OPPORTUNISTIC SYSTEMIC MYCOSIS

 Aspergillosis
 Systemic candidosis
 Cryptococcosis
 Pneumocystis carinii infection
 Penicillium marneffi and others

Aspergillosis

 > 100 spp of Aspergillus but only a few implicated in human disease
 Most important:
- A. fumigates
- A. niger
- A. flavus
- A. terreus
- A. nidulans
 All are mycelial fungi with septate hyphae and distinctive sporing structures: ie:
- The spore-bearing hyphae (conidiophores) terminates in a swollen vesicle surrounded by
1 to 2 rows of cells (sterigmata)
 From sterigmata are produced chains of asexual conidia
 Aspergillus spores are ubiquitious
- Esp. prevalent in decating vegetation like hay
- Spore couns up to 2 x 10^7/m^3 reported! – even inside buildings!
 Aspergillosis most frequently affect the lungs.
 Infections to other sites like:
- Nasal sinuses
- Superficial tissue
= may occur
 Disease is most frequently caused by A. fumigates, through inhalation of spores.
 This may lead to:
- Colonization of existing lung cavities (ASPERGILLOMA form)
- Hypersensitivity reaction (ALLERGIC ASPERGILLOSIS)
 Rarely, Aspergillus spp may cause invasive disease of the lung with dissemination to other
organs (usually in SEVERELY IMMUNOCOMPROMISED PATIENTS!)

ALLERGIC ASPERGILLOSIS

 Usually seen in atopic individuals

 Increase IgE
 About 10-20 % asthamatics react to A.fumigatus
 Asthma with eosinophilia is the more chronic form.
Fungus can grow in airway -> plug it with mycelia -> coughed out!
- If observation under microscope (+) = diagnostic.
 Allergic alveolitis follows after heavy exposure to spores (several hours post-exposure):
- Breathlessness
 - Fever
- Malaise
 Repeated attacks -> Lung damage
 E.g. Maltster’s lung (A. clavatus in barley during malting process)

ASPERGILLOMA (fungal ball)

 Colonizes pre-existing cavities (usually tuberculous) -> compact ball of mycelium. Eventually
surrounded by dense fibrous wall
 Usually solitary
 Patient – usually asymptomatic
But can -> cough with sputum or hemoptysis
 Treatment : Surgical resection

INVASIVE ASPERGILLOSIS

 Usually in severly immunocompromised individuals

 Lung – sole site in 70% cases
 Dissemination to other organ ofren occurs -> widespread destructive growth of aspergillus
spp in tissue
 Can invade blood vessels
 Lead to:
- Thrombosis
- Emboli -> organs
 Prognosis : Poor
 Often diagnosed at P.M
 Endocarditis in immunosuppressed patients or in open-heat surgery
 Paranasal granuloma
- Usually A. favius or A.fumigatus
- Invade paranasal sinuses -> orbit of eye -> brain

Lab Diagnosis

 Depends on clinical form of disease

 Direct microscopy:
Sputum
- Non-pigmented septate mycelium (3-5 icrom)
- Dichotomous branching (characteristic)
- Mycelial head of aspergillus present
 In allergy
– sputum : fungus +++
– Myceliul plugs +
 In aspergilloma –fungus may be difficult to visualize
 Invasive aspergillosis:
- Microscopy usually (-)
- Biopsy = PAS or methenamine-silver
 Culture – Sabouraud’s agar without Cycloheximide
1-2 days : colonies (+)
 Skin test: Ag – A.fumigatus
Treatment: Type I HS
In Eosinophilia: 70% type III HS (Arthus reaction)
 Serology:
- ID, CIE, LPA, RIA, ELISA
- Treatment: Amphotericin B, beta conazole, Itraconazole