***Note: Mukha lng pong mahaba kasi table form at saka ung pictures hahaha.

Pero maiksi lng yan, promise! Hahaha =] pls take note yung mga nakabold at underlined kasi un ang usually inemphasized ni Dra. Padla :3 Systemic Mycosis Are inherently virulent Orginate primarily in the lungs; can spread to different body organs Caused by dimorphic fungi Broad distribution, however, is confined in the body and the absence of animal-to human horizontal transmission typifies this.

A. Endemic Respiratory Mycoses Have restricted geographical locations Exhibit thermal dimorphism (2 forms: mold and yeast; depends on temperature) Acquired through inhalation of conidia (asexual spores) from the soil Portal of entry: Respiratory tract Lungs are the main focus of infection Usually asymptomatic or of very short duration Accompanied by a high degree of specific resistance to reinfection Affect otherwise healthy individuals At rm temp, molds persist, but at 37OC, molds transforms into yeast. Disease Characteristics Geographical Distribution/Transmision Clinical Disease Laboratory Diagnosis Identification/Lab Test Exoantigen test; nucleic acid probe Skin test Serology (cf test); Antigen (Ag) detection Treatment and prevention Usually not required, Lungs: Itraconazole, ketoconazole, fluconazole

Histoplasmosis

to North Aka darlings dse; Endemic Locally cavers dse, America, spelunkers dse, N. distributed American histoplasmosis; Habitat: Grow in soil Caused by contaminated with bat

Asymptomatic infection (90-95%) [self limiting flu-like illness; Pulmonary infection -inhaled microconidia taken

GMS/Giemsa/PA S show small round to oval intracellular and extracellular yeast cell KOH not

histoplasma capsulatum

and bird excreta

Transmission: soil An ascomycte with infections, bat, avian habitat; can be controlled telemorphic by occupational exposure (ajellomyces capsulatus = sexual Not transmissible from state) human to human or animal to human. Thermally dimorphic; facultative intracellular

Infectious particle: Microconidia Tissue form: intracellular yeast cell

up by alveolar macrophage; mimics PTB (acute/chronic); Disseminated infection (includes RES and mucocutaneous; skin lesions); primary sign is splenomegaly (assoc w. immunosuppressio) Primary cutaneous is rare Mimics Pulmonary Tuberculosis (PTB) because homogenous appearance at the hilar H. capsulate var duboisii is large, thick walled yeast causing a variant form of histoplasmosis prevalent in Africans that preferentially involves the skin, subcutaneous tissues, lymphatics and bones

applicable Rm Temp Culture: fine septate hyphae, large tuberculate macroconidia and small microcondia (therefore highly infectious) Tuberculate macroconidia dx of the organism Invitro/Cuture at BHIA: 37OC: appear single budding yeast cell

Systemic: Amphotherici nB Others: Surgical debridement Prevention: Wearing protecting clothing, mask, soil decontaminati on with 3-5% formalin

Blastomycosis B for Broad Based Bud!

Aka N. American blastomycosis; Chicago dse, gilchrist;s dse; suppurative granulomatous mycosis of the lungs, skin and subcutaneous tissue caused blastomyces dermatitidis ascomycyte, thermally dimorphic

found in N. America, Africa, Asia

outbreaks associated with activities with moist soil enriched with organic debris and rotting wood

Natural disease that is common in cats and dogs therefore not by and transmissible from these animals.

