systemic mycosis
TRANSCRIPT
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Crisologo, Ferrer, Sorveto,
Kalon, De Luzon
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SYSTEMIC MYCOSES
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DE LUZON, ANA ROSE D.
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Histoplasma
• H. capsulatum is a dimorphic fungi• H. capsulatum causes histoplasmosis
– reticuloendothelial cytomycosis– caver’s disease– spelunker’s disease–Darling’s disease
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Histoplasma capsulatum
• Morphology
Macroscopic Microscopic
Slow growth White to dark tan
Woolly, cottony or granular
Microconidia small, one-celled,round, smooth-walled
(2-5µm)
Tuberculated macroconidia w/ typical thick walls , fingerlike
projections (7-12µm)
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Histoplasma capsulatum
• Infects RES – bone marrow specimen of choice
• Primary focus pulmonary• may be confused with Sepedonium
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Histoplasma capsulatum
• Identification Techniques1. Wrights and Giemsa stain
yeast cells are commonly seen w/in monocyte and macrophages
2. Sabourauds dextrose Agar shows typical structure e.g. tuberculate
macroconidia
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Histoplasma capsulatum
• MOT endemic in Ohio, Missouri and Mississippi
river valleys grows in soil, particularly if the soil is heavily
contaminated w/ bird droppings Histoplamosis is acquired by the inhalation
of microconidia of H. capsulatum
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Histoplasma capsulatum
• Prevention and Control Asymptomatic or mild primary infection –
no therapy needed With progressive lung lesion – oral
ketoconazole In disseminated diseases – amphotericin B There are no means of prevention except
avoiding exposure in endemic area
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Histoplasma capsulatum
• Pathology• Chronic pulmonary histoplasmosis in patients
w/ chronic obstructive pulmonary disease may occur
» Other manifestations of the disease are mediastinitis, pericarditis, and mucocutaneous lesions.
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Sorveto Dayle Daniel G.
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• habitat-soil of many arid regions
• infectious form- arthroconidia
• MOT-inhalation
• virulence- extracellular proteinase
• Difficult to convert from mold to yeast phase
• Endemic in desert southwest and semi rid regions
Coccidiodes imitis
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• Dimorphic fungi
• Mould phase/saprophobic (soil)– Spherule (40C)
• Yeast phase/parasitic phase(tissue)– Sperules containing endospores
• Tissue from large, rough walled spherule containing endospores
• Barrel shaped
C.Immitis morphology
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Coccidiomycosis
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• Primary in pulmonary disease
• “Valley fever”(San Joaqin Valley California) or desert rheumatism (Arizona)
pathogenesis
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• Clinical specimens include
• Sputum
• pus from skin lesions
• gastric washings
• CSF
• biopsy material from skin lesions.
• Grows on SDA 25 celsius
Specimen collection:
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Al-hadad Kalon
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Paracoccidioides brasiliensis
• Central and South America (Brazil, Venezuela, Colombia)
• High humidity and temperature
MORPHOLOGY• YEAST• The yeast forms consists of Oval or
globose cells 2- 30 microns, in diameter, with small buds attached by a narrow neck encircling the parent cells.
• “Mariners Wheel”• MOLD
• Similar to Lollipopforms
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Pathology
• P. brasiliensis is the causative agent of
– Paracoccidiomycosis (South American blastomycosis, Brazilian blastomycosis, Lutz-Splendore-Almeids disease and paracoccidiodalgranuloma)
– Is pulmonary and infection is usually asymptomatic, subsequent dessimenation leads to the formation of ulcerative granulomatous lesions of the buccal, nasal and occasionally gastrointestinal mucosa.
• Disease presentation:– Pneumonia– Disseminated infection– Extrapulmonary lesions on the face and oral
mucosa
• Lymphatic system spleen, Intestines, Liver involvement
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Mode of Transmission
• Transmitted by inhalation of
the spores• Restricted to South
and Central America• Isolated in acidic soil
and its growth requires increasedhumidity
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Identification techniques
• Endemic in Central and South America (Brazil, Venezuela, Colombia) – In soil (High humidity and
temperature ~23°C.)
