microsporum The wall of macroconidia is thin, moderately
audouinii which was known as the Atlantic City thick or thick in nature which can traverse inside
board epidemic among the school children. to produce 1–15 septa. They are generally
In India, Dey and Kakoti (1955) first reported arranged singly along the hyphae (Figs. 4.3 and
the isolation of Microsporum gypseum from ring- 4.4). The microconidia are sessile or stalked, less
worm lesion in a laboratory rabbit. Kandhari and abundant, clavate in shape and arranged singly
Sethi (1964) established the presence of M. canis along the hyphae.
infection in dogs in Delhi. The presence of
M. nanum in the Indian pigs was reported by
Gupta et al. (1968), whereas M. gypseum infec- 4.2.2 Classification
tion in other domestic animals such as cattle
(Gupta et al. 1970), sheep (Thakur et al. 1983), All dermatophytes belonged to the phylum
goat (Thakur and Verma 1984), horse (Tewari Ascomycota, class Euascomycetes, order
Table 4.7 Teleomorphs of Microsporum species in the soil. Some of the geophilic Microsporum
Microsporum species (anamorph) Teleomorph (M. gypseum) can survive in the environment
M. canis var. canis, Arthroderma otae in absence of keratinous materials also such
M. canis var. distortum as in sewage sludge, sediment/soil within the
M. nanum A. obtusum cave and cave wall. The infectious agent of
M. gypseum A. gypseum Microsporum (anthropophilic) is chlamydo-
M. gypseum A. incurvata spores or arthrospores which can survive in the
M. vanbreuseghemii A. grubyi environment for several years and are heat resis-
M. fulvum A. fulvum tant especially within the skin scales.
M. persicolor A. persicolor
Microsporum is worldwide in distribution,
M. racemosum A. racemosum
although some species are endemic in limited
M. amazonicum A. borelli
geographical location. M. canis is the major etio-
M. cookei A. cajetani
logical agent of tinea capitis and tinea corporis
M. boullardii A. corniculata
Unnamed A. cookiella
in some parts of Europe (Slovenia, Croatia
and Italy), the eastern Mediterranean, South
America, Asia (Iran, Yemen and Palestine) and
The sexual reproduction of other ascomy- Africa (Libya). Whereas M. audouinii, causing
cetous fungi such as Aspergillus is controlled tinea capitis in children, was restricted within
by MAT locus with two idiomorphs such as North America but currently is distributed in
MAT-1 and MAT-2. The heterothallic MAT-1 Asia and Africa. In Germany, it was considered
and MAT-2 can undergo sexual mating. The as major etiological agent of favus in humans.
similar kind of MAT locus is identified in two After introduction of griseofulvin (1958), they
species of Microsporum such as Microsporum are almost eradicated from Germany and other
gypseum (geophilic) and Microsporum canis parts of Central Europe. However, M. audouinii
(zoophilic) which indicates their mating compe- is still prevalent in African countries (Malawi,
tence. However, the teleomorph of Microsporum Western Kenya), causing tinea capitis in
(Arthroderma) isolates always exhibit only one human. M. gypseum was isolated from human
mating type which shows the possibility of inter- dermatophytic lesions in Asia (in Iran it shares
species sexual recombination as observed in mat- 4.1 % of the dermatophytic lesions) and Africa
ing between T. rubrum and Arthroderma simii. (Nigeria). Microsporum ferrugineum is now
restricted to a few rural areas of Asia and Africa.
M. canis is the predominant species causing
4.2.4 Susceptibility to Disinfectants dermatophytosis in dogs and cats in Italy which is
followed by geophilic species such as M. gypseum.
The spores of Microsporum are susceptible to In Iran, stray cats were reported to harbour
lime sulphur (1:33), 0.2 % enilconazole and chlo- M. canis without showing any symptom. In South-
rine bleach (1:10 to 1:100) ern India (Chennai), prevalence of M. gypseum
complex was detected among the stray dogs.
although observed in neonatal and intensive care due to clipping, playing, aggressive behaviour,
units where an infected nurse was detected as the ectoparasite infestation, pruritus). After penetra-
source of infection. Among children no gender tion through the skin trauma, the Microsporum
predilection is observed, whereas in adults, spores germinate in the stratum corneum. The
women are infected more frequently than men, hyphae grow along the hair shaft to the follicles
with a ratio ranging from 3:1 to 6:1. where they produce spores. The spores remain
attached by forming a thick layer around the hair
shaft. As Microsporum cannot colonise the
4.2.11 Pathogenesis deeper part of the skin or hair follicles, the hairs
grow normally but break near the skin surface
Microsporum spores cannot invade the healthy causing alopecia. The fungal metabolites induce
skin of the animals after transmission. So many inflammatory reaction at the site of infection.
animals such as cats and dogs become carrier of The inflammation causes the pathogen to move
M. canis arthrospores. This carrier stage may away from the site of infection in a circular way
progress to infection which depends on certain with healing at the centre and papules at the
predisposing factors such as young age, immu- periphery which is responsible for classical
nosuppression (virus or drug induced), ringed lesion.
nutritional deficiency (protein, vitamin A) and The invasion of stratum corneum may occur
high environmental temperature with high in immunosuppressed animals with the help
humidity and skin trauma (injury or scratches of the virulence factors (Table 4.9). It produces
4.2 Microsporum 27
generalised skin illness with secondary bacterial restricted area (head in cats) which disappears
infection. Rarely, a marked inflammatory after several weeks or after proper treatment.
response against the hyphae produces a
nodular granulomatous reaction in dermis
(pseudomycetoma) in Persian cats. 4.2.12 Disease Produced
In immunocompetent animals which are kept
in hygienic conditions, the Microsporum- The major animal and human diseases produced
induced ringworm lesions are limited in a by Microsporum are enlisted in Table 4.10.
4.2.15 Treatment
4.3 Epidermophyton
In cats, the mild lesions recover spontaneously,
although the treatment can reduce the course of The earlier report of Epidermophyton in the
the disease and transmission risk into the human. scientific literature was detected in 1870 when
Topical application of antifungals is not so effec- Harz described tinea cruris due to Acrothecium
tive due to undetected exact position of lesions, floccosum. Sabouraud (1910) classified the
poor penetration of drugs through the thick hair causal agents of dermatophytosis into four
coat and lack of tolerance in some breeds. The groups, i.e. Achorion, Epidermophyton, Tricho-
systemic treatment should be followed at least phyton and Microsporum. In 1923, Ota and
for 10 weeks, preferably up to when the lesions Langeron finally proposed the nomenclature of
heal and become culture negative. The Epidermophyton floccosum which was originally
antifungals used in systemic treatment of cats described by Harz (1870). Emmons (1934)
include itraconazole (better tolerance with less modernised the classification system and divided
reported toxicity except anorexia), terbinafine all dermatophyte species into three genera,
(side effects include vomition, pruritus), ketoco- i.e. Microsporum, Trichophyton and Epider-
nazole (major adverse effects are liver toxicity, mophyton, and declared that the genus Achorion
vomition, diarrhoea, anorexia, contraindicated in is unnecessary.
pregnancy) and griseofulvin (anorexia, vomition,
diarrhoea, bone marrow suppression especially
in Siamese, Himalayan, Abyssinian cats). The 4.3.1 Morphology
drug of choice is itraconazole which is
administered by pulse therapy. The pulse therapy Epidermophyton produces septate hyphae like
includes administration of ketoconazole at 5 mg/ other dermatophytes with production of
kg body weight/day for 1 week in every 2 weeks macroconidia. No microconidia are produced.
which should be continued for 6 weeks. Use of The macroconidia are smooth, thick or thin
M. canis-based vaccine produces poor immunity walled with 1–9 septa, club shaped (clavate)
against the pathogen in cats. and occur singly or in a cluster of 2–6 cells
In human, treatment of tinea capitis due (Fig. 4.5).
to M. canis infection is difficult than the
infection with Trichophyton probably due to
ectothrix type of hair invasion and small size
of the spores which make them inaccessible 4.3.2 Classification
to the antifungals. Commonly used oral anti-
fungals against M. canis are griseofulvin All dermatophytes belonged to the phylum
(microlyophilised form) and terbinafine. The Ascomycota, class Euascomycetes, order
fungistatic itraconazole can be used in children Onygenales and family Arthrodermataceae. The
to treat kerion celsi type of tinea capitis along family Arthrodermataceae contains four morpho-
with topical antifungals and antibacterials, even logical anamorph genera such as Trichophyton,
with the poor response of M. canis to topical Microsporum, Epidermophyton and
antifungals. Chrysosporium. The genus Epidermophyton
Among plant-based antifungals, Neem possesses 2 species which are E. floccosum and
(Azadirachta indica A. Juss) seed and leaf E. stockdaleae. The type species and only patho-
extracts, Curtisia dentata (triterpenoids) extracts genic species under the genus is E. floccosum.
showed antidermatophytic activity against The ecological niche-based classification system
M. nanum and M. canis, respectively, in vitro. describes E. floccosum as anthropophilic.
30 4 Cutaneous, Subcutaneous and Systemic Mycology
The dermatophyte spores are susceptible to The information regarding the whole genome of
benzalkonium chloride, 1 % sodium hypochlorite, E. floccosum is currently not available. Although
enilconazole (0.2 %), formaldehyde, iodophors, the complete sequence of the 30.9 kb mitochon-
glutaraldehyde, phenolic compounds, benzyl- drial (mt) genome is reported, the major genes
ammonium bromide and ethoxyllauric alcohol. present in the mitochondrial genome include
The last two are especially effective against the reduced nicotinamide adenine dinucleotide-
anthropophilic dermatophyte such as E. floccosum. ubiquinone oxidoreductase (nad1, nad2, nad3,
Recent finding indicated that Candida nad4, nad4L, nad5, nad6), cytochrome oxidase
albicans releases volatile compounds such as (cox1, cox2, cox3), apocytochrome b (cob), ATP
dihydrofarnesol (R-DHF) and (2E, 6E) farnesol synthase (atp6, atp8, atp9), the small and large
(F-ol) which can prevent the growth of dermato- ribosomal RNAs (rns and rnl) and 25 tRNAs.
phytes such as T. rubrum, T. mentagrophytes, The order of the genes present in the mtDNA
M. canis and E. floccosum in a concentration of E. floccosum is similar with Trichophyton
dependent manner. E. floccosum is completely rubrum mtDNA with the exception of some
destroyed by 12.5 mcg/mL dihydrofarnesol. tRNA genes. The phylogenetic analysis confirms
T. rubrum as a close relative of E. floccosum.
earlier (Sects. 4.1 and 4.2). As E. floccosum water in the churches. In 1749, Reaumur first
never invades hair in vivo, no fluorescence is described avian aspergillosis in birds which was
detected in wood’s lamp examination. followed by report of similar syndrome in duck
2. Isolation and identification: Media and (Montagu 1813). The pathogenic Aspergillus
incubation condition as described earlier will (A. candidus) was detected in air sac lesion of a
serve the purpose. bullfinch in 1842 by Rayer and Montagene.
3. Molecular biology: The conventional diag- Whereas A. fumigatus was first detected in the
nostic PCR is employed targeting the DNA lung of a great bustard (Otis tarda) in 1863
topoisomerase II gene for detection of by Fresenius, who was the first to use the term
E. floccosum from cultures. Further, the ‘aspergillosis’ for this respiratory disease. The
uniplex PCR-ELISA can also specifically major members of aflatoxins were first detected
identify E. floccosum directly from clinical and its association with Aspergillus flavus was
specimens. The dermatophyte-specific single established in 1961 during investigation of
tube real-time PCR assay is also developed mysterious ‘turkey-X disease’, causing high
which can identify the individual dermato- mortality in turkey poults (Sargeant et al. 1961).
phyte species including E. floccosum directly In 1962, the name ‘aflatoxin’, using first letter
from clinical samples such as nails. from ‘Aspergillus’ and the first 3 letters from
‘flavus’, was proposed.
In India, Datta (1938) first reported the asso-
4.3.13 Treatment ciation of Aspergillus with bovine haematuria
affecting the kidney and bladder. Asthana
In tinea pedis and tinea cruris, topical application (1944) first isolated Aspergillus from the lungs,
of terbinafine cream once daily for 1 week and caeca, intestine, kidney, ovary and testes from
butenafine 1 % cream applied once daily for poultry in India. Pal (1996) first reported guttural
2 weeks can produce effective result. Systemic pouch mycosis in horses.
(oral) antifungal drugs (as described in Sects. 4.1
and 4.2) may be necessary in severe cases, or if
the infection does not respond to treatment or 4.4.1 Morphology
reappears.
The leaves and stem powder prepared from The mycelium is composed of septate hyphae
Commelina cyanea (indigenous plant common in (3–6 μm) with dichotomous branching. The
Northwest Cameroon) and ethanolic extract of primary branch originating from the vegetative
propolis (wax-like substance) were detected hypha is known as foot cell which is further
to have in vitro antifungal activity against branched into the conidiophores (300 μm in
E. floccosum. length and 5–8 μm in diameter). The condio-
phores contain flask-shaped vesicles, 20–30 μm
in diameter. The distal half of the vesicle is
4.4 Aspergillus covered with a single series of phialide, 6–8 μm
in length, arranged upwards paralleling the axis
Aspergillus (L. aspergillus – a special type of of the conidiophore. From these phialides, the
brush) is a filamentous, most widespread fungal chains of conidia (asexual spores) originate
genus containing both the pathogenic and bene- (Fig. 4.6). The conidial chain length occurs up
ficial species producing antibiotics, antifungals to 400 μm (A. fumigatus). In the tissues, only
and antitumour drugs. In 1729, Micheli first mycelium is observed, and in the body cavities
described Aspergillus who found the similarity filled with air (air sac, nasal passage), the
between the spore chain of the fungi with the conidiophores with the phialides are found. Dif-
brush (‘Aspergillum’) used for sprinkling holy ferent species of Aspergillus can be identified on
4.4 Aspergillus 33
the basis of their microscopic morphological The sialic acid helps in attachment of the conidia
appearances. with the extracellular matrix. The conidia are
The cell wall of Aspergillus (A. flavus) consists produced in large numbers, and due to their
of glycoproteins, β-(1, 3) glucan, β-(1, 6) glucan, small size (2–3 μm) and hydrophobicity, they
galactomannan and chitin. In A. fumigatus, the can remain viable in the air for prolonged
cell wall is composed of β-(1, 3) glucan, period. The mean concentration of Aspergillus
β-(1, 3/1,4) glucan, β-(1, 6) glucan, α (1, 3) glu- conidia in air is 0.2–15 conidia/m3 and is up to
can, chitin, mannan, β-(1, 5) galactofuranose, 106 conidia/m3 in some agricultural settings.
galactomannan (GM) and galactomannoprotein. In the favourable environment, the conidia can
These components are cross-linked with several swell and germinate into the hyphae.
other proteins. The cell wall is anchored with the Most of the Aspergillus does not have any
underlying cell membrane by glycosylphosphati- sexual stage of the growth (Fungi imperfecti)
dylinositol (GPI)-binding protein. Sometimes out- except A. fumigatus (teleomorph Neosartorya
side the cell wall, a hydrophobic layer is found fumigata), A. oryzae and A. nidulans which can
both in hyphae and conidia. produce sexual spores (ascospores). In both
The conidia or asexual spores are pigmented, A. fumigatus and A. oryzae, two opposite mating
echinulate, globose to subglobose. In addition to types (idiomorphs, MAT1-1 and MAT1-2)
the hydrophobic layer outside the cell wall, the are commonly found near close vicinity with
conidia also contain a melanin layer. The sialic the same frequency of occurrence (1:1). The
acid, composed of unsubstituted N-acetyl MAT1-1 idiomorph is associated with increased
neuraminic acid linked with galactose by α-2, virulence and higher resistance against
6 bond, is detected in the conidial surface. antifungals.
34 4 Cutaneous, Subcutaneous and Systemic Mycology
encoding small proteins which are involved in composed of mannose with side chains of
colony growth and establishment of different β (1, 5)-linked galactofuranosyl residues. It is a
clinical forms of aspergillosis. part of cell wall along with chitin. It is released
through the pores at the growing hyphal tips
during logarithmic growth phase of the fungi in
4.4.6 Isolation, Growth and Colony highest amount which helps in the detection
Characteristics of the antigen for diagnosis. GM is found in
other fungi including Penicillium, Fusarium,
Aspergillus can be isolated in Sabouraud Alternaria, Histoplasma and yeasts including
dextrose agar (SDA) with or without chloram- Cryptococcus which can produce antigenic
phenicol (0.05 g/L) and other common bacterio- cross-reaction.
logical media such as blood agar. The The cell wall of Aspergillus contains 1, 3 β D
cycloheximide can inhibit the growth. The plates glucan (BDG) which is also secreted during late
are incubated at 37 C for 4–5 days. The species logarithmic growth phase of the fungi. The BDG is
which cannot tolerate this temperature can be present in the cell walls of many pathogenic fungi
incubated at 25 C. Some species, such as including Candida, Cryptococcus, Fusarium and
A. fumigatus, is thermophilic which is able to Pneumocystis producing antigenic cross-reaction.
grow at 55–75 C. Heat shock protein (Hsp1/Asp f 12) is also
The colonies of A. fumigatus are white cot- detected as an immunodominant antigen in
tony which becomes velvety or granular with A. fumigatus which plays role in protective
green colouration after several days (Fig. 4.7). immunity.
Whereas A. flavus colonies are primarily cot-
tony and later become ‘sugary texture’ with
yellowish green colour, A. niger colonies are 4.4.8 Toxins
white in colour in the primary stage which later
becomes black due to production of black- The mycotoxins are generally produced during
coloured conidia. Similarly, A. terreus colonies hyphal growth and conidiogenesis which are
are initially white which later become cinnamon- secreted in the environment or released after the
buff coloured with ‘sugary texture’. death of the hyphae. Conidia may also contain
the preformed mycotoxin. A. fumigatus produces
many toxins as secondary metabolites.
4.4.7 Antigenic Characteristics
4.4.8.1 Aflatoxins
Galactomannan (GM) is the major antigen of Aflatoxins are difuranocoumarin compounds
Aspergillus which is a carbohydrate molecule produced by different species of Aspergillus as
secondary metabolite. It has six major types such characterised by a disulphide bridge across a
as B1, B2, G1, G2, M1 and M2. Aflatoxin M1 piperazine ring which is essential for their toxic-
and M2 are produced as metabolites of B1 and ity. It can inhibit macrophage and neutrophil-
B2, and they are commonly found in milk and to mediated phagocytosis, mitogen-activated
some extent in eggs. Among different species T cell proliferation, mast cell activation, cyto-
Aspergillus flavus is the chief producer which toxic T cell response and reactive oxygen species
can affect many agricultural crops such as production. Further, the gliotoxin causes mono-
maize, cotton, groundnuts (peanuts), Brazil cyte apoptosis, inhibition of epithelial cells cili-
nuts, pecans, pistachio nuts and walnuts. Both ary movement and epithelial cell damage. There
preharvest and postharvest contamination of is a putative 12-gene cluster which encodes
these crops with aflatoxins is common. However, the toxin. Among the gene cluster, gliZ and gliP
other species such as A. fumigatus can produce play major role.
aflatoxin B1 and G1.
Among the six types of aflatoxin, B1 (AFB1) 4.4.8.3 Ochratoxins
is the most potent toxin and carcinogen than In tropical countries, ochratoxins are mainly
others in human and animals including birds, produced by A. ochraceus and A. carbonarius.
fish and rodents. The chronic intoxication can A. ochraceus are mostly associated with dried
cause immunosuppression, malnutrition, and stored foods (cereals). Whereas A. carbo-
centrilobular necrosis and fatty infiltration of narius is commonly found in fruits (grapes) that
the liver including hepatomas and degeneration mature in sunlight and at high temperature, the
of respiratory system. Maximum permissible ochratoxin is considered as potent nephrotoxic,
limit of total aflatoxin and M1 (AFM1) is carcinogenic (human carcinogen of 2B group),
20 ppb in feed and food for human and 0.5 ppb genotoxic and immunotoxic.
in milk, respectively, as guidelined by the
US Food and Drug Administration (FDA). 4.4.8.4 Citrinin
European Commission has set the limit at It is a fungal metabolite which was first isolated
15 ppb for total aflatoxin in groundnuts. from Penicillium citrinum. Other fungi such as
The aflatoxin synthesis genes are located by A. terreus can also produce citrinin. It is fre-
making a cluster in the genome of A. flavus. The quently detected in feed stuffs or food along
major regulator gene is aflR, located in the centre with ochratoxin A, and it can increase the toxic-
of the cluster. Major transcription regulator gene ity of ochratoxin synergistically. The intoxica-
is aflS (aflJ) located adjacent to the aflR. Other tion with both of the toxins together may cause
unrelated genes such as laeA and veA are endemic nephropathy. Further, citrinin is also
involved in global regulatory role in aflatoxin embryocidal and foetotoxic.
biosynthesis. Many nutritional factors such as
carbon, nitrogen, amino acid, lipid and trace 4.4.8.5 Ribotoxins (Restrictocin,
elements control aflatoxin biosynthesis. Other Mitogillin)
regulatory factors required for aflatoxin synthesis The ribotoxins are produced by A. fumigatus
includes the temperature (28–35 C), acidic pH, which specifically targets the sarcin/ricin domain
hot weather and drought conditions, sporulation of 28S rRNA and inhibits the protein synthesis.
and sclerotia formation of the fungi and oxidative The toxins are encoded by asp f1/mitF/res gene.
stress. Certain plant metabolite such as n-decyl Mitogillin is highly cytotoxic causing cell death
aldehyde is inhibitory to aflatoxin production. even in low concentration.
Table 4.12 Major diseases of animals and human caused by Aspergillus sp.
Fungi Host Disease
A. fumigatus, A. flavus, A. niger, Poultry (poultry are relatively more Avian aspergillosis/brooder pneumonia
A. glaucus, A. nidulans susceptible due to differences in The disease is characterised by rhinitis,
(A. fumigatus is the major cause anatomical, physiological and mycotic keratitis associated with
probably due to smaller size of the respiratory immune system blepharospasm, photophobia, periorbital
spores than other species which compared with other mammals) swelling, turbid discharge, swollen and
helps in easy transmission) adhered eyelids, cloudy cornea and cheesy
yellow exudates within the conjunctival sac,
lung congestion, unilateral drooping of the
wing due to infection of the thoracic air sac,
clavicular air sac or the proximal humerus,
repeated vomition due to lesions in the
anterior air sacs. The respiratory signs are
not regularly detected. In postmortem
examination, green/yellow/white necrotic
foci are observed in the lung and other
organs
A. fumigatus Horse (a) Guttural pouch mycosis
Necrotizing inflammation and formation of
diphtheritic membrane in guttural pouch
(auditory tube diverticulum). Clinical signs
include epistaxis, unilateral purulent nasal
discharge, abnormal head position.
