Groupone Mycology
Groupone Mycology
Groupone Mycology
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Table of content Page
1) OpportunsticMycoses
• Introudaction……………………………………………......3
• Some are opportunistic……………………………………...3
1.1)Candidiasis………………………………………....3
2.2) Cryptococosis……………………………………....6
3.3) Pneumocystic Carinni (P.jiroveci)…………………..8
4.4) Aspergillosis………………………………………..10
2) Summery………………………………………………………….…13
3) Referance……………………………………………………………13
Objectives
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Introduction
• The opportunistic mycoses are caused by fungi that can not infect healthy humans
but can cause serious often fatal mycoses in people whose resistance has been
lowered (immunocompromised patients): AIDs patients,Leukemic
patients,Diabetics, Individuals on chemotherapy for treatment of cancer and
Alcoholics
• Unless the predisposing conditions are corrected, many opportunistic mycosis can
be fatal, even with antibiotic treatment.
• The laboratory must identify and report completely the presence of all fungi
recovered from immunocompromised patients since every organism is a potential
pathogen.
➢ Although there is an ongoing list of opportunistic mycoses, some are seen more
often and include: ,Candidiasis,Cryptococcosis,Pneumocystosis,Aspergillosis
1.1) Candidiasis
• A relatively common human infection that can take forms of superficial,
mucocutanous or systemic disease.
• Since the species of Candida, including C. albicans are part of the normal
endogenous microbial flora, candidiasis is usually the result of autoinfection
during a metabolic or an immunologic disturbance.
• The organisms may be recovered from the oropharynx ,GI, genitourinary tract,
and skin.
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Pathogenesis and Clinical future
A.Cutaneous Candidiasis (Candidosis)
Classification
Intertrigo
Genital
➢ Balanitis
➢ Vulvitis
➢ Oropharyngeal Candidiasis
Erythematous (atrophic) candidiasis
➢ Angular cheilitis
Laboratory diagnosis
• Superficial or mucocutaneous candidiasis is diagnosed by finding the fungus in
tissue scraping and culture.
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Direct examination
• KOH
Exposed lesions can usually be easily diagnosed by clinical appearance together with
finding typical budding yeast cells and pseudohyphae and/or true hyphae in lesion
scrapings treated with KOH.
• Gram- stain
Gram stain smears show large gram positive budding yeast cells with
pseudohyphae.
1.2) Cryptococcosis
Chronic meningitis and meningoencephalitis and pulmonary
Etiologic Agents.
➢ Cryptococcus neoformans is worldwide Cryptococcus gattii causes fewer than 5%
of cases producing infectious basidiospores
Ecologic Niche.
➢ C. neoformans lives in soil mixed with pigeon droppings
Pulmonary Cryptococcosis
➢In persons living with AIDS presents with fever, cough, dyspnea, and pleuritic
chest pain thoseCentral Nervous System (CNS) Cryptococcosis
➢ The symptoms are headache, memory loss, dizziness and irritability, and visual
disturbances
Cutaneous Cryptococcosis
➢ Skin lesions occur via hematogenous spread of the fungus from a pulmonary site
in immunosuppressed patients
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Laboratory Diagnosis
➢ Detection of Cryptococcus neoformans in sputum and CSF.
Direct examination
➢ The capsulated yeast cells are best seen in an India ink preparation (wet mount)
Immunofluorescent stain is applied to dried smear.
Serologic test
➢ Capsular antigens are detected in csf and in the circulation by using anti-capsular
antibodies and Antibodies can be detected in the serum of patients.
➢ P. carinii is wide spread in nature and often found in several mammals; especially
rodents,cats, dogs, sheep, and goats
Etiologic Agent
➢ Pneumocystis jirovecii is an atypical ascomycete fungus.
Ecologic Niche.
➢ Worldwide, P. jirovecii is an endogenous opportunist restricted to humans and it
cannot be cultured in vitro; and there is no known environmental reservoir
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➢ The organism has two forms
Cyst stage
➢ It measures 5-8µm in diameter
➢ Covered with tiny projections for attachment to the host epithelial cells.
The cyst form is inhaled and the intracystic bodies are released into the alveoli of the
lungs.
The trophic form develops and multiplies asexually on the surface of the epithelial cells.
➢ P. carinii pneumonia (PCP) was one of the first opportunistic pathogens linked to
AIDS, Today more than half of all AIDS patients have P.carinii infection and it
remains a leading cause of death in these patients.
➢ The infection may disseminate in AIDS patients into the eyes, liver, spleen or
bone marrow.
Laboratory diagnosis
➢ Direct examination
Microscopic observation of the cyst or trophic form in lung secretion or lung tissue after
staining using toluidine blue O, Modified Gomori methenamine silver nitrate, or Giemsa
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4.4 )Aspergillosis
The serious form is invasive pulmonary disease in the immunocompromised host caused
by Aspergillus fumigatus and related species includes a broad range of clinical forms;-
RiskGroups/Factors
✓ Organtransplants
✓ Diabetes
✓ Solid tumors
✓ Radiation theraphy
✓ Stem cell transplant
✓ Hematological machiner
✓ Cystic fibrosis
✓ Prologede neutrophenia
✓ Cytomegalovirus
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Transmission
➢ Infection is via the respiratory route inhalation of airborne conidia
Clinical Syndromes
➢ Conidia Once inhaled, to reach all levels of the respiratory tract,Conidia that
evade phagocytosis can germinate,form hyphae,release proteinases which erode
the lung epithelia,Next, in the immune compromised neutropenic host,the hyphae
can invade the lung parenchyma.
Pulmonary aspergilloma
➢ Aspergilloma is a fungus ball in the lung caused by an Aspergillus a mass of
fungal hyphae embedded in a matrix of cell debris and fibrin, contained in a
preexisting pulmonary cavity.
➢ The cavity wall may become thickened and gradually the fungus ball may move
freely in the cavity,fungus ball begins to fill the entire cavity the air crescent sign
Clinical findings
➢ Relatively asymptomatic in most patients,In some patients invasive pulmonary
aspergillosis, subacute necrotizing form, haemoptysis) cough
➢ Maxillary sinus aspergilloma chronic sinusitis with chronic nasal discharge, sinus
congestion, pain
➢ Otomycosis external otitis media with ear pain and drainage black conidiophores
in the ear canal
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Tracheobronchitis
➢ Trachea and bronchi;-Clinical form of aspergillosis aspergillus hyphae, which
cause airway Obstructing bronchial aspergillosis is found in persons living with
AIDS and in lung transplant recipients and diagnosis requires bronchoscopy
Lab. Diagnosis
➢ Direct Microscopy
Histopathology
➢ GMS or PAS stained tissue section, sputum and hyaline septate hyphae with
parallel cross walls and dichotomously branched at acute angles
➢ Culture
Colonies are usually fast growing, white, yellow, yellow-brown, brown to black
or shades and Conidiophores terminate in a vesicle covered with either a single
palisade-like layer of phialides (uniseriate) or a layer of subtending cells (metulae)
which bear small whorls of phialides (the so called biseriate structure)
Serology
➢ Sandwich ELISA technique that utilizes a monoclonal antibody to galactomannan
antigen and also sensitivity for detecting invasive aspergillosis is more than 90%
with a PPV of >80%
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Therapy.
➢ Primary therapy with voriconazole (VRC) is superior to amphotericin B (AmB),
to AmB-lipid And Choices for salvage therapy include monotherapy with AmB,
caspofungin (CASF), or posaconazole (PSC), or combination therapy
Summery
Referance
Brooks, Geo.F.etal,(2007);Medical microbiolgy,24ed.
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