MYCOSES

MALLARE MORALES QUIBAL

MYCOSES

INTRODUCTION

MYCOLOGY

Study of fungi
Etymology: Greek term
MYKES
meaning
mushroom
Other terms related
Puffballs

Molds

Bracket
fungi

Mushroo
m

Mildew

MYCOSES

IMPORTANCE

MYCOLOGY

Food Source
(Nutrition)

Food
Production

Antibiotic
source

Symbiosis
(Mycorrhizae
) aiding in
absorption of
water and
minerals
from the soil

More than
100,000
species, only
a few (200)
are
pathogenic

MYCOSES
FUNGI
Characteristics

CHARACTERISTI
CS
Fungi

Bacteria

Type of Cell

Eukaryotic

Prokaryotic

Cell Membrane

Ergosterol are Present

No sterols except in Mycoplasma

and Ureaplasma

Cell Wall

Composed of complex CHO such as

GLUCANS, MANNAS & CHITIN

Peptidoglycans (NAG and NAM)

Spores

Sexual and Asexual (for

Reproduction)

Endospores (Not for

Reproduction) some asexual
spores

Oxygen Requirement

Aerobic (Molds) Facultative Anaerobe

(Yeasts)

Aerobic, Facultative Anaerobe,

Anaerobe

pH Requirement

pH 5 (acidic)

Neutral pH

Antibiotic Sensitivity

Polynes, Imidazoles, Griseofulvin

Penicillin, Tetracyclines,
Aminoglycosides

MYCOSES

STRUCTURE

TWO TYPES OF FUNGI

MYCOSES

STRUCTURE

YEAST
Unicellular, Round; Nonfilamentous
Can produce PSEUDOHYPHAE
Reproduce by Budding or Binary
Fission
Grows at 35-37 C

YEAST
TRUE YEAST
cells retain individuality

Cells attach to each others

side - by side forming Pseudohypha

Appear as Moist, Creamy or

Buttery Colonies with an alcohol
like odor
Can be identified by Biochemical
Tests

Examples:
Saccharomyces cerevisiae
Candida albicans

YEAST-LIKE

MYCOSES

STRUCTURE

MOLD
MOLDS
Hypha Septum

Multicellular; Filamentous
Capable of forming HYPHAE
Reproduce by Fragmentation and
Spore formation

Septate hypha

Grows at Room Temperature

Appear as Dry, Cottony with a
Velvety Surface

Examples:
Can be identified by appearance
of spores and hypha

Aspergillus
Penicilium Rhizopus

Nonseptate hypha

MYCOSES

REPRODUCTION

ASEXUAL REPRODUCTION
I) Asexual: Only mitotic cell division
1) Somatic Yeasts by budding
Molds by hyphal fragmentation
2) Spore formation:
a) Sporangium
b) Chlamydoconidia
c) Blastoconidia

MYCOSES

REPRODUCTION

SEXUAL REPRODUCTION
II) Sexual: Fusion, mitosis, meiosis
Sexual spores: Oospore, Zygospore, Ascospore,
Basidiospore
Zygospore
Basidiocarp
Zygomycetes
e.g. Rhizopus, Mucor

Gills
Basidiomycetes
e.g. Mushrooms

Basidiospore

Basidium

Ascocarp

Ascus
Ascospore
Ascomycetes

e.g. Truffles

MYCOSES
GROUPS OF FUNGAL
INFECTION

SUPERFICIAL MYCOSES
CUTANEOUS MYCOSES

SUBCUTANEOUS MYCOSES
SYSTEMIC MYCOSES
OPPORTUNISTIC MYCOSES

SUPERFICIAL
MYCOSES

SUPERFICIAL
MYCOSES

INTRODUCTION

Affects the non-living layer of the skin and extra

follicular parts of the hair

SUPERFICIAL
MYCOSES

TINEA
VESICOLOR

AKA Pityriasis versicolor

Hyper/Hypopigmentated macules and patches
May enlarge or coalesce
Common sites: chest, upper back, shoulder, upper
arms, abdomen
Rare: scalp, palms, feet
Etiologic agent: Malassezia furfur

SUPERFICIAL
MYCOSES

TINEA
VESICOLOR

Mot: direct contact to infected areas

Lab dx: skin scrapings Wood's light (fluorescence)
Culture: SDA with oil or whole fat milk
Colonies: dry, smooth, lightly wrinkled, glistening,
white-cream
Treatment: whitfield's ointment (salicylic acid and
benzoyl peroxide)
High recurrence rate