It occurs most commonly in stabled horses
during summer
(b) Nasal granuloma
(c) Corneal ulcer
A. fumigatus Dogs (a) Canine sinonasal aspergillosis/canine
rhinitis
The disease is characterised by persistent
sneezing and nasal discharge which is
unresponsive to antibiotics. The infection
involves paranasal sinuses, nasal cavity,
turbinate bones and CNS. Golden Retrievers
and Collie breeds are more susceptible
(b) Otitis externa
(c) Chronic rhinitis
A. fumigatus Human Invasive aspergillosis
A disease of the respiratory tract which
involves the lung parenchyma, pleura,
trachea and bronchi. It is common in the
patients with haematological malignancy,
prolonged antibiotic users or stem cell
transplant recipients
A. fumigatus Cattle, horse Sporadic abortion especially during winter
which is associated with hay feeding. The
fungi invade the foetus and produce
cutaneous lesions
A. fumigatus Cattle (a) Mastitis (abscess in udder)
(b) Pneumonia
Aspergillus sp. Calves Mycotic gastritis
Aspergillus sp. Horses Keratomycosis
It is characterised by corneal opacity,
ulceration and formation of endothelial
plaques in the centre of the cornea
42 4 Cutaneous, Subcutaneous and Systemic Mycology
(β-glucan, GM, chitin) act as ligand (pathogen- receptor for advanced glycation end products
associated molecular pattern, PAMP). The soluble (RAGE) to activate the T cells. The epithelial
receptors act as opsonin which enhances phagocy- cells in addition express the pattern recognition
tosis by the alveolar macrophages. Pentraxin receptors for fungal recognition and as a conse-
(PTX3) specifically binds the conidia (not hyphae) quence induce the T cell tolerance.
and enhances their phagocytosis by dendritic The activated Th1 cells secrete IFN γ which
cells and alveolar macrophages. After the compat- helps in the clearance of the hyphae and produces
ible binding of the fungi and cell-associated a protective immunity. Whereas activation of
PRRs, the cytoplasmic tail attached with the Th2 cells causes the secretion of IL4, IL5 is
receptors which contains an immunoreceptor responsible for fungal allergy in the host and it
tyrosine-based activation (ITAM)-like motif gets prevents the clearance. Th17 cell activation
phosphorylated. This phosphorylation activates correlates with Aspergillus infection during
several pathways to stimulate the phagocytes immunodeficiencies. The Th17 cells secrete
for killing of the conidia through the produc- IL17 and IL22 which recruits neutrophils. Fur-
tion of NADPH-dependent reactive oxygen ther, fungal growth, inflammatory immunity and
species (ROS). The phosphorylation also acti- tolerance to Aspergillus are controlled by the
vates the NFκB and stimulates the secretion of activation of natural (n) Treg cells. This kind of
pro-inflammatory cytokines (IL12, TNFα). The Treg cells can suppress the neutrophils through
cytokines help in the recruitment of the immune the combined actions of IL10 and CTLA4 acting
cells at the site of the infection. Further, on dendritic cells to produce indoleamine
A. fumigates hyphae (not conidia), through the 2, 3-dioxygenase (IDO). This enzyme helps in
production of ROS, can stimulate NLRP3 controlling inflammation, infection and allergy.
inflammasome to release active IL1β which can Thus, protective immunity to Aspergillus is
recruit more amount of neutrophils. These dependent on balanced act of Treg cells over
neutrophils produce a neutrophil entrapment effector Th1 and Th17 cells, with the contribu-
traps (NETs) to engulf the larger hyphae which tion of IDO.
are not phagocytosed by the macrophages.
The innate immune system also influences
the subsequent development of T cell-mediated 4.4.14 Diagnosis
adaptive response. The adaptive response is
initiated with the dendritic cells which can engulf 4.4.14.1 Clinical Specimens
the conidia or hyphae to carry them into the The clinical specimens from animals or poultry
draining lymph nodes. The conidial engulfment include mastitic milk, foetal stomach contents,
occurs through the ‘coiling phagocytosis’ in ear swabs, skin scrapping and biopsies from
which the dendritic pseudopods rotate around nasal granuloma and plaques in the guttural
the conidia to form a layer following the binding pouch. The specimen from human is lower respi-
of the mannose receptor DC-SIGN and comple- ratory tract sample by bronchoalveolar lavage.
ment receptor 3 (CR3). Whereas the hyphal After postmortem, pneumonic lung, nodules
engulfment occurs through ‘zipper phagocytosis’ from vital organs may be collected. The small
after the binding of Fc receptor (as ligand) and tissue samples may be wrapped in a piece of
complement receptor 3 (CR3), this kind of paper before putting into the 10 % formalin.
phagocytosis occurs following the contour of
the fungi which further activates the 4.4.14.2 Laboratory Examination
IL4-producing CD4 T cells in the spleen and 1. Direct examination:
mediastinal lymph nodes. The dendritic cells The clinical specimens especially the tissue
can also recognise the damage-associated molec- scrapings should be cleared with 10 % KOH
ular pattern (DAMP) of the fungi through the and are observed under the microscope.
4.4 Aspergillus 43
Table 4.14 Major diseases of animal and human caused by Blastomyces dermatitidis
Fungi Host Disease
Blastomyces Dogs Lung lesions occur in 65–85 % of cases and may be clinically silent or associated with
dermatitidis cough, tachypnea, exercise intolerance, cyanosis or respiratory distress. Other major
clinical signs are anorexia, focal bone infections causing lameness and osteolysis,
lymphadenopathy, skin lesions, corneal opacity, conjunctivitis, blindness, orchitis and
immunosuppression. Neurologic symptoms are uncommon in dogs reported in only 3–6 %
of cases. Reported neurologic signs include lethargy, neck pain, circling, cranial nerve
deficits, head pressing, seizures, hypermetria, ataxia and tetraparesis
Cats Pyrogranulomatous inflammation of different organs, nasal discharge, cough, weight loss
Horses Pyrogranulomatous pneumonia, pleuritis, peritonitis, cutaneous abscess
Human The clinical signs are highly variable. Common signs include weight loss, fever, fatigue
and other nonspecific complaints. Pulmonary infection produces either acute or chronic
pneumonia. The acute pneumonic patients show fever, chills and productive purulent
cough, with or without haemoptysis. The patients with chronic pneumonia show weight
loss, night sweats, fever and cough with sputum production. The extrapulmonary infection
is characterised by skin lesions which are either verrucous (raised lesion with sharp and
irregular border) or ulcerative, osteomyelitis, prostatitis, orchitis and meningitis
other organ-producing granulomas. These transfer of antibodies could not protect the exper-
granulomas do not caseate as occurs in case of imental animals infected with B. dermatitidis.
tuberculosis. After recovery from the pulmonary
infection, sometimes endogenous reactivation
occurs with or without previous therapy. 4.5.14 Diagnosis
are also demonstrated by the negative staining and Coccidioides immitis. Blastomyces is
with the Diff-Quik (DQ) stain which demon- weakly positive, whereas Coccidioides
strates the unstained yeast cells present in immitis is negative. In situ hybridisation with
the stained background. Since they are not specific probe can diagnose Blastomyces
commensal and colonisation does not occur within the tissues.
so their detection in direct smear establishes 4. Detection of antigen: In human, the ELISA-
the diagnosis, and it is considered as most based kits are available to detect the
rapid diagnostic technique for blastomycosis. Blastomyces antigen (A-antigen) in urine,
However, negative finding is inconclusive as cerebrospinal fluid and bronchoalveolar
37–46 % of human blastomycosis patients lavage fluid. Sometimes it produces cross-
reveal the presence of Blastomyces in direct reaction with Histoplasma capsulatum var.
smear. capsulatum due to the presence of shared
2. Isolation and identification: Media and incu- carbohydrate fraction of A-antigen. Currently
bation condition as described earlier will BAD1 is the antigenic target having no cross-
serve the purpose. It is the most sensitive reaction with Histoplasma as it does not con-
and gold standard method for diagnosis of tain carbohydrate. Detection of β-D-glucan
blastomycosis. However, the mycelial form (BDG) is not so effective in blastomycosis.
is highly infectious, and the caution should 5. Serological tests:
be taken in handling of the culture in the (a) Complement fixation test (CFT) can be
laboratory and it is a time-consuming process performed with the yeast phase antigen
causing delay in diagnosis. The confirmation for detection of anti-Blastomyces
of culture can be done by conversion of antibodies. However, the sensitivity and
yeast phase into the mould phase, PCR and specificity is low (57 and 30 %,
commercially available DNA probe. respectively).
3. Histopathology: In the clinical specimens (b) Immunodiffusion using purified
such as saliva or sputum, fine needle aspirates B. dermatitidis A-antigen is more specific
and formalin-fixed tissues, the classical look and sensitive (65–80 %).
of the Blastomyces yeasts such as round to (c) Enzyme-linked immunossorbent assay
oval multinucleate cells with a single broad- (ELISA) and radio immune assay (RIA)-
based bud located intra or extracellularly based techniques are currently most
helps in diagnosis. The tissue sections are sensitive techniques for the detection
stained with haematoxylin and eosin, periodic of Blastomyces antibodies. The sand-
acid–Schiff stain (PAS), PAS with haema- wich and competitive-binding inhibition
toxylin counter stain and Grocott methena- ELISA are used for detection of antibodies.
mine silver (GMS). If the classical look 6. Skin test (delayed type of hypersensitivity):
is not detected, then the diagnosis becomes The crude fungal extract (blastomycin)
difficult as it produces confusion with can be inoculated into the susceptible animal
other yeasts. In such cases, the mucicarmine for detection of hypersensitivity (like tuber-
stain can differentiate the Cryptococcus culin test). However, the test is neither sensi-
neoformans and Blastomyces as it can specifi- tive nor specific. The swelling rapidly
cally stain the capsule present surrounding the diminishes and the test is negative during
Cryptococcus cells. Melanin stain can also repeat testing.
differentiate Blastomyces from other yeasts. 7. Molecular biology: PCR-based technique
The Alcian blue or acid-fast stain can be such as nested PCR can be used for detection
used for differentiation between Blastomyces of Blastomyces.
50 4 Cutaneous, Subcutaneous and Systemic Mycology
of certain enzymes such as chitinase and There are minor differences in amino acid
glucanase is observed. The endospores may fur- sequence between two species, but they are
ther generate the mycelial form if they return to similar in antigenicity, virulence or morphology.
the soil or grow in artificial culture medium
(Fig. 4.11).
4.6.3 Reproduction
The young colonies are white and moist, to six copies of proline and aspartic acid-rich
glabrous and tenacious, and adhering to the sequences. The number of copies varies with
medium. At this young stage, no arthroconidia strain. However, the antigen is shared by geneti-
is detected. With maturity of the culture, discrete cally and geographically diverse strains.
concentric rings and the filamentous area The saprobic phase contains a heat-stable,
containing arthroconidia become visible. The 19 kDa antigen with proteinase activity which
pigmentation with tan, brown, pink, grey or is also considered as a Coccidioides-specific
yellow colour was also detected in matured antigen (CS-Ag). Recently, an in-house antigen
colonies. of Coccidioides is described containing
β-glucosidase (45–67 KDa) and glutamine syn-
thetase (67–97 KDa) as major immunoreactive
4.6.8 Antigenic Characteristics proteins which can react with serum samples of
the patients suffering from the infection.
The major immunodominant antigen of The carbohydrate antigen is detected in the
C. immitis is spherule outer wall glycoprotein mycelial extract (coccidioidin) along with some
(SOW Gp) which can produce both antibody- amino acid nitrogen.
mediated and cellular immune responses. This
glycoprotein consists of a signal peptide and
pro-peptide, a proline and aspartic acid-rich tan- 4.6.9 Virulence Factors
dem repeat motif, and a glycosylphosphatidy-
linositol (GPI) anchor. The repeat domain is The virulence factors possessed by Coccidioides
41–47 amino acids in length and contains three immitis are enlisted in Table 4.15.
4.6.10 Transmission
Table 4.17 Pattern recognition receptors and their with endospores which is diagnostic of
ligands involved in recognition of Coccidioides coccidioidomycosis. The presence of imma-
Coccidioidal pathogen- ture spherule or endospores without spherule
Pattern recognition receptors associated molecular may be confused with other fungal infection.
(PRRs) pattern (PAMPs)
The calcofluor white (CFW) fluorescent stain
TLR2 Unidentified
offers best detection of the fungi by binding
Dectin1 β-glucan
the chitin and cellulose of the cell wall.
Mannose receptor (MR) Mannan
However, it can also nonspecifically stain the
Surfactant proteins A (SPA) Unidentified
Surfactant proteins D (SPD) Unidentified
plant and fatty substances.
2. Isolation and identification: Media and
incubation condition as described earlier will
to bind and internalise the spherules. It is followed serve the purpose. However, Coccidioides is
by production of a T cell-mediated response extremely hazardous to handle, and several
because they can elevate the T cell cases of infection from the laboratories are
co-stimulatory molecule production. documented through inhalation of arthro-
The PAMP–PRR interactions stimulate the conidia. It is also considered as a ‘select
production of IL12 and IL23 which can convert agent’ of bioterrorism. So, Coccidioides-
the naive T cells into antigen-specific T cell specific laboratory should have biosafety
populations. There are two functionally distinct level 3 containment maintained with negative
subsets of CD4+ T cells, i.e. Th1 and Th2 cells. air pressure. Further, expertise is needed in
Both clinical and experimental evidence have handling of the colonies because the
demonstrated that Th1-mediated immunity is arthroconidia are easily generated. However,
essential for defence against coccidioidomyco- the routine laboratory where suspected culture
sis. The activation of Th1 cells will increase the of Coccidioides is handled should have mini-
level of IFNγ, IL2 and other cytokines which mum biosafety level 2 facilities. All the
provides the signals for recruiting and activating cultures are handled under class II biological
immune effector cells, whereas the activation of safety cabinet containing vertical laminar air-
Th2 response increases the antibody level such as flow with HEPA (high efficiency particulate
serum IgG, IgE and IgA which does not offer any air) filter and exhaust air. The lid of the Petri
protection. dishes along with suspected culture should be
taped, if preserved for 5–7 days. After identi-
fication, the routine laboratory should destroy
4.6.14 Diagnosis the culture properly. The culture should not be
transferred without prior permission from the
4.6.14.1 Clinical Specimens authority.
The clinical specimens for diagnosis of coccidi- 3. Histopathology: The histopathological exam-
oidomycosis include pus or exudates from lesion, ination can be performed on the biopsy
transtracheal washes, skin scrapings and biopsies materials collected from the skin, bone,
from lymph node, bone, etc. In human, the lung, brain, etc., to confirm whether the infec-
specimens include sputum, bronchoalveolar tion is disseminated into different organs.
lavage, transtracheal aspirates and lung biopsies. In the tissues, endosporulating spherules,
All specimens should be labelled as potentially empty ruptured spherules and immature non-
hazardous during transport. endosporulating spherules can be detected by
staining. Sometimes, mycelia are observed in
4.6.14.2 Laboratory Examination the tissues which are indistinguishable from
1. Direct examination: The wet mounts with other common fungi. The Grocott methena-
10 % KOH are employed on the clinical mine silver stain is the best stain for detection
specimen for detection of the spherule of Coccidioides in histopathological sections.
4.6 Coccidioides 57
However, Grocott methenamine silver can higher IgG titres with Histoplasma and
also stain the tissue elements such as mucus, Blastomyces antigens than with Coccidioides
glycogen granules and some bacteria. It antigen.
causes overstaining of the fungi which can Currently ELISA-based tests are also
mask the endospores within the spherule. developed for detection of anti-Coccidioides
Other histological stains, such as periodic antibodies.
acid–Schiff (PAS), haematoxylin-eosin, 6. Skin test for detection of delayed-type hyper-
Giemsa, papanicolaou and mucicarmine, can sensitivity (DTH): The antigen used in classi-
also be used as a substitute. cal skin test is known as ‘coccidioidin’.
4. Detection of antigen: Detection of antigen is Primarily it was prepared as a soluble broth
useful in the very early stage of coccidioido- culture filtrate of mycelial cells grown for
mycosis when antibody is not developed 2 months in a synthetic asparagine–gly-
(within 1 week) and in the patients suffering cerol–salt medium. Later, an aqueous lysate
from hypogammaglobulinaemia or other of spherules was prepared from Coccidioides
immunodeficiency who are unable to produce strain (Silveira) that had been grown in Con-
the antibody. The tests such as radioimmuno- verse medium and then incubated in distilled
assay (RIA) and inhibition ELISA were water for up to 40 days at 34 C. The soluble
developed to detect the protein–carbohydrate aqueous lysate is designated as ‘spherulin’
conjugate antigen of the fungi. which can also be used as antigen in skin
5. Serological tests: The serological tests are test. The skin test can be performed in
not only diagnostic but also indicative about human, dogs, horses, llamas and nonhuman
the prognosis of the infection. Detection of primates. Reversion of positive result into
anti-Coccidioides IgM (within 1–3 weeks the negative indicates grave prognosis. How-
of infection) can be done by tube precipitin ever, negative result cannot rule out the
(TP) and immunodiffusion (ID) tests. The infection.
TP is based on heat-stable 120 kDa β glu- 7. Molecular biology: Primarily a polymerase
cosidase antigen, whereas detection of IgG chain reaction (PCR) was developed using
(after third week–several months) can be the primers of 18S rDNA of Coccidioides.
done by complement fixation test (CFT) Further, a real-time PCR is developed with
which is based on heat-labile chitinase anti- primers amplifying a 170 base-pair part in
gen. However, canine serum contains anti- the ITS2 (internal-transcribed spacer 2) region
complementary substances; so CFT cannot of the rDNA genome. Several studies also
be performed in the dogs. Serological IgG successfully validated about using PCR to
titre can indicate about the severity of the detect the unique coccidioidal gene [antigen-
infection in human. For example, increasing 2/proline rich antigen (Ag2/PRA)].
IgG titre such as 1:32 or more indicates about
the disseminated infection in human, whereas
IgG titre between 1:2 and 1:16 is considered 4.6.15 Treatment
as positive for infected dogs.
Sometimes, false-positive band is produced In dogs and cats, oral treatment with keto-
in ID test due to reaction between coccidioidal conazole, itraconazole and fluconazole with a
antigen and C-reactive substances present dose range between 2.5 mg/kg twice daily to
in the serum. This false band can be dissolved 20 mg/kg twice daily is usually performed to
with 1.5 % aqueous solution of sodium treat coccidioidomycosis. The adverse side
EDTA, whereas the authentic band will effects of oral azole therapy in dogs and cats
remain as such even after washing. are similar with human. It includes reduced
The cross-reaction is observed with other appetite, vomition and diarrhoea. Sometimes,
systemic fungi. The sera from mild and pri- a vasculitis causing suppurative skin lesions has
mary cases of coccidioidomycosis produce been observed as an adverse effect of itraconazole
58 4 Cutaneous, Subcutaneous and Systemic Mycology
in dogs. Similarly, polyuria/polydipsia, thinning whom had resided in Panama for a long period.
of hair coat is detected with fluconazole treatment Initially the fungal aetiology was not ascertained;
in dogs. Reduced fertility of male dogs is reported rather it was thought as ‘encapsulated protozoa
with ketoconazole treatment. residing within histiocytes’, so it was named as
As an intravenous infusion, amphotericin B Histoplasma. In 1934, William DeMonbreun
deoxycholate can be given. However, it has established the association of histoplasmosis
potent renal toxicity. Instead, currently ampho- with fungus. He first isolated the organism in
tericin B lipid complex is preferred to treat the artificial media, showed its dimorphism and
canine and feline patients who are not responding experimentally produced the infection in labora-
with the orally administered azoles. tory animals to meet the conditions of Koch’s
Administration of oral antifungals is not so postulate (De Monbreun 1934). In 1939, he
effective in llamas and alpacas where the drugs described the infection in a dog died from
are metabolised and lost without absorption hepatomegaly (De Monbreun 1939).
in the fermentative forestomach. Further, their
jugular vein is also not easily accessible for
intravenous application of antifungals. 4.7.1 Morphology
also plays an important role in protection. IL23 (Th17 response) plays a vital role in
It can also stimulate the fungicidal activity of protection.
macrophages with the production of nitric oxide In contrast, Th2 type of immunity generated
and indirectly organises cellular migration by by IL4 delays the clearance of H. capsulatum
controlling chemokine production and adjusts from the lungs and spleen. IL4 enhances the
the emergence of regulatory T cells (Tregs). intracellular fungal growth by reducing nitric
Tregs in TNFα-neutralised mice dampen the pro- oxide production and increasing the availability
tective immune response in an IL10-dependent of iron, zinc and calcium.
manner. Other Th1-associated cytokines such as The antibody response to Histoplasma
granulocyte-macrophage colony-stimulating fac- capsulatum infection is characterised with an
tor (GM-CSF) stimulates macrophage fungistatic increase in IgM by 2 weeks, followed by rising
activity against H. capsulatum yeast. titres of IgA and IgG. The IgG fraction contains
Recently the role of Th17 response in complement-fixing and precipitating antibodies.
H. capsulatum infection is also explored. In However, the protective role of humoral immu-
pulmonary histoplasmosis, IL17, IL6 and IL23 nity is uncertain. Experimentally no significant
gradually increase the first week of infection and difference was observed between B cell-deficient
declines thereafter. CD4+ and CD8+ T cells and the wild-type mice in primary and secondary
expressing CD25 are the predominant source of histoplasmosis.
IL17 during infection. IL17 can enhance the
entry of inflammatory cells into the lungs; how- 4.7.12.2 H. capsulatum var. farciminosum
ever, it directly has minimal role in protection, Cellular immunity plays a protective role in
whereas in the absence of IL12 (Th1 response), epizootic lymphangitis. The antibodies develop
66 4 Cutaneous, Subcutaneous and Systemic Mycology
more specific than CFT. It gives positive neck. The inoculation site is examined
results in the majority of progressive for the presence of swelling at 24, 48
pulmonary and disseminated forms, and and 72 h postinjection. In positive case,
its titres are related to the fungal burden, an indurated and elevated area at the
so they decrease with the successful treat- injection site will be observed.
ment. Immunodiffusion is not very useful 6. Molecular biology: A PCR assay was devel-
in HIV-positive patients with histoplas- oped for detection of H. capsulatum var.
mosis, since it gives positive results in capsulatum from both the clinical samples
only 35 % of mycologically proved cases and culture using the primers for the gene
of histoplasmosis. encoding M antigen. This assay had a sensi-
The CFT uses two types of antigens, tivity and specificity of 100 %.
i.e. yeast and mycelial (histoplasmin). The Real-time PCR showed promising result by
diagnosis is based on fourfold rise in CF detection of H. capsulatum var. capsulatum
antibody titre; a single titre of 1:32 from tissue biopsies and bronchoalveolar
is suggestive but not diagnostic. The CF lavage fluid from human patients who had
antibody persists for more than 1 year. documented histoplasmosis.
The test is cross-reactive with other fungal
infection and granulomatous diseases
such as tuberculosis and sarcoidosis. 4.7.14 Treatment
Histoplasma antibody was detected in
the urine of 89 % of human patients with In human suffering from pulmonary and
disseminated form of histoplasmosis and disseminated form of histoplasmosis, liposomal
37 % of human patients with other forms amphotericin B (for 2–3 weeks) followed by
of histoplasmosis by RIA and ELISA itraconazole can be administered. In chronic pul-
methods. The specificity was noted as monary histoplasmosis, itraconazole and keto-
99 %. However, false-positive result was conazole are effective. The course of treatment
noted in transplant patients receiving is 3 months to 1 year depending on the severity.
rabbit antithymocyte globulin. The sero- Due to prolonged therapy, careful monitoring for
logical response is strongly detectable nephrotoxicity (amphotericin B) and drug inter-
in pulmonary histoplasmosis than diss- action (itraconazole) is required. Itraconazole
eminated and asymptomatic forms due to is also used as prophylactic drug in patients of
lower intensity of exposure resulting in endemic zone having less CD4+ T cells. In AIDS
reduced fungal burden and antigenic sim- patients, bioavailability of itraconazole is
ulation or due to immunosuppression. decreased. Oral posaconazole and voriconazole
(b) Skin hypersensitivity test (histofarcin test) are currently considered as alternative treatments
The mycelial form of H. capsulatum for non-severe disseminated histoplasmosis.
var. farciminosum is grown on polysty- Fluconazole is less effective but can be used in
rene discs floating PPLO media the patients who are allergic to itraconazole.
containing 2 % glucose and 2.5 % glycer- In horses suffering from epizootic
ine at 23–25 C for 4 months. The fungus- lymphangitis, surgical removal of lesion along
free culture filtrate is mixed with acetone with amphotericin B administration is
(2:1) and held at 4 C for 48 h. The super- recommended.
natant is decanted and the acetone is In dog and cats, drug of choice is itraconazole
allowed to evaporate. The precipitate is due to low level of toxicity. Other drugs such as
suspended to 1/10 original volume in dis- ketoconazole and fluconazole are also effective.
tilled water. The animals are inoculated Pulmonary form is curable with proper treatment.
intradermally with 0.1 ml of antigen in the The prognosis of disseminated form is grave.