Asymptomatic (50%) Pulmonary infection (50%) TB like Disseminated infection Chronic cutaneous infection (verrucous/ulcerative crusty, elevated lesions with microabscesses that weeps) Primary cutaneous (rare)

KOH shows thick walled yeast cells with single broad based bud At Rm temperature: White, cottony Mycelia form, Pyriform conidia borne singly on septate hyphae Culture at 37C: Double walled yeast cells with single broad based bud attached to a parent by a wide base which are pathognomic of blastomycosis

Exoantigen test; nucleic acid probe Others: Skin test Serology Immunofluorescence (IF) Ag detection

Ketoconazole, itraconazole, fluconaole Disseminated: Ampho b Exicision for skin lesion

inhabits decaying wood, soil saprophyte

Infectious particle: conidia Tissue form:broad based yeast cells Aka Posadas dse, San Joaquin Valley Fever, Desert Rheumatism Caused by

Coccidiomycosis

Endemic in western hemisphere; desert; Dust storm; Soil tillage; California; Sonoran desert

Highly infectious, acute, self limited nd usually benign respiratory disease

KOH shows thick walled spherules filled with nonbudding small endospores

Exoantigen; nucleic acid probe, demonstration of spherule production in animals

Acute Respi Disease not necessary to treat

coccidiooides immitis Deutoremycete (imperfect fungi thus reproduce asexually) Thermally dimorphic

Infectious particle: arthroconidia -very resistant to heat, dryness, salinity -asexual spore which can be divided thallic (fragmentation of septate hyphae and blastic yeast cells)

Tissue form: spherules (filled with endospore w.o budding)

Infections involving the Highest endemicity in skin, bone, joints, lymph Spherules (370C are semi-arid regions with nodes, adrenals and CNS not yeast cells; they alkaline soils are parasitic form; has lots of endospore Asymptomiatic Outbreaks occur inside which can Evident hair following dust storms, develop into adenopathy on earthquakes and earth individual spherules. xrays excavation Pulmonary infection Culture at RT: (38-40%) Transmission: Inhalation Hyphae bearing - PTB like; egg of arthroconidia barrel shaped shell cavity on (Rectangle conidia) atroconindia xray; acute, self trapped in alveolar space separated by limited usu. where they develop into Benign respi dse dysjunctor cells spherules filled with Disseminated infect endospores -Infection involving CNS, Culture at 37: not routinely done joints, bones, skin because it is highly -Meningitis (cause of infectious and death) - mortality is higher in requires stringent dark-skinned ethnic conditions group

Itraconazole, Other test: ketoconazole, Skin test ampothericin (coccidiodin, B spherulin), serology, IF Meningitis: Fluconazole Surgery: Reduce exposure to dust in endemic areas; Vaccine devt in progress

Paracoccidiomyc osis P for Pulmonary dse!!!

Aka pulmonary dse; South American Blastomycosis; LutzSplendore-Almeidas Dse Caused by Paracoccidiooides braziliensis Deuteromycete Thermally dimorphic

Habitat: unknown but found to reside in humid soil rich in proteins; cultivated in fruit bats and armadillos

Infectious particle: Conidia

Higher incidence ratio in Clinical specimens: Males because estrogen sputum, pus, crusts inhibits conversion of from lesions mycelium to yeast. KOH shows yeast cells with multiple Asymptomatic narrow based buds infection Pulmonary infection (blasto kasi is broad based) Dissemination infect (oral/nasal mucosa) KOH shows mariners - Chronic wheel appearance Granulomatous lesions formed by stimulation of alpha- Culture rm temp: septate hyphae with glucan [cell wall no typical pattern of polysaccharide] - Mulberry Lesions @ sporulation GIT mucosa Cutlture at 37OC - Facial skin most - Thick Yeast cells common site of with ships or infection mariners - Triad of sxs in steering wheel endemic areas: appearance Pulmonary lesions, - Cells are large, edentulous mouth, spherical to cervical pyriform and lymphadenopathy with thick walls Affects both healthy and immunosuppressed individuals who have traveled or lived in endemic areas

Exoantigen Dna proble ID: Skin test Serology

Itraconazole, ketoconazole, ampothericin B, sulfa drugs Others: surgical excision localized lesion

of

Penicilosis

caused by Penicilloisis marneffei Only Penicillum species that is

Bamboo rat (reservoir); endemic in SEA; Portal of entry: lungs

KOH shows small Exoantigen test yeast cells with Conversion to yeast transverse septum forms Culture at RT:

