Trusted Medical Answers-In Seconds.: General Mycology

1/17/2021 General mycology - AMBOSS
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General mycology Last updated: January 7, 2021
Summary
Mycoses are infections caused by fungi. They may be caused by dermatophytes (e.g.,
Trichophyton), yeast (e.g., Candida), or molds (e.g., Aspergillus). In immunocompetent
individuals, mycoses usually result in local infection, which can be treated with local
antifungals. Fungal infections may cause systemic infection in immunocompromised
individuals (e.g., HIV-positive individuals, bone marrow transplant recipients), potentially
leading to meningitis or severe sepsis.
Basics of mycology
https://www.amboss.com/us/knowledge/General_mycology 1/19
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Structure and characteristics of fungi
Fungi are eukaryotes.

Possess a cell wall and a cell membrane that contains ergosterol (analogous to cholesterol
in humans)
Basic morphological elements
Particularly in dermatophytes and molds

Hyphae: multicellular compartments, which are connected by porous septa
Mycelium: a network of hyphae, which are formed by asexual reproduction
Particularly in yeasts
Budding cells (blastospores): in unicellular fungi, formed by budding of daughter cells
Pseudomycelium (pseudohyphae): chains of budding cells, which are stretched in a

hyphen-like manner but are divided by septa
Fungi are not considered plants and are nonphotosynthetic. They extract
energy (e.g., sugar and proteins) from living or dead organic matter.
Azoles target the synthesis of ergosterol, the principal sterol in fungal

cell membranes. They inhibit the synthesis of ergosterol from lanosterol by
interfering with 14α-demethylase (cytochrome P-450 enzyme).
Substances synthesized by fungi
Penicillin by Penicillium chrysogenum
Toxins
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A atoxins by molds (e.g., Aspergillus avus) on nuts, seeds, and grains; : poisonous
carcinogen associated with hepatocellular carcinoma
Amanitin (see “Amanita phalloides”)
Ergot alkaloids such as ergotamine produced by the ergot fungus Claviceps purpurea,
which grows on rye: causes vasoconstriction by binding to 5-HT1D serotonin receptors
and alpha-adrenergic receptors
Detection of fungal infections
Clinical features and microscopy for evaluation of fungal morphology

Additional characterization via:
Culture, e.g., Sabouraud agar (a growth medium that contains dextrose and peptones)
Staining, e.g.:
Silver stain
India ink stain: a type of negative stain with carbon that is most commonly used to
identify organisms with a polysaccharide capsule such as Cryptococcus neoformans (the
capsule is not penetrated by the ink and appears as a halo around the organism against a
dark background)
Mucicarmine: a staining method used to identify the thick polysaccharide capsule of
some organisms (e.g., Cryptococcus neoformans) and mucin (e.g., in gastric tumors)
Antigen detection, e.g., capsule components in serum
Antibody detection plays a minor role.

Wood lamp examination: a diagnostic test to examine skin lesions with a lamp that emits
ultraviolet light
Used to evaluate super cial fungal infections of the skin (e.g., tinea versicolor) which
appear characteristically yellow-green uorescent under ultraviolet light
Can also be used to evaluate hypopigmented or depigmented lesions (e.g., vitiligo) which
appear blue-white uorescent
Latex agglutination test
Fungi overview
Dermatophytes: lamentous fungi (mainly affect skin and nails)

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Trichophyton
Microsporum
Epidermophyton species
Yeasts: budding fungi (may affect skin, mucous membranes, and internal organs)
Candida species (particularly Candida albicans) cause candidiasis
Cryptococcus neoformans causes cryptococcosis
Malassezia furfur causes tinea versicolor
Molds: Aspergillus fumigatus causes aspergillosis (may affect internal organs)
Dimorphic fungi: exist as molds (hyphal form) at colder temperatures (∼ 20oC) and as yeasts
at warmer temperatures (∼ 37oC)
Blastomyces dermatitidis
Candida albicans
Histoplasma capsulatum
Sporothrix schenckii
See “Systemic fungal infections” below.
To remember the temperatures at which the different forms of

dimorphic fungi exist, think of “Mold in the cold, yeast in the beast!”.
Dimorphic fungi exist as molds at cooler temperatures (cold) and as yeasts at
warmer temperatures (beastly heat).
Opportunistic fungal infections
Overview of the most common opportunistic fungal infections
Pathogen Risk factors Clinical features Diagno

