Agents of Opportunistic Mycoses ○ Deferoxamine is an iron chelation which serves as fungal

Pre test siderophore which directly delivers iron to the neocoralis

Colored text: lifted from transes ○ In the past, iron overloaded patients with end-stage renal

Black text: from ppt failure who are treated with deferoxamine had higher risk of

TRUE or FALSE developing fatal disseminated mucormycosis

False True pathogens are organisms which are normal biota ● Stem cell or Solid organ transplantation
that causes infections in immunosuppressed and
● Infant prematurity
immunocompromised individuals when they have opportunity
● Malignancy: Leukemia, Lymphoma
True The most prevalent agent under the order Mucorales is
● Severe Burns
Rhizopus oryzae
Mode of Transmission
False Parenteral is the most common mode of transmission
for Pneumocystis spp ● Respiratory route – most common route

True Pneumocystis jirovecii causes Interstitial Plasma Cell ● External implantation

Pneumonia ● Hematogenous dissemination

False Talaromyces is formerly known as Penillin ● Nosocomial settings

General chararacteristics ○ Could be acquired through the hospital

• Surgical wounds are ideal points of inoculation, allowing

saprobes to become opportunistic agents of disease. Mucormycosis or Zygomycosis
• Skin and nail bed infections as well as severe respiratory
infections can be caused by a variety of fungi in patients ● Group of life-threatening infections caused by fungi in the
with AIDS. order Mucorales.
• Ubiquitous thermotolerant saprobes
○ Ubiquitous - present everywhere ● Highly invasive, progressive

○ Thermotolerant - ability to tolerate high temperatures
○ Saprobes - free-living microorganisms that are present in
the environment but are not typically of concern with regard
to human disease
○ Resulting in higher rates of morbidity and mortality than
many other infections
● Leading pathogens : Genera Rhizopus, Rhizomucor,
Lichtheimia, Cunninghamella, and Mucor

