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The Fungi of Medical Importance. Chapter 22. Fungi as infectious agents. molds & yeasts are widely distributed in air, dust, fomites & normal flora humans are relatively resistant fungi are relatively nonpathogenic

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fungi as infectious agents
Fungi as infectious agents
  • molds & yeasts are widely distributed in air, dust, fomites & normal flora
  • humans are relatively resistant
  • fungi are relatively nonpathogenic
  • of the 100,000 fungal species, only 300 have been linked to disease in animals
  • fungi are the most common plant pathogens
  • human mycoses are caused by both true pathogens and opportunistic pathogens
mycoses general statements on
Mycoses (general statements on)
  • Most fungal pathogens do not require a host to complete their life cycles and infections are not communicable
  • Dermaphytes & Candida sp naturally inhabit human body & are transmissible
  • Dermaphytoses most prevalent fungal infection
  • Most cases go undiagnosed or misdiagnosed
  • Infections can be systemic, subcutaneous, cutaneous or superficial
mycoses
Mycoses
  • immunity to fungal infections consist of nonspecific barriers, inflammation & cell mediated defenses
  • diagnosis & identification require microscopic examination of stained specimens, culturing in selective & enriched media & specific biochemical & serological tests
  • control with Antifungals such as amphotericin B, flucytosine, azoles & nystatin
antifungal therapies
Antifungal Therapies
  • Mycoses are among the most difficult diseases to heal
    • Fungi can often resist the oxidative damage of T cells during cell-mediated immune responses
    • Fungi are biochemically similar to human cells and antifungal drugs can harm human tissues
  • Fungi have ergosterol in their membranes rather than cholesterol and it is often a target for antifungal treatment
    • Side effects can still result, especially with long-term use
systemic mycoses caused by true pathogens
Systemic mycoses caused by true pathogens
  • Thermal dimorphism
  • Restricted to certain endemic regions of the world
  • Soil is normal habitat
  • Infection by inhalation of spores  Pulmonary infections
    • Histoplasma capsulatum
    • Coccidioides immitis
    • Blastomyces dermatitidis
    • Paracoccidioidomycosisbrasiliensis
slide8

Thermal Dimorphism

25 degrees - Hyphal state………………..37 degrees – Yeast state

Thermal dimorphism is a property of true fungal pathogens but is uncommon for opportunistic pathogens

histoplasma capsulatum
Histoplasmacapsulatum
  • causes histoplasmosis
  • typically dimorphic
  • distributed worldwide, most prevalent in eastern & central regions of US
  • grow in moist soil high in nitrogen content (bat and bird droppings)
  • Inhalation of organism produces primary pulmonary infection that may progress to systemic involvement of a variety of organs & chronic lung disease
  • amphotericin B, ketoconazole
histoplasma capsulatum1
Histoplasma capsulatum

Areas with large amounts of bird droppings are esp. dangerous

coccidioides immitis
Coccidioidesimmitis
  • causes coccidioidomycosis
  • dimorphic
  • lives in alkaline soils in semiarid, hot climates & is endemic to southwestern US
  • spores inhaled from dust leads to primary pulmonary infection which can progress to system body-wide disease
  • amphotericin B treatment
coccidioides immitis2
Coccidioides immitis

Disseminated coccidiomycosis

blastomyces dermatitidis
Blastomycesdermatitidis
  • causes blastomycosis
  • dimorphic
  • free-living species distributed in soil of a large section of the midwestern and southeastern US
  • inhaled spores convert to yeasts & multiply in lungs
  • symptoms include cough & fever
  • chronic cutaneous, bone, & nervous system complications
  • amphotericin B
blastomyces dermatitidis1
Blastomyces dermatitidis

Hyphal state

Yeast state

blastomyces dermatitidis2
Blastomycesdermatitidis

Cutaneous blastomycosis

paracoccidioidomycosis brasiliensis
Paracoccidioidomycosisbrasiliensis
  • Distributed in Central & South America
  • Infections of the lung or skin
  • Most infections are self-limiting, systemic disease is not common
  • Ketoconazole, amphotericin B, sulfa drugs

Budding yeast

subcutaneous mycoses
Subcutaneous mycoses
  • Invade traumatized skin, rarely become systemic but can cause destructive local lesions
    • lymphocutaneous sporotrichosis
    • chromoblastomycosis
    • mycetoma
sporothrix schenckii
Sporothrixschenckii
  • sporotrichosis (rose-gardener’s disease)
  • very common saprobic fungus that decomposes plant matter in soil
  • infects appendages & lungs
  • Lymphocutaneous variety occurs when contaminated plant matter penetrates the skin & the pathogen forms a nodule, then spreads to nearby lymph nodes
lymphocutaneous sprotrichosis
lymphocutaneous sprotrichosis