SUPERFICIAL
MYCOSES

TINEA
VESICOLOR

SUPERFICIAL
MYCOSES

PIEDRA

Means stone
AKA Tinea nodosa; beigel's disease; chignon's disease
S/S: firm irregular nodules/ encrustations; hair shaft
and follicle appears normal
MOT: unclear

SUPERFICIAL
MYCOSES

BLACK PIEDRA

Etiologic agent: Piedraia hortae

Affected areas: scalp, facial hairs, pubic haif
Nodules: hard, fusiform, firmly attached to hair shaft,
not penetrate hair cortex
Tropics and subtropics
Lab Diagnosis: Direct microscopic exam

SUPERFICIAL
MYCOSES

BLACK PIEDRA

Hypha dematiaceous
Asci: in the locules with up to 8 ascospores
Culture: dark brown to black; conical colonies; short
aerial hyphaeSlow growing at room temp

SUPERFICIAL
MYCOSES

BLACK PIEDRA

SUPERFICIAL
MYCOSES

BLACK PIEDRA

Affected areas: facial and genital hair; axilla

Nodule: soft, muciliginous, white-yellowish, less adherent,
with irregular transparent sheath, hair follicles not affected
Etiologic agent: trichosporon beigelii
Lab diagnosis: KOH transparent, greenish, irregular
sheath; unorganized; blastospores and arthrospores
Culture: moderate growth on SDA at room temp
Colonies: smooth, highly wrinkled, radially folded, cream
colored

SUPERFICIAL
MYCOSES

BLACK PIEDRA

Aka keratomycosis nigricans palmaris; pityriasis nigra

Chronic, asymptomatic infection in palms

Affected areas: palms, sole of foot, interdigits, wrist, neck

Often misdiagnosed as melanoma

Etiologic agent: Hortaea werneckii; Exophiala werneckii

Lesion: dark patch on palm; irregular margin 1-5 cm

diameter; stained appearance

SUPERFICIAL
MYCOSES

WHTE PIEDRA

SUPERFICIAL
MYCOSES

TINEA NIGRA

Aka keratomycosis nigricans palmaris; pityriasis nigra

Chronic, asymptomatic infection in palms

Affected areas: palms, sole of foot, interdigits, wrist, neck

Often misdiagnosed as melanoma

Etiologic agent: Hortaea werneckii; Exophiala

werneckii

Lesion: dark patch on palm; irregular margin 1-5 cm

diameter; stained appearance

SUPERFICIAL
MYCOSES

TINEA NIGRA

Lab dx: direct microscopic exam (KOH) long, sinous,

extremely dematiaceous branching, septate hyphae,
elongated budding cells

Culture: sda with antibiotics at room temp

Colonies: shiny, moist, yeast like, dirty white to brown,

masses of conidia and budding cells; turn black in 2-3
wks

Treatment: whitfield's ointment; tincture of iodine; azoles

SUPERFICIAL
MYCOSES

TINEA NIGRA

SYSTEMIC
MYCOSES

SYSTEMIC
MYCOSES

DIMORPHISM

Systemic Mycoses are caused by DIMORPHIC FUNGI

i.e. YEAST PHASE (or Spherules in certain species)
MOLD PHASE at certain temperatures
These have the ability to bypass the bodys defenses
by changing their morphological form

SYSTEMIC
MYCOSES

PARACOCCIDIOIDES

DIMORPHISM
BLASTOMYCES

HISTOPLASMA

COCCIDIOIDES

SYSTEMIC
MYCOSES

GENERALITIES

AKA Primary Mycoses

Pathogens primarily inhabit the soil
MOT: Inhalation of Spores

SYSTEMIC
MYCOSES

GENERALITIES

Occurrence is Rare, these diseases are limited and

endemic to certain geographic areas
Primary site of infection: Lungs (Pulmonary)
Probability of Dissemination is High
Most Dimorphic Fungi are LABORATORY HAZARDS

SYSTEMIC
MYCOSES

GENERALITIES

Culture of Blastomyces dermatitidis, Coccidiodes

immitis, and Histoplasma capsulatum represent a
severe biohazard to laboratory personnel and must be
handled with extreme caution in an appropriate
pathogen handling cabinet