● Common environmental isolates - associated with soil and ● Rhizopus oryzae – most prevalent
plants
6 Clinical Syndromes of Mucormycosis
● Often considered as common contaminants within mycology
1. Rhino - Orbital - Cerebral Disease
laboratory
2. Pulmonary Disease
Risk Factors
3. Cutaneous Disease
● Diabetes - patients with diabetic ketoacidosis
4. Gastrointestinal Disease
○ Patients with DKA are at high risk of developing
rhinocerebral mucormycosis 5. Disseminated
● Defect in phagocytic action - eg. Neutropenia or patients on 6. Miscellaneous Forms of Disease
glucocorticoid use or treatment
Mucorales
● Elevated levels of Free Iron
Cunninghamella.
○ Supports the fungal growth in serum and tissues • can be recovered from the sinuses or other organs during
disseminated disease.
● Deferoxamine use
 • Sporangiophores are erect, branching into several vesicles
that bear sporangioles and can be covered with long, fine
spines.
• that form a cottony colony that is initially white but
becomes gray with age.
Lichtheimia.
• Lichtheimia spp. have a predilection for vascular invasion,
causing thrombosis and necrosis of the tissues
• usually found in diabetic patients suffering from
ketoacidosis
• From the sinuses, infection rapidly spreads to the orbits,
face, palate, and brain.
• This presentation is known as rhinocerebralzygomycosis.
• Lichtheimia hyphae are broad and ribbon-like, with few
septations
• Erect sporangiophores, solitary or in groups (slightly
branched), terminate in an apophysis surrounded by a
sporangium.
• Sporangiospores are smooth and ovoid.
• Internodal rhizoids (short, thin projections that anchor the
growing cells to substratum) are present
Laboratory
Broad and ribbon like with few septations
- Sporangiophores: erect; solitary or in groups; sometimes
slightly branched which terminate in apoptosis surrounded by
sporangium
- Sporangiospores: smooth and ovoid solitary
- Internodal rhizoids - short tiny projections that anchor the
growing cells to the substratum
- Colony: Initially - white; Aged - gray to gray brown
- Usually, the colonies are wooly and rapidly growing
Mucor.
• Mucor spp. have been implicated in rhinocerebral
zygomycosis in addition to disseminated disease.
• Sporangiospores are formed in sporangia on erect
sporangiophores.
• The sporangia frequently remain intact, as opposed to
Rhizopus spp., in which the sporangia typically collapse.
• Mucor spp. growing rapid and form cottony, dirty white
colonies that become mousy brown to gray with age.
Laboratory
Commonly isolated in the environment worldwide
Sporangiospores: formed in sporangia on erect
sporangiosphore
- Rhizoids are absent
- Potato Dextrose Agar (PDA): Colony - rapid growing;Initially -
cottony, dirty white; Aged - mousy brown to gray
Rhizopus.
• It is typically involved in diabetic patients with ketoacidosis,
presenting as rhinocerebral mucormycosis.
• At the base of the sporangiophores are brown rhizoids.
• Separate clusters of sporangiophores are joined by stolons,
arching filaments that terminate at the rhizoids.
• The sporangia are typically fragile and are not easily
retained when making slide culture preparations, resulting
in an umbrella-shaped structure at the end of the
conidiophores.
Laboratory
● Rapidly growing
- Sporangiophores: erect
- Sporangia: umbrella shaped structure
- SBD: Colony - rapidly growing, woolly colonies; Initially -
white;
Aged - gray to brown
- At the base of sporangiospores, we could observe a brown
rhizoids
- Separate clusters of sporangiospores are joined by stolons
which are arching the filaments that terminate at the rhizoid.
(middle image)
- Fragile and are not easily retained when making slide culture
- Umbrella shaped structure at the end of the conidiophore
- Usually, produce rapid growing woolly colonies that cover
the
entire surface of the culture medium.
Syncephalastrum.
• Syncephalastrum is rarely implicated in human disease but
has been documented in cutaneous infections.
• Microscopically, erect sporangiophores are noted.
• Each sporangiophore has a large columella on which
merosporangia, containing stacks of sporangiospores, are
formed
Septate and Hyaline Saprophytes
Aspergillus.
• Aspergillus fumigatus is the species most commonly
isolated; other pathogenic species include A. flavus, A.
terreus, and A. niger.
