Medically

Important
Fungi
Cha pte r five

147
 Anatomy and site of action of major anti-fungals:

cell wall mannan, glucan and chitin

• Ergosterol membrane sterol

Squalene Lanosterol Ergosterol

Squalene epoxidase 14- -demethylase

Mannoprotein

-glucans – inhibited by echinocandins

Chitin – inhibited by nikkomycin and polyoxins

Ergosterol (bound by polyenes, napthoquinones,

eugenol analogues, isoquercitrin
• Inhibition of squalene epoxidase –
terbinafine and naftifine
• Inhibition of 14- -demethylase – azoles

DNA synthesis – inhibited by 5-flucytosine

Ribosomes – inhibition of protein synthesis -

sordarins

Mitochondria – production of ROS, RNS -

amphotericin B, miconazole, ciclopirox

Microtubules – assembly inhibited – griseofulvin

148
 Life Cycle:
conidia

spores

• Yeasts blastoconidia
• Molds hypha
mycelium
septate aseptate
• Pseudohyphae

B H C S Blastomyces,
Histoplasma, Coccidioides Sporothrix

Diagnosis:

•
• Silver stains
• India ink Cryptococcus.

• Mucicarmine Cryptococcus
• Gram stain
Candida

149
 Mycoses by Tissue Layers
Keratinized tissues: Malassezia furfur
Epidemiology:

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

Pityriasis versicolor.

150
 Cutaneous tissues (Dermatophytoses)
Epidemiology:

Microsporum
Trichophyton
Epidermophyton

Tinea capitis
Tinea barbae
Tinea cruris
Tinea pedis
Tinea corporis
Tinea unguium
Patients, Pathogenesis and Pharmacotherapy:

Chief Vignette Clues Pathogenesis Rx

Complaint

Woods lamp

151
 Subcutaneous Tissues: Sporothrix schenckii
Epidemiology:

rose gardener’s disease

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

Eumycotic mycetoma

152
 Systemic Mycoses
dimorphs.

WA NH
VT ME
MT ND
MN
OR MA
ID SD WI NY
WY MI RI
IA PA CT
NV NE NJ
IN OH
IL DE
UT WV
CA CO MD
KS MO KY VA
NC
TN
AZ OK AR
NM SC
MS AL GA
LA
TX

FL
AK

HI

153
 Blastomyces dermatitidis
Epidemiology:
Histoplasma

Patients, Pathogenesis and Pharmacotherapy:

Chief Vignette Clues Pathogenesis Rx

Complaint

North
Carolina, Wisconsin

Broad-based budding

154
 Histoplasma capsulatum (not encapsulated)
Epidemiology:

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

Facultative intracellular.

(chicken coops,
caves). AIDS prophylaxis at 100
CD4 cells

calcifying lesions
small intracellular
yeasts.

155
 Coccidioides immitis
Epidemiology:

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

Large,
double-walled, round spherule

Erythema nodosum (desert

bumps)

156
 Paracoccidioides brasiliensis (South American
blastomycosis)
Epidemiology:

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

“captain’s
wheel”

157
 Opportunistic Fungal Infections
Cryptococcus neoformans
Epidemiology:

bird droppings (pigeons, turkeys, chickens)

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

100 CD4 cells/µL or

Capsular
halo India Ink or
mucicarmine +

158
 Aspergillus fumigatus
Epidemiology:

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

Fungus ball, aspergilloma

159
 Candida albicans
Epidemiology:

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

Germ tube test

pseudohyphae

160
 Zygomycosis (Mucormycosis, Rhizomycosis,
Absidiomycosis)
Epidemiology:

Patients, Pathogenesis and Pharmacotherapy:

Chief Vignette Clues Pathogenesis Rx

Complaint

Ketoacidotic diabetic or

irregularly wide, ribbon-like Rhinocerebral infection

hyphae that branch at 90 angles.
o

161
 Pneumocystis jirovecii
Epidemiology:

• Atypical fungus:

Patients, Pathogenesis and Pharmacotherapy:

Chief
Vignette Clues Pathogenesis Rx
Complaint

Atypical pneumonia in AIDS. kills

type I pneumocytes
prophylaxis at CD4 count
of 200/µL

162
 Before you leave, can you…

163