68 4 Cutaneous, Subcutaneous and Systemic Mycology
The mature endospores contain a bilaminated After release, the endospores increases in size
thin cell wall (1–3 μm), 15–20 spherical (1–3 μm (10–70 μm) and lose all the EDBs to become a
in diameter) electron-dense bodies (EDB), juvenile sporangium and the cycle is repeated.
nucleus with nucleolus, Golgi apparatus, endo- The life cycle of Rhinosporidium seeberi is
plasmic reticulum and mitochondria. The shown in Fig. 4.17.
electron-dense bodies either act as nutrient reser-
voir or precursor of endosporulated sporangia
and they are known as ‘spore-morula’.
The mature endospores are released from the 4.8.2 Classification
sporangium through the pore. There are two
explanations of the endospore release mecha- The taxonomical status of Rhinosporidium
nism. In contact with watery material, lytic seeberi is controversial because it could not be
enzymes are accumulated at the pore site of the isolated in artificial culture. Previously, it was
mature sporangia. The inner osmotic pressure of considered as a cyanobacterium under the genus
the mature sporangia is also increased which Microcystis probably due to morphological
facilitates the release of endospores through the resemblance between coccal-shaped Microcystis
pore. Another explanation states that due to nanocytes and spherical endospores of
high antigenicity of the sporangia, anti-sporangia Rhinosporidium. However, 16S rRNA sequence
antibodies are developed by the host defence analysis revealed only 79–86 % similarity with
system. The immune complexes are produced Microcystis. The ultrastructural studies revealed
by the interaction of the antigen and antibody. that the nanocytes do not possess a true cell wall
The complexes aid in expulsion of endospores by and are held together with an amorphous matrix,
producing external pressure during expansion of whereas the R. seeberi endospores are
the sporangia through increased water intake. surrounded with a thin cell wall.
Protists
The total period of exposure of endospores to
the studied disinfectants was for 7 min which
Plant Animal produced metabolic inactivation.
Jellyfish
Fungi
Sponge 4.8.4 Natural Habitat and Distribution
Choanoflagellate
DRIP
Aquatic environment is detected as major eco-
logical niche of R. seeberi because most of the
Fig. 4.18 Phylogenetic position of DRIP group
patients are observed in close proximity with
same water source in a locality such as lake,
Further studies revealed its eukaryotic nature pond, etc. However, the fungi are also present
and claimed its morphological similarities with in the dry areas of North India, Middle East
Chytridiales group of fungi. However, compara- countries and Argentina probably through the
tive studies by other workers showed certain formation of a resistant structure.
morphological dissimilarities especially in the The fungus is reported from more than
cell wall structure between R. seeberi and proto- 70 countries with highest incidence (95 %) in
type member of Chytridiales. The most impor- India and Srilanka which are considered as
tant dissimilarity is the compulsive intracellular endemic zones. India and Srilanka is followed
nature of Chytridiales which is not possible in by South America, Brazil, Argentina and Mexico
R. seeberi due to their larger size. and a few reports are available from Nepal,
Later, phylogenetic and taxonomic analysis Columbia, Venezuela, United States, Uganda,
placed it under the new cluster of aquatic Madagascar, Ghana, Iran, Russia, Europe and
pathogens, known as the DRIP group Southeast Asia. Most of the cases in human and
(Dermocystidium, rosette agent which is pres- animals such as cattle, buffalo, goat, dog, cat,
ently known as S. destruens, Ichthyophonus mule, duck, geese and water fowl are sporadic.
and Psorospermium). The DRIP group was The sole human and swan outbreak of ocular and
renamed as Mesomycetozoa class which is nasal rhinosporiodiosis was reported so far from
located at the divergence between animals Serbia and Florida, United States, respectively.
and fungi (Fig. 4.18). The class is composed
of two orders such as Dermocystida and
Ichthyophonida. The morphological and phylo- 4.8.5 Genome
genetic analysis of R. seeberi revealed its simi-
larity with the members of Dermocystida. The The juvenile sporangium of R. seeberi contains
presence of synchronised nuclear division with four chromosomes. Other genome characterisa-
the formation of endospores in the matured stage tion of R. seeberi is poorly known because most
confirms its association with Mesomycetozoa of the sequences deposited in the genbank
class. (NCBI) are rDNA sequences rather than the
protein-coding sequences. Further no informa-
tion is also available about the genome of closely
4.8.3 Susceptibility to Disinfectants related mesomycetozoeans.
culture without any success. Although a few these factors. There is no clear evidence of
workers have claimed about isolation of transmission between human, animals, human
R. seeberi in artificial culture and in human rectal to animals and vice versa.
epitheloid cell line, further studies failed to sup-
port their statement. The confirmational studies
revealed that the isolates were environmental 4.8.9 Pathogenesis
contaminant. In crushed rhinosporidial tissues,
formation of endospores and sporangium was The primary lesion develops in the nasal passage
noticed when kept at low temperature or room of the host after transmission of the infection.
temperature. However, the sustained propagation The rhinosporidial lesions are polypoidal, less
with repetition of the whole life cycle was not than 3 cm in diameter, pedunculated or sessile,
found in any culture system. granular, multilobed and red in colour due to
marked vascularity. Due to pronounced vascular-
ity, the lesion bleeds easily. The surface of the
4.8.7 Antigenic Characteristics lesion contains yellowish small spots underlying
mature sporangia. The polypoidal lesions devel-
In the mature sporangium of R. seeberi, an oped in the face and trunk are converted into
immunodominant antigen is detected which is verrucous warts.
absent in juvenile or early mature sporangium The dissemination of infection may occur
and the endospores. The antigen is located in through the blood circulation into the distant
the inner electron lucent cytoplasmic layers of viscera. The local spread may occur into the
the mature sporangium. Another study revealed adjacent area of the polypoidal lesions by spill-
the presence of a circulating antigen in the sera of age of the endospores during trauma or surgery
the patients infected with R. seeberi. However, of the polyp. It is known as ‘autoinoculation’.
further characterisation is needed to detect their The disseminated lesions have been detected
chemical structure. in the conjunctival sac, ear, vagina, limbs, trunk
and other external part of the body where it
appears as subcutaneous lump with intact skin.
4.8.8 Transmission The lesions are ulcerated growths resembling
sarcomas and carcinomas. The involvement of
In human, nasal form is the most common form the limbs often causes the destruction of under-
of rhinosporidiosis which occurs due to frequent lying bones. The dissemination of the infection
bathing or working in stagnant fresh water. The into the central nervous system has fatal
skin injury is the most frequent predisposing consequence.
factor. It is commonly observed in river-sand
workers in India and Srilanka. The sand particles
cause skin abrasions through which the infection 4.8.10 Disease Produced
can occur during direct contact with the
contaminated river water. However, in arid There are four clinical forms of rhinosporidiosis
zones such as in North India and Middle East detected in human patients. In nasal form, the
countries, ocular form predominates and the lesions (polyp) develop at the anterior nares,
resistant endospores are considered as major nasal cavity, septum and floor. The nasopharynx,
infectious agent. The endospores are transmitted larynx and soft palate are sometimes affected.
through air especially during sand storms. The formation of polyp is painless until it
In animals, the infection takes place through becomes large enough to obstruct the nasal
traumatised skin from the contaminated passage or to put pressure on the nerve and vas-
water bodies. The hunting or street dogs are culature endings. In ocular form, the lesions
in increased risk due to more exposure to develop in the bulbar and palpebral conjunctiva.
72 4 Cutaneous, Subcutaneous and Systemic Mycology
The ocular lesion begins with a sessile growth macerated polyp to detect the sporangia
which later becomes pedunculated, degenerating (350–400 μm in diameter) with endospores
to friable. If the lesion becomes large, there is or the empty sporangia and free endospores
redness of eyes, tearing, photophobia, lid ever- in positive samples. It may produce confusion
sion and conjunctivitis. The cutaneous form is with the spherules of Coccidioides immitis
characterised by formation of papule initially which are smaller (60–100 μm diameter;
which later becomes wart-like growth with a Fig. 4.12) than the mature sporangia of
crenulated surface. In the disseminated form, R. seeberi.
the sporangia are detected from the bone, liver, 2. Histopathology: The histological inspection
spleen, lung and brain. of the lesion detected hyperplastic epithelium
In dogs, the clinical signs such as visible mass with sporangia containing endospores below
within the nares, wheezing, sneezing, unilateral the surface. The area is highly vascularised
purulent nasal discharge and epistaxis are and surrounded by a connective tissue layer.
noticed. Different immune cells such as polymorpho-
nuclear cells, lymphocytes, plasma cells, giant
cells and histiocytes infiltrate into the area.
4.8.11 Immunity Different stages of R. seeberi can be observed
with special fungus stains such as the Gomori
The cell-mediated immune (CMI) response (Th1 methenamine silver, Gridley’s, periodic
mediated) is generated against R. seeberi along acid–Schiff stains and haematoxylin–eosin
with suppressor reaction. The major cell popula- stain.
tion involved in CMI response are macrophages 3. Molecular biology: The polymerase chain
(CD68), NK cells (CD57+), numerous CD8+ T reaction can detect R. seeberi by amplification
lymphocytes and less numbers of CD4+ T of the 18S rRNA gene directly from the
lymphocytes. In chronic and disseminated infec- infected tissues.
tion, the immune response is converted into
Th2-mediated response. The antibodies are
generated without any protective role against 4.8.13 Treatment
infective endospores. The antibodies are detected
to bind the soluble antigen of R. seeberi which is Spontaneous regression of the nasal growth is
released by sonication of the sporangia in vitro. observed in human and animals which is rare in
Probably it acts as an immune evasion mecha- occurrence. So, surgical intervention or treat-
nism which protects the endospores from the ment with drugs is required. Radiotherapy has
antibodies in vivo. no effect in curing of the rhinosporidial polyp.
The surgery by hot or cold snare techniques is
the treatment of choice; however, recurrence of
4.8.12 Diagnosis polyp may occur sometimes (10 %).
In animals, berenil (diminazine aceturate) and
4.8.12.1 Clinical Specimens imizol (imidocarb dipropionate) can be used.
The clinical specimens for rhinosporidiosis The human and animal drugs such as ampho-
include nasal scrape, fine needle aspirates from tericin B, dapsone, ketoconazole, trimethoprim–-
the lesion and tissue biopsy specimens. The nasal sulphadiazine and sodium stibogluconate
scrape is preferred over the fine needle aspirates showed effective in vitro anti-rhinosporidial
because the lesions bleed easily. activity. However, in vivo trial report is available
with amphotericin B which was effective topi-
4.8.12.2 Laboratory Examination cally. Instead, dapsone may be a better choice for
1. Direct examination: The KOH mount can be treatment with a dosage of 100 mg/kg body
prepared from the clinical samples such as weight orally for 6 months to 1 year.
4.9 Rhizopus 73
4.9 Rhizopus
4.9.3 Reproduction
4.9.6 Genome
4.9.8 Antigenic Characteristics
The genome of R. oryzae is 45.3 Mbp in size and
20 % of the genome is composed of transposable The heat-stable, extracellular polysaccharide
elements (repetitive DNA sequences). There are (EPS) antigen of Rhizopus has an immuno-
approximately 13,895 protein-encoding genes dominant carbohydrate epitope constituted with
which do not overlap with transposable elements. 2-O-methyl-D-mannose residue. This is a com-
The phylogenetic analysis revealed ancestral mon compound detected in Rhizopus, Mucor,
whole genome duplication which increases the Absidia and Rhizomucor which is responsible
expression of genes related with virulence, fungi- for the cross-reactivity between these genera.
specific cell wall synthesis and signal transduc- Rhizopus also secretes rhizoferrin, a
tion. This genome duplication also allows the siderophore that belongs to the polycarboxylate
fungi to grow under various adverse conditions. family. This siderophore can elicit immune
The genome contains two types of lactate response.
76 4 Cutaneous, Subcutaneous and Systemic Mycology
prolonged uncontrolled diabetes mellitus, and a The hyphae can penetrate the blood vessels
proportion of cases are detected in renal trans- especially the arteries (angioinvasion), causing
plant recipients. thrombosis and necrosis. The endothelial
The seasonal variation in Rhizopus infection glucose-regulated protein (GRP78/BiP/HSPA5)
in human is also detected. The studies in Asian acts as receptor for R. oryzae, although the fungal
countries (Israel, Japan) identified the autumn ligand is still not identified. The interaction
season (August–September) as most suitable for between the ligand and receptor helps in endocy-
transmission of Mucorales infection. tosis of hyphae. The endocytosis of both live and
killed hyphae produces endothelial cell damage,
indicating the presence of a toxic chemical in the
4.9.11 Pathogenesis hyphae which is not identified. As a conse-
quence, the vascular smooth muscle cells are
The entry of sporangiospores into the immuno- exposed releasing tissue factors and producing
competent host cannot ensure the establishment intravascular thrombosis.
of infection. If the host is immunosuppressed due The proliferation and dissemination of the
to prolonged use of steroids or the host is fungal hyphae depends on production of viru-
suffering from diabetes and satisfy the other lence factors such as ketone reductase, proteases,
predisposing factors, there is every possibility lipases and iron acquisition system (Table 4.20).
of establishment and progress of infection. The angioinvasion helps in haematogenous
Under favourable conditions such as low pH, dissemination of the fungi into the different tar-
increased iron content and high glucose con- get organs such as the uterus of the immuno-
centration, the sporangiospores germinate suppressed dam causing mycotic abortion.
and produce hyphae. The low pH (acidosis)
impairs the iron-binding capacity of serum trans-
ferrin and increases the level of free iron which 4.9.12 Disease Produced
favours the fungal growth. So, diabetic
ketoacidosis (DKA) patients suffer more from The major animal and human diseases produced
mucormycosis. by Rhizopus are enlisted in Table 4.21.
deliquesces, and the spores remain attached Like Rhizopus, a similar sex locus was
with the columella, so that they could not be reported in the M. circinelloides and M. mucedo
carried away with the wind. The sporangiospores genome. The putative sex locus contains a single
are ellipsoidal, uninucleate (except M. mucedo) high mobility group (HMG) transcription factor
in nature, but they vary in size according gene which is flanked by an RNA helicase and a
to the species. M. bacilliformis produces the triose phosphate transporter gene. The HMG
smallest and M. mucedo produces the largest proteins are designated as SexP for the (+) and
sporangiospores. The cell wall of the sporangio- SexM for the () mating type, respectively. The
spores is enriched with protein, lipid, melanin transcription of SexM is highly stimulated than
and glucan. The melanin and glucan are absent SexP with the pheromone (trisporic acid) in
in hyphae, whereas the galactose and fucose M. mucedo cultures kept in vitro. The higher-
present in hyphal cell wall are not detected in transcriptional stimulation is correlated with dif-
sporangiospores. The sporangiospores help in ference in the promoter sequences of SexM and
the transmission of infection. They germinate SexP. However, whether the similar kind of
to produce hyphae or yeast cells. The spores higher-transcriptional stimulation of SexM and
first undergo a logarithmic growth phase (spheri- simultaneously repression of (+) mating type
cal growth) due to macromolecular synthesis. occurs under in vivo condition is yet to be
During this growth phase, a new vegetative cell elucidated.
wall is synthesised under the spore cell wall. The The () mating types of M. circinelloides can
chemical constituents of the vegetative cell produce larger spores and are more virulent than
wall are specific for either yeast or hyphae in the (+) mating types.
dimorphic Mucor.
4.10.3 Classification
4.10.2 Reproduction
The genus Mucor is placed under the order
Most of the Mucor species are able to reproduce Mucorales (described in details in Sect. 4.9).
sexually by heterothallic (M. racemosus, The major species under the genus Mucor are
M. mucedo, M. hiemalis) or homothallic mating M. circinelloides complex, M. hiemalis,
(M. rouxii, M. genevensis). In heterothallic mat- M. racemosus, M. ramosissimus and
ing, fusion of gametangia occurs between oppo- M. rouxianus. The M. circinelloides complex
site mating types. In homothallic mating, fusion consists of three subspecies, i.e. M. circinelloides
occurs between the gametangia located at the f. lusitanicus (Mcl), M. circinelloides f. cir-
different sites of the same thallus. The cinelloides (Mcc) and M. circinelloides
zygophores develop at the end of the hyphal f. griseocyanus (Mcg).
branches. In response of trisporic acid secreted
by the opposite mating types from prohormone
precursors, the zygophores are attracted to each 4.10.4 Susceptibility to Disinfectants
other. After direct contact between two
zygophores, they swell and form progametangia. Mucor are susceptible to sodium hypochlorite
The progametangia fuse to produce the gametan- (2.4 %), phenol, chloroxylenol and isorophyl
gium, which undergoes plasmogamy and kary- alcohol.
ogamy. The wall becomes thickened with
multiple layers and forms the zygospores. How-
ever, the generation of zygospores with karyog- 4.10.5 Natural Habitat and Distribution
amy is rare in nature. The zygospores germinate
to produce haploid sporangiospores with unipa- Mucor is saprophyte and ubiquitous in nature.
rental genetic makeup. They are commonly detected in soil, hay, dog
4.10 Mucor 81
fur, cereals, nut and flour (M. circinelloides, Table 4.22 Colony characteristics of Mucor species
M. hiemalis), wheat grains (M. racemosus), Mucor species Colony characteristics
soyabean seeds, stored cabbage (M. hiemalis), M. circinelloides The growth takes place at 25–37 C
oranges (M. circinelloides) and environmental and the colonies are pale grey or
samples throughout the world. yellowish. The colonies become
brownish at 37 C
M. hiemalis Optimum growth temperature is 32 C.
Greyish colonies are produced and
reverse pigmentation is pale
4.10.6 Genome
M. rouxianus Optimum growth temperature is 37 C
and the required temperature range is
The nuclear genome of Mucor (M. miehei) 9–45 C. The colours of the colonies
contains about 100 copies of rRNA gene, each are white, yellow or grey. The colonies
of which is 7.7–12 kbp in size and is arranged in are 4 mm in height and delicate in
nature
tandem. The genes encoding the 25S, 18S and
M. racemosus The colonies are low to moderately
5.8S rRNAs are closely linked within the raised and are brownish in colour due
repeated unit which also contains the 5S gene. to formation of sporangia
This 5S gene appears to be transcribed in the M. ramosissimus Rapid growth occurs at 25 C. The
opposite direction. In M. racemosus genome, colonies are grey to buff in colour
the 35S rDNA cistron and the 5S rDNA are
linked but are transcribed from opposite strands.
The transposable element is also detected in
4.10.8 Antigenic Characteristics
nuclear genome of Mucor racemosus and other
Mucor (M. racemosus) possesses a heat-stable,
Mucor species. In eukaryotes, most of them
extracellular polysaccharide (EPS) antigen
influence gene expression and promote genetic
which is shared with Rhizopus, Absidia and
diversity by mediating genetic rearrangements.
Rhizomucor.
Such kind of function is yet to be elucidated
in Mucor.
The mitochondrial genome of Mucor contains
a circular chromosome. The approximate size 4.10.9 Virulence Factors
is 63.8 kbp in circumference (M. racemosus).
The average size of M. piriformis mitochondrial The virulence factors of Mucor are enlisted in
genome is 33.6 kbp containing the mitochondrial Table 4.23.
genes such as cob, nad2 and SrRNA. Excep-
tionally, the M. racemosus mitochondrial
genome is found to exist in the form of two
4.10.10 Transmission
flip-flop isomers with inverted repeat sequences
encoding rRNA genes.
Like other Mucorales, the transmission of Mucor
occurs by inhalation, ingestion and percutanoeus
route. Inhalation of spores results rhinocerebral
4.10.7 Isolation, Growth and Colony and pulmonary form of the infection in human.
Characteristics The percutaneous infection may occur during
injection, insect bite and trauma. The nail infec-
Mucor can be isolated in selective or nonselec- tion with Mucor in human was reported to be
tive fungal media. They are rapid grower, and the originated from handling with the contaminated
mycelia can fill and reach up to the lid of the Petri objects (e.g. orange).
dish within 1–7 days (‘lid-lifters’). The colony Immunosuppression due to bone marrow
characteristics of major Mucor species are transplantation, aplastic anaemia, diabetes,
described in Table 4.22. asthma, burns, hepatitis and human
82 4 Cutaneous, Subcutaneous and Systemic Mycology
Table 4.23 Virulence mechanisms and factors possessed papules, nodules and plaques without superficial
by Mucor necrosis are noted in the skin. In the nails,
Virulence punctate erosions are observed.
factors Functions
Thermotolerance Mucor does not show any
thermotolerance. Only M. rouxianus
grows optimally at 37 C, whereas 4.10.12 Disease Produced
M. ramosissimus and M. circinelloides
grow slowly and M. hiemalis does not The major animal and human diseases produced
grow at all at this temperature
by Mucor are enlisted in Table 4.24.
Spore size Larger spore size of M. circinelloides
complex is associated with virulence,
and generally () mating types
produce abundant larger spores than
the (+) mating types. The larger spores
4.10.13 Immunity
are more virulent probably due to
shorter time requirement for germ tube The ciliated bronchial cells and mucus in the
generation and subsequent hyphal respiratory tract are the first line of defence.
growth
The ciliary movement and the cough attempt to
Fungal It is produced by M. hiemalis and it can
metabolite suppress cell division in germinating
expel the sporangiospores of Mucor during inha-
grains lation. The pulmonary alveolar macrophages act
Calcineurin The calcineurin pathway helps in the as second line of defence which can phagocytose
dimorphic transition from yeast to the sporangiospores before their germination.
hyphae, correlated with virulence The spores of Mucor ramosissimus,
Sialic acid The surface sialic acids contribute to
M. plumbeus and M. circinelloides are also
the negative charge of Mucor yeasts
and spore cells and protect them from observed to activate alternative complement
phagocytosis pathway. The intact skin and mucous membrane
act as barrier to prevent the entry of the spores.
immunodeficiency virus (HIV) infection may act
as predisposing factors for Mucor infection.