SYSTEMIC
MYCOSES

GENERALITIES

Systemic Fungi affect immunocompetent individuals

Each fungal agent has a well defined endemic area
Culture
Mold Phase: SDA, Potato Dextrose Agar, SDA with
antibiotics
Yeast Phase: BHI, BHI with blood, Pines, Kelleys

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MYCOSES

BLASTOMYCOSIS

GENEALITIES

AKA
Gilchrists
disease,
North
American
Blastomycosis, Chicago disease
Chronic infection found mainly in the lungs with
suppurative
and
granulomatous
lesions
with
characteristic skin lesion
Etiology Blastomyces dermatitidis

SYSTEMIC
MYCOSES

BLASTOMYCOSIS

CLINICAL FORMS
Pulmonary

1.

Acute and Pulmonary

Radiographically, it may mimic PTB
S/S flu-like

Extra-pulmonary

2.

Granulomatous lesions and abscesses often occur

Skin and Bones, Genitourinary Blastomycosis

SYSTEMIC
MYCOSES

PULMONARY BLASTOMYCOSIS

EPIDEMIOLOGY

Primarily Endemic in Mississippi River Valley basin

Less commonly in Africa, parts of Central and South

America

Reported also in other parts of the world

Reservoir: Soil

Factors: pH, high nitrogen and organic temperature; soil

temperature

SYSTEMIC
MYCOSES

PULMONARY BLASTOMYCOSIS

EPIDEMIOLOGY

Primarily Endemic in Mississippi River Valley basin

Less commonly in Africa, parts of Central and South

America

Reported also in other parts of the world

Reservoir: Soil

Factors: pH, high nitrogen and organic temperature; soil

temperature

SYSTEMIC
MYCOSES

PULMONARY BLASTOMYCOSIS

SYSTEMIC
MYCOSES

PULMONARY BLASTOMYCOSIS

PREDILECTION

Men
Persons who have more than normal contact with soil

SYSTEMIC
MYCOSES

PULMONARY BLASTOMYCOSIS

LABORATORY DIAGNOSIS

Tissue Form

Grows as thick walled yeast

cells with broad based bud

SYSTEMIC
MYCOSES

PULMONARY BLASTOMYCOSIS

LABORATORY DIAGNOSIS

Mold Phase

Microconidia (Oval or Pyriform)

SYSTEMIC
MYCOSES

PULMONARY BLASTOMYCOSIS

LABORATORY DIAGNOSIS

Culture

At 25-30 C

Fluffy
white
colonies
glabrous tan colonies

to

At 37 C

Colonies yeast cells hyaline

smooth walled thick walled

SYSTEMIC
MYCOSES

PARACOCCIDIOIDOMYCOSIS

GENERALITIES

AKA South American Blastomycosis,

Blastomycosis, paracoccidioidal granuloma
Etiology: Paracoccidioides brasiliensis
MOT: Inhalation of Conidia

Brazilian

SYSTEMIC
MYCOSES
GENERALITIES

PARACOCCIDIOIDOMYCOSIS

SYSTEMIC
MYCOSES

PARACOCCIDIOIDOMYCOSIS

GENERALITIES

Disease has a LONG LATENCY

10 20 years before disease manifestation

Travel History to Endemic Areas is important in

diagnosis

SYSTEMIC
MYCOSES

PARACOCCIDIOIDOMYCOSIS

EPIDEMIOLOGY

South America esp. Brazil

Organism probably resides in the soil

SYSTEMIC
MYCOSES

PARACOCCIDIOIDOMYCOSIS

LABORATORY DIAGNOSIS

Specimens: Lower respiratory samples, specimens

coming from lesions, lymph nodes, adrenal glands
Laboratory
Test:
Direct
Microscopy,
Molecular
methods, Culture, Serology

SYSTEMIC
MYCOSES

PARACOCCIDIOIDOMYCOSIS

LABORATORY DIAGNOSIS

Tissue Phase

Translucent walled yeast

cells with multiple buds

Mickey mouse cell

Mariners wheele
cell

Yeast phase

Paracoccidioides brasiliensis

SYSTEMIC
MYCOSES

PARACOCCIDIOIDOMYCOSIS

LABORATORY DIAGNOSIS

Mold Phase

Small one celled conidia

(microconidia) similar to
B. dermatitidis
Conidium

Chlamydospore

Paracoccidioides brasiliensis

Mold phase

SYSTEMIC
MYCOSES

PARACOCCIDIOIDOMYCOSIS

LABORATORY DIAGNOSIS
Culture
At 25 -30 C

Small one celled conidia

(microconidia) similar to
B. dermatitidis
At 37 C
Yeast cells

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

AKA San Joaquin Valley fever, desert fever, desert

rheumatism, cocci, the bumps
Etiology - Coccidioides immitis
Coccidioides posadasii