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Aspergillosis Aspergillus Immunocompromise ABPA ABP

fumigatus Associated with E
Chronic
asthma and
Aspergillus granulomatous E
cystic brosis
avus infection le
Causes P
bronchiectasis i
and eosinophilia c
Pulmonary
Pulm
aspergilloma:
asp
chronic cough,
X
hemoptysis
m
Invasive
S
aspergillosis
p
: fever, cough,
A
respiratory distress
Inva
Endocarditis : tis
sho
bra
hyp
bod
Candidiasis Candida Immunosuppression Oral thrush Bes

albicans (e.g., HIV, sho
Candida esophagitis
diabetes mellitus) yea
Vaginal yeast pse
Medications infection 20°
(antibiotics, steroids
, cytostatic agents, Candidiasis of the Con
immunosuppressive skin: erythematous cult
therapy patches with small tiss
) satellite lesions in
AID
intertriginous areas
↑ Estrogen levels and digital web
con
during pregnancy if es
spaces
trac
Hematologic
Diaper dermatitis lung
malignancies (e.g.,
Disseminated: sepsis invo
acute myeloid
leukemia , meningitis, multiple
, multiple myeloma) abscesses,
endocarditis
Compromised skin
(excessive moisture,
local lesions from
dentures or burns)

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Cryptococcosis Cryptococcus AIDS Cryptococcal Late

neoformans meningoencephalitis test
Exposure to pigeon
or brain abscess : po
droppings/soil
Hematogenous cryp
Transmission via spread of fungi to poly
inhalation meninges cap
H
Headache, fever,
a
signs of increased
intracranial S
pressure o
, confusion, CSF
absent I
meningeal signs c
Isolated pneumonia
M
is possible
s
i
p
c
F
S
s
MR
lesi
cryp
enc
AID
con
if ex

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Pneumocystis P. jirovecii Immunosuppression Fever, CT:

(previously (especially if CD4 exertional dyspnea, gro
pneumonia
P. carinii) count < 200/μL) nonproductive opa
cough, weight loss,
impaired
X-ra
oxygenation
opa
Bro
lava
or lu
spu
silve
imm
sho
yea
AID
con

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Zygomycetes Diabetes, Invasive Ima

Mucormycosis Mucor and particularly with chronic sinusitis and A
Rhizopus ketoacidosis orbital cellulitis o
(e.g., a
Immunosuppression May lead to tissue
Rhizopus i
Chronic sinusitis (> necrosis and and
oryzae)
3 months) contiguous spread H
to the orbit, brain, w
Iron overload or and palate i
treatment with Headache, facial i
deferoxamine pain Tiss
Black necrotic (con
eschar on face ang
and/or palate irre
bro
Possible cranial
hyp
nerve
involvement
Rhinocerebral,
frontal lobe abscess
Cavernous sinus
thrombosis
Pulmonary
mucormycosis:
aggressive infection
of the bronchioli and
alveoli, manifesting
with fever and
hemoptysis
Cerebritis,
mediastinitis,
cardiac involvement
in severe cases
Candida, Aspergillus, and Cryptococcus are opportunistic fungal pathogens

with low inherent virulence. They commonly cause systemic mycoses in
immunocompromised hosts but do not normally affect healthy hosts.
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Cutaneous fungal infections
Overview of the most common cutaneous fungal infections
Pathogen Risk factors Clinical features Diagnostic
Dermatophytes Trichophyton Profuse sweating, Tinea capitis Best ini

obesity, diabetes, (head): scaling KOH sh
Microsporum
immunosuppression and hair loss hyphae
Epidermophyton
Tinea corporis Con rm
(body): ring- fungal c
shaped, pruritic Wood l
lesions with test for
central clearing tinea ca
and elevated
borders on an
erythematous
base
Tinea cruris
(groin): usually
spares the
scrotum
Tinea manuum
(hand),
tinea pedis
(foot): pruritic
lesions in
interdigital
spaces, on the
soles of the feet
or as vesicles
Onychomycosis
(nails): thick,
opaque nails
Overview of the most common cutaneous fungal infections