4.10.14 Diagnosis
4.11.1 Morphology
phialides. The first uninucleate bud is a metula divided into two major clades, i.e. Penicillium
which subsequently buds to produce more spo- sensu stricto (previously Penicillium subgenus
rogenous cell type, known as phialide. These of Pitt’s classification) and Talaromyces (previ-
phialides produce conidia in basipetal mode, ously Talaromyces and Penicillium species under
i.e. old spores are replaced with new spores. the subgenus Biverticillium). Penicillium sensu
Thus, a chain of conidia is produced having stricto currently includes the genera Eupeni-
green colouration. Under carbon-limited condi- cillium, Chromocleista, Eladia, Hemicarpen-
tion, short unbranched stalks with conidia are teles, Thysanophora and Torulomyces. Some
produced or sometimes the metulae appear authors prefer to treat this clade under the
directly from the foot cells. singular genus Penicillium. There are total
The conidia can germinate and produce highly 225 accepted species under the genus Penicil-
branched hyphae at 37 C. These hyphal cells are lium. Major important species are Penicillium
shorter (20 μm) than vegetative hyphal cells marneffei, P. chrysogenum, P. commune,
(40 μm) produced at 25 C and are separated by P. cyclopium, P. lilacinum and P. oxalicum.
double septa. This is a transitory phase and these Penicillium is pleomorphic fungi detected
hyphal cells are known as ‘prearthroconidial either separately as anamorph (asexual),
cells’. These prearthroconidial cells generate teleomorph (sexual) or the holomorph (both
arthroconidia (uninucleate) by dissolving the phases). A few species have only one known
double septa within 48 h. The arthroconidia state. However, some authors segregated sexu-
divide by fission to generate true yeast cells ally reproducing Penicillium (teleomorph) into
within 72 h. This kind of arthroconidiation the genus Talaromyces, Hamigera and
followed by yeast formation is unique in dimor- Eupenicillium.
phic P. marneffei. Within the body of the host, Modern taxonomy is based on fungal genome
the yeast cells may remain as intracellular sequencing and genealogical concordance phylo-
(within macrophages) or extracellular. The intra- genetic species recognition (GCPSR)-based
cellular yeast cells are oval or spherical and analysis of sequence data. It changed nomencla-
smaller (2–3 μm in diameter). The extracellular ture of certain important Penicillium species.
yeast cells are elongated and larger (13 μm in For example, the major pathogenic species
diameter). (Penicillium marneffei) is currently designated
The yeast cells can undergo coupled nuclear as Talaromyces marneffei. The original strain
and cytoplasmic divisions. When the yeast cells of Fleming was later identified as Penicillium
are shifted at 25 C, the nuclear division becomes chrysogenum. Recent taxonomy showed that
uncoupled. The elongated multinucleate cells Penicillium chrysogenum is a complex of
divide only by septation without cell separation, five species, i.e. P. chrysogenum, P. rubens,
and they produce branched hyphal network P. vanluykii, P. tardochrysogenum, P. allii-
(yeast to hyphae transition). sativi. Fleming’s strain and the classical strain
The dimorphic switch in P. marneffei is used for the penicillin production (Wisconsin
regulated by temperature which causes cellular strain) are actually P. rubens.
changes such as coupling and uncoupling of There are several genera having Penicillium-
cellular and nuclear divisions, septation with or like conidiophores including Hamigera,
without cell separation, etc. Paecilomyces, Rasamsonia, Sagenomella,
Talaromyces and Trichocoma which are also
known as Penicillium-like anamorphs.
4.11.3 Classification
stages of conidiation. In the first stage, the mechanism. Nutrient starvation is detected by
extension of apically growing hyphae is seized several protein sensors in the hyphae which can
which is followed by the formation of septum to transmit a positive signal for conidiation. There
separate the apical cell. The apical cell is swelled are certain endogenous inducers such as
and there is subapical branching (stage 2). The conidiogenone, conidiogenol, sporogen (PF1)
apical cell differentiates into phialide (stage 3) which may induce the conidiation through quo-
which buds at the tip to generate the conidium rum sensing, a communication network detected
(stage 4) (Fig. 4.24). Upon the first conidium, in bacteria. The sporogen can act as inducer in
new conidia appear at hourly interval to produce darkness also. The conidiation signalling path-
a chain of conidia. The whole procedure up to way is regulated by GasA G protein α-subunit in
stage 4 takes approximately 7 h time. From the P. marneffei. The signalling involves a cAMP-
subapical branches, formation of phialides and dependent protein kinase A cascade.
conidia takes place to generate the typical brush- Majority of Penicillium species (73 %)
like structure (‘penicillus’). including P. marneffei do not have any sexual
Certain environmental factors regulate state. However, the presence of stlA gene (homo-
conidiation in Penicillium such as exposure to logue of conserved STE12) suggests a cryptic
air, light, high osmolarity, calcium and nutrient sexual cycle in P. marneffei. The sexual cycle is
starvation. The hydrophobin coating of aerial apparently not visible probably due to heterothal-
hyphae prevents the drying during exposure lic nature of P. marneffei. Heterothallic fungi
to air. Light is not a major requirement for require two compatible mating types for pairing
conidiation as some species of Penicillium can which may not be available in the environment
produce conidia without light. The calcium can simultaneously. Majority of other Penicillium
bind the Penicillium hyphae extracellularly to species having sexual reproduction are homo-
trigger the induction of conidia by an unexplored thallic in nature. The sexual reproduction is
4.11 Penicillium 87
noted in P. chrysogenum and P. dipodomyis, (ITS) region contains very high GC mol%. The
and experimentally sexual cycle is induced mitochondrial genome (35 kb) has similarity with
in P. pinophilum, previously considered as an the mould (Aspergillus nidulans) than the yeast.
asexual species. The abaA gene present in P. marneffei
genome controls the generation of conidia prob-
ably through the control of cell cycle during
4.11.5 Natural Habitat and Distribution sporulation. The expression of abaA gene is
increased during conidiation. The abaA deletion
Penicillium and Aspergillus are considered as mutants produce phialide-like cells but are
the most prevalent fungi in the world including unable to produce conidia. Another asexual
temperate, tropical as well as arctic locations. reproduction regulatory gene is stuA which is a
Many species of penicillia are soil saprophytes member of the APSES group of transcription
except P. marneffei. The saprophytic penicillia factors possessing a basic helix-loop-helix
can be isolated from rotting fruits, plant roots and (bHLH) DNA-binding motif. The expression
indoor environments such as archives, compost of stuA is also increased during conidiation.
heaps, damp buildings, etc. They can liberate However, stuA deletion mutants are unable to
different enzymes (phosphatase), chelators, produce metulae and phialides, but the conidia
organic anions and siderophores (trihydroxy- are generated directly from the conidiophores.
mates, coprogen, ferricrocin) to survive in the The other regulatory genes for asexual develop-
soil. Association of penicillia with the plant ment and secondary metabolite formation include
roots stimulate the plant defence system leading Gα-subunit gene (gasA). There is a CDC42 homo-
to improved seed germination and growth. For logue (cflA) detected in P. marneffei which is
pathogenic penicillia (P. marneffei), different required for correct morphogenesis of yeast cells
species of bamboo rats (Rhizomys sinensis, and accurate polarisation of hyphae. However,
R. pruinosus, R. sumatrensis, reddish-brown these regulatory genes (stuA, gasA, cflA) have no
subspecies of Cannomys badius) are considered role in dimorphic switch of P. marneffei.
as enzootic reservoir. In India (especially in MAT gene was identified in several Penicillium
Manipur, a Northeastern state), Cannomys species with both MAT1-1 and MAT1-2 genotypes.
badius acts as major reservoir. Other sex-related genes such as stlA (homologue of
The epidemiological study of P. marneffei in conserved STE12), pheromone precursor and
human identified Southeast Asia as an endemic receptor genes were detected in P. marneffei
zone. The infection was reported from North- (within RST) and P. chrysogenum, respectively.
eastern India, Thailand, China, Taiwan, Hong Comparative genomic analysis between
Kong, Laos, Cambodia, Malaysia, Vietnam and penicillin-producing strains (P. chrysogenum)
Myanmar. Soil exposure especially in rainy sea- revealed higher transcription of penicillin biosyn-
son was the critical risk factor associated with thesis genes (pcbAB, pcbC, penDE) in high amount
P. marneffei infection. of penicillin-producing strains. Due to high geno-
mic plasticity and ability to grow in different media
and conditions, strains of P. chrysogenum are the
4.11.6 Genome first choice for the production of penicillin
enzymes in biotechnology industry.
The genome of P. marneffei contains three
chromosomes (2.2, 4, 5 Mbp); however, the size
of the genome is 17.8–26.2 Mbp. A section of 4.11.7 Isolation, Growth and Colony
genome (9 %) is occupied by random sequence Characteristics
tags (RST) containing genes for ribosomal pro-
tein, tRNA synthetase, translation initiation, Penicillium can be isolated on Czapek dox agar,
elongation factor, metabolism and multidrug potato dextrose agar and 25 C. Most species
resistance. The internally transcribed spacer sporulate within 7 days, whereas the mycelial
88 4 Cutaneous, Subcutaneous and Systemic Mycology
phase of P. marneffei can be isolated in ripening (meat processing) or from the animals
Sabouraud glucose agar without cycloheximide fed with contaminated cereals. The ochratoxin is
at 25 C. They are converted into the yeast phase considered as potent nephrotoxic, carcinogenic
at 37 C in brain–heart infusion agar (thermal (human carcinogen of 2B group), genotoxic and
dimorphism). immunotoxic.
The colonies of Penicillium are bluish-green
and velvety. The colour and texture of the 4.11.9.2 Citrinin
colonies vary with the species. For example, Citrinin is a fungal metabolite which was first
P. marneffei produces diffusible wine red or isolated from Penicillium citrinum. Other species
brownish red pigment in the media. such as P. expansum and P. verrucosum can also
produce citrinin. It is frequently detected in feed
stuffs or food along with ochratoxin A and it can
4.11.8 Antigenic Characteristics increase the toxicity of ochratoxin synergisti-
cally. The intoxication with both of the toxins
Galactomannan (GM) is the major antigen of may cause endemic nephropathy. Further, citri-
Penicillium which is a carbohydrate molecule nin is also embryocidal and foetotoxic probably
composed of mannose residues with side chains due to the production of oxidative stress or
of β (1, 5)-linked galactofuranosyl residues. increased permeability of mitochondrial
It is released through the pores at the growing membranes. Oral LD50 for rats is 50 mg/kg
hyphal tips during logarithmic growth phase of body weight, while subcutaneous LD50 is
the fungi in highest amount which helps in the 67 mg/kg body weight. The heat-decomposed
detection of the antigen for diagnosis. GM is products of citrinin (CTN H1 and CTN H2) are
found in other moulds such as Aspergillus, more toxic than the parent citrinin.
Fusarium, Alternaria, Histoplasma and yeasts
including Cryptococcus which can produce anti- 4.11.9.3 Ribotoxin (RNase T1)
genic cross-reaction. Certain Penicillium species can produce a
Pen c is a protective antigen and allergen ribotoxin known as RNase T1. Like other
detected in P. citrinum and it is the homologue ribotoxins, RNase T1 can also cleave the
of Asp f commonly found in Aspergillus. The phosphodiester bond located within a universally
Asp f is a 19 KDa protein and it has two T cell conserved sequence of the large rRNA gene
epitopes (11mer and 13mer) which offer protec- (sarcin–ricin loop). The cleaving inhibits protein
tion against the fungi. synthesis and causes cellular death. The virus-
The yeast phase of P. marneffei contains three infected or virus-transformed cells having altered
immunodominant proteins (50 KDa, 54 KDa and cellular membrane are more susceptible to
61 KDa) which are specific for the fungi and can ribotoxin. The ribotoxins are used in preparation
be used in serodiagnosis. of immunotoxin due to their cytolytic property.
yeast cells can multiply and kill the macrophages neutrophils after activation with the granulocyte-
with dissemination throughout the body and pro- macrophage colony-stimulating factor (GM-CSF)
duce fatal necrotising reactions and histiocyte can lyse the yeast cells (not conidia) with the
infiltrations. Severe P. marneffei infections can secretion of different granular cytolytic
affect different tissues and organs such as the molecules.
bone marrow, liver, spleen, kidney, lungs,
lymph nodes, skin and soft tissues, whereas in
immunocompetent patients, granulomatous and
4.11.15 Diagnosis
suppurative reactions are detected in the lung,
skin, liver and subcutaneous tissues with the 4.11.15.1 Clinical Specimen
The human clinical specimens for diagnosis
formation of multiple abscesses.
of P. marneffei infection include bone marrow
aspirate, blood, skin scrapings, sputum, broncho-
alveolar lavage, pleural fluid, cerebrospinal fluid,
4.11.13 Disease Produced pharyngeal ulcer scrapings, palatal papule
scrapings, urine, faeces and lymph node biopsies,
The major human and animal diseases produced skin biopsies, liver biopsies, kidney, pericar-
by Penicillium are enlisted in Table 4.26. dium, stomach or intestine.
The animal clinical specimens include mas-
titic milk, skin scrapings, aborted foetus.
4.11.14 Immunity
4.11.15.2 Laboratory Examination
The conidia of P. marneffei are attached with 1. Direct examination: Detection of Penicillium
the respiratory epithelial cells with the help is possible by direct examination of the
90 4 Cutaneous, Subcutaneous and Systemic Mycology
smears prepared from the clinical specimens 4. Detection of fungal antigen: The fungal anti-
(blood, bone marrow aspirate, biopsies) and gen can be detected with immunodiffusion
stained with Wright’s stain. test, latex agglutination test, monoclonal
2. Isolation and identification: Media and antibody-based sandwich ELISA.
incubation condition as described earlier 5. Serological tests: The antibodies developed
will serve the purpose. The ideal clinical in patients against P. marneffei infection
specimens for culture are bone marrow, can be detected by immunodiffusion, indirect
blood and skin biopsy. fluorescent antibody test (detects IgG) and
3. Histopathology: The haematoxylin and eosin ELISA with a recombinant mannoprotein
(H&E), Grocott methenamine silver and (Mp1p). Western blot analysis detected two
periodic acid–Schiff (PAS) stains are used yeast phase-specific immunodominant protein
for the demonstration of P. marneffei in the of P. marneffei (50KDa, 54 KDa).
tissue section. Within the macrophages or 6. Molecular biology: The PCR can detect
histiocytes, round or oval yeast cells are P. marneffei targeting the genes for 5.8S
detected. Sometimes they appear as fission rRNA and internally transcribed spacer
arthroconidia which will produce yeast cells (ITS1). The detection of 18S rRNA gene is
by cross wall formation which is considered possible by PCR hybridisation assay having
as differentiating criteria from other yeasts. sensitivity of 0.1 pgm/μL of DNA and one
Extracellular elongated or sausage-shaped tube semi-nested PCR. A TaqMan real-time
cells are also observed. PCR is also developed to detect P. marneffei
In histological sections, indirect fluores- 5.8S rRNA gene in clinical samples and
cent antibody test can detect P. marneffei. In culture.
paraffin-embedded formalin-fixed tissues,
P. marneffei can be detected with monoclonal
antibody against the galactomannan antigen 4.11.16 Treatment
(EBA1). Immunoperoxidase staining can
detect the fungi in deparaffinised tissue P. marneffei is susceptible to miconazole,
sections of skin biopsies. itraconazole, ketoconazole and flucytosine
4.12 Cryptococcus 91
4.12 Cryptococcus
neoformans, C. neoformans var. grubii and and rounder. This type of mating generates
C. gattii (C. bacillisporus). Sometimes inter- diversity in C. neoformans populations and
species hybrids of C. neoformans and C. gattii also it contributes to the global spread of
are observed. The teleomorphs of C. neoformans cryptococcosis.
var. neoformans and C. gattii are Filobasidiella
neoformans and Filobasidiella bacillispora,
respectively. Other closely related species such 4.12.4 Susceptibility to Disinfectants
as Cryptococcus amylolentus, Tsuchiyaea
wingfieldii and Filobasidiella depauperata are The replication of Cryptococcus stops above
isolated from insects. 40 C. Alkaline pH is detrimental for the yeast.
Among chemical disinfectants, C. neoformans is
susceptible to 1 % sodium hypochlorite, iodine,
4.12.3 Reproduction phenolics, glutaraldehyde and formaldehyde.
United States (California). Currently the preva- locus regulating the sexual growth phase
lence area is expanding throughout the world spanning over 100 kb with more than 20 genes.
especially in North America. It is quite larger than other MAT loci of different
In India, the reports of C. neoformans var. fungi. This locus can encode one of the two
neoformans isolation from HIV patients and idiomorphic alleles which determines whether
pigeon droppings in Tamil Nadu and C. gattii the cell will be MATa or MATα. In general two
isolation from the trees (Eucalyptus types of genes in a MAT loci, one encoding
camaldulensis) in Punjab are noticed. In cattle pheromone and pheromone receptor and the
and buffalo, C. neoformans was detected from other encoding homeodomain transcription
cases of mastitis in other states such as Madhya factor, are required for sexual mating. Initially
Pradesh. In cats, C. neoformans was isolated during mating of C. neoformans, compatibility
from meningitis and cutaneous lesion. of the pheromone and pheromone receptor
genes is required for cellular fusion, followed
by dikaryon formation which is dependent on
4.12.6 Genome compatible homeodomain transcription factors
(Sxi1α/Sxi2a). Further, CLP1 gene products
Cryptococcal genome is rich in introns also have regulatory role in dikaryon formation
(5.5 introns/gene) and antisense messages which is Sxi-dependent. Mutation in Sxi1α gene
(endogenous antisense transcripts) in comparison can modify the mitochondrial DNA inheritance
to other Ascomycota yeasts. The reported from uniparental to biparental.
genome sequence of two related strains of Comparative genome analysis of C. neofor-
C. neoformans serotype D (JEC21 and mans var. neoformans and C. neoformans var.
B-3501A) revealed a 19-Mb genome sequence grubii revealed the transfer of a nonreciprocal
(excluding the ribosomal RNA repeats) which 40Kb segment (‘identity island’) from
spans 14 chromosomes from 762 kb to 2.3 Mb. C. neoformans var. grubii to C. neoformans
A total of 6572 protein-encoding genes were var. neoformans nearly 2 million years ago. At
identified, which contain an average of 6.3 present the ‘identity island’ is widely prevalent
exons of 255 bp and 5.3 introns of 67 bp. There among the C. neoformans var. neoformans
was no evidence of whole genome duplication. isolates in nature.
Overall 65 % of the genes of C. neoformans are C. neoformans also contains small noncoding
conserved, 10 % of the genes are unique to RNAs (sRNAs) like other eukaryotes such as
C. neoformans and the remaining 25 % have small interfering RNAs (SiRNA) and micro
non-fungal sequences. There are total 11 gene RNAs (miR1 and miR2). The micro RNAs are
families, among them 2 are exclusive for 22 (miR1) and 18 nucleotides (miR2) in length
C. neoformans, one encodes protein required for and are derived from 70 nucleotide RNA
capsule formation and the other encodes nucleo- precursors. In the genome, miR1 and miR2 are
tide sugar epimerases associated with cell wall distributed in 4 (chromosome 1,4,9,12) and
formation. Approximately 5 % of the genome 7 chromosomes (chromosome 1,3,4,6,8,9,13),
is constituted with transposons clustered in respectively. These sRNAs actively take part in
single blocks (40–100Kb) that may represent gene silencing process via RNA interference
sequence-independent regional centromeres. mechanism.
Each block contains Tcn5 and Tcn6 transposons. The mitochondrial DNA (mtDNA) size varies
The transposons are also clustered adjacent to the from 24 to 34 Kb. The genome is present in high
rDNA repeats and within the mating-type (MAT) copy number and shows a higher mutation rate
locus. The genome shows the evidence of alter- than the nuclear DNA. The genes associated with
native splicing (e.g. exon skipping, truncation, mitochondrial function (ND1, ND2, ND3, ND4,
etc.) and antisense transcripts which have no ND4L, ND5, ND6, ATP6, ATP9, COX1, COX2
coding potentiality. There is a single mating and COB) and protein synthesis (SsrRNA and
4.12 Cryptococcus 95
LsrRNA) are localised in the mitochondrial colony type. The smooth colonies are round with
genome. The number of introns in some genes smooth-domed surface and smooth edges,
(COX1, COB, LsrRNA) vary between different whereas the mucoid colonies have a shiny
species (C. neoformans var. neoformans and mucoid surface due to excess production of vis-
C. neoformans var. grubii) of Cryptococcus. In cous polysaccharide. These mucoid varieties
several introns of the COB and COX1 genes, show slower growth rate and produce the larger
LAGLIDADG motifs are present. The intergenic capsule. The major constituent of the capsule
regions are highly conserved in mtDNA. (GXM) is more viscous, can accumulate in the
meninges and cerebrospinal fluid (CSF) and is
more resistant to phagocytosis by the macro-
4.12.7 Isolation, Growth and Colony phages which enhance the virulence of the
Characteristics mucoid varieties. Further, the mucoid varieties
can increase the intracranial pressure in chronic
Cryptococcus can be isolated in corn meal agar, experimental cryptococcosis as observed in rat
Sabouraud dextrose agar, blood agar, honey agar, model.
brain–heart infusion agar and malt agar. The
specific medium is birdseed agar/Staib medium
(niger seed agar)/sunflower seed extract agar 4.12.8 Biochemical Characteristics
with antibiotics to eliminate the bacterial con-
tamination. They are sensitive to cycloheximide. C. neoformans and C. gattii can hydrolyse urea
The plates are incubated at 28–37 C for (within 4 h) and assimilate inositol and creati-
2 days–2 weeks. The pathogenic strains prefer nine, do not ferment carbohydrates and produce
to grow at 37 C. The colonies are initially small, melanin which differ it from other pathogenic
convex, mucoid, creamy in colour and increases yeasts. They cannot reduce nitrate but can obtain
in diameter up to several centimetres after their nitrogen from urea, creatinine and peptone.
prolonged incubation. In birdseed agar, the C. gattii can also use D-proline, glycine and
colonies appear as brown coloured in the centre tryptophan as a nitrogen source.
of the plate due to the production of melanin. The
optimum capsule production is detected in choc-
olate agar after incubation at 37 C with 5 % CO2 4.12.9 Antigenic Characteristics
tension. The L-canavanine glycine bromothymol
blue media can differentiate C. neoformans and The capsular polysachharide is the major antigen
C. gattii by the formation of distinctive blue of Cryptococcus. The serotyping is based on the
colouration with the growth of C. gattii. variations in the O-acetylation of the capsular
In Cryptococcus and a few other yeasts polysachharide. C. neoformans was initially
(Candida albicans), ‘phenotypic switching’ of divided into five serotypes, A, B, C, D and
the colony is observed. It is defined as spontane- AD. Currently, C. neoformans var. neoformans
ous emergence of colonies with altered colony has the serotypes D, AD; C. neoformans var.
morphology at rates higher (102 to 105 per grubii has the serotypes A, AD; and C. gattii
generation) than the somatic mutation (107 to has the serotype B, C. Further, molecular tools
108 per generation). It is a reversible process such as PCR-based fingerprinting, amplified
and occurs only in a small fraction of the patho- fragment length polymorphisms, restriction frag-
genic population both in vitro and in vivo espe- ment length polymorphism, random amplifica-
cially during chronic infection. It is detected in tion of polymorphic DNA and multilocus
Cryptococcus neoformans serotype A, D and in sequence typing have generated several molecu-
C. neoformans var. gattii. The switching results lar types. C. neoformans var. grubii (serotype A)
the change of the smooth colonies into mucoid isolates belong to molecular types VNI and
96 4 Cutaneous, Subcutaneous and Systemic Mycology
endothelial cells. The survival strategy includes intervention with lipid metabolism, antioxidant
increased capsule synthesis, enzyme production system (superoxide dismutase, glutathione per-
(laccase, phospholipaseB1), production of mela- oxidase), interference with nitric oxide synthase
nin, Ssa1 (heat shock protein homolog), (NOS) induction leading to inhibition of nitric
4.12 Cryptococcus 99
oxide production and capability to exit the cells they are present in a membrane-bound vacuole,
(expulsion or phagosome extrusion). Further, and they can exit from the cells with minimal
Cryptococcus can modulate the adaptive immune damage. Thus, the endothelial cells are used as a
response by several ways such as inhibition of vehicle by the yeasts to penetrate the barrier
T cell activation and induction of T cell apopto- (transcytosis). Occasionally it is observed that
sis, induction of nonprotective Th2 response, occludin (tight junction maker protein) is
interference with dendritic cell maturation and degraded during the Cryptococcus and BMEC
interference with antibody function that also interaction which suggests the partial disruption
helps in dormancy of the yeasts. of tight junction to allow the passage of the
During immunosuppression of the hosts, the yeasts. Further, the ‘Trojan horse mechanism’
spores reactivate and disseminate into the differ- through the infected macrophages or other
ent organs such as the skin, eyes, myocardium, phagocytes is also used by the yeasts to penetrate
bones, joints, lungs, prostate gland, urinary tract the blood–brain barrier.
and the central nervous system (CNS). The dis-
semination into the blood circulation can occur 4.12.12.2 C. neoformans var. gattii
through the infected macrophages (‘Trojan The pathogenesis described for C. neoformans
horse mechanism’). They can multiply within var. neoformans is also applicable for C. gattii
the macrophages to produce ‘cryptococcal with some distinctions. C. gattii can arrest the
phagosome’ which lyses the macrophages to neutrophil migration both in vivo and in vitro
release the daughter yeast cells. Occasionally which explains the reason behind the susceptibil-
the daughter cells exit by extrusion without ity of healthy individuals to this fungus. Further
lysis. Sometimes they are again engulfed by it can produce extracellular fibrils which can
fresh macrophages to avoid the contact with the prevent the phagocytosis by the neutrophils and
host defence. After development of fungaemia, help to establish the initial pulmonary infection.
through the blood circulation, they can reach the Trehalose is detected as major antioxidant in
blood–brain barrier (BBB) and penetrate the bar- C. gattii. The genes encoding for trehalose
rier to enter the CNS and cause rapid multiplica- synthase (TPS1p and TPS2p) are required for
tion and meningoencephalitis as a consequence. thermotolerance, virulence and expression of
The human or animal cerebellum is a rich source the capsule and melanin in C. gattii.
of inositol which maintains the normal neurolog-
ical responses. Cryptococcus can use the inositol
as a sole carbon source which explains their 4.12.13 Disease Produced
affinity for the brain.
