Fungi Causing Systemic Mycoses

= majority causes inapparent infection

= causative organism are dimorphic fungi

1. Blastomyces dermatitides

Characteristics:
= dimorphic can exist as:
mold in soil, yeast in tissue
Yeast form is round-shaped with a thick
refractile wall and single broad-
based bud
= natural habitat Is soil rich in organic
material
 Disease: Blastomycosis (Gilchrist’s Dse, North
American)
Blastomycosis
= a chronic infection characterized by
formation of
suppurative and granulomatous lesion
found
mainly in the lungs and disseminate
throughout the body

MOT = inhalation of airborne spore (conidia)

Pathogenesis: = infection occurs mainly in the

respiratory tract
= inhaled conidia differentiate into
yeast
cell which initially cause
abscesses
 Laboratory Diagnosis:
1. Direct microscopic examination of sputum or
skin
scrapping (KOH mount)/Tissue biopsy:
= demonstrate charac. thick walled “yeast
cell with
single broad-based bud”
2. Culture - SDA
= grows as fluffy, brownish to white fungus
which
produces pyriform spores
3. Hypersensitivity test – Blastomycin test
= Serological test not useful

Treatment: Itraconazole (drug of choice)

Amphotericin B - used to treat severe
cases
2. Coccidiodes immitis
Characteristics:
= dimorphic fungus that exist as:
spherules in tissues containing
endospores
mold at 250C in soil which forms hyphae
with
alternating arthrospores
= natural habitat is soil

Disease: Coccidiodomycosis (San Joaquin Valley

Fever,)
Dessert Fever
= disease simulate pneumonia wherein large
part of the lung becomes consolidated

MOT: inhalation of airborne arthrospores

Pathogenesis: Arthrospores inhaled →to the lungs

 Septate hyphae

Septate hyphae

Arthroconidia
Laboratory Diagnosis:
A) Microscopic examination of tissue scrapping or
sputum
(KOH mount) = demonstrate the
characteristic
spherules containing endospores
B) Culture
Sabouraud medium – presence of hyphae
containing
arthrospores.
C) Serological test
Precipitin test– demonstrate a rising titer of IgM
Ab
(indicates recent infection)
CF test - a rising titer IgG antibody indicates
dissemination of infection
D) Skin test – Coccidioidin test – using mycelial
extract or
spherulin (an extract from spherules) as
Treatment: Ketoconazole (for primary infection)
Amphotericin B/Itraconazole (for disseminated
infection)
Fluconazole - drug of choice in cases of
meningitis

Prevention: No vaccine and Prophylactic drug available

3. Paracoccidiodes braziliensis
Characteristics:
= dimorphic fungus exist as: mold in soil
yeast in tissue
(yeast form is thick walled with multiple
buds) resembling a ship steering-
wheel
= habitat - soil
Disease: Paracoccidioidomycosis
(South American Blastomycosis)
= chronic granulomatous disease of the
skin,mucous
membrane, lymph node and internal
organs.

MOT : inhalation of airborne conidia

Pathogenesis: = spores are inhaled an early

 Laboratory Diagnosis:
A) Direct microscopic examination from pus or
tissues (KOH mount)
= presence of large yeast cell
w/multiple
buds
B) Culture
Sabourauds agar – presence of septate
hyphae
with microconidia
C) Skin test not useful
D) Serological: CF/Immunodiffusion test - rise
in AB
titer significant

Treatment: Itraconazole
4) Histoplasma capsulatum

= dimorphic fungus that exist as:

yeast cell in tissue w/c forms 2types of asexual
spore
a) Tuberculate macroconidia
(thick-walled finger like projection)
b) Microconidia- thin, small, smooth-
walled
mold in soil enriched with bird droppings

Disease: Histoplasmosis (Darling’s Disease)

= acute, benign pulmonary disease acquired by
inhalation of airborne spores
(microconidia)
which are present from dropping of birds
= inhaled spore are engulfed by macrophages
which
 Laboratory Diagnosis:
A. Microscopic examination of sputum, tissue biopsy,
bone
marrow aspirate
= oval yeast cell within macrophages
B. Culture
Sabourauds agar = presence of septate hyphae
with
tuberculate chlamydospore in culture at 250C
is
diagnostic
BHIA – presence of fusiform blastospores with large
vacuole giving a characteristic cresent-shaped
appearance
C. Skin test – Histoplasmin test
-using mycelial extract as antigen
-useful for epidemiologic determination of
incidence of infection
-not use to diagnose actual disease
Budding yeast cell
inside macrophages
 Fungi Causing Opportunistic Mycoses