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Pathogen Risk factors Clinical features Diagnostic
Tinea Malassezia Hot or humid Small, Best ini

furfur weather conditions hyperpigmented KOH sh
versicolor
or short hy
( hypopigmented and spo
pityriasis macules on that hav
versicolor chest and back “spaghe
and
)
meatba
May coalesce to
appeara
form patches
Systemic fungal infections

Etiology
Pathogen: dimorphic fungi
No interpersonal transmission
Clinical features: pneumonia, disseminated systemic infection
Overview of the most common systemic fungal infections
Pathogen Risk factors Clinical features
Histoplasmosis Histoplasma Endemic areas: Often asymptomatic

capsulatum Mississippi and the
Flulike illness: fever
Flulike illness: fever,
Ohio river valley
Overview of the most common systemic fungal infections weight loss,
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Exposure to bird or erythema nodosum,
bat droppings in hepatosplenomegaly,
endemic areas lymphadenopathy,
through activities nonproductive cough
such as spelunking Ulcerative oral lesion
(cave exploration) (palatal, tongue ulcer
Immunosuppression
(e.g., AIDS)
Coccidioidomycosis ( Coccidioides Travel to Flu-like illness or

immitis Southwestern pneumonia: fever,
valley fever)
valley fever)
United States, cough, night sweats,
Overview of the most common systemic fungal infections
California REGISTER / LOG
anorexia, chest pain,IN
and dyspnea
Soil/dust exposure
in endemic areas Extrapulmonary
(e.g., during ndings
windstorms, CNS: meningitis
earthquakes, Skin:
archeological erythema nodosum
explorations) [2] (desert bumps)
Joints: arthralgia
(desert rheumatism
Bone: multiple
osteolytic lesions [
Paracoccidioidomycosis Paracoccidioides Travel to South and Infected patients ofte

species Central America asymptomatic
Paracoccidioides
brasiliensis
♂>♀ [4] Painful nasal,
pharyngeal, and
Paracoccidioides laryngeal mucosal
lutzii ulcerations
Lymphadenopathy
(usually cervical)
Can disseminate →
extrapulmonary
manifestations (e.g.,
verrucous skin lesion
similar to those of
cutaneous
blastomycosis)
Blastomyces Travel to Pneumonia

Blastomycosis dermatitidis Southeastern,
Extrapulmonary
Extrapulmonary
Central, Eastern,
Overview of the most common systemic fungal infections ndings
and the Great Lakes REGISTER / LOG IN
Skin: verrucous
region of the United
lesions and
Pathogen Risk factors
States Clinical features
granulomatous
nodules (lesions
resemble
squamous cell
cancer
)
Bone:
osteolytic lesions
(most commonly in
the ribs, vertebrae
and long bones) [5]
Genitourinary
involvement:
prostatitis, orchitis
epididymitis
CNS lesions:
meningitis,
epidural/intracran
abscesses
“History of the hidden Ohio and Mississippi river valleys:” Histoplasma is

hidden within macrophages and Ohio and Mississippi river valleys are the
endemic regions of histoplasma.
“Paracoccidiomycosis steers the ship to South and Central America at the

captain's wheel: ”Paracoccidiomycosis is endemic in South and Central
America and its budding yeast has a captain's wheel appearance.
The yeast form of Blastomycosis forms broad-based buds.
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Unlike most other dimorphic fungi, Blastomyces can cause disseminated

disease even in immunocompetent hosts.
Other fungal infections
Sporotrichosis (Rose gardener disease)
Etiology
Pathogen: Sporothrix schenckii (a dimorphic fungus that feeds on vegetation)
Risk factor: traumatic injury to the skin while gardening (e.g., thorn prick)
Clinical features
Pustules and ulcers with ascending lymphangitis

Nodules along draining lymphatics
Disseminated disease (in immunocompromised patients): pneumonia, meningitis