Penetration of the barrier is crucial for the The major animal and human diseases produced
development of meningitis. They can induce by different species of Cryptococcus are enlisted
the formation of microvilli-like protrusions by in Table 4.29.
the reorganisation of the host cell cytoskeletal
structures. These protrusions help the yeast cells
to enter brain microvascular endothelial cells 4.12.14 Immunity
(BMECs). Sometimes the yeast cells utilise
CD44 protein present in the lipid rafts of the Innate immunity offers first line of defence
host endothelial cells as receptor for invasion of against Cryptococcus by recognising the Cry-
BMECs (hyaluronic acid of the yeast acts as ptococcal patterns through toll-like receptor
ligand). After close attachment with the host (TLR), β-glucan receptor, mannose receptor
endothelial cells, the activation of host protein and the complement system. The professional
kinase C α-isoform occurs followed by cytoskel- phagocytes especially the bronchoalveolar
eton rearrangement that contributes to the intra- macrophages engage in complement-mediated
cellular transport. Within the cell cytoplasm, phagocytosis of the yeasts. The dendritic cells
100 4 Cutaneous, Subcutaneous and Systemic Mycology
(DC), natural killer cells (NK) and neutrophils effective clearance of the infection, regulatory
can also be lethal for the nonpathogenic Crypto- T cell (Treg) response develops for the suppres-
coccus. The capsule can activate the alternative sion of the response through the production of
complement pathway and the binding of C3 with tumour growth factor (TGFβ) and IL10. How-
the yeasts. This C3-mediated binding is absent in ever, pathogenic yeasts can also induce Treg
CNS explaining another reason for their CNS response for their survival. The antibodies are
affinity. Most pathogenic strains produce differ- also part of the immune response because the
ent virulence factors (Table 4.28) which can antibodies against the capsule component
evade the innante response. The innate response glucuronoxylomannan (GXM) can lyse the
helps to develop the adaptive immune response. fungi in vitro.
The protective anti-Cryptococcal immunity is The mucoid colony producers of Cryptococ-
T cell-mediated (CD4+ Th1 and Th17). After cus after switching generate a different type of
4.12 Cryptococcus 101
6. Molecular biology: Polymerase chain reaction flavonoids, tannins), Curtisia dentata (triter-
(PCR) is developed to detect Cryptococcal penoids), Polygonum acuminatum (sesquiter-
CAP 59 gene in biopsy samples collected penes) and Daucus carota (sesquiterpenes) have
from suspected animals. antifungal activity against C. neoformans.
Treatment in the early phase of the infection in Candida (previously known as Monilia) is
animals is successful. However, diagnosis with- imperfect unicellular dimorphic fungus which
out the laboratory help is difficult as most of the often reproduces by budding, and it can produce
clinical signs are vague. Further, prolonged anti- hyphae or pseudohyphae depending on the envi-
fungal therapy (1–2 months) is required for ronmental condition. Hippocrates (460–377 BC)
effective clearance of the yeasts which may not first documented oral pseudomembranous candi-
be a cost-effective option for the owners. diasis, and he described it with the name of
Amphotericin B (0.5 mcg/mL minimum inhibi- ‘aphthae albae’ which was later supported by
tory concentration) is the suitable antifungal for Galen (130–200 BC). In modern era, Berg and
the animals especially with the CNS involve- Wilkinson separately described oral candidiasis
ment. Other antifungals such as ketoconazole, (1841) and vaginal candidiasis (1849), respec-
itraconazole, albaconazole and fluconazole may tively, for the first time. Candida was first
be used. Itraconazole is more effective in the described as a separate genus in 1923 by
lung and bone involvement. Periodic assessment Berkhout. Candida parapsilosis was first isolated
of liver enzymes is required with prolonged keto- by Ashford from the stool of a diarrhoeic patient
conazole therapy in animals. Further, manage- in Puerto Rico in 1928.
ment of increased intracranial pressure is In India, Pathak and Singh (1962) reported for
required especially during the first 3–4 weeks the first time the occurrence of Candida albicans,
of the infection. Nonsteroidal anti-inflammatory C. tropicalis and C. paratropicalis from the
drug is recommended as the corticosteroids crops of the fowls. Candida was also isolated
are not useful in Cryptococcal infection. For from empyema (Pal 1987), mastitis in buffaloes
evaluation, fungal antigen detection should be (Pal 1997) and pneumonia in goats (Pal and
performed just after completion of therapy and Lee 1999).
1 month later to know whether there is any
relapse. The titre should be either undetectable
or decreased by twofolds. Surgical intervention, 4.13.1 Morphology
cryotherapy and administration of amphotericin
B and sodium iodide are recommended for There are three major morphological forms of
treatment of Cryptococcal rhinitis. Candida such as unicellular yeast, hyphae and
In human, second-generation triazoles such as pseudohyphae. The yeast form is oval (3.5–6 μm
voriconazole and posaconazole are being used 6–10 μm) with axial or bipolar budding. The
nowadays. The voriconazole has better penetra- hyphae are long tubes consisted of the cells with
tion capacity of blood–brain barrier than parallel sides, uniform width and true septum
posaconazole. However, antifungal therapy espe- without any constriction (Figs. 4.27 and 4.28).
cially with amphotericin B can promote the The pores are present in septa for cell-to-cell
selection of more virulent mucoid variety which communication.
often causes treatment failure. The pseudohyphae are chains of elongated
The extracts of certain plants such as ellipsoidal cells with constriction between them.
Blepharispermum subsessile (desmethyl isoence- In the yeast and pseudohyphae, the nuclear divi-
calin), Anacardium occidentale (phenolic lipids, sion and septa formation takes place near the
4.13 Candida 103
The morphological switch between the yeast form flat and grey or opaque colonies. Certain
and filamentous form is correlated with the viru- phenotype-specific genes (WH11, EFG1) are
lence. Several external (environmental cues) expressed by white cells, while OP4 and SAP4
and internal factors regulate the morphological are expressed by opaque cells. White cells are
switch of Candida. The environmental cues more virulent and can easily colonise the host
include presence of serum, temperature (37 C), internal organs, whereas the opaque cells are
low levels of oxygen, high levels of CO2 and associated with cutaneous infection probably
poor nutrition. Bacterial peptidoglycan present due to expression of SAP4 gene. The stable
in serum, N-acetylglucosamine found in mucus opaque type and either a or α-mating-type cell
of gastrointestinal tract, 5 % CO2 as a product of can undergo efficient sexual mating. Master
host cellular respiration and poor nutrition regulator of this complex switching system
can induce the filamentous growth through the is WOR1 which can convert the white cells into
activation of cAMP/PKA pathway (regulated by opaque cells. This WOR1 expression produces a
Candida Ras protein). The pH change response direct positive feedback loop by binding its own
is mediated through Candida Rim101 pathway. promoter and turning ‘on’ its own expression.
The contact-dependent response and osmotic The a/α-heterodimer cells (mating type) cannot
sensing are regulated by Mkc1 and Hog1 switch from white to opaque because they
MAPK pathway, respectively. The internal directly repress the WOR1 promoter. The host
factors include the filament-induced gene environmental factors regulating white–opaque
(HGC1) which encodes a cyclin-related protein transition are CO2 and N-acetyl glucosamine
required for septin phosphorylation and inhibi- (present in commensal bacterial cell wall and
tion of cell separation. Several members of gastrointestinal tract mucus) which can produce
secreted aspartyl proteinase (SAP) gene family stable opaque phenotype. Other factors, such
(SAP4, SAP5, SAP6) are also expressed during as oxidative stress, UV light and adenine, also
morphological switch required for invasion of regulate white–opaque transition.
host tissues. The transition from yeast to hyphal
phase in Candida is regulated by the activation of
mitogen-activated protein (MAP) kinase and 4.13.2 Classification
cAMP-protein kinase A (PKA) signal transduc-
tion pathways which can also coordinately regu- The genus Candida belongs to the class
late the virulence gene expression associated Saccharomycetes (Hemiascomycetes). It has
with this transition. Three sensor histidine more than 200 species. Approximately, 20 spe-
kinases (Sln1, Chk1, Nik1) also regulate the cies have been associated with causing candi-
phase conversion and mutants are unable to pro- diasis in human and animals among which
duce hyphae. Quorum-sensing (microbial com- seven species are of major importance. Candida
munication) molecules such as farnesol, tyrosol albicans, Candida tropicalis and Candida
and dodecanol are also associated with the glabrata are the most frequently isolated
transition. from clinical specimens. The other pathogenic
Another type of morphological transition species are C. parapsilosis, C. stellatoidea,
observed in C. albicans is known as C. guilliermondii, C. krusei and C. pseudo-
white–opaque transition. In the laboratory, this tropicalis. In dogs C. natalensis is the most fre-
switching is rare (1 in every 104 cell division) quently identified species.
and it is regulated by host environmental factors.
These morphological types are genetically sta-
ble, i.e. white or opaque cells always produce 4.13.3 Reproduction
white or opaque type of progeny, respectively.
The ‘white’ cells are relatively round and Recent evidence suggests the presence of sexual
form smooth colonies on solid media, while reproduction in several Candida species espe-
‘opaque’ cells are large and elongated and cially in C. albicans (not yet detected in
4.13 Candida 105
poly A polymerases (PAP) with unknown role in C. dubliniensis isolates exhibited a hyphal fringe
mating. In some species of Candida, homothallic surrounding the colonies.
mating between same sexes is detected where
either the MTL is absent or both the loci are
fused into a single locus. 4.13.8 Biochemical Characteristics
Table 4.32 Major diseases of animal and human caused by Candida sp.
Fungi Host Disease
Candida albicans Poultry Thrush (crop mycosis): It is observed in chicken, turkey, guinea fowls. In acute cases,
the birds may die without any syndrome. The crop, mouth, oesophagus,
proventriculus and gizzards are commonly affected. The lesions are white plaque,
ulcer and/or pseudomembrane adherent with the mucosal surface. The crop mucosa
produces characteristic ‘Turkish towel’ appearance. The disease is associated with
coccidiosis, overcrowding
Candida Cattle Mycotic mastitis: Usually prevalence is low in cattle herd (10 %) and the infection is
parapsilosis, mild and self-limiting in nature. It has been associated with using contaminated
C. krusei, syringes, canulars and antibiotic preparations. Teat injuries may act as predisposing
C. tropicalis, cause. It is transmitted either from contaminated udder skin through the milker’s
C. rugosa hand, milking machine or from the contaminated floors, straw, feed, sanitary agents
and other equipments
Candida albicans, Foals, Gastroesophageal candidiasis and gastric ulceration
C. krusei calves
Candida albicans Pigs Alopecia, circular skin lesion covered with exudates, pseudomembrane formation
Candida albicans, Dogs Exfoliative dermatitis in the muzzle, scrotum and feet along with pruritis and
C. parapsilosis, alopecia, otitis externa, genital tract infection
C. guilliermondii
C. albicans, Dogs Canine peritonitis with marked pyogranulomatous inflammation
C. glabrata
Candida albicans, Cats Localised and disseminated infection associated with feline panleukopenia and feline
C. parapsilosis immunodeficiency virus, granulomatous rhinitis associated with chronic use of
immunosuppressive drug, enteritis
Candida albicans, Human (a) Invasive candidiasis: It is associated with immunosuppression, neutropenia due to
C. glabrata, stem cell or solid organ such as liver transplantation. Candida is among the important
C. parapsilosis, pathogens in the patients admitted to the intensive care unit. It causes high rate of
C. tropicalis morbidity and mortality without specific syndrome
(b) Oral candidiasis: The patients receiving broad spectrum antibiotics, steroid or
cytotoxic therapy and having diabetes mellitus, xerostomia, nutritional deficiency
and AIDS are susceptible to oral candidiasis. It is characterised by white patches on
the surface of oral mucosa (thrush); erythematous lesion on the dorsum of the tongue,
palate or mucosa (antibiotic sore mouth); formation of leukoplakia (chronic lesion);
denture-induced stomatitis; glossitis; etc.
Table 4.33 Pathogen-associated molecular pattern (PAMP) of C. albicans and their pattern recognition receptors
(PRR) expressed by different immune cells
PRR Immune cells PAMP
Toll-like receptors (TLR)
TLR2 Macrophage, neutrophil, Phospholipomannan
dendritic cells, CD4+ T cells
TLR4 Macrophage, neutrophil, dendritic Mannan
cells, CD4+ T cells
TLR9 Macrophage, neutrophil, dendritic cells CpG oligodeoxynucleotides
C-type lectin receptors (CLR)
Mannose receptor Macrophage, dendritic cells Mannan
Dectin-1 Macrophage, neutrophil, dendritic cells β-1,3-glucan
Dectin-2 Macrophage, neutrophil, dendritic cells High-mannose structures
(Man9GlcNAc2)
DC-SIGN Macrophage, dendritic cells High-mannose structures
(Man9GlcNAc2)
Galectin-3 Macrophage β-1,2-mannosides
Mincle (Clec4e and Clecsf9) Macrophage Unknown
Complement receptor 3 (CR3) Neutrophils β-glucan
Langerin Langerhans cells Mannose, fucose
NOD-like receptors (NLR)
NLRP3 (NLR Unknown
family pyrin domain containing 3)
human serum and incubated at 37 C for stained smear can be identified. A monoclonal
1–2 h. After the incubation, a drop of prepara- antibody (3H8) is developed against
tion is observed under the phase contrast or C. albicans cell wall mannoprotein which
dry objective of the microscope. In positive can specifically recognise C. albicans in cul-
case, small tubes projecting from the yeast ture and in paraffin-embedded tissue sections
cells without any constriction at the point of using immunofluorescent and immunohisto-
attachment are observed. This is a character- chemical staining. This antibody specifically
istic of C. albicans and C. tropicalis (after detects the mycelial forms and to a lesser
prolonged incubation for 3 h). extent blastospores of C. albicans and does
4. Demonstration of chlamydospore production: not react with any other Candida spp. Fluo-
For demonstration of chlamydospore, single rescent in situ hybridisation (FISH) using oli-
isolated Candidal colony can be inoculated gonucleotide probes directed against 18S
into the cornmeal tween 80 agar or chlamydo- rRNA has been used to differentiate
spore agar by making the parallel cuts in the C. albicans from C. parapsilosis in tissues.
media. Sometimes below the surface inocula- 6. Immunological assays: The ELISA-based
tion is preferred for better chlamydospore pro- tests are developed to detect the Candidal
duction in low-oxygen tension. The plates are antigens such as secreted aspartyl proteinase,
incubated at 30 C for 2–4 days. A coverslip is mannan and β-D glucan. Dissociation of
placed over the surface, and the plate is antigen–antibody complexes is necessary for
observed under the high dry objective for the the optimal detection of mannan in the circu-
detection of thick-walled chlamydospores lation. This antigen is heat stable and resists
(8–12 μm) at the tips of pseudohyphae. boiling, proteinase treatment and acidic
5. Histopathology: The presence of blastospores pH. So antigen–antibody complexes are rou-
and pseudohyphae in the histochemically tinely dissociated by boiling with EDTA or by
112 4 Cutaneous, Subcutaneous and Systemic Mycology
endemic zones are found in India, Japan, Peru, The production of conidia is better detected
Mexico, Colombia, Uruguay, Guatemala, Brazil in potato dextrose agar and corn meal agar.
and African countries. The largest human out-
break was detected in South Africa which was
originated from wooden beam used in the mines. 4.14.8 Antigenic Characteristics
Cases are also reported from United States,
France, Spain, Italy, China and Thailand. The major antigen of S. schenckii is cell wall
In India, West Bengal and North Eastern glycopeptides (peptidorhamnomannan). The
states such as Assam and Manipur are considered antigenicity varies with the rhamnose/mannose
as endemic zone of Sporotrichosis. Sporadic molar ratio depending on the cultural conditions.
cases are reported from Himachal Pradesh, The peptide portion is composed of threonine,
Sikkim, Tripura, Meghalaya and Nagaland. serine, aspartic acid and glutamic acid.
The peptidorhamnomannans can react with
the carbohydrate-binding protein concanavalin A,
4.14.6 Genome but the rhamnomannan is nonreactive. The reac-
tive fraction is extracted and is known as
S. schenckii possesses six to eight chromosomes S. schenckii conA-binding fraction (SsCBF).
of 460–6,200 kb, with a total genome size of It is used in serodiagnosis for the detection of
approximately 28 Mbp. The average guanine IgG in human and feline patients. The SsCBF
cytosine (GC) content of the genome is is composed of three glycoproteins, i.e. gp70,
54.7 mol%. The genome is diploid containing gp84 and gp58. Among them, gp70 is the major
approximately50fg DNA per cell in both the antigen which is present in both yeast and myce-
filamentous and yeast phases. The mitochondrial lial phases. The protein (gp70) acts as adhesin to
DNA (mtDNA) analysis helps to establish the bind with the extracellular matrix protein such
fungal types in epidemiological study. So far, as fibronectin and mice dermis.
32 mtDNA types of S. schenckii are detected
which is based on restriction enzyme analysis
of mtDNA with HaeIII. 4.14.9 Virulence Factors
sporotrichosis due to cat bite or scratches immune status. After transmission, the mycelial
occurred in Brazil (1998–2001), in which phase is converted into the yeast cells due
156 cases (out of 178) had direct contact with to exposure to the higher temperature or uni-
the cats infected with S. schenckii. The cats are dentified signal. The yeast cells are either
considered as the most potent animals capable of localised in the subcutaneous tissues or spread
zoonotic transmission probably due to the pro- via lymphatics or blood producing either fixed or
duction of large amount of yeast cells. The yeast lymphocutaneous or disseminated clinical forms,
cells can directly infect the human even in the respectively. The disseminated form occurs
absence of cat scratches or biting history. either due to immunosuppression or due to inoc-
Rarely, S. schenckii is transmitted through ulation of huge quantity of yeast cells from the
inhalation route producing extracutaneous form infected cats at the multiple locations of the host.
of sporotrichosis, i.e. granulomatous pneu- The fixed form is characterised by ulcerated
monitis. The laboratory-acquired infection is lesion with erythematous edges. Most of the
also reported during culturing of the fungi with- clinical cases (75 %) manifest the lympho-
out proper precautions. cutaneous form which starts with the formation
of a papule at the site of trauma. The papule is
converted into a subcutaneous nodule with ulcer-
4.14.11 Pathogenesis ation and pus formation. Secondary lesions arise
along the course of lymphatics. However, the
Clinical manifestation varies with the load and involvement of lymph node and other vital
pathogenicity of the fungi along with the host organs is rare in human. The disseminated form
4.14 Sporothrix 117
centre along with the host IgG and IgM on the immunosuppressed patients and false-positive
spikes of the radiated crown. Thus, the aster- reaction is produced in healthy patients previ-
oid bodies use the host immune molecules to ously suffered from the infection. Experimen-
provide a safe shelter to the yeasts. tally the sporotrichin test with SsCBF antigen
4. Serological tests: The serological tests such in guinea pig was found reactive. In Brazil,
as agarose gel precipitation test (AGPT), the sporotrichin test was carried out among
tube agglutination (96 % sensitivity), latex the captive mammals present in a zoo for
agglutination (94 % sensitivity) and immuno- epidemiological investigation.
electrophoresis can be employed for detection 6. Molecular biology: The chitin synthase gene
of antibodies against S. schenckii. The AGPT (ChS1)-based PCR was first developed which
does not cross-react with the sera from leish- can detect up to 10 picogram of genomic
maniasis. However, these tests are not so S. schenckii DNA. Further PCR-based assays
much sensitive for the diagnosis of cutaneous are also developed, detecting DNA topoisom-
form of the infection. Enzymatic immune erase II and internal transcriber space in the
assay such as ELISA is a preferred choice of rRNA gene of S. schenckii.
serodiagnosis. The test was initially devel-
oped against the S. schenckii conA-binding
fraction (SsCBF) antigen. However, in sero- 4.14.15 Treatment
diagnosis of cutaneous form, this antigen-
based ELISA produces cross-reaction with Potassium iodide (KI) or sodium iodide (NaI)
other infection such as paracoccidioi- is commonly used for the treatment of sporotri-
domycosis. Later, the exoantigens produced chosis especially for the lymphocutaneous and
by a mycelial phase of S. schenckii strain, fixed forms of the infection in cats, dogs and
isolated from Brazil, were used in ELISA horses. The compounds have high efficacy with
which produced no cross-reaction with minimal side effects. It is easy to administer and
antigens and serum samples from patients is relatively low in cost in comparison to the
with coccidioidomycosis, histoplasmosis or standard antifungals. KI has immunostimulation
paracoccidioidomycosis. property which can activate the neutrophils and
5. Skin test for detection of delayed-type hyper- monocytes to destroy the fungi. Some authors
sensitivity (DTH): The ‘sporotrichin test’ is a claim its proteolytic nature which helps to
tuberculin-like skin test for the detection of resolve the granulomas. However, exact mecha-
DTH against sporotrichosis. The antigen used nism of action is not known. The KI therapy
for the test varies with the country and accord- should be continued for 2–3 months for complete
ingly the result also varies. The 5 McFarland cure. However, in human, some side effects such
standard suspension of heat-killed yeast cells, as nausea, vomition, diarrhoea, abdominal pain
extracted mycelial antigens at 1:2,000 dilution and metallic taste are noted. Some cats are
(approximately 5 107 cells/mL) or diluted also susceptible to iodide toxicosis.
yeast phase antigens at 1:4,000 were used as In human, itraconazole is the first choice treat-
antigen in Brazil and Mexico, respectively. ment with the dose rate of 100–200 mg/day
The antigen is inoculated at 0.1 mL into the orally (for lymphocutaneous and fixed forms).
forearm or back of the suspected patient. It has minimal toxicity and good tolerance even
A positive result involves an indurated, ery- in long-term treatment except during pregnancy.
thematous and painful area of more than 5 mm In cats and dogs, also itraconazole is preferred
in diameter at the site of the injection 48 h nowadays. For disseminated form of sporotricho-
after inoculation. The test is sensitive for sis, amphotericin B is preferred even in pregnant
detection of lymphocutaneous and fixed women (after 12 weeks of pregnancy) and
cutaneous forms. Rarely, the false-negative immunosuppressed patients. Fluconazole is less
reaction is produced in anergic or effective and is preferred only for those patients
120 4 Cutaneous, Subcutaneous and Systemic Mycology
Table 4.36 Fungal species associated with mycetoma and properties of grains produced
Fungi Grain colour Size and texture
Madurella mycetomatis Black 0.5–4 mm, hard
Pseudallescheria boydii White 0.5–1 mm, soft
Trematosphaeria grisea (Madurella grisea) Black 0.3–0.6 mm, hard
Aspergillus flavus Green 0.5–3 mm, soft
Aspergillus nidulans White 0.5–4 mm, soft
Fusarium oxysoprum White 0.5–1 mm, soft
Curvularia geniculata Black 0.5–1 mm, hard
Acremonium falciforme White 0.5–1 mm, soft
Falciformispora senegalensis (Leptosphaeria senegalensis) Black 0.5–2 mm, hard
Neotestudina rosati White 0.5–1 mm, hard
Exophiala jeanselmei Black 0.2–0.3 mm, soft
Cylindrocarpon cyanescens White –
Polycytella hominis White –
Plenodomus avramii Black –
Corynespora cassiicola Black –
Pyrenochaeta mackinnonii Black –
Phialophora verrucosa Black –
boydii is the most common etiological agent of produces two types of conidia. Round conidia
eumycetoma in human. are detected in flask-shaped phialides, and
In addition, Microsporum canis, Cladophialo- pyriform conidia are observed in branched or
phora bantiana and Curvularia lunata are also unbranched conidiophores without phialides.
detected as aetiology of mycetoma in cat, dog, In Trematosphaeria grisea (Madurella grisea),
and dog and parrot, respectively. two types of hyphae are observed, i.e. thin
(1–3 μm width) and broad (3–5 μm width).