• Neutropenia is the single most predictive factor for
• developing aspergillosis.
• Aspergillus spp. are the most frequent cause of disease in
bone marrow transplant recipients in addition to other
cancer and transplantation patients.
• The infection easily spreads hematogenously, and it is not
uncommon to find multiorgan system involvement,
including the brain, liver, heart, and bone.
• Another frequent presentation is so-called fungus balls in
the lungs of agricultural workers who routinely are in
contact with fungal conidia from environmental sources.
• Aspergilli may be uniseriate or biseriate.
• Uniseriate species are those whose phialides attach
directly to the vesicle at the end of the conidiophore.
• Biseriate species possess a supporting structure called a
metula.
• Metulae attach directly to the vesicle, andbattached to
each of the metula are phialides
• Colors range from black to white and include yellow,
brown, green, gray, pink, beige, and tan.
• A granular texture is seen in species with abundant
conidial formation.
 • Most known pathogens in this group form green- to tan- • Penicillium spp. rarely cause infections; most reports of
colored colonies. disease involve chronic fungal sinusitis.
• Conidiophores are erect, sometimes branched, with
metulae bearing one or several phialides on which oval to
Beauveria. ovoid conidia are produced in long, loose chains.
• Beauveria bassiana is a rare human isolate, uncommonly • This commonly seen fungus is a rapid grower with colonies
associated with keratitis. usually in shades of green or blue-green.
• This fungus is a known insect pathogen and is found Generalities
worldwide on vegetation and in the soil. ● Penicillium marneffei (old)
• Abundant, single-celled, tear-shaped sympoduloconidia ● Talaromyces marneffei (new)
are formed on sympodulae, which taper extremely from a ● Dimorphic - exist both in yeast and mold forms
rather swollen base. ● Endemic (Opportunistic Pathogen)–Southeast Asia
• Conidiophores may cluster in some isolates to form radial ○ South eastern China
tufts. ○ Thailand
○ Vietnam
Chrysosporium. ○ Indonesia
• have been recovered from nails and skin lesions. ○ Hong Kong
• Microscopically simple, wide-based, single-celled conidia ○ Taiwan
are produced on nonspecialized cells ○ Many poor state of India
• The conidiogenous cell disintegrates or breaks to release ● Reservoir –bamboo rat
the conidia. Both arthroconidia and aleurioconidia may be Risk Factors
seen. ● HIV/AIDS
• Colonies are hyaline with a moderate growth rate that ● Tuberculosis
with age, can develop light shades of pink, gray, or tan ● Corticosteroid treatment
pigment. ● Hematologic malignancies - Lymphoproliferative disease
● Autoimmune disease
Fusarium. ● Organ transplantation
• Fusarium spp. are frequently seen in mycotic keratitis.
• Patients present with high fever, possibly disseminated Mode of Transmission
skin lesions and, in some patients, fungemia. ● Respiratory route
• Macroconidia are banana- or canoe- shaped and are Laboratory:
formed singly, in small clusters, or clustered together in Can be diagnosed by using a small sample from the body part
mats termed sporodochia. that is affected.
• Macroconidia typically are multicelled. ● Specimens:
• Fusarium is a rapidly growing hyaline fungus that can ○ Bone marrow
develop various colors with age, ranging from rose to ○ Skin
mauve to purple to yellow. ○ Blood
○ Lung
Geotrichum. ○ Lymph node
• Geotrichum has been implicated in pulmonary disease in - Microscopic image stained with Lactophenol blue
immunocompromised patients. - Ultrastructural details of the Penicillium marneffei
• Microscopic evaluation reveals abundant arthroconidia - Filamentous septate hyphae - septate conidiophores topped
formed from the vegetative hypha that occurs singly or by metulae followed distally by phialides
may be branched. - Chains of round, unicellular conidia,resembling a paint brush,
• Colonies are white to cream, yeastlike, and can be and known as penicilli.
confused with Trichosporon spp. ● Granular colony of P. marneffei with a characteristic red
diffusible pigment on Sabouraud’s dextrose agar after 7 days
Paecilomyces. incubation at 25°C.
• Phialides of Paecilomyces are generally longer and more - Dimorphic organism; can manifest as yeast or mold form
