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id & micro - fungi & parasites - pathology

id & micro - fungi & parasites - pathology

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Published by: jmosser on Jan 19, 2010
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Pathology: ID & Micro (Fungi & Parasites)

Characteristics & Concepts of Medically Important Fungi..................................................................................................... 2 Superficial / Cutaneous Fungal Infections.............................................................................................................................. 5 Opportunistic Mycoses................................ ................................................................................................ ........................... 8 Pathogenic Mycoses............................................................................................................................................................. 12 Introduction to Parasitology................................ ................................................................................................ ................. 14

2
Characteristics & Concepts of Medically Important Fungi
What is a fungus?
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Eukaryotic (hard to treat; close relationship to other euk)
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Heterotrophic: feed off of other sources
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Polymorphic: different shapes/forms
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Cell wall: complex, heteropolysaccharides/peptides, target of
antimicrobial therapy
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Cell membrane: containsster ols, commonly ergosterol (target of ampho B)
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Reproduction: all reproduceasex ually, 75% have sexual cycle
Fungico ntain chitinbutn ot cellulose (plants have both)
Taxonomy based on characteristics of sexual reproduction; 4 classes cause human infections:

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Zygomycetes (mucoralis is order): lower fungi, reproduce sexually
o
Rhizopus
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Ascomycetes:repro duce sexually
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Bacidiomycetes: reproduce sexually, basicallymushrooms, one exception (Cryptococcus neoformans)
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Deuteromycetes: (deutero = \u201cother\u201d), sexual function has been lost (Candida spp.)
Morphologic Forms
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Yeast: unicellular fungus, reproduces by asexual budding (generation time =hour s)
o
Budding: create daughter cell, leave mother cell
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Filamentous: fungus whose vegetative form is a mass of individual hyphae(mo l d)
o
Hyphae: characteristics used for dx in laboratory
Branching
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dichotomous = \u201cY-shaped\u201d
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right-angled = \u201cT-shaped\u201d
Septation
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septate
, e.g. Apergillus,
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non-septate, zygomycetes, e.g. rhizopus)
\ue000If NON-SEPTATE, think ZYGOMYCOSIS\ue001A M PH O TER I CIN is immediate response
\ue000BRANCHING SEPTATE hyphaein immuncompromised with PNEUMONIA\ue001Asper g il l us
\ue000
Pseudohyphae: look like hyphae but not filamentous (yeast elongating)
\ue000 If HYPHAE, PSEUDOHYPHAE, and YEAST formspre se nt: CANDIDA
Dimorphism: ability of some fungi to exist in two different morphological forms
Classic dimorphism: e.g.Hist oplasm osis
\ue000
MOLDin ENVIRONMENT (room temp), YEASTin US
(tissue/lab)
\ue000
Taken up by M\u03d5, cell-mediated immunity critical
Candida: opposite of classic dimorphism
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YEAST in environment, MOLD in us
Structure of a fungus
Encapsulated:o nly CRYPTOCOCCUS NEOFORMANS!
\ue000
Protects against host response
\ue000
Cryptococcal antigen: capsular antigen can be detected from LP in CSFv ia latex agglutination assay or ELISA.
Extremelys ens i ti v e test, targetsglucu ro n xy loman n an, produced in huge amounts in cryptococcal infections
Cell Wall:
\ue000
Rigid, heteropolysaccharide wall, very resistant to hydrolysis, strength & stability
\ue000Candida: 3rd-4th most common cause of blood
stream infection
\ue000Aspergillis: most common cause of infectious
pneumonic mortality in BMTrecipient s
\ue000PCP/PJP, crytococcus: among most common
AIDS-defining infections in HIV pts
3
\ue000
NOT a barrier to environment (cell membrane): like a chain link fence
\ue000
Multi-layered: glucans: inner fibrillar/inner matrix of cell wall; glycopeptides: inner/outer layers.
o
90% polysaccharide, 10% peptides
o
1,3-\u03b2-glucans: enchinocandins target this specific component of cell wall (Candida, Aspergillus)
o
Also mannans, chitin, 1,6-\u03b2-glucans
\ue000 Canmoni tor mannans or glucans as markers in detection of invasive fungal infections
\ue000
Composition varies between different forms of fungi; target of cell/humoral immune response
\ue000
Importantr ec eptor s for cells, intracellular matrices, and HARDWARE (catheters!)
Septum / septae
\ue000
Ingrowth of cell wall; appears to divide hyphae into individual cells; different
septae for different organisms
Cell membrane
\ue000
Typicalbil ay er membrane; this is the real barrier between fungal cell/environment
\ue000
Sterols incorporated into lipid portion; most common is ergosterol, help maintain fluidity
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TARGET for drugs (ampho B = targets ergosterol in membranedir ectly, alloamines/azoles targetbiosynthesis)
Other structural features: ER/ribosomes, unstacked Golgi, simple mitochondria, membrane bound vacuoles,
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mosthapl oi d in vegetative form
Reproduction
Sexual reproduction: via fusion of hyphae (see picture on right)
Asexual reproduction:
\ue000
asexual spores, germinate\ue001 colony with identical genetic composition to parent
strain
\ue000
more resistant to organism, better dispersion
\ue000
can be infective respiratory inoculum in patients (esp. immunocompromised e.g.
AIDS pt, raking leaves\ue001 aspergillosis)
\ue000
Sporangiospores: asexual spores, produced in sac-like cell called
sporangiumby zygomycetes
\ue000
Condida: asexual spores (not sporangium) by all other major
groups (e.g. Aspergillus)
Mycoses & Humans
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Virulence:v ari es widely between fungi; depends on host status
\ue000
Cause wide spectrum of infection ( -osis = disease)
\ue000
Transmission: endogenous flora, natural environment; mostnot
person-person
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Pathogenic morphologic forms can be varied; different than those in vitro
Fungal structure
Examples
Budding yeast forms only
Crypto, histo, blasto, sporo
Budding yeast + hyphae
Candida, tinea versicolor
Hyphae
Aspergillosis, zycomycosis, dermatophytosis
Spherule
Coccidiomycosis
(Large spherical structure with internal spores)
Virulence factors:
\ue000
Cell surface receptors (epithelial cells, endothelial cells, caths, etc.)
FUNGUS
SEPTAE
Zygomycetes
Few/none
Ascomycetes
Simple
Basidiomycetes
Elaborate

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