Diagnostics
Fungal culture; (sputum, pus, biopsy tissue) showing dimorphic, cigar-shaped yeast (this
form exists in humans)
Septate hyphae, rosette-like clusters of conidia at the tips of the conidiophores (this form
exists in soil/vegetation)
Treatment
Cutaneous or lymphocutaneous: oral itraconazole OR potassium iodide
Disseminated: IV amphotericin B
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“A rose gardener plants roses in a pot while smoking a cigar:” sporotrichosis is

associated with traumatic gardening injuries, treatment includes potassium
iodide, and Sporothrix appears as a cigar-shaped yeast in culture.
Dermatophytes
Pathogenicity
Dermatophytes produce keratinase, which allows them to infect the skin, hair, and nails.
Many dermatophytes are obligate pathogens.
Morphology
Form hyphae and mycelium
After penetration into the skin, concentric propagation may occur around the entry site.
Overview of the most important dermatophytes
Characteristics Diseases Treatment
Occurs worldwide Tinea corporis Local: terbina ne PLUS

Trichophyton (ringworm) azoles
Partial yellow-green
species
uorescence under Tinea capitis Systemic: terbina ne,
Wood lamp itraconazole, uconazole,
Tinea or griseofulvin
Occurs worldwide unguinum (
Epidermophyton
No typical onychomycosis
species )
uorescence under
Wood lamp Tinea cruris (
jock itch)
Tinea pedis (
Overview of the most important dermatophytes
athlete's foot) REGISTER / LOG IN
Occurs worldwide
Microsporum
Partial blue-green
species
uorescence under
Wood lamp
Yeasts
Pathogenicity
Usually an opportunistic pathogen
Can infect the skin, mucous membranes, or internal organs

Morphology
Demonstrate budding cells and pseudomycelium

Single yeast cells are 5–8 μm in size.
Gram positive staining
Overview of the most important yeasts
Overview of the most important yeasts

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Candida albicans is the most Vaginal yeast Local: ciclopirox,

Candida common Candida species infection nystatin,
species worldwide and is almost , balanitis clotrimazole,
exclusively found in miconazole,
Erosio
humans. ketoconazole
interdigitalis
blastomycetica Systemic
IV caspofungin OR
Oral thrush micafungin (
echinocandins)
Candida
Alternatively:
esophagitis
uconazole
OR
Candidal amphotericin B
intertrigo
Invasive
candidiasis
Humans are infected via Cryptococcal Amphotericin B

Cryptococcus contaminated dust meningitis PLUS ucytosine,
neoformans particles. followed by
uconazole
Possesses a capsule, which Cryptococcosis
maintenance therapy
can be visualized using
for at least 12
India ink
months
Yellow-orange uorescence Tinea Local: selenium

Malassezia under Wood lamp versicolor sul de lotion or
furfur shampoo, miconazole
Particularly present in the
, ketoconazole, OR
infundibulum of the hair Involved in the
terbina ne
follicle pathogenesis
of Systemic:
seborrheic uconazole OR
eczema itraconazole
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Molds
Pathogenicity
Usually an opportunistic pathogen
Mold antigens are one of the most frequent causes of allergies.

Molds produce various toxins. Infection is caused by either aerogenic uptake or is
foodborne (e.g., a atoxins).
Morphology
Formation of monomorphic septate hyphae that branch at 45° and mycelium

Mold can infest food products and acquire a fuzzy appearance that is macroscopically
visible.
Pathogen: Aspergillus fumigatus
Ubiquitous occurrence
Some species produce a atoxins
Diseases
Aspergillosis
Allergic bronchopulmonary aspergillosis (ABPA)

Aspergilloma
Invasive pulmonary aspergillosis

Endocarditis
Treatment
ABPA
Oral prednisone if severe
Itraconazole if recurrent
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Pulmonary aspergilloma: lobectomy
Invasive aspergillosis: IV voriconazole, caspofungin, amphotericin
References
1. Zhang P, Lian L, Wang F. Magnetic resonance imaging features of gelatinous pseudocysts in
cryptococcal meningoencephalitis. Acta Neurol Belg. 2018; 119 (2): p.265-267. doi:
10.1007/s13760-018-1033-6 . | Open in Read by QxMD
2. Thompson G, Brown J, Benedict K, Park B. Coccidioidomycosis: epidemiology. Clinical