obviously tapered, and they may be singly formed or ● .Yeast-like colony of P. marneffei without red diffusible
arranged in a verticillate pattern, on which long chains of pigment on Sabouranud’s dextrose agar after 7 days of
spindle-shaped or somewhat cylindric conidia are formed incubation at 35°C.
• Paecilomyces spp. grow rapidly and usually form flat,
granular to velvety colonies in shades of tan, brownish Scopulariopsis.
gold, or mauve. • Scopulariopsis spp. are commonly isolated from nail
specimens and have been implicated in pulmonary
Penicillium. disease in immunocompromised patients.
 • Conidia are formed from annellides, which increase in
length as conidia are formed.
• The truncate-based conidia tend to remain in chains on the
annellides.
• Scopulariopsis grows moderately rapidly and forms
colonies covered by tan to buff conidia.
• Some species are phaeoid
Trichoderma.
• pulmonary and skin infections.
• rapidly growing and form hyaline hyphae that give rise to
yellow-green to green patches of conidia formed on
clusters of tapering phialides
• Conidia may remain clustered in balls at the phialide tips.
• Colonies are intensely green and granular, with an
abundance of conidia
Septate and Phaeoid Saprophytes
Alternaria.
• they are primarily implicated in chronic fungal sinusitis.
• Can be found systemically in those suffering from immune
suppression.
• Multicelled conidia have angular cross walls and taper
toward the distal end.
• Alternaria spp. are phaeoid, rapidly growing fungi with
colonies ranging from shades of gray to brown to black.
Aureobasidium.
• This organism may be recovered from blood, tissues, and
abscesses.
• It is recovered worldwide primarily in wet conditions, such
as shower tiles and water lines.
• With age, phaeoid hyphae develop and break up into
arthroconidia, which do not bear hyaline conidia.
• These arthroconidia are responsible for the darkening
colony morphology.
• Young cultures are off-white to pink, but with age they
become black, with the production of darkly pigmented
arthroconidia.
Chaetomium.
• Infections by Chaetomium organisms have been reported
in the brains of patients with central nervous system
disease.
• These fungi are found in the environment and have a
predilection for cellulose products.
• They have been known to devastate printed literature and
library holdings and have been associated with indoor air
quality problems.
• These perithecia are pineapple-shaped and are
ornamented with straight or curled hairs.
• at maturity the pigmented, lemon-shaped ascospores are
released within the perithecium.
• Some species produce a diffusible pigment that turns the
agar completely red
Cladosporium.
• Infections are typically confined to the sinuses or following
traumatic inoculation.
• Cladosporium spp. form brown to olive to black hyphae
and conidia
• branched conidium-bearing cells may dislodge, and the
three scars on each of these cells give them the
appearance of a shield.
• These organisms are slowly to moderately growing
phaeoid fungi, with granular velvety to fluffy colonies,
ranging in color from olive to brown or black.
Curvularia.
• Curvularia spp. isolates are usually implicated in chronic
sinusitis in immunocompetent patients.
• This genus is among the easiest to identify because of the
frequently seen crescent- shaped conidia with three to
five cells of unequal size and an enlarged central cell.
• These fungi form a rapidly growing phaeoid colony that is
cottony and dirty gray to black.
Phoma.
• Phoma spp. produce pycnidia, which appear as black
fruiting bodies that are globose and lined inside with short
conidiophores
• Large numbers of hyaline conidia are generated in the
pycnidium and flow out of a small apical pore.
• Phoma spp. produce a moderately rapid growing gray to
brown colony.
Pithomyces.
• Conidia are somewhat barrelshaped, formed singly on
simple short conidiophores
• Conidia have both transverse and longitudinal crosswalls
and are often echinulate.
• Pithomyces spp. produce rapidly growing phaeoid colonies.
Ulocladium.
• Conidiophores bear dark, multicelled conidia on sympodial
conidiophores
• Conidia have angular cross walls and, in some species,
echinulate surfaces.
• Ulocladium spp. are rapidly growing phaeoid fungi,
forming colonies ranging in color from brown to
olivaceous to black.