= produce disease in those individual with impaired

host
defenses

1. Candida albicans

Characteristics:
= is an oval yeast cell with a single bud
= part of the normal flora of the mucous
membrane
of the upper respiratory tract,
gastrointestinal
and female genital tract
= in tissues can appear as yeast cell or as
psuedohyphae (which are elongated yeast
that
 MOT: - part of the normal of the skin, mucous
membrane
and gastrointestinal tract of human
= no person to person transmission

Pathogenesis: Opportunistic pathogen

= disease may results when host defenses
are
impaired

Diseases:
1. Thrush (Moniliasis)
2. Vulvovaginitis
3. Infection of the Nail (Paronychia)
4. Skin lesion occurs frequently in moisture-
damage
skin
Laboratory Diagnosis:
A. Direct microscopic examination (KOH
mount)
= presence of budding yeast cell
w/pseudohyphae

B. Culture
SDA – presence of yeast cell,
pseudohyphae
and large chlamydospore
Germ tube form in serum at 370C
differentiate
albicans from other species

C. Skin test with candida antigen

= (+) among immunocompetent adult
and
Treatment: Nystatin / Miconazole oral/topical
for skin and mucous membrane disease
Amphotericin B - disseminated infection
Ketoconazole – for chronic mucocutaneous
candidiasis

Prevention: No vaccine available

= predisposing factors should be reduced or
eliminated
= Clotrimazole trochis / Nystatin–used for
prevention of oral thrush
2. Aspergillus fumigatus/Aspergillus
flavus/Aspergillus niger

Characteristics:
= exist only as mold with septate hyphae that
branch
at a V-shaped angle
= monomorphic
= organism is normally found in soil

Diseases: 1. Aspergillosis (major disease)

= a granulomatous necrotizing disease of the
lung
which often disseminates hematogenously
to
various organs of the body
= involving the skin, eyes, ear, and other vital
organ
 Pathogenesis:
= opportunistic pathogen
= produce invasive disease among
munocompromised
individual
= organism can invade bloodvessels causing
ombosis
and infarction
= patient with lung cavity (tuberculosis) may
velop
fungal ball (Aspergilloma)
= allergic patient with bronchial asthma can
velop
allergic bronhopulmonary aspergillosis
Laboratory Diagnosis:
A. Microscopic examination (KOH mount) =
presence of
hyaline septate hyphae, dichotomously
Treatment: Amphotericin B – for invasive aspergillosis
Surgical removal – for aspergilloma (fungus
ball)
Steroid – recommended for allergic
bronchopulmonary aspergillosis

Prevention: No vaccine / Prophylactic drug available

3. Rhizopus/Mucor

Characteristic:
= mold with non-septate hyphae w/
sporangiospore
that typically branch at 90O angle
= monomorphic
= habitat in soil

MOT: inhalation of airborne spores

Disease: Mucormycoses (Zygomycoses;

Phycomycoses)
= is a systemic disease cause by saprophytic
mold
(Mucor, Rhizopus and Absidia) found
widely
 Laboratory Diagnosis:
1. Microscopic examination of tissue (KOH mount)
= presence of non-septate hyphae that
branch at
wide right angle
2. Culture – SDA - large hyaline coenocytic
hyphae with
spores found inside sporangium
3. Serologic test – not available

Treatment: Amphotericin B

Prevention: No vaccine / Prophylaxis drug

available
4. Cryptococcus neoformans
= is an oval yeast-like budding cell
surrounded by a
wide polysaccharide capsule
= not dimorphic
= habitat soil enriched with pigeon droppings

Disease: Cryptococcosis(Torulosis, European

Blastomycosis)
= most common life-threatening fungal
disease in
AIDS patient
MOT: inhalation of airborne yeast cell
= no human to human transmission
Pathogenesis:
= lung infection as a result of inhalation is
often
asymptomatic or may produce
Laboratory Diagnosis:
= Direct visualization of the encapsulated yeast-like
budding cell from spinal fluid by India
Ink staining
(yeast cell surrounded by a wide unstained
capsule)
= Culture (spinal fluid/sputum) SDA – presence of
encapsulated yeast cell.
= Serological – Latex particle agglutination test
- detects polysaccharide capsular
antigen in
spinal fluid

Treatment: Amphotericin B plus Flucytosine for

meningitis

Prevention: No vaccine
Capsule

Budding
yeast