• Serological findings (detection of specific antibodies)
• Microscopy – Sputum , Pus,• Biopsy of glaucomatous lesions• Direct histopathologic examination
of infected tissue• Yeast
Multiple buds resembling “mariners wheel”These daughter cells are connected by a narrow base, giving the appearance of a “Mickey Mouse Cap”
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Identification techniques
• Culture– kept for 6 weeks– 25 c moulds– 37 c yeasts
– Saboraud’s agar– At room temperature it grows a
non spore forming septate fungus– Brain Heart Infusion at 35° C– It produces yeast that is seen in
tissue
• Direct Microscopy– 10-20% KOH– 1-2 drops are used– demonstration of multiple
budding yeast
• Others – Paracoccidioidin skin test– Complement fixation test– Immunodiffusion test
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Treatment and Prevention
• Amphotericin B
• Itraconazole
• Long term therapy is required
• Prevent inhalation of dust in endemic area
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Mollie Carl Ferrer/Zenaida Crisologo
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Morphology
• Yeast form:
– Large yeast cells (8-12 µm)
– Blastoconidiaattached by broad base
– Double contoured wall
• Mold phase:
– Lollipop forms
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Macroscopic Morphology
• Slow to moderate growth– White to dark tan
• Young colonies– Tenacious
• Older colonies– Glabrous to wooly
• Oval ,pyriform, to globusesmooth conidia borne on short, lateral hyphalikeconidiophores
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Mode of Transmission & Epidemiology
• Presumably owing to men’s greater occupational and recreational exposure to the soil
• It grows in moist soil rich in organic material, forming hyphae with small pear-shaped conidia
• Inhalation of the conidia *
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Epidemiology
• North America and parts of Africa*
• Mississippi and Ohio River basins
– St. Lawrence River basin*
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Identification Technique
• KOH (10%) or Calcofluor white –use to aid for examination of yeast cell
• 22 C – colonies may be white tan or brown and may be fluffy or glabrous
• Spicules- seen in the center of colonies
• 37 C (blood Agar) – broad base budding yeast cell
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Prevention & Control
• Ketoconazole
• Surgical excision
• There are no means of prevention
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Pathology
• Primary infection: Flulike symptoms
• Asymptomatic and cannot accuratety define the time of onset
• Pulmonary disease (cough,weightloss, chest pain and fever)
• Progressive pulmonary or invasive disease may follow.(ulcerative lesions of bone and skin)
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• ** immunodeficientpatient : multiple organ system
• Blastomycosis
- Gilchrist disease, North American Blastomycosisand chicago disease
- Occurs primarily: North America and Parts of Africa
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• United States(endemic)- Mississipi , Ohio river basins and St. Lawrence River basin
** Dogs and Horses
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Sporotrichosis
• Sporothrix schenckii
– Cutaneous inoculation of fungus from penetrating injury with a spore or thorn (rose bush)
– Initial skin lesion w/wo ulceration
– Lymph-cutaneous spread – bone – systemic
– Pulmonary and CNS infections are rare but reported
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Starts as one ulcerative lesion and then chains
Up the lymphatics – can involve lymph nodes
and bone
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Sporothrix schenckii
• Dimorphic fungus
• MOLD PHASE
– 30*˚C growth in 3 -5 days
– Turns brown to black over time
– Septate hyphae with conidia in daisy wheel pattern
• YEAST PHASE
– At 37˚C small oval yeast cells,
elongated 2 – 5 µM, described as cigar bodies
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Sporothrix schenckii
• Histology –
– Pyogenic – to – granulomatous inflammation
– Hard to find yeast in human tissue
– Asteroid body known as Splendore-Hoeppli phenomenon can be seen – also seen in:
• Zygomycetes (mucorales)
• Aspergillus
• Blastomycosis
• Candida
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Daisy like spore arrangement
Sporothrix schenckii
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