Itraconazole and ketoconazole For serious

thermally dimorphic Produces red pigments around the colony (kasi other penicillium produces yellow) Reproduce: transverse fission/schizogony

Infectious Conidia

particle:

Conidiophore branch Indicator of HIV infection into metullae which in endemic areas support the phialides that bear chains of conidia (brush like or Pulmonary infection finger like) Disseminated infection -similar to histoplasmosis; Colonies produce affects many internal diffusible red organs; exhibits as skin pigment around the lesion such as those seen colony (very characteristics) in AIDS patients Culture @ 37OC: Round to oval yeast cell with cross walls

infection: Ampho B

B. Opportunistic Mycoses Portal of entry: respiratory, mucocutaneous (for Candidiasis) Infectious particle: conidia, mycelia Widely distributed as saprophytes or as members of normal flora (in comparison with endemic na restricted and distribution) Invade only in the presence of underlying predisposition Invade mainly those who are immunosuppressed Disease Characteristics Geographical Distribution/ Transmission Endogenously acquired Clinical Disease Laboratory Diagnosis Gramstain/KOH shows small budding yeast cell and pseudohyphae (meaning no true Identification/Lab Test Germ Tube Test (GTT) (+) for C. albicans Other test: Assimilation Treatment and Prevention Cutaneous: Topical Nystatin, ketoconazole, fluconazole

Candidiasis

Caused by Candida spp Mostly C. albicans Normal flora

Most common systemic/opportunistic fungal infection Normally found worldwide; clinical in Normal flora spectrum: extremely of skin, mouth, diverse

of GIT Ascomycete Dimorphic [lang! not thermally] Exist as pseudohypha e or hyphjae Reproduce by budding

Infectious/tissue form: yeast cell and pseudohyphae

vagina, mucous septation) membranes, Leading fungal infection stool patients with HIV-AIDS Culture at RT and 37: Major -Pseudophyae Cutaneous and colonizing with clusters of Subcutaneous habitat: GIT Systemic/disseminated round blastoconida /invasive - Chlamydospore, - Candidemia yeast cells and (catheter related) pseudohyphae - Acute chronic produced on disseminated chlamydospore - Deep organ candidiasis (pulmo on cornmeal agar candidiasis) Predisposing factors: Physiological (pregnancy and age) Trauma (burn, infection) Hematological (neutropenia, cellular immunodeficiency) Endocrinological (DM, Hypothyroidism, Addisons dse) Iatrogenic (chemotherapeutics, corticosteroids, oral contraceptives, catheters, etc) Others: IV drug addiction, malnutrition

test Biotyping IF Immunohistochemistry DNA probes, PCR Mannan antigen detection (RIA, ELISA, LAT)

Systemic: Ketoconazole, fluconazole, itraconazole, flucytosine, ampho B Prevention: Avoid disturbing the normal balance of microbial flora and intact host defense

Aspergillosis A for ABPA! A for Acute Angle!

KOH show Allergic form: soil 1. wide septate Allergic dichotomousl Bronchopulmonary y branching Aspergillosis (ABPA) frequent hpyhae may give rise to laboratory (45deg or asthma or hay contaminants acute angle); fever 2. condial colonizing heads form/pulmonary Transmission: supports aspergilloma or inhalation of swollen fungus ball conidia vesicle with Invasive or Infectious particle: rows of disseminated (for Asexual spore: phialides immunocompromised) conidia bering radial Mycotoxicosis chains of (ingestion of food Tissue form: conidia. products with toxin) hyphae ***so take note niyo to ung diff kasi zygomycomycete kamuka nia*** Caused by Aspergillus spp ( commonly fumigates and flavus) Ascomycte; Ubiquitous; freq lab contaminants

Natural reservoir: and air

Serology Immunohistochemistry Galactomannan antigen detection in serum

Allergic form: itraconazole; corticosterioid Aspergilloma: Surgery & ampho B Diseminated: Itraconazole, fluconazole, ampho B Prevention: Avoid or minimize exposure to conidia; prophylactic low-dose ampho B or itraconazole