Epidemiology. 2013 : p.185. doi: 10.2147/clep.s34434 . | Open in Read by QxMD
3. Arora NP, Taneja V, ReyesSacin C, Bhanot R, Natesan SK. Coccidioidomycosis masquerading
as malignancy.. BMJ case reports. 2012; 2012 . doi: 10.1136/bcr.12.2011.5357 . | Open in
Read by QxMD
4. Paracoccidioidomycosis. https://rarediseases.org/rare-diseases/paracoccidioidomycosis/ .
Updated: January 1, 2009. Accessed: April 22, 2020.
5. Blastomycosis. https://rarediseases.org/rare-diseases/blastomycosis/ . Updated: January 1,

2009. Accessed: May 2, 2020.
6. Kumar V, Abbas AK, Aster JC. Robbins & Cotran Pathologic Basis of Disease. Elsevier
Saunders ; 2014
7. Le T, Bhushan V, Sochat M, Chavda Y, Zureick A. First Aid for the USMLE Step 1 2018.
McGraw-Hill Medical ; 2017
8. Brooks G, Carroll KC, Butel J, Morse S, Mietzner TA. Jawetz Melnick & Adelbergs Medical
Microbiology. McGraw Hill Professional ; 2012
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1/17/2021 General mycology - AMBOSS

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TRY FREE FOR 5 DAYS

General mycology Last updated: January 7, 2021

Fungi are eukaryotes.

Particularly in dermatophytes and molds

Pseudomycelium (pseudohyphae): chains of budding cells, which are stretched in a

Azoles target the synthesis of ergosterol, the principal sterol in fungal

Substances synthesized by fungi

Penicillin by Penicillium chrysogenum

Detection of fungal infections

Clinical features and microscopy for evaluation of fungal morphology

Antigen detection, e.g., capsule components in serum

Antibody detection plays a minor role.

Latex agglutination test

Dermatophytes: lamentous fungi (mainly affect skin and nails)

Candida species (particularly Candida albicans) cause candidiasis

Cryptococcus neoformans causes cryptococcosis

Malassezia furfur causes tinea versicolor

Molds: Aspergillus fumigatus causes aspergillosis (may affect internal organs)

See “Systemic fungal infections” below.

To remember the temperatures at which the different forms of

Opportunistic fungal infections

Overview of the most common opportunistic fungal infections

Pathogen Risk factors Clinical features Diagno

Overview of the most common opportunistic fungal infections

Pathogen Risk factors Clinical features Diagno

Aspergillosis Aspergillus Immunocompromise ABPA ABP

Candidiasis Candida Immunosuppression Oral thrush Bes

Overview of the most common opportunistic fungal infections

Pathogen Risk factors Clinical features Diagno

Cryptococcosis Cryptococcus AIDS Cryptococcal Late

Overview of the most common opportunistic fungal infections

Pathogen Risk factors Clinical features Diagno

Pneumocystis P. jirovecii Immunosuppression Fever, CT:

Overview of the most common opportunistic fungal infections

Pathogen Risk factors Clinical features Diagno

Zygomycetes Diabetes, Invasive Ima

Candida, Aspergillus, and Cryptococcus are opportunistic fungal pathogens

Cutaneous fungal infections

Overview of the most common cutaneous fungal infections

Pathogen Risk factors Clinical features Diagnostic

Dermatophytes Trichophyton Profuse sweating, Tinea capitis Best ini

Overview of the most common cutaneous fungal infections

Pathogen Risk factors Clinical features Diagnostic

Tinea Malassezia Hot or humid Small, Best ini

Systemic fungal infections

Pathogen: dimorphic fungi

Overview of the most common systemic fungal infections

Pathogen Risk factors Clinical features

Histoplasmosis Histoplasma Endemic areas: Often asymptomatic

Coccidioidomycosis ( Coccidioides Travel to Flu-like illness or

Paracoccidioidomycosis Paracoccidioides Travel to South and Infected patients ofte

Blastomyces Travel to Pneumonia

“History of the hidden Ohio and Mississippi river valleys:” Histoplasma is

“Paracoccidiomycosis steers the ship to South and Central America at the

The yeast form of Blastomycosis forms broad-based buds.

Unlike most other dimorphic fungi, Blastomyces can cause disseminated

Other fungal infections

Sporotrichosis (Rose gardener disease)

Pustules and ulcers with ascending lymphangitis

Disseminated disease (in immunocompromised patients): pneumonia, meningitis

“A rose gardener plants roses in a pot while smoking a cigar:” sporotrichosis is