MOT: Inhalation of Arthroconidia

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

Respiratory/Pulmonary Infection that may progress to

a chronic or systemic disseminated disease involving
the meninges, bones, joints, subcutaneous and
cutaneous tissues
Hypersensitivity reactions
Occurrence of Valley Fever (40% of newly infected )
Presence of Erythema nodosum and Erythema
multiforme
Arthritis

SYSTEMIC
MYCOSES
INHALATION OF

COCCIDIOIDOMYCOSIS

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

CLINICAL MANIFESTATION

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

CLINICAL MANIFESTATIONS

DISEMINATED Forms

Common Areas: Skin, Skeletal System and Meninges

Skin: Papules, Ulcers, Abscesses
Skeletal System: Arthritis
Meningitis

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

CLINICAL MANIFESTATION

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

EPIDEMIOLOGY

Endemic in Southwestern US (Desert

Areas)
Found in soils and rodents (but no
evidence
that
infected
rodents
contribute to the spread)
Race: Filipinos and African Americans
have
high
incidences
for
the
disseminated forms
Sex: More common in Men
Not communicable from person to
person

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

LABORATORY DIAGNOSIS

Specimens: Skin scraping, sputum and bronchial

washing, cerebrospinal fluid, pleural and blood, bone
marrow, urine, and tissue biopsies from various organs
Lab Test: Direct Microscopy, EIA, Molecular Methods

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

LABORATORY DIAGNOSIS

Tissue Form at 37 C

Presence
of
thick
walled spherules

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

LABORATORY DIAGNOSIS

Mold Form

Barrel Shaped Arthroconidia

SYSTEMIC
MYCOSES

COCCIDIOIDOMYCOSIS

LABORATORY DIAGNOSIS

Culture (22 C)

White gray, moist, glabrous

TREATMENT
Amphotericin B (Disseminated Cases)
Azoles (Less Severe Forms)

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MYCOSES

HISTOPLASMOSIS

AKA Darlings Disease, Cave disease, Spelunker

disease, African Histoplasmosis
Etiology: Histoplasma capsulatum var. capsulatum
Histoplasma capsulatum var. duboisii

MOT: Inhalation of Microconidia

SYSTEMIC
MYCOSES

HISTOPLASMOSIS

HISTOPLASMA CAPSULATUM

Dimorphic, imperfect, moniliaceous fungus.

Mold in nature and in culture at 30oC
Yeast in human body and in culture at 37oC

The mold phase has white colonies, septate hyphae, produces

two types of conidia; Tuberculated macroconidia (8-14m), and
smooth microconidia (2-5 m).
Tuberculated macroconidium

Microconidium
H.cap.var.cap.
Yeast phase

H.cap.var.dub.
Yeast phase

Histoplasma capsulatum
Mold phase

SYSTEMIC
MYCOSES

HISTOPLASMOSIS

HISTOPLASMA CAPSULATUM

The natural habitat of the fungus

is specific soils rich in animal
excreta especially bat guano and
droppings of certain birds.
Because caves harbor bats Thus
called Cave Disease.

The perfect stage of the fungus

has been known; it is ascomycete
producing ascospores sexually
called Ajellomyces capsulatus.

SYSTEMIC
MYCOSES

HISTOPLASMOSIS

CLINICAL MANIFESTATION

Histoplasmosis: skin and mucous area

SYSTEMIC
MYCOSES

HISTOPLASMOSIS

LABORATORY DIAGNOSIS

Specimen: sputum, BM samples, CSF, biopsy tissue of

affected site, blood

Laboratory
test:
Direct
Examination,
Detection, Culture, and Serology

TREATMENT: Amphotericin B

Antigen

MYCOSES
MYCOLOGY
Superficial mycoses - infection of the outer, dead layers

No pain or discomfort

Dermatophytic mycoses - skin, hair, and nails

Deeper than the Superficial
Still no living skin penetration
Subcutaneous muscle, bone connective tissues
Systemic any tissue
Opportunistic immunocompromised patients

END