Cryptococcosis [has 3 biotypes]

[singit ko dito ang virulence factors ah? Wala ng box eh :P ]

Aka bussebuschke dse; Torulosis Caused by Filobasidella neoformans Sexual phase: Basidiomycete (the spores are produced

Widespread in nature; soil saprophyte and abundanct in avian habitats Transmission: Inhalation of nonencapsulated

Biochemical test: (+) Urease Test: fuschia pink in One of the most life color threatening infection with (+) caffeic acid AIDS Culture 37OC: test due to -Creamy, mucoid phenoloxidase production Pulmo (acute/chronic) yeast colonies usually -Brown to blkack on Others: asymptomatic; mx: colonies

Primary site of infection: Lungs

KOH/India ink shows yeast cells with wide capsule

Ampho B; ampho B 5 FC combination; fluconazole prophylaxis ff primary treatment (for AIDS patients)

Virulence factors: 1)Capusule: -wide -Antiphagocytic -Serotype A,B,C,D and AD 2.Production of phenoloxidase convert phenoilic compounds to melanin; survival mechanism within phagocytes

externally, on Or minimally the end of encapsulated specialized yeast cells cells called basidia.) Specifically Cryptococcus neoformans and C. gattii Encapsulated yeast Replicate by budding 0nly fungal species with well-defined virulence factor

Infectious particle: nonencapsulated yeast (at 27 and 37 C); basidiospore C Neoformans var neoformans [1st biotype] Serotype D

soilatary pulmo niger/bird seed nodulein the agar due to mediastinum phenoloxidase mimicking a carcinoma Disseminated Predilection for the CNS Meningitis: most frequent diagnosed form [difference ke cocciodiomycosis naman cause of death] Neutropism related to phenoloxidase activity Cutaneous (rare) mx: nodule in the lungs

Direct IF Ag detection test Differential Growth on Lcanavarine glycine bromtymol blue - appear in cobalt blue for C. Gatti (blue) - Yellow on C. neofromans

Found in soil Affects contaminated immunocompromised Virulence factor: with pigeon Capsule + 37 + droppings (rich phenoloxidase nitrogen and production alkaline pH of the droppings favors survival

of the yeast) Globally distributed (predominantly in N. Europe and N. America Found in Affects immunocompetent eucalyptus tree Clinica Mx: Pneumonia specifically: caladunensis (river red gum tree, and teretucornic s (forest red gum tree), decaying wood forming hollows in living trees; Worldwide distribution; Common on tropical/sub trop climates; (predominantly in SEA, S. California,

C neoformans var gattii [2nd biotype]

Serotype B and C Telemorphic name of filbasidiella bacillispora Infectious particle: basidiospores

***B = more prevalent and pathogenic

C neoformans var grubii [3rd biotype]

Serotype A

Zygomycosis

Aka mucormycosis /phycomycosis Caused by filamentous fungi namely: rhizopus, mucor, absidia Order: mucorales, Class: zygomycetes Non-septate Asexual form: sporangispore Sexual form: zygospore

Australia, Africa Biological, ecological and epidemiological characteristics not yet clearly defined; Acquired by Primary Site of Infection: exposure to Lungs sporangiospores Rhinocerebral Natural Most common; reservoir: soil cotton like fungus air and water Pulmonary Cutaneous Ubiquitous; GIT frequently Disseminated encountered as -aggresive angiocontaminants invaised and (e.g bread predominantly mold) infarctive. Risk factors: Diabetic acidosis Immunosuppression

KOH shows wide ribbon like aseptate hyphae branching of right angle (ung narrow or acute angle is aspergillus) Culture @ RT: Cotton candy appearance of colonies Morphologic features identify species Caution in interpreting results because they are common contaminants

Rhizopus: sporangia round; sporangiospore unbranched and at nodal;