Pseudallescheria boydii (teleomorph) has
4.15.2 Morphology more than one anamorph, i.e. Scedosporium
apiospermum (anamorph) and Graphium
The mycetomal lesion consists of hyphal eumorphum (synanamorph). P. boydii is a homo-
aggregates, known as ‘grain’. The morphology thallic fungus. The reproductive structure
and colour of grain help in the identification of (cleistothecium/ascocarp) is produced in nutri-
fungal species (Table 4.36). Most of the grains tionally poor media. It initiates with the forma-
are round or oval and trilobed. Two types of tion of coiled ascogonia which is converted into
grains are detected, i.e. filamentous and vesicular matured cleistothecia (100–300 μm) within
(rare). The filamentous grain is composed of 10 days. The cleistothecial wall is composed of
branched, septate and brown hyphae. The vesic- thin, flat, polygonal brown cells, and it contains
ular grains consist vesicles and light-coloured globose or subglobose ascus which bears eight
hyphae at the centre and cementing substance at ascospores inside. The ascospores (4–5 μm
the periphery (melanin, heavy metal, protein and 7–9 μm) are unicellular, oval or ellipsoidal
lipid). The cementing substances interfere the and yellow-brown. The ascospores contain an
penetration of host immune effector molecules oil droplet inside (Fig. 4.34).
and antifungals. Scedosporium (anamorph) contains hyaline,
Microscopic study revealed that the thallus of septate and cylindrical hyphae (2–4 μm in diam-
Madurella mycetomatis is composed of regularly eter). The conidiogenous cells emerge from
septate hyphae. Most of the cultures are sterile. the hyphae which produce oval, brown, sticky
Sometimes conidiation is observed which conidia (4–9 μm 6–10 μm) which do not
122 4 Cutaneous, Subcutaneous and Systemic Mycology
Trematosphaeria grisea (previously Madurella polluted environmental niches having poor air
grisea) belongs to the order Pleosporales. circulation and high osmotic pressure.
Pseudallescheria boydii (teleomorph) and Mycetoma may occur throughout the world
Scedosporium apiospermum (anamorph) belonged but is common in tropical and subtropical zone
to phylum Ascomycota, class Euascomycetes, (between the latitudes of 15S and 30N) with
order Microascales and family Microascaceae. major foci in Asia (southern India), Africa
The genus Pseudallescheria is composed of (Somalia, Senegal, Sudan, Mauritania, Niger,
seven species such as P. boydii, P. africana, Ethiopia, Chad, Cameron) and South and Central
P. angusta, P. desertorum, P. ellipsoidea, America (Mexico, Argentina, Brazil, Venezuela)
P. fimeti and P. fusoidea. Among them, P. boydii (‘mycetoma belt’). Sudan has the highest inci-
is the only pathogenic species. Molecular phyloge- dence of mycetoma in human which is followed
netic analysis revealed that P. boydii is a species by Mexico. The endemic zone should have arid
complex consisting 44 haplotypes. and hot climate with limited rainfall. The
cases are also reported from the United States
(Texas, California), Germany, Egypt, Turkey,
4.15.4 Susceptibility to Disinfectants Philippines, Japan, Lebanon, Thailand, Iran,
The Netherlands, Ceylon and Saudi Arabia.
M. mycetomatis is susceptible to 70 % ethanol
and moist heat (60 C for 30 min).
4.15.6 Genome
4.15.5 Natural Habitat and Distribution
The mitochondrial genome of M. mycetomatis is
Madurella resides in the soil and sometimes a compact, circular DNA molecule (45,590 bp).
in thorns of the plants (Acacia) which also Most part of genome is AT rich and the overall
helps in the transmission of the infection. GC content is only 26.8 %. The genome encodes
Pseudallescheria boydii/S. apiospermum is for the rRNAs, tRNAs (27), proteins of respira-
detected in brackish water, saltwater, sewage, tory chain complexes (11), ATP synthase
soil, swamps, coastal tidelands, manure of poul- subunits and 6 intronic proteins including the
try, cattle and bat guano. They can tolerate high ribosomal protein (rps3).
temperature, low-oxygen tension and high salt The genomic organisation of Pseudalles-
concentration (5 %). So they are common in cheria boydii is still unknown.
124 4 Cutaneous, Subcutaneous and Systemic Mycology
4.15.7 Isolation, Growth and Colony agar, soil extract agar and water agar. The
Characteristics colonies of M. grisea are leathery, folded with
radial grooves, light brown to greyish in colour
The grains are collected from the mycetomal which later become dark brown to reddish-brown
lesion for isolation of etiological fungi or bacte- and have a brownish-black reverse.
ria. The grains are washed with sterile saline and The colonies of P. boydii in Sabouraud glu-
antibiotics, crushed with sterile glass rod and are cose agar look different from the upper surface
spread over the plate. The medium commonly (obverse) and from the reverse. The colour is
used is Sabouraud dextrose agar with antibiotics initially white and later becomes dark grey or
such as gentamicin sulphate (400 mcg/mL), pen- smoky brown (obverse), while from the reverse,
icillin G (20 U/mL), streptomycin (40 mcg/mL) the colonies appear pale with brownish-black
and chloramphenicol (50mcg/mL) for isolation zones. During preservation of the culture for
of Madurella. Some species of Madurella are many years, the colonies become dirty white
inhibited by antibiotics, so one plate without coloured and have fur-like surface without any
antibiotic should also be kept. Recently, the use conidia.
of trypticase soy agar with 5 % horse serum
has been proposed to enhance the growth of
M. mycetomatis. M. mycetomatis grows at 4.15.8 Antigenic Characteristics
37 C, while M. grisea grows at 30 C.
Sabouraud glucose agar is preferred for isola- M. mycetomatis secretes enzymes such as
tion of P.boydii/Scedosporium apiospermum fructose-bisphosphate aldolase (FBA) and pyru-
which requires 25 C as optimum growth tem- vate kinase (PK) which act as immunodominant
perature. This fungus can tolerate up to antigens. The antibodies against them are
37–42 C, low-oxygen tension or anaerobic con- detected in the sera of patients.
dition, high concentration of magnesium chloride P. boydii has a peptidopolysaccharide
(5 %) or sodium chloride (5 %). Addition of antigen (peptidorhamnomannan) which has a
benomyl, amphotericin B or dichloran makes similarity with Sporothrix schenckii pepti-
the medium selective for isolation of P. boydii/ dorhamnomannan, but they do not cross-react
Scedosporium apiospermum. during serological reactions.
The colonies of M. mycetomatis are white,
flat, woolly or leathery at the beginning which
later produce a diffusible brownish pigment and 4.15.9 Virulence Factors
become folded and heaped due to production of
aerial mycelium. The sporulation is better The virulence factors of M. mycetomatis and
observed in straw extract agar, wheat extract P. boydii are enlisted in Table 4.37.
Table 4.37 Virulence mechanisms and factors possessed by M. mycetomatis and P. boydii
Virulence mechanisms/
factors Functions
Ability to grow at 37 C It helps in better adaptation of M. mycetomatis to the host body temperature
Grain formation Within the host tissues, both M. mycetomatis and P. boydii produce grain (sclerotia or
granules) to evade the host immune response. Grains are fungal aggregates along with a
matrix or cementing substance
Peptidase (28 KDa, The extracellular peptidases are released by P. boydii. The peptidases split host fibronectin
34 KDa) and laminin which may help to escape the fungi from host effector cells such as fibronectin-
activated macrophage and monocyte
Serine protease It is released by S. apiospermum which splits host fibrinogen and helps in tissue invasion
(33 KDa)
4.15 Mycetoma (Madurella, Pseudallescheria, Scedosporium) 125
Following entry of the organism through the The clinical features of eumycetoma in human
wound, the fungi produce an aggregate with a and animals are described in Table 4.38.
sensitivity. ELISA is also used for the granulomatous disease in horses known as
detection of antibodies. Previously the ‘bursattee’ in local language. Later the aetiology
ultrasonicated mycelial extract (cytoplasmic of the disease was correlated with the fungi based
protein) was used as antigen in serological on histology. In 1901, Dutch investigators
tests which produce variable results and (de Haan and Hoogkamer) working in Indonesia
cross-reaction with other fungi. The use of isolated the fungi and identified them as
recombinant antigens [fructose-bisphosphate Zygomycetes (due to lack of sporulation) from
aldolase (FBA) and pyruvate kinase (PK)] in the horses having similar kind of infection
ELISA produces promising result for detec- (Hyphomycosis destruens equi). Witkamp
tion of M. mycetomatis antibodies. (1924), another Dutch scientist, also isolated the
5. Molecular biology: The PCR is developed for fungi from the horses showing a similar kind of
the detection of M. mycetomatis and syndrome. In 1974, Austwick and Copland
Pseudallescheria boydii using the primer for recognised them as a member of the genus
internal-transcribed spacer (ITS) located Pythium under oomycete family. Based on this
between 18S and 28S genes and beta-tubulin finding, Chandler et al. (1980) proposed the term
(BT2) genes, respectively. Rolling circle pythiosis for the infection. In 1987, de Cock first
amplification (RCA) technique is used to detect identified them as a new species under the genus
P. boydii which is based on the amplification Pythium and proposed the nomenclature of
of the ITS region with pan-fungal primers. Pythium insidiosum.
The loop-mediated isothermal amplification
(LAMP) method is also developed for the con-
firmation of P. boydii which do not require
4.16.1 Morphology
sophisticated instruments and is suitable for
endemic zones of developing countries.
Pythium can produce wide (4–10 μm), hyaline,
coenocytic or sparsely septate hyphae which pro-
duce branches at right angle (lateral pegs). In
4.15.15 Treatment older cultures, sporangia-like swellings
(12–30 μm) are observed. However, it is not
In human, ketoconazole or itraconazole with sur- considered as a true fungus due to lack of chitin
gical excision is recommended for eumycetoma. and sterol in cell wall and cytoplasmic mem-
Further, treatment with cotrimoxazole- brane, respectively. The cell wall is composed
streptomycin, trimethoprim and sulphame- of cellulose and β-glucans.
toxazole, and tetracyclins or rifampicine also
produces promising result. The study with exper-
imental Scedosporium infection in laboratory
4.16.2 Life Cycle
mice revealed that posaconazole, fluconazole
and voriconazole are effective in reduction of
The motile zoospores are considered as an infec-
fungal burden.
tious form of P. insidiosum. They are released in
In animals especially in horses, surgical exci-
the aquatic environment and infect the damaged
sion with thiabendazole powder applied topically
skin or gastrointestinal mucosa of animals and
is found effective against M. mycetomatis
human. The formation and release of zoospores
infection.
take place from the zoosporangium. The
zoosporangia are produced from the hyphae
which are in contact with certain plants. The
4.16 Pythium long, narrow and thin-walled tubular structure
with widen tip is developed from zoosporangia
Smith (1884), a veterinarian working in India, (discharge tube). The sporangial protoplasm
first described a chronic cutaneous enters the discharge tube to produce a terminal
128 4 Cutaneous, Subcutaneous and Systemic Mycology
vesicle. The vesicle expands in size and it is was detected, and the new genus Phytopythium
released from the discharge tube as a zoospore. has been proposed. Pythium is necrotroph
The zoospores are motile with two flagella pres- and zoospores are produced from a vesicle in
ent in anterior (tinsel) and posterior (whiplash) the zoosporangia, whereas Phytophthora is
site. The tinsel flagellum produces the thrust and hemibiotroph and the zoospores are produced
the whiplash flagellum acts as rudder during directly within the sporangia.
the swimming of the zoospores.
The swimming of the zoospores is directed
by chemotaxis (calcium, sugars and amino 4.16.4 Reproduction
acids released from the damaged plant root,
animal skin or tissues), electrotaxis and auto- Some strains of P. insidiosum can undergo sexual
aggregation. The aggregation of zoospores in a reproduction to produce oospores. The genera-
site attracts more zoospores to adhere which tion of oospores occurs in the oogonium (female
is known as auto-aggregation. The zoospores structure) which is intercalary, smooth and
adhere with the damaged skin surface of the subglobose, whereas the antheridium (male
animals and human by formation of a cyst-like structure) is diclinous (unisexual). The antherid-
structure. The gelatinous sticky glycoprotein ium produces a rigid fertilisation tube from
covering of the cyst helps in adherence. Germ their tip during conjugation. The oospores are
tubes are produced from the cyst which generates aplerotic which cannot fill the oogonium
hyphae. The hyphae penetrate the host tissues completely and often pressed to one side of the
to establish the infection. oogonium.
The asexual reproduction generates zoospores
which are described earlier.
4.16.3 Classification
4.16.8 Isolation, Growth and Colony Direct contact with P. insidiosum zoospores-
Characteristics infested water is the major route of transmission
in animals and human. The damaged skin or
P. insidiosum can be isolated in common fungal gastrointestinal mucosa helps in the adherence
media such as Sabouraud dextrose agar, vegeta- of the zoospores and dissemination of infection.
ble extract agar, peptone yeast glucose agar, In horses, most of the pythiosis lesions occur in
cornmeal agar, potato flakes agar and V8 the legs and ventral abdomen (Fig. 4.37).
agar with streptomycin (200 mcg/mL) and ampi- Recently, P. insidiosum is also isolated from the
cillin (100 mcg/mL). As an alternative, Campy larvae of Culex quinquefasciatus (tropical mos-
blood agar with trimethoprim, vancomycin, quito) in India which indicates the possible role
polymyxin B, cephalothin and amphotericin B of mosquito in propagation of infection.
can be used for isolation. The small pieces of The large, male, young (1–3 years) and out-
fresh, non-macerated tissues are directly placed door working dog breeds (e.g. Labrador
on the surface of plates. The plates can be
incubated both at 25 or 37 C along with a beaker Table 4.39 Virulence mechanisms and factors pos-
sessed by P. insidiosum
filled with distilled water to provide the moisture.
The typical colonies are observed within Virulence
factors Functions
12 –24 h. The colonies are submerged, white
Protease P. insidiosum produces three or more
to colourless, and have an irregular radiate proteases of different molecular weight.
pattern. In the laboratory, zoospore production They are considered as serine proteases.
can be induced by keeping boiled grass blades The proteases help in host tissue invasion
on the surface of a 1–2-day-old colony growing Mechanical The mechanical force is exerted by the tips
on 2 % water agar and incubating at 37 C for force of the elongating hyphae which also help
in host tissue invasion
18–24 h.
130 4 Cutaneous, Subcutaneous and Systemic Mycology
4.16.14 Immunity
Table 4.41 Physical properties of conidia and colony characteristics produced by different melanised fungi
Fungi Conidia Colony characteristics
Cladosporium The conidiophores are branched or unbranched. During Colonies are olivaceous to black and
conidiogenesis, ramoconidia (shield cells) are produced velvety
first which give rise to branching chains of dark-coloured,
single- or double-celled conidia with prominent attachment
scar (hila)
Alternaria Chains of conidia are found which are large, dark, euseptate Colonies are woolly, pale to olivaceous to
alternata and muriform black. The growth of the colony is rapid
A. infectoria The conidia have long apical beaks which serve as
secondary conidiogenous cells
Bipolaris There is bipolar germination of conidia. The conidiophores Colonies are woolly, grey to black, with
spicifera are geniculate (bent) with flattened hilum. B. spicifera has rapid growth
three distosepta (pseudosepta where inner walls are
involved) and four cells
Exophiala The conidiogenous cells produce conidia by short Colonies are primarily mucoid which
percurrent proliferations (annellations). The tip of an later become more filamentous
annellide increases in length and becomes narrower as each
subsequent conidium is formed. Sometimes phialides are
also present
Fonsecaea The conidia are produced from swollen denticles (small Colonies are olivaceous to black and
projection). The secondary and tertiary conidia in chains velvety
(four conidia) are also produced on sympodial
conidiophores or on phialides
Phialophora It has dark, funnel-shaped collarettes Colonies are olivaceous to black and
verrucosa velvety
Ochroconis The conidia are clavate and borne from denticles Colonies are brown, velvety with a red
gallopava diffusing pigment
explains about their affinity for central nervous bantiana, Ochroconis gallopava) in Sabouraud
system due to the structural similarity between dextrose agar, brain–heart infusion agar, potato
the hydrocarbon and neurotransmitter. dextrose agar, malt extract agar, V8 juice agar,
Most of the species are able to grow at 37 C cereal agar, carnation leaf agar, cornmeal dextrose
or at higher temperature (Cladophialophora agar (nonselective) or cycloheximide-containing
134 4 Cutaneous, Subcutaneous and Systemic Mycology
granuloma with lymphocytes, granulocytes and sections of the nodules in cats reveal granu-
giant cells (highly developed immune system). lomatous dermatitis containing neutrophils,
In debilitated mammals such as immunocompro- macrophages and giant cells. The pigmented,
mised animals or wild animals kept in captivity, yeast-like cells and hyphal elements are identified
chances of infection are more. in the tissue sections of nodules in cutaneous or
Ochroconis gallopava was reported to subcutaneous form and black granular necrotic
cause epidemic encephalitis in poultry, turkey, areas throughout the liver in systemic form.
captive owl and cats. It causes cerebral Other histopathological stains such as melanin
phaeohyphomycosis in quail chicks and grey- Fontana–Masson, periodic acid–Schiff (PAS)
winged trumpeters (Psophia crepitans). The and Gomori methenamine silver can be used for
birds showed sudden ataxia, intermittent torticol- the detection of light-melanised fungi. Isolation of
lis and rigidity of legs. the melanised fungi in artificial culture is required
In cats, cutaneous, subcutaneous and systemic to confirm the infection. However, the specimens
phaeohyphomycoses were reported which from the patients receiving antifungals may not
were caused by Cladophialophora bantiana, produce any growth, and in such cases histopa-
Phialophora verrucosa, Fonsecaea pedrosoi, thology helps in identification. The nucleic acid
Exophiala spinifera, Alternaria alternate and sequencing of the internal-transcribed spacer
A. infectoria. The infection showed nasal, ocular, (ITS1 of rRNA gene) is developed for the detec-
renal and cerebellar involvement. tion of black yeast (Chaetothyriales) infection in
In dogs, Ochroconis gallopava and Bipolaris animals.
spicifera were detected to cause systemic Treatment of melanised fungi in human and
phaeohyphomycosis which involved the brain, animals is difficult due to the presence of mela-
bone and kidney. Cladosporium cladosporioides nin in their cell wall which make them refractory
was detected to cause granulomatous encephali- to the most of the antifungals. In animals, the
tis and nephritis. Onychorrhexis (breakage of systemic antifungals such as amphotericin B,
nails) on the digits and blackened corium, black itraconazole, voriconazole, posaconazole, caspo-
plaque-like lesion in mouth was observed in fungin and anidulafungin are used for the treat-
dogs suffering from Alternaria infection. ment of black yeast infection. Clean and hygienic
In sheep (merino breed), Cladosporium pen and poultry houses can prevent the transmis-
cladosporioides causes systemic phaeohypho- sion of black yeast.
mycoses which was characterised by anorexia,
fever and respiratory distress followed by death.
In horse, firm brown-coloured skin nodule, alo- 4.17.2 Pneumocystis
pecia and scaling in head and neck were detected
due to Alternaria infection. Carlos Chagas (1909) first observed the cystic
The clinical specimens include tissue forms of Pneumocystis in the lungs of rats and
biopsies, aspirates and body fluids. The postmor- guinea pigs. Vanek and Jirovec (1952) first
tem samples such as the brain sections can also described Pneumocystis as an aetiological agent
be collected from the animals died due to of endemic pneumonia in children. Later (1960
suspected encephalitis. The blood from the onwards) it was recognised as an opportunistic
suspected animals is collected for culture if the pathogen in immunocompromised children.
lesions are not accessible. Gram stain, KOH wet In 1980s, Pneumocystis was recorded as most
mount and fluorescent staining (calcofluor white) widespread opportunistic pathogen in individuals
are the most commonly used methods for the suffering from AIDS. With the advancement
direct examination of specimens. The histo- of antiretroviral therapy, the incidence of
pathological staining of brain tissues with Pneumocystis infection in human subsided.
haematoxylin and eosin shows the invasion of Earlier Pneumocystis was considered as
septate, melanised hyphae. The histological protozoa. The molecular phylogenetic study
136 4 Cutaneous, Subcutaneous and Systemic Mycology
based on 16S rRNA and mitochondrial gene endoplasmic reticulum-like structure. A nucleus
established its correlation with the kingdom is present in the variable position of the cell with
Fungi. Recent classification included a nucleolus either centrally or peripherally. The
Pneumocystis under the phylum Ascomycota, vacuoles, microtubules and a budding Golgi
class Archiascomycetes, order Pneumocystidales complex are also sometimes observed. Some
and family Pneumocystidaceae. Pneumocystis trophozoites contain filopodium-like structure
infects mammals only and is highly host specific. which helps in making contact with host cells.