Agents of Yeast Infections
• Yeast fungi can be classified into one of two groups,
yeasts and yeastlike fungi.
• Isolates that reproduce sexually, either by forming
ascospores or basidiospores, are truly yeasts.
• Most isolates that are not capable of sexual
reproduction or whose sexual state has not yet been
discovered are correctly termed yeastlike fungi.
General Characteristics
They do not induce disease to immunocompetent or persons
who have good immune system
○ They cause disease in patients with altered immune system
● Cause disease in persons who have altered host defense
mechanism
○ Immunocompromised (AIDS, Chemotherapy)
○ Debilitated patients (Chronic diseases)
Eg. cancer, leukemia, and major genetic disorders
• The color of a yeast colony ranges from white to
cream or tan, with a few species forming pink- to salmon-
colored colonies.
• Some yeast isolates, referred to as phaeoid yeasts, are
darkly pigmented because of melanin in their cell walls.
• The texture of the yeast colonies also varies.
• Some yeasts are butter-like, and others range in
texture from velvety to wrinkled.
• Strain to strain variation in texture may be noted
within a species.
Candida
Colonizes the skin surfaces of all humans soon after birth
● There is a risk of endogenous infection
● They usually are ever present
● Most common
● Diseases: Candidiasis, moniliasis, oral thrush, mycotic
vulvovaginitis, Candida paronychia, Candida endocarditis
● Most notorious agent of yeast infection and common cause
of fungemia
● Normal flora: skin, mucous membranes and GI tract
● Usually, the candida species are aggressive with patients
with multiple co-morbidities and they may be difficult to treat
with traditional antifungal therapy. It causes disease in any
site when the host’s conditions are altered.
● C.albicans which is the premier cause of yeast infection in
the world
● C. glabrata is the second most common
• normal biota of the mucosa, skin, and digestive tract
• Clinical disease ranges from superficial skin infections
to disseminated disease.
C. Albicans
● Major cause of candidiasis
● Normal flora: skin, mucous membranes and GI tract
● Common cause of fungal infection in immunocompromised
or debilitated patients.
● C. albicans is the major cause of candidiasis so they have a
wide range of tropism into body that can infect the skin, the
mucous membrane and the gastrointestinal tract
● There are different terms used if the C. albicans is present in
that particular body:
○ Cutaneous area - Cutaneous candidiasis if it in the
○ Vagina area - Vulvovaginal candidiasis
○ Thrush or Oral mucosa - Oropharyngeal candidiasis
○ Conjunctivitis candidiasis
○ Gastrointestinal candidiasis
○ Urinary Tract Infection Candidiasis
○ Systemic circulation (fungemia) - Systemic candidiasis
• It is recovered as normal biota from a variety of sites,
including skin, oral mucosa, and vagina.
• When host conditions are altered, however, this
isolate is capable of causing disease in almost any site.
• One of the most widely recognized manifestations of
C. albicans infection is thrush, an infection of the oral
mucosa.
Candida glabrata
• Infections associated with C. glabrata tend to be
aggressive and difficult to treat with traditional antifungal
therapy.
• the second most common Candida species to cause
disease and may account for 21% of all urinary yeast
isolates
• This organism has different sugar assimilation patterns,
notably rapid assimilation of trehalose, from those of C.
albicans and therefore can be easily differentiated.
• Other notable species of Candida are C. krusei and C.
tropicalis.
• C. parapsilosis has become a major cause of outbreaks
of nosocomial infections..
Cryptococcus
• C. neoformans, the most notable pathogen in this
genus, has become a major cause of opportunistic
infection in patients with AIDS.
• Commonly found in soil contaminated with pigeon
droppings and is most likely acquired by inhalation.
• Cryptococcus gattii is an emerging pathogen,
particularly in the Pacific Northwest of the United States.
• Cryptococcus spp. express a capsule that produces the
characteristic mucoid colony.
• The capsule can be detected surrounding the budding
yeast in spinal fluid with the aid of India ink or Nigrosin .
• The use of India ink preparation is being replaced by
the latex agglutination test for cryptococcal antigen
because of the former’s low sensitivity.
• All species of the genus are urease- positive, and the
nitrate reaction varies.
• Production of phenol oxidase is a feature
differentiating C. neoformans from many other
Cryptococcus spp.
• A key laboratory characteristic is that C. gattii will use
glycine as a sole carbon and nitrogen source in the
presence of canavanine, whereas C. neoformans will not.
• Canavanine glycine bromothymol blue agar is
commercially available for this purpose and should be
used for suspected colonies of C. neoformans.
Rhodotorula
• Rhodotorula spp. are noted for their bright salmon-
pink color.
 • They are closely related to the cryptococci because
they bear a capsule and are urease- positive.
• Some species are also nitratepositive.
Pneumocystis Infection
• P. carinii was originally classified with the protozoa
• P. carinii is the species most commonly found in rats,
and P. jirovecii is the species most often recovered from
humans.
• Pneumocystis spp. infection is acquired early in life;
serologic studies have shown that most humans have
antibodies or antigens by 2 to 4 years of age.
• in immunocompromised patients, serious life-
threatening pneumonia can develop.
• Pneumocystis sp. initially was identified as the
causative agent in interstitial plasma cell pneumonia seen
in malnourished or premature infants.
Life Cycle
• Pneumocystis is a nonfilamentous fungus.
• The life cycle of Pneumocystis sp. has three stages—
the trophozoite, which is 1 to 5 μm in size and is
irregularly shaped; the precyst, 5 to 8 μm; and the cyst,
which is a thick-walled sphere of about 8 μm containing up
to eight intracystic bodies.
• Transmission of the organism is known to occur
through the respiratory route, with the cyst being the
infective stage.
• The spores or intracystic bodies are released from the
cyst in the lung, and these trophic forms multiply asexually
by binary fission on the surface of the epithelial cells
(pneumocyte) lining the lung.
Laboratory Diagnosis
• Specimens now used include bronchoalveolar lavage,
transbronchial biopsy, tracheal aspirate, pleural fluid, and
induced sputum.
• Sputum, however, is the least productive specimen.
• Histologic stains such as Giemsa and Gomori
methenamine silver are used.
• With the methenamine silver stain, the cyst wall stains
black.
• Cysts often have a punched-out ping-pong ball
appearance.
• With the Giemsa stain, the organism appears round,
and the cyst wall is barely visible.
• The cyst wall does not pick up the stain, but the nuclei
of all forms stain pink, and the intracystic bodies can be
demonstrated as a circular arrangement within the cyst.