Ampho B Surgical debridement Control of predisposing factors

Mucor: sporangia round; branch and at intermodal; columellae round to oval; rhizoid absent Absidia: Rudimentary, collumellae conical;branch; in between nodes

Characteristics of Species Causing Zygomycosis Characteristics Sporangia Sporangiospores Collumellae Rhizoids Collarettes Rhizopus Round Unbranched, nodal Hemi-spherical Well developed None remains when sporangial wall is dissolved Mucor Round Branched, intermodal Round to oval Absent Present when sporangial wall is dissolved Absidia Pyriform Branched, intermodal Conical Rudimentary ===

Endemic Respiratory Mycosis 1. Histoplasmosis H. Capsulatum

GMS/giems/PAS show small round to oval intra and extracell yeast cell Culture at rm tem: fine septate hyphae, large tuberculate macroconidia and small microcondia (therefore highly infectious) Invitro/Cuture at 37: ppear single budding yeast cell

2. Blastomycosis B. dermatitidis

KOH shows thick walled yeast cells with single broad based bud (3rd pic) At Rm temperature: White, cottony Mycelia form, Pyriform conidia borne singly on septate hyphae (1st pic) Culture at 37C: Double walled yeast cells with single broad based bud attached to a parent by a wide base which are pathognomic of blastomycosis (2nd pic) 3. Coccidiomycosis C. immitis

4.

Koh shows thich walled endospore spherules Culture at RT: Hyphae bearing barrel shaped atroconindia separated by dysjunctor cells (2nd pic) Culture at 37: not routinely done Paracoccidiomycosis P. braziliensis

KOH shows yeast cells with multiple narrow based buds (blasto kasi is broad based) [2nd pic] KOH shows mariners wheel appearance [1st pic] Culture rm temp: septate hyphae with no typical pattern of sporulation Cutlture at 37OC: Thick Yeast cells with ships or mariners steering wheel appearance [or sometimes mickey mouse]; Cells are large, spherical to pyriform and with thick walls 5. Pencillosis P. marneffei

KOH shows small yeast cells with transverse septum (2nd pic) Culture at RT: Conidiophore branch into metullae which support the phialides that bear chains of conidia (brush like or finger like) [1st and 3rd pic] Culture: Colonies produce diffusible red pigment around the colony (very characteristic ) [3rd pic] Culture at 37OC temp : Round to oval yeast cell with cross walls

Opportunistic Mycoses

1. Candidiasis C. albicans Gramstain/KOH shows small budding yeast cell and pseudohyphae (meaning no true septation) Culture at RT and 37: Pseudophyae with clusters of round blastoconida; Chlamydospore, yeast cells and pseudohyphae produced on chlamydospore on cornmeal agar 2. Aspergillosis Aspergillus spp.

KOH show a) wide septate dichotomously branching hpyhae (45deg or acute angle); (3rd pic) b) condial heads supports swollen vesicle with rows of phialides bering radial chains of conidia. (2nd pic) ***so un ang diff this to zygo kasi magkamuka cla***

3. Cryptococcosis C. neoformans

KOH/India ink shows yeast cells with wide capsule Culture 37OC:Creamy, mucoid yeast colonies;Brown to blkack colonies on niger/bird seed agar due to phenoloxidase

4.Zygomycosis filamentous fungi namely: Rhizopus, Mucor, Absidia

KOH shows wide ribbon like aseptate hyphae branching of right angle (ung narrow or acute angle is aspergillus) Culture @ RT: Cotton candy appearance of colonies; Morphologic features identify species Rhizopus: sporangia round; sporangiospore unbranched and at nodal (1st row); Mucor: sporangia round; branch and at intermodal; columellae round to oval; rhizoid absent (2nd row) Absidia: Rudimentary, collumellae conical;branch; in between nodes (3rd row)

Further differentiation:

Penicillium brush like, finger like Aspergillus swollen head na may fingerlike din ang dulo Rhizopus round sporangia, unbranched

A. Rhizopus B. Mucor C. Absidia