Previously all the forms of Pneumocystis was Both the developmental stages lack sterol (ergos-
designated as Pneumocystis carinii as an honour terol) in their cell wall.
to Antonio Carini, an Italian biologist who Pneumocystis is ubiquitous in nature which is
described them in rats. At present P. carinii is commonly detected in soil, pond water and
used to describe the rat or other animal-related indoor or outdoor air. The antibodies are detected
forms of Pneumocystis. It is detected in dogs, in children (7 months–4 years) and adults (both
cats, sheep, goat, monkey, rat and mice. Human in HIV and non-HIV healthy patients) through-
form of Pneumocystis is designated as out the world without any clinical syndrome,
Pneumocystis jirovecii in honour of Jirovec. indicating their exposure to the organism. The
In the life cycle of P. carinii, two develop- fungi cause a major opportunistic infection
mental stages exist, i.e. the mature cyst and the (pneumonia) throughout the world, and the prev-
trophozoite. The matured cysts are spherical alence rate is rising in developing countries of
(5–8 μm in diameter) containing up to eight Asia (Thailand, Vietnam, Cambodia), Africa
numbers of intracystic bodies (1.2 μm mean (Tanzania, Congo, Ivory Coast, Zimbabwe,
diameter). The cysts are surrounded by two cell Kenya, Ethiopia, South Africa) and North and
layers, i.e. outer layer (15 nm thick) and inner South America (Mexico, Panama, Guatemala,
layer (35 nm thick). The cyst protoplasm consists Venezuela, Brazil, Chile, Argentina and Peru).
of a matrix and intracystic bodies. The matrix In India, the prevalence rate of pneumonia
contains mitochondria, ribosome, empty caused by Pneumocystis is low (5–6.1 %).
vacuoles and membrane debris. The intracystic The genome of P. carinii is haploid and
body is spherical to oval containing a centrally consists of 13–15 linear chromosomes (300–700
located nucleus, endoplasmic reticulum, free Kbp each). The genes present in the genome
ribosome, mitochondria and glycogen particles. contain 60–65 % AT sequences and introns
After release of intracystic bodies, the cyst (less than 50 bp, nine per gene in number).
becomes banana shaped which is known as Pneumocystis isolation in artificial culture is
remnants of the ruptured cysts. The intracystic not possible probably due to its stringent require-
bodies originate trophozoites. ment which cannot be reproduced outside
The trophozoites are 0.3 μm in diameter, vary the host.
in shape and produce clusters, and they are The major antigen of Pneumocystis is a sur-
associated with pneumocytes in the lung tissue. face glycoprotein (major surface glycoprotein/
They are haploid in nature and they can undergo glycoprotein A, 90–120 KDa), encoded by msg
binary fission (endogeny). Later two trophozoites gene. The relatively conserved carboxy-terminal
conjugate to produce a diploid cell which region of the protein (MsgC) is immunodominant
undergoes meiosis (three times) to produce a in nature, and anti-MsgC antibody titre is often
spherical cell (cyst) with eight intracystic bodies. detected in infected patients. The Msg protein
The trophozoites are surrounded with a helps in interaction with a number of host cell
20–30 nm thick dense coat which contains proteins (fibronectin, vitronectin, surfactants)
small electron translucid areas. The coat helps and attachment with the host epithelial cells.
in anchoring and nutrient uptake. The trophozo- Pneumocystis can secrete proteases [kexin
ite cytoplasm is rich in free ribosome, glycogen (Kex1, Prt1)] having similarity with serine
particles, mitochondria with cristae and proteases (Kex2) produced by Saccharomyces
4.17 Emerging and Uncommon Pathogenic Fungi 137
cerevisiae. The kexin acts as virulence factor by Pneumocystis. The natural antibodies help in rec-
proteolytic processing and activation of Msg ognition of fungi by dendritic cells and enhance
protein. dendritic cell maturation and migration into the
Transmission of P. jirovecii occurs from a draining lymph nodes. The natural antibodies
common environmental source or through also help in the development of anti-
person-to-person contact. The animal-to-human Pneumocystis-adaptive immunity containing
transmission of Pneumocystis is not observed. both humoural and cellular responses. The anti-
The infection can also reactivate from latent Pneumocystis humoural immunity plays a major
childhood contamination during immunocom- role in protection. The passive transfer of hyper-
promised condition. The childhood contamina- immune antiserum or monoclonal antibodies
tion may remain latent in the host for a conferred protection in experimentally infected
prolonged period due to changing capability of mice. As a component of cellular immunity, opti-
Pneumocystis Msg structure to evade immune mum level of CD4+ T cells (Th1, Th2, Th17)
response. The seroconversion rate of along with functional co-stimulatory molecules
Pneumocystis in children was detected as 5 % (CD2, CD28) is associated with the control of
per month. The children may act as reservoir and Pneumocystis infection. The level of Th2 was
transmit the infection to other persons who are detected to be maximum during experimental
healthy or immunocompromised. In healthy infection. The natural IgM is required for the
persons again it maintains the latency, whereas development of Th2 response, Th17 cell differen-
in immunocompromised patients, it produces tiation and immunoglobulin class switching,
fatal pneumonia. In animals, inhalation is the whereas CD8+ T cells offer a partial protection
major route of transmission. only. Further, γδ T cells may play a role in
After transmission, the organisms proliferate controlling inflammation and pulmonary injury
extracellularly in the lung alveoli. The virulence during diminished αβ-T cell concentration.
factor (Msg) of Pneumocystis interacts with alve- The diagnosis depends on direct examination
olar epithelial cells for attachment. Diffuse alve- of clinical specimens such as sputum, saliva,
olar lesions are observed which suggest the bronchoalveolar lavage (BAL) and lung tissues.
involvement of host immune response with T The commonly used stains are Giemsa, methena-
cell-mediated inflammation. mine silver, toluidine blue and Diff-Quik. How-
P. jirovecii causes pneumonia (PcP) in immu- ever, direct detection method especially in
nocompromised human patients due to histological sections requires expertise. Instead,
malignancies, immunosuppressive therapy, con- detection of Pneumocystis antigen (β-D glucan)
genital immunodeficiency or other infection in BAL and antibodies in serum is an alternative
(HIV) and malnourished children. P. carinii can diagnostic strategy. The PCR is a better choice
infect Arabian foals with or without severe com- for diagnosis targeting the genes encoding Msg
bined immunodeficiency. The clinical signs in antigen or mitochondrial large subunit rRNA
horses include dyspnoea, cough and nasal dis- (mtLSU) gene. The real-time PCR is also devel-
charge. The lungs become firm, meaty and mot- oped for the detection of Pneumocystis heat
tled. The lung parenchyma resists of being cut shock protein 70 gene (hsp70). Currently
and bulges on cut section during in vitro test. attempts are in progress with cdc2 as target
Naturally occurring P. carinii infection is also gene to increase the sensitivity and specificity
reported from piglets, goats, dogs, cats and non- of the molecular assay.
human primates. In goats, P. carinii infection Trimethoprim–sulphamethoxazole is the drug
was associated with Mycobacterium avium of choice for treatment and prophylaxis of
subsp. paratuberculosis. Pneumocystis-associated pneumonia in human.
The natural antibodies (IgM) generated with- Some patients with HIV infection (25 %) are
out any antigenic stimulation as a component of unable to tolerate a full course of trimethoprim–
innate immunity offered protection against sulphamethoxazole. In such cases, intravenous
138 4 Cutaneous, Subcutaneous and Systemic Mycology
4.17.3 Prototheca
and rrn5 are detected in the mitochondrial Prototheca (P. zopfii genotype 2) causes sub-
genome of P. wickerhamii which indicates their clinical or chronic mastitis in cattle without sys-
relationship with algae, the simplest plant. temic involvement. The clinical syndrome is pain
Prototheca is heterotrophic in nature. They in udder, watery milk secretion with clots and
require external sources of organic carbon (glu- decreased milk production. The somatic cell
cose, fructose and galactose), nitrogen (protein or count varies between 6 and 9 million cells/mL.
inorganic nitrogen), oxygen and thiamine for The infection is limited within the udder and
their growth. They can be isolated in blood regional lymph node. However, sporangia and
agar, brain–heart infusion agar and Sabouraud sporangiospores are detected within the macro-
dextrose agar (SDA) without cycloheximide. phage and neutrophils in the alveolar lumen and
The specific medium for Prototheca should con- interstitium, indicating the intracellular nature of
tain folate (for inhibition of bacteria) and the infection. So it is difficult to eradicate and it
5-fluorocytosine (for inhibition of yeast). The becomes chronic mastitis which persists for sev-
plates are incubated at 25–37 C for 48–72 h. eral lactation periods. The chronic mastitis
P. wickerhamii colonies are smooth, moist, becomes progressive interstitial mastitis with
cream-coloured and yeast-like. P. zopfii colonies consequent alveolar atrophy and severe
in SDA are large, dull white, irregularly mar- decreased milk production.
gined and granular with a central protrusion. P. zopfii (sometimes P. wickerhamii) causes
P. zopfii has three biotypes (I, II, III) which systemic protothecosis in dogs. The transmission
are based on carbohydrate assimilation. The bio- of infection occurs by ingestion route. The algae
type II (associated with bovine mastitis) can fer- pass through the intestinal mucosa and are
ment glucose and glycerol but not galactose disseminated throughout the body via blood or
(delayed fermentation may occur in some lymph. Gastrointestinal disorders producing
isolates), whereas biotype III (swine isolates) vomition, tenesmus and intermittent diarrhoea
cannot ferment glycerol. The antigenic structure (with blood and slime) are most commonly
differs between the three biotypes. Based on 18S manifested. Diffuse hyperaemia, haemorrhages,
rRNA gene sequence and cellular fatty acids, the ulcerations and multiple granulomas are
biotype III is recently proposed as a novel species observed in the intestinal mucosa (especially in
(P. blaschkeae sp. nov.). Further, all the three the colon) which may result intestinal stricture
biotypes are currently considered as three and obstipation. The infection can spread to the
genotypes (1–3) of P. zopfii. central nervous system, cardiovascular system,
The transmission of Prototheca occurs by urinary tract, liver, skeletal muscle, lymph
direct contact or traumatic inoculation in nodes, thyroid gland, pancreas, peritoneum and
human, dogs and cats. In cattle, the organism diaphragm. The eye infection leading to blind-
enters from contaminated environment (faeces, ness due to glaucoma and retinal ablation is
wet litter) through direct contact with teat end, another common clinical sign.
especially 25–30 min after milking when the teat P. wickerhamii causes cutaneous protothecosis
canal sphincter is relaxed to prevent the ascend- in cats and dogs. It is characterised by ulcerative
ing infection. Alternatively, Prototheca is also lesions, scabs and pyogranulomatous dermatitis in
transmitted through intramammary infusion the limbs, trunk and mucosal surfaces.
material. The cow-to-cow transmission during Human infection is primarily caused by
milking is also possible. The predisposing factors P. wickerhamii (rarely by P. zopfii). Three clini-
include poor milking hygiene, prolonged antimi- cal forms such as cutaneous, olecranon bursitis
crobial therapy and warm and humid weather. In and systemic form are commonly detected. The
dogs, transmission may occur via ingestion also cutaneous form occurs in immunocompromised
which results systemic infection. Man-to-man or individuals, and it is characterised by the forma-
man-to-animal and vice versa transmission of tion of vesiculobullous and ulcerative lesion with
Prototheca is not detected. purulent discharge, erythematous plaques,
140 4 Cutaneous, Subcutaneous and Systemic Mycology
pustules, papules, nodules, pyodermic and PAS staining with diastase can differentiate
herpetiform, and hypopigmented or atrophic Prototheca and green algae. The green algae
lesions in exposed areas such as extremities and contain cytoplasmic starch granules that are
face. The olecranon bursitis takes place as a PAS negative following diastase treatment. Sero-
result of injuries or grazing of the elbow. The logical tests for the detection of anti-Prototheca
signs include mild induration of the bursa along antibodies can be performed in cattle to confirm
with tenderness, erythema and production of the subclinical infection. The PCR based on 18S
serosanguineous fluid. The systemic form occurs rDNA sequence is developed for differentiation
in immunocompromised patients. The tissues of three P. zopfii genotypes. Taqman probe-based
and organs such as the skin, subcutaneous tissue, quantitative PCR is recently developed for the
gut, peritoneum, blood and spleen are affected. differentiation of P. zopfii genotype which is
The clinical specimens for diagnosis of based on small subunit ribosomal DNA
Prototheca infection in animals include faeces, sequences.
urine, mastitic milk, skin scrapings and lesion In human, amphotericin B is used in systemic
exudates, whereas from human, skin scarificates protothecosis which prevents the ergosterol syn-
(cutaneous protothecosis) or joint punctuate thesis of Prototheca. The immidazoles have also
(olecranon bursitis) can be collected. Direct attempted without any conclusive findings. Sur-
examination of the wet mount slides prepared gical excision is preferred in some cases. In
from the clinical specimen or culture and stained immunocompromised individuals, the prognosis
with lactophenol cotton blue or calcofluor white is grave.
can be done (Fig. 4.43). The tissues can be In dogs with systemic protothecosis,
stained with Gridley fungus stain, Grocott’s amphotericin B and immidazoles are used,
modification of Gomori methenamine silver, although the effect of such antifungals is not
PAS with or without diastase and haematoxy- concluded. Surgical excision is performed in
lin–eosin (less sensitive). Prototheca appears as cutaneous form.
large, spherical, oval or elliptical, non-budding The effective treatment for protothecal bovine
cells both in wet mount and tissues. The size of mastitis is yet not developed, although the
Prototheca sporangia is usually smaller in vitro antifungal sensitivity of P. zopfii was
(10–30 μm) than the other fungi, and it contains observed against amphotericin B, nystatin, poly-
2–20 numbers of sporangiospores. In Gram- myxin, gentamicin and neomycin. The control of
stained smears, spores stain as gram positive mastitis can be achieved by detection and exclu-
and the empty sporangia are gram negative. The sion of infected animals from the herd and by
adaptation of common hygienic measures such as
teat dipping before and after milking, etc.
4.17.4 Lobomycosis
both asexual (zoospores) and sexual spores The diagnosis of lagenidiosis is based on
(oospores). The zoospores are biflagellate and histological observation, isolation of fungi and
motile which can infect the mosquito larvae. serological and molecular tests. In contrast to
The zoospores do not have a cell wall and are Pythium, the hyphae of Lagenidium can be
fragile in nature (48 h survival period). The observed in haematoxylin–eosin (H&E)-stained
oospores are resistant to desiccation and mechan- smear and the smears stained with Gomori
ical abrasion and remain viable for several years methenamine silver (GMS). The Lagenidium
in the environment. hyphae are broader (7–25 μm) than Pythium
L. giganteum was isolated from different parts hyphae (4–10 μm). The ELISA can detect the
of the world including North America, Europe, anti-Lagenidium antibodies in canine serum.
Africa, Asia and even Antarctica. Canine However, these antibodies may produce cross-
pathogenic Lagenidium is so far reported from reaction with Pythium infection. So,
young- to middle-aged dogs residing at south- Lagenidium-ELISA should always be performed
eastern United States. They reside in the aquatic along with Pythium-ELISA to get a confirmative
environment as a saprophyte. The dogs suffering diagnosis. The PCR is developed using the
from Lagenidium infection had previous internal-transcribed spacer (ITS) of rRNA gene
exposures to ponds or lakes. Lagenidium are as a target. The PCR is successfully applicable
sterol auxotrophs and incorporate sterols from for the confirmation of DNA extracted from the
the environment rather than producing them. culture and clinical specimens if preserved prop-
Lagenidium can be isolated in peptone yeast erly. The sequencing of the PCR product and its
glucose (PYG) agar with ampicillin alignment study can definitively diagnose the
(100 mcg/mL) and streptomycin (200 mcg/mL) fungi.
and 2 % Sabouraud dextrose agar. The small In animals, surgical resection of infected
pieces of tissues are directly placed on the sur- tissues with wide margin is the treatment of
face of plates. The plates are incubated at 37 C. choice for lagenidiosis. Amputation is suggested
The typical colonies are observed within if the infection occurs in limbs. Assessment of
24–48 h. The colonies are submerged, glabrous internal organs is recommended before surgical
and white to colourless. The zoospores can be resection to determine the stage of dissemination,
artificially produced in Sabouraud dextrose agar if any. Treatment with antifungals is not so much
(pH 7.0) and corn meal agar. successful. However, use of itraconazole and
The infection produced by Lagenidium is terbinafine combined with surgical resection
known as lagenidiosis. The lagenidiosis in was found effective in dogs. In human suffering
dogs is characterised by progressive cutaneous from keratitis, repeat penetrating keratoplasty
or subcutaneous multifocal lesions which successfully eradicated the infection and
involve the extremities, mammary gland, peri- prevented the recurrence.
neum and trunk. The lesions are nodular or
ulcerated with draining tracts. The dissemina-
tion of infection occurs into the regional lymph 4.17.6 Basidiobolus and Conidiobolus
nodes and abdominal great vessels. Sometimes
the infection in dogs is associated with Basidiobolus and Conidiobolus belong to the
hyperglobulinaemia, hypoalbuminaemia and order Entomophthorales (entemon ¼ insect)
hypercalcaemia. Cats, ruminants and other under the class Zygomycetes and phylum
domestic animals are not reported to be infected Zygomycota. Recently a new subphylum
with Lagenidium. However, lagenidiosis is a (incertae sedis), namely, Entomophthoro-
common problem in shrimp culture, causing mycotina, is proposed to include the order
lethargy and mortality of larvae. In human, Entomophthorales. Major species under the
severe keratitis is reported with Lagenidium genera are Basidiobolus ranarum, Conidiobolus
infection. coronatus, C. incongruus and C. lamprauges.
4.17 Emerging and Uncommon Pathogenic Fungi 143
The hyphae are broad, thin walled, coenocytic (Basidiobolus). The typical colonies are flat,
with little branches. The hyphal diameter of waxy in consistency and grey in colour. With
Basidiobolus is 5–20 μm (mean 9 μm) and the maturity, the colonies become heaped and
Conidiobolus is 5–13 μm (mean 8 μm). Both of radially folded. The aerial hyphae are generated
the fungi produce asexual (conidia) and sexual and the different conidia are discharged. The
spores (zygospores). The conidiophores are discharged spores (primary, secondary and
unbranched. Primary conidia are produced singly capilliconidia) cover the colony surface and lid
at the swollen tip of the conidiophores which are of the Petri dish.
discharged forcibly. The primary conidia are The transmission of the infection occurs by
spherical, 12–40 μm in diameter, and have a percutaneous entrance of the spores through the
prominent basal papilla or hair-like projections trauma, insect bite, etc. Mites and other insects
(villose conidia). Secondary conidia are can carry the fungal spores (capilliconidia of
generated from the primary conidia which are Basidiobolus ranarum) on their surface. Some-
smaller. Sometimes, oval to elongate spores times ingestion and inhalation of the spores can
with a terminal knob are produced which are also transmit the infection. Dogs get infected
known as ‘capilliconidia’. The zygospores are while chewing of the wood which is old and
thick-walled, smooth, undulant and contain a decaying. The reptiles and amphibians excrete
characteristic ‘copulatory beak’ (remnant of the the spores in the environment, although the sta-
copulation tube). bility of the spores in the environment is low.
Most of them are saprophytes and are com- The virulence factors include thermotolerance,
monly found in soil, decaying plant materials. serine protease, lipase and collagenase.
They are also present in insects and faeces of Thermotolerance (37 C) helps in adaptation of
amphibians and reptiles. Both of the fungi are the fungi in mammalian host. The serine protease
worldwide in distribution but are more prevalent is involved in discharge of fungal spores. Other
in tropical countries or countries with warm and proteases, lipase and collagenase cause tissue deg-
moist climate such as India, Australia, Africa, radation and help in invasion of the fungi. Cellular
Central America, Brazil, Colombia and south- degradation products provide nutrition to the fungi.
eastern United States. The major diseases produced by Conidiobolus
Both of the fungi can be isolated in common and Basidiobolus are enlisted in Table 4.43.
media such as Sabouraud dextrose agar and The clinical specimens for the diagnosis of
potato dextrose agar. The plates are incubated Conidiobolus and Basidiobolus infection in
at 25 C for 2days (Conidiobolus) to 5 days animals and human include polyp, scrapings,
Table 4.43 Major diseases of animal and human caused by Conidiobolus and Basidiobolus
Fungi Host Disease
Conidiobolus Horses Equine conidiobolomycosis (rhinophycomycosis): It is characterised by
pyrogranulomatous lesion in nasal mucosa which causes epistaxis, nasal discharge and
dyspnoea
Sheep, deer, Nasopharyngeal infection with or without local dissemination into face,
human retropharyngeal region and retrobulbar space. Nasal polyp may develop which can
block the passage. The human infection was previously described as ‘subcutaneous
phycomycosis’
Dogs Nasopharyngeal conidiobolomycosis: It is characterised by the formation of severe
chronic ulcerative dermatitis in the nasal planum, ulcer in hard palate, regional
lymphadenopathy, mutifocal ulcerative subcutaneous lesions and pneumonia
Cats Lesion in the gastrointestinal tract, lungs, hard palate
Basidiobolus Dogs Gastrointestinal tract lesion, focal preputial/vulvar lesion, ulcerative draining skin
lesions (rare)
Horses Pruritic granulomatous lesions in the trunk, neck, thorax, ventral abdomen and head
144 4 Cutaneous, Subcutaneous and Systemic Mycology
exudates, nasal discharge and bronchoalveolar adiaconidia by the fungi, the infection is known
lavage. The direct examination of the specimens as adiaspiromycosis.
can be done with KOH mount which reveals the Emmonsia belongs to the family
presence of broad, thin-walled, coenocytic Onygenaceae. The major species under the
hyphae with little branches in positive cases. genus are Emmonsia crescens (formerly
The branches are emerged at right angles from Chrysosporium parvum var. crescens) and
the hyphae (‘lateral peg’). The histological E. parva. The hyphae are hyaline, septate and
sections are characterised by granulomatous branched. The conidiophores come up at right
inflammation infiltrated with neutrophils, plasma angle from the vegetative hyphae and produce
cells, eosinophils and multinucleate giant cells. small aleurioconidia (2–4 μm). These spores are
In haematoxylin–eosin-stained smear, the granu- transmitted into the host by inhalation. In the
loma contains hyphae at the centre as clear or lung tissue (or in artificial culture at 40 C), the
basophilic mass. It is surrounded by a wide spores are converted into a spherical structure
(2.5–25 μm) eosinophilic sleeve (‘eosinophilic (adiaconidia). The adiaconidium matures into a
cuff’) which differentiates Conidiobolus and thick-walled spherule (200–400 μm in diameter).
Basidiobolus infection (Entomophthorales infec- No further replication of spherule is observed.
tion) from others such as pythiosis and The spherule wall is refractile and bilayered.
lagenidiosis. This sleeve is an antigen–antibody The outer layer is narrow and eosinophilic,
complex and the incident is called ‘Splendor- whereas the inner layer is wide, hyaline and
e–Hoeppli phenomenon’. The serological test chiefly made of chitin. The spherules in the tissue
such as ELISA for the detection of antibodies is appear as empty or may contain small eosino-
also developed. philic globules. When the spherule concentration
The most effective treatment in animals is increases in the body, they may collapse the lung
aggressive surgical resection of infected tissues alveoli and produce respiratory distress and
which is followed by itraconazole for 2–3 failure.
months. If surgery is not preferred by the owners, The adiaspiromycosis is detected in human,
the combination of itraconazole or amphotericin dogs, goat, horse and soil burrowing mammals
B lipid complex is recommended. The subcuta- such as armadillos, ground squirrels, mink, mice,
neous infection can be treated with itraconazole, skunks, etc. In human, three clinical forms are
amphotericin B lipid complex and potassium reported depending on the concentration of
iodide. The equine conidiobolomycosis is also spores transmitted into the body. The forms are
treated with direct injection of amphotericin B solitary granuloma, localised granulomatous
within the lesion along with systemic sodium and form and disseminated form. In low concentra-
potassium iodide therapy. tion of spores, pulmonary nodules develop and
the infection remains asymptomatic. In
disseminated form, fever, cough and dyspnoea
4.17.7 Adiaspiromycosis (Adiaspirosis, are observed due to compression and displace-
Haplomycosis) ment of alveolar parenchyma by the expanding
granulomas. Rarely the infection may spread into
Adiaspiromycosis is a non-contagious, self- the other body parts such as the skin, peritoneum
limiting pulmonary infection of mammals and bone. In animals, the infection is mostly
(rarely human) caused by dimorphic fungi of asymptomatic and light grey to yellowish lesions
the genus Emmonsia (previously known as are observed in the lungs.
Chrysosporium). The fungus was first isolated The diagnosis depends on the histopathological
by Emmons and Ashburn (1942) from wild detection of characteristic spherule in the lung
rodents in Arizona. The fungus is currently tissue. In the tissues, the spherule is detected in
worldwide in distribution and it is present as the centre of a granuloma produced by giant cells,
saprophyte in the soil. Due to production of epithelioid cells and fibrous tissues. All the
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The collection of proper clinical specimens with Ear and nose: The ear and nasal swabs are
sterile instruments and their timely shipment collected by gently mopping the ear or nasal
with appropriate arrangements into the labora- canal with the help of sterile cotton swabs. The
tory is a crucial matter for isolation and identifi- swabs should be moistened with transport
cation of fungi. The correct type of specimen medium before collection. The collected swabs
with sufficient quantity is required for proper are put into Stuart transport medium or sterile
identification. Table 5.1 describes the types of Sabouraud broth or BHI broth for transport. The
clinical specimens that can be collected from fine-needle aspirates from nasal polyp can be
different body systems and types of fungal collected with a long needle. In rhinosporidiosis,
infection that can be identified from those nasal scrape is preferred over the fine-needle
specimens. The collection methods of clinical aspirates because the lesions bleed easily.
materials and their despatch are mentioned Gastrointestinal tract: The faeces should be
below. collected in sterile, wide-mouth and screw-
Cerebrospinal fluid (CSF): The CSF is col- capped short jars. Rubber caps should be avoided
lected slowly by lumbar puncture between third because the gas generated in the collected faeces
and fourth vertebrae with a needle (18–20 s.w.g.) may blow the cap. The faeces and urine should
and a stylet (10 cm). However, in animals, the not be mixed together. Rectal or cloacal swabs
collection of CSF is not always safe. The animals can be collected as described above. Gastric
have increased CSF pressure and the collection lavages are collected by flushing the empty stom-
of CSF rapidly decreases the pressure with fatal ach with sterile water. The washings are taken
consequences. into sterile screw-capped glass containers.
Eye: The corneal swabs are collected by hold- Respiratory system: In human the sputum is
ing the palpebra apart and gently swabbing the collected in empty stomach in a screw-capped
surface with the help of sterile cotton swabs. The wide-mouth sterile container. In full stomach
corneal scrapings are taken from the base and the sample may be contaminated with bacteria
margin of corneal ulcers with a sterile spatula and other saprophytic fungi. The fresh single
under local anaesthesia. The swabs and scrapings cough specimen expectorated in the early morn-
are put into Stuart transport medium or sterile ing is the most ideal for fungal investigation. In
Sabouraud broth for transport. The anterior animals, the sputum is collected with small throat
chamber fluid of eye can be collected immedi- swabs as described above. The sputum should be
ately after death of the animal. It is done by transported and processed rapidly to reduce the
inserting a small gauge needle through the cornea contamination level. The bronchoalveolar lavage
into the anterior chamber and aspirating the fluid (BAL) is preferably collected with a broncho-
into a 3 or 5 ml syringe. scope from human patients who cannot produce
blood (with anticoagulant) in triplicate is used for swabs are placed into glass tubes with Sabouraud
isolation of fungi. The serum is used for serolog- broth. The pus can be also collected by fine-
ical diagnosis of fungi and testing with paired needle aspiration technique. After collection of
sera (sera collected during acute phase and con- pus or exudate in sterile syringe, the needle
valescent phase) can confirm the infection. After should be discarded and the syringe should be
collection the serum is preserved with merthio- capped before transport to reduce the environ-
late (1:1,000) or carbolic acid (0.5 %). mental contamination. The skin biopsies should
Mammary gland: Milk from the mastitic be collected both from periphery and centre of
animals is collected for fungal investigations. the lesion. The punch biopsy technique can be
The udder is washed with antiseptic solution and used under local anaesthesia.
the teats are cleaned with ethanol (70 %) swabs Hair: The affected hairs should be plucked
before collection. The primary stripping is from the lesion without breakage. The use of
discarded and later 10–15 ml of mid-stream milk Mackenzie’s hair brush, a hard-bristled hand
is collected in a sterile and capped container. brush (2.5 in. 1.5 in.), produces better isola-
Aborted foetus: The abomasal content is col- tion of dermatophytes than the hair plucking. In
lected in sterile, wide-mouth glass bottle and the human, tweezer (forcep) is used to pluck the
organs are taken in sterile petri dishes. hairs. About 10–15 hairs are collected and placed
Vagina: The area should be disinfected with into brown paper or sealed envelope for trans-
antiseptic and dried before collection of the vagi- port. The hair soiled with pus or exudates should
nal discharge. The discharge is collected in a ster- not be collected.
ile screw-capped glass container with a pipette.
Joint: The synovial fluid in sufficient amount
is collected from the joint with sterile needle and 5.1 Transport of Clinical Materials
syringe and is transported in a screw-capped
bottle. All the clinical materials should be packed prop-
Nail: The nails are swabbed with 70 % ethanol erly according to the guidelines of dangerous
and dried before collection. The affected nail bed goods regulations (DGR, available in http://
is exposed by removing the onycholytic nail www.iata.org/publications/dgr). The packaging
plate with a nail clipper. They are wrapped in should be strong enough so that no sample is
brown paper (or coloured paper) and are kept in a leaked from the container. Three-tier packaging
tight container preferably without moisture for which consists of a primary container (leak proof),
transport into the laboratory. The powdery nail secondary packaging and a rigid outer packaging
shavings are sent in glass plates. is recommended. The dry ice or pre-frozen pack
Skin: The lesion area should be cleaned with can be used surrounding the secondary packaging.
70 % ethanol to remove the bacterial contamina- The fungal agents causing animal or human
tion. The scales from the active lesions should be diseases are not included in the DGR list of infec-
collected with a blunt scalpel (or toothbrush). tious agents affecting animals (UN 2900) or
The scrapings are packed in envelope or brown human (UN 2814) except Coccidioides immitis
paper and put into airtight container for transport. (culture only). So the packaged clinical materials
To collect the exudates or pus from the skin can be labelled as ‘Diagnostic specimen’/‘Clinical
lesion, the moist cotton swabs are gently rubbed specimen’/‘Biological substance category B
over the lesion surface. After collection the (UN 3373)’ which should be clearly visible.
Diagnostic Techniques for Fungi
6
The conventional and modern diagnostic cell debris and leaves the sugar-
techniques which are used for identification of containing fungal cell wall. The diges-
fungi are discussed below. tion of keratin with the KOH can be
(a) Direct examination: It provides rapid infor- speed up with heat. An alternative prep-
mation about the presence or absence of aration is 20 % KOH with 36 % DMSO
fungi. Accordingly the treatment of the that provides rapid diagnosis without
affected animal or human may be started. heating and the specimens can be pre-
The direct examination depends on the qual- served for a long time. Addition of
ity of the sample. Parker ink with 10 % KOH (1:10) or
(i) Smears are prepared from the clinical chlorazol azole black (0.1 %) further
samples such as sputum, blood, exudates, improves the visualisation. Currently
urine deposit, tissue impression, etc. Parker ink is not available and chlorazol
in triplicate. The first two smears is mostly preferred. Chlorazol helps in
are stained with Giemsa, Gram’s or identification of hyphae by staining the
Wright’s stain (Penicillium). The third carbohydrate-rich wall without staining
smear is kept as reserve. Gram stain effec- the contaminants such as cotton or elas-
tively stains the yeast cells (Candida, tic fibres.
Histoplasma yeast phase). The yeast cells (iii) Fluorescent staining: Treatment of
are also demonstrated by the negative specimens with calcofluor white or
staining with Diff-Quik (DQ) which blankophor or acridinium orange can
demonstrates the unstained yeast cells also produce early diagnosis with better
present in the stained background. The sensitivity than wet mount. These fluo-
fine-needle aspirates can be stained with rochrome stains bind with chitin of fun-
the May –Grunwald–Giemsa method. gal cell wall and produce fluorescence
(ii) Wet mount: The clinical materials such under ultraviolet light. The arthrospores
as skin scrapings, hair including the hair appear as brightening structures.
bulb, nail fragments, sputum and pus can However, it can also non-specifically
be observed under microscope by wet stain the plant and fatty substances
mount with 10 % KOH preparation. (Fig. 6.1).
The wet mount preserves fungal mor- (iv) Capsule staining: Capsule of Cryptococ-
phology without any distortion and cus can be demonstrated by negative
helps in identification but lacks sensitiv- staining with India ink, nigrosin and
ity. The KOH acts as a clearing agent Romanowski (Fig. 6.2). Romanowski
which digests the proteinaceous host stain produces clearer capsule against
(NTS) region of the rRNA genes are and it has revolutionised the diagnostic
used for phylogenetic analysis and identi- microbiology. The method is specific,
fication of dermatophyte strains. Confir- sensitive and quick to process, and it has
mation of Aspergillus fumigatus isolates relatively low cost than the nucleic acid
by PCR-RFLP can be performed using sequencing. The technique can identify
BccI, MspI and Sau3AI restriction the fungi both from culture grown in SDA,
enzymes. blood agar and chrom agar and from the
(iii) PCR-ELISA: Recent progress includes clinical specimens such as urine. The
the use of PCR-ELISA which can spe- intact cells of the target fungi are directly
cifically identify the PCR amplified streaked onto the MALDI target plate and
product with the help of enzyme overlaid with a matrix solution lysing the
labelled probe producing colour reac- cells. The cell components after lysis are
tion in positive cases. The uniplex- embedded into the matrix. Matrices act as
PCR-ELISA can identify Trichophyton ionising agent and it also helps in energy
rubrum, T. interdigitale, T. tonsurans transfer from the laser to the analyte
and T. violaceum individually. (cell components). The laser fire desorbs
(iv) Real-time PCR: Real-time PCR is devel- the analytes from the target plate. The
oped using Taqman probe or light cycler resulting ions are accelerated in an electric
system for identification of Candida, field and focused to fly along the flight tube
Coccidioides, Histoplasma capsulatum attached with a detector. Small ions move
var. capsulatum, Mucor and Penicillium faster than the larger ones to reach the
marneffei. detector. The differences in the time
(v) DNA microarray: DNA microarray is required for the ions to reach the detector
developed for simultaneous detection of show differences in analysed peak (spec-
several pathogenic fungi such as Mucor, trum) which is specific for a species and
Aspergillus, Candida, Cryptococcus, subspecies. The species is identified by
dermatophytes, etc. comparing the test spectra with references
(vi) Loop-mediated isothermal amplification available in central database. The MALDI-
(LAMP): It is developed for the confir- TOF-MS is successfully used in differentia-
mation of mycetoma caused by tion between Trichophyton species of
Pseudallescheria boydii which do not Arthroderma benhamiae and Microsporum
require any sophisticated instrument. canis, differentiation of Candida species,
(l) Matrix-Assisted Laser Desorption Ioniza- identification of different phenotypic
tion Time-of-Flight Mass Spectrometry variations of Aspergillus species and differ-
(MALDI-TOF-MS): MALDI-TOF-MS is entiation of filamentous fungal species
used in identification of bacteria and fungi, including Rhizopus.
Appendix
Giemsa 1.0 g After dissolving by gentle heat add 0.05 g cotton blue
Glycerol 66.0 ml Use: It is used for primary study of fungal morphology
isolated from animals and human
Absolute methyl alcohol 66.0 ml
Commercially the above composition is available which
is mixed with supplied buffer (1:9) Narayan stain (mounting fluid)
Use: Demonstration of yeast cells and moulds Methylene blue 0.5 ml
Dimethyl sulphoxide 7.0 ml
Glycerine jelly (mounting fluid) Glycerine 4.0 ml
Gelatin 1.0 g Use: It is used for primary study of fungi and algae
Glycerol 7.0 g morphology isolated from animals and human
Distilled water (with 1 % phenol) 6.0 ml
Use: Primary study of fungal morphology New methylene blue stain
Potassium oxalate 1.6 g
New methylene blue powder 0.5 g
India ink
Distilled water 100 ml
India ink 1.0 ml
Formalin (40 %) 9.0 ml Use: Differentiation of viable and dead yeast cells. Viable
cells will be unstained and dead cells will be stained as
Use: Demonstration of capsule in Cryptococcus blue colour
Sabouraud dextrose agar (Emmon’s) with antibiotic Sunflower seed agar (Pal’s medium)
Dextrose 20.0 g Pulverised sunflower seed 45.0 g
Peptone 10.0 g Chloramphenicol 100 mg
Agar 20.0 g Agar 20.0 g
Chloramphenicol (dissolved in 95 % ethanol) 50.0 mg Distilled water 1,000 ml
Distilled water 1,000 ml
Use: Isolation of Cryptococcus neoformans
Use: Isolation of fungi from clinical materials
Budding, 3, 6, 7, 39, 45, 47, 59, 66, 84, 91, 101–103, 109, Coiling phagocytosis, 42
110, 114, 132, 136, 169, 170 Collarettes, 133, 169
Bursattee, 2, 127 Columella, 74, 79, 80, 169
Complement fixation test (CFT), 49, 57, 66, 67
C Conidia, 7, 11, 12, 14–17, 21, 22, 32–35, 37–40, 42–47,
Cadherin, 108 53, 56, 59, 63, 84–87, 89, 113–116, 118, 121–124,
Calcofluor, 20, 48, 56, 78, 82, 126, 135, 140, 159, 160 126, 132–134, 143, 160, 169
California disease, 55 Conidiobolus, 10, 74, 142–144
Campy blood agar, 129 Conidiogenol, 86
Canary, 83, 93 Conidiogenone, 86
Candida, 3, 6, 10, 30, 35, 43, 83, 95, 102–112, 156, Conidiophore, 7, 32–34, 43, 44, 84, 85, 87, 113, 121,
159, 160, 162, 163, 166 122, 133, 143, 144, 169
Capilliconidia, 143 Copper sulphate, 112
Capsule, 5, 47, 49, 58, 92, 94–101, 113, 118, 138, Copulatory beak, 143
159, 160, 165, 166 Corneal, 41, 48, 131, 155, 156
Carcinogen, 36, 88 Cornmeal tween-80 agar, 111
Carnation leaf agar, 133 Counter immune electrophoresis (CIE), 126
Caspofungin, 78, 112, 132 Crop mycosis, 110, 112
Cat, 16, 17, 23–29, 48, 55, 57, 65, 67, 70, 77, 83, 91, 94, Cross pathway control, 39
100, 110, 114–121, 131, 135–137, 139, 142, 143 Cryptococcus, 3, 5, 6, 10, 35, 49, 74, 88, 91–102, 109,
Cathepsin, 28 156, 160, 162, 163, 165–167
Cave, 24, 61, 62 Crystal violet, 105
Cell wall proteins (CWP), 103 CSF. See Cerebrospinal fluid (CSF)
Ceramide, 59 Curvularia, 120, 121
Cerebrospinal fluid (CSF), 48, 49, 66, 79, 89, 95, 101, Cycloheximide, 6, 15, 25, 30, 35, 46, 52, 61, 75, 88, 95,
118, 155, 156 106, 115, 133, 139, 160, 166, 167
CFT. See Complement fixation test (CFT) Cyclophilin, 64
Chemotaxis, 96, 125, 128 Cyst, 128, 130, 136, 138
Chitin, 4, 5, 7, 19, 20, 26, 33, 35, 37, 38, 42, 48, 50, 56, 59, Cytokine, 19, 28, 38, 42, 47, 56, 63–65, 78, 89, 96, 101,
63, 68, 78, 103, 119, 127, 138, 141, 144, 159, 162 108–110, 118, 126
Chlamydopsore, 7, 24, 62, 103, 111, 126, 166, 169 Czapek dox agar, 87
Chlamydospore agar, 111
Chloramphenicol, 6, 15, 25, 30, 61, 106, 115, 124, 130, D
160, 166, 167 Daisy flower, 113
Chlorazol black, 20 Damage associated molecular pattern (DAMP), 42
Chlorella, 138 Dangerous goods regulations (DGR), 157
Chlorhexidine gluconate, 105 Dapsone, 72
Chlorine, 14, 51 Dectin, 19, 28, 39, 40, 55, 56, 63, 109, 111
Chloroxylenol, 70, 80 Deep sequencing, 34
Christae, 68, 136 Defensin, 40, 110
CHROMagar, 106 Deferoxamine, 76
Chromosome, 5, 15, 34, 52, 61, 70, 81, 87, 94, 105, Delayed type of hypersensitivity, 49
115, 136 Dendritic cells, 38, 42, 54, 55, 64, 96, 99, 109, 111,
Cigar shaped bud, 113, 118 126, 137
Citrinin, 36, 88 Denticle, 113, 133, 170
Cladophialophora, 10, 132, 133, 135 Derjaguin–Landau–Verwey–Overbeek (DLVO)
Cladosporium, 10, 132–135 theory, 108
Classification, 9–11, 13–14, 22–23, 29–30, 34, 45, 51, Dermatitis, 18, 19, 27, 55, 65, 83, 90, 110, 135,
60, 69–70, 74, 80, 85, 92–93, 104, 112, 114, 139, 143
122–123, 128, 136 Dermatophyte test medium, 166
Clavate, 22, 29, 113, 133, 169 Dermatophytosis, 1, 11, 17, 24, 27, 29
Cleistothecia, 8, 45, 121, 169 Desert fever, 55
Clofazimine, 141 Diabetes mellitus, 76, 77, 110
Coccidioides, 1, 3, 10, 49–58, 60, 68, 72, 145, 156, Diabetic ketoacidosis (DKA), 77
157, 162, 163 Diarrhoea, 29, 57, 65, 77, 83, 119, 131, 139
Coccidioides-specific antigen (CS-Ag), 53 Diclinous, 128
Coccidioidin, 53, 57 Diff-Quik (DQ), 49, 137, 159
Coccidioidomycosis, 50, 52, 54–57, 119 Dihydrofarnesol, 30
Coenocytic, 4, 73, 78, 79, 83, 127, 131, 141, 143, 144, 169 Dikaryotic hypha, 93
Index 175
Dimorphic, 3, 5, 14, 50, 58, 79, 80, 82, 84, 85, 87, 91, 102, Fomite, 16, 31, 45
113, 115, 144, 160, 167, 170 Fonsecaea, 10, 132, 133, 135
Diploid, 7, 105, 115, 136 Foot cell, 32, 84, 85, 170
Discharge tube, 127, 128 Formaldehyde, 30, 51, 93, 114
Distosepta, 133 Fruiting body, 8, 43
DMSO, 19, 159 Fumagillin, 37
Dog, 11, 14, 16, 17, 22–28, 30, 31, 41, 44, 46–48, Fumitremorgin, 37
50, 55, 57, 58, 65–67, 70–72, 77, 80, 86, 91, Fungaemia, 55, 99
100, 104, 110, 114, 115, 117–119, 121, 125, Fungi, 1–10, 14–18, 23, 24, 26, 27, 32–43, 45–48,
129, 131, 132, 135–137, 139–144 51–53, 55–57, 61–65, 70, 73–78, 82–94, 96,
Dolphin, 91, 140, 141 100, 107–110, 112, 114–121, 124–128, 131–145,
Domain, 15, 36, 46, 53, 63, 111 155–157, 159–163, 165–167
Downs strain, 61 Fungi imperfecti, 33
DRIP group, 70 Fusarium, 35, 43, 88, 120, 121, 126, 162
E G
Echinulate, 33, 170 Galactomannan, 5, 33, 35, 37, 38, 43, 62, 88, 90, 162
Ecoconazole, 21 Gametangium, 7, 8, 74
Electrotaxis, 128 GC. See Guanine-cytosine (GC)
ELISA. See Enzyme-linked immunossorbent Geniculate, 133, 170
assay (ELISA) Genome, 5, 15, 24–25, 30, 34–36, 38, 46, 52, 57, 61, 70,
Emmonsia, 10, 144, 145 75, 80, 81, 85, 87, 94–95, 105–106, 115, 123, 129,
Encephalitis, 135 136, 138, 139, 141
Endogenous antisense transcript, 94 Genome sequencing and genealogical concordance
Endogeny, 136 phylogenetic species recognition (GCPSR), 85
Endosporulation antigen (EA), 54, 55 Genomic island, 52
Enilconazole, 24, 30, 44 Genomic plasticity, 87
Entomophthoromycosis, 73 Gentamicin, 15, 25, 124, 140
Enzyme-linked immunossorbent assay (ELISA), Geophilic, 13, 14, 23–25, 28, 170
43, 49, 57, 66, 67, 90, 101, 111, 112, 119, Germosporangium, 74
127, 131, 142, 144, 162 Germ tube, 39, 40, 82, 84, 103, 110, 114, 130, 160, 170
Eosinophilic sleeve, 144 Giant cell, 83, 118, 125, 131, 135, 141, 144
Epidermophyton, 4, 10, 13, 22, 23, 29–32, 156 Giemsa, 20, 57–59, 92, 118, 137, 159, 165
Epizootic lymphangitis, 65 Gliotoxin, 36, 37, 40
Ergosterol peroxide, 116 Globose, 33, 73, 121
Erythema, 18, 27, 82, 140 Glucan, 4–6, 33, 35, 38, 50, 59, 80, 106, 113
Eucalyptus, 91, 94 Glutaraldehyde, 30, 45, 93
Exon, 25, 52, 94, 129 GM-CSF. See Granulocyte macrophage-colony
Exophiala, 10, 121, 132–135 stimulating factor (GM-CSF)
Exudate, 11, 41, 48, 56, 66, 83, 110, 118, 125, 126, GMS. See Grocott methenamine silver (GMS)
130, 140, 141, 144, 156, 157, 159 Gomori methenamine silver, 126, 131, 135, 140
G protein-coupled receptor (GPCR), 91
F Grain, 34, 76, 81, 82, 120, 121, 124–126
FAT. See Fluorescent antibody technique (FAT) Granulocyte macrophage-colony stimulating factor
Favic chandeliers, 4, 5 (GM-CSF), 19, 65, 89
Favus, 11, 24, 27 Granuloma, 17, 18, 41, 42, 44, 55, 77, 83, 100, 117, 118,
Fibronectin, 37, 38, 64, 108, 115, 116, 124, 136 135, 141, 144
Filobasidiella, 91, 93 Graphium, 121–123
Filopodium, 136 Griseofulvin, 11, 21, 24, 29
Fine-needle aspirates, 20, 49, 72, 155, 156 Grocott methenamine silver (GMS), 20, 49, 57, 90, 103,
Fission, 6, 84, 85, 90, 136 118, 131, 141, 142
Fluconazole, 21, 44, 50, 57, 58, 61, 67, 102, 119, Grocott’s silver, 43
127, 132, 145 Growth, 5–7, 15, 17, 25, 30–31, 33, 35, 38–40, 42, 46, 47,
Flucytosine, 90 52–54, 61–63, 65, 70–73, 75–77, 79–82, 84,
Fluorescent antibody technique (FAT), 45, 66, 90, 101 87–88, 91, 94–96, 98, 100, 103–107, 115, 124,
Fluorescent in-situ hybridization (FISH), 111 129, 130, 133, 135, 139, 156, 160, 161
Flux, 138 Guanine-cytosine (GC), 15, 25, 52, 87, 115, 123
Folate, 40, 139 Guano, 61, 123
176 Index