SUPERFICIAL MYCOSES

⚫ Infections confined to the outermost layer of the skin or hair

⚫ One time believed to be the result of burrowing worms that formed ring-shaped patterns in the skin, hence the term tinea, the Latin word for worm, was applied to each
disease.

PYTRIASIS VERSICOLOR /TINEA VERSICOLOR

⚫ An example of nondermatophytic tinea
⚫ Characterized by discoloration or depigmentation and scaling of the skin
⚫ It is caused by Malassezia furfur complex
⚫ Site of infection: stratum corneum
⚫ Apparent in individuals with dark complexion

Tinea nigra
⚫ Nondermatophytic superficial infection
⚫ Caused by Phaeoannallomyces werneckii
⚫ Characterized by brown or black macular patches, primarily in the palms
⚫ Biopsy and culture of the site are important to differentiate from a serious nonfungal disease, melanoma.

Piedra
⚫ Confined to the hair shaft and is characterized by nodules composed of hyphae and a cement-like substance that attaches it to hair shaft.
⚫ Black Piedra is caused by Piedraia hortae
⚫ White Piedra is caused by Trichophyton ovoides and T. inkin

Malassezia spp
PATHOGENICITY :
⚫ Normal skin flora
⚫ Etiological agents of ptyriasis
⚫ Superficial infection characterized by pale or dark patches of skin
⚫ Associated with folliculitis, resembling acne, and seborrheic dermatitis,
⚫ characterized by red scaly lesions
⚫ Catheter-associated sepsis is seen in neonates and adults receiving
⚫ prolonged IV lipids
⚫ Pulmonary infection may develop in these patients, with respiratory
⚫ failure in neonates related to propagation of the organism in
⚫ subendothelial deposits of liid
RATE OF GROWTH
⚫ Rapid, mature in 5 days at 30-35°C
⚫ Grow poorly at 25°C
⚫ Do not grow well at 37°C
⚫ Grown on media containing cycloheximide
 DERMATOPHYTES
Tinea barbae - bearded areas of the face and neck
⚫ Filamentous fungi
Tinea capitis -scalp and hair shaft
⚫ Digest and obtain nutrients from keratin Tinea corporis - i glabrous skin on body parts not otherwise specified (usually the trunk
⚫ Infection usually involves only the keratinized layer of the skin of the body)
⚫ among the most common infectious agents of humans Tinea cruris -groin, perineum, and perianal region
Tinea manuum - hand
Tinea pedis - feet
Tinea unguium -nails (onychomycosis is infection of the nail caused by any fungus, not
necessarily caused by a dermatophyte)

PATHOGENICITY RATE OF GROWTH COLONY MICROSCOPIC MORPHOLOGY

MORPHOLOGY
TRICHOPHYTON SPP. Trichophyton ➢ zoophilic dermatophyte ➢ Moderate ➢ may be buff and powdery or ➢ Septate hyphae
mentagrophytes ➢ common cause of tinea pedis and ➢ Mature in 6–10 days. white and downy. ➢ Coiled-spiral hyphae often seen
⚫ Macroconidia rare, onychomycosis Powdery form ➢
thin walled, ➢ ➢ concentric and radial folds Microconidia (Powdery form)
smooth. Reverse: Brownish tan ➢ very round (4–6 mm in diameter)
⚫ Microconidia ➢ clustered on branched
numerous. conidiophores
⚫ Microconidia (Fluffy form)
(Some species do not ➢ Smaller
produce any conidia) ➢ fewer in number
➢ tear shaped
➢ more easily confused with those
of Trichophyton rubrum

Macronidia
➢ Cigar-shaped
➢ Thin walled
➢ have narrow attachments to
hyphae
➢ contain 1-6 cells
➢ more readily found in young
primary cultures 5–10 days old

Trichophyton rubrum ➢ Infects the skin and nails ➢ Moderately slow ➢ Surface is granular or fluffy, white ➢ Septate hyphae
➢ one of the most commonly recognized causes ➢ Mature within 14 to buff.
of dermatophytosis and onychomycosis in days. Reverse: deep red/purplish Microconidia
humans worldwide. (pigment production is best seen on ➢ Tear-shaped
➢ Most common sites of infection: potato dextrose agar/ cornmeal
Macronodidia
- feet (tinea pedis)
➢ abundant, rare, or absent;
 - nails (onychomycosis)

dextrose agar) (If present)

➢ Long
➢ Narrow
➢ thin walled
➢ with parallel sides (pencil-like)
➢ have 4–10 cells.

Trichophyton tonsurans ➢ principal etiologic agent of tinea capitis also ➢ Moderately slow; ➢ Highly variable ➢ Septate hyphae
➢ infects the skin and nails causes tinea capitis ➢ Mature in 12 days ➢ may be white, grayish, yellow, ➢ may have spiral coils and
➢ principally in children who live in large urban rose, or brownish arthroconidia.
areas. ➢ Surface: usually suedelike, ➢ has a partial requirement for
with many radial or concentric folds THIAMINE
Reverse: reddish brown ➢

Microconidia
➢ usually teardrop or club shaped
➢ may be elongate or enlarge to
round “balloon” forms.
Macroconidia
➢ Rare
➢ irregular in form
➢ A bit thick walled
 Trichophyton schoeleinii ➢ Causes favus - a severe, chronic, scarring scalp ➢ Slow ➢ whitish, waxy, or slightly downy ➢ Septate hyphae
infection that results in permanent hair loss ➢ Mature within 15 days ➢ heaped or folded ➢ highly irregular
➢ primary isolates are sometimes ➢ knobby
yeastlike ➢ subsurface hyphae: antlerlike
➢ SPLITS THE AGAR MEDIUM branching structures (FAVIC
Reverse: Colorless or pale yellowish CHANDELIERS)
orange to tan ➢ Chlamydoconidia are numerous.
➢ ABSENT MICROCONIDIA AND
MACROCONIDIA
➢

Trichophyton verrucosum ➢ zoophilic pathogen ➢ Slow ➢ Small ➢ hyphae with many intercalary
➢ usually contracted from CATTLE ➢ Mature in 14–21 days. ➢ Heaped chlamydoconidia (typically in
➢ infects the scalp, beard, nails, and skin on ➢ grows best at 37°C ➢ Buttonlike chains) and some antlerlike
various parts of the body. ➢ Texture: skinlike, waxy, or branches.
slightly downy
➢ Usually white Enriched media with thiamine