Primary sore and series of secondary nodules along lymphatic chain in the arm

mycetoma
mycetoma
  • when soil microbes are accidentally implanted into the skin
  • progressive, tumorlike disease of the hand or foot due to chronic fungal infection; may lead to loss of body part
  • caused by Pseudallescheria or Madurella
cutaneous mycoses
Cutaneous mycoses
  • infections strictly confined to keratinized epidermis (skin, hair, nails) are called dermatophytoses-ringworm
  • 39 species in the genera Trichophyton, Microsporum, Epidermophyton
  • communicable among humans, animals, & soil
  • infection facilitated by moist, chafed skin
slide25
Ringworm of scalp (tinea capitis) affects scalp & hair-bearing regions of head; hair may be lost
  • Ringworm of body (tinea corporis) occurs as inflamed, red ring lesions anywhere on smooth skin
  • Ringworm of groin (tinea cruris) “jock itch” affects groin & scrotal regions
  • Ringworm or foot & hand (tinea pedis & tinea manuum) is spread by exposure to public surfaces; occurs between digits & on soles. (Athlete’s foot)
  • Ringworm of nails (tinea unguium) is a persistent colonization of the nails of the hands & feet that distorts the nail bed
ringworm treatment
Ringworm treatment
  • ointments containing tolnaftate, miconazole or menthol & camphor
  • lamisil or griscofulvin 1-2 years
superficial mycoses
Superficial mycoses
  • Tineaversicolor causes mild scaling, mottling of skin
  • White piedra is whitish or colored masses on the long hairs of the body
  • Black piedra causes dark, hard concretions on scalp hairs
    • White & black piedra
      • Transmission is often mediated by shared hair brushes or combs
      • Several members of a family are usually infected at the same time
      • Infected areas must often be shaved to remove the fungi
candida albicans
Candida albicans
  • widespread yeast
  • infections can be short-lived, superficial skin irritations to overwhelming, fatal systemic diseases
  • budding cells of varying size that my form both elongate pseudohyphae & true hyphae
  • forms off-white, pasty colony with a yeasty odor
candida albicans1
Candida albicans
  • Normal flora of oral cavity, genitalia, large intestine or skin of 20% of humans
  • Account for 80% of nosocomial fungal infections
  • Account for 30% of deaths from nosocomial infections
  • Thrush – occurs as a thick, white, adherent growth on the mucous membranes of mouth & throat
  • Vulvovaginal yeast infection – painful inflammatory condition of the female genital region that causes ulceration & whitish discharge
  • Cutaneouscandidiasis– occurs in chronically moist areas of skin and burn patients
candida albicans2
Candida albicans

Thrush

Candidal diaper rash

Vaginitis

cryptococcus neoformans
Cryptococcus neoformans
  • a widespread encapsulated yeast that inhabits soils around pigeon roosts
  • causes cryptococcosis
  • common infection of AIDS, cancer or diabetes patients
  • infection of lungs leads to cough, fever, & lung nodules
  • dissemination to meninges & brain can cause severe neurological disturbance & death
pneumocystis jiroveci p carinii
Pneumocystisjiroveci(P.carinii)
  • a small, unicellular fungus that causes pneumonia (PCP), the most prominent opportunistic infection in AIDS patients
  • this pneumonia forms secretions in the lungs that block breathing & can be rapidly fatal if not controlled with medication
  • pentamidine & cotrimoxazole
aspergillus
Aspergillus
  • very common airborne soil fungus
  • 600 species, 8 involved in human disease
  • inhalation of spores causes fungus balls in lungs and invasive disease in the eyes, heart, & brain
  • amphotericin B & nystatin
aspergillus1
Aspergillus

Invasive eye infection

Conjunctival infection

Brain abscesses (darkened areas)

zygomycosis
zygomycosis
  • Zygomycota are extremely abundant saprobic fungi found in soil, water, organic debris, & food
  • Genera most often involved are Rhizopus, Absidia, & Mucor
  • usually harmless air contaminants invade the membranes of the nose, eyes, heart, & brain of people with diabetes, malnutrition with severe consequences
fungal allergies mycotoxicoses
Fungal allergies & mycotoxicoses
  • Fungal spores are common sources of atopic allergies
  • asthma, often occurring in seasonal episodes
  • farmer’s lung, a chronic & sometimes fatal allergy of agricultural workers exposed to moldy grasses
  • teapicker’s lung
  • bagassosis, a condition caused by inhaling moldy dust from processed sugarcane debris
  • bark stripper’s disease caused by inhaling spores from logs
  • Fungal toxins lead to mycotoxicoses

Some may be caused by eating poisonous or hallucinogenic mushrooms

Ergot poisoning can occur from ingestion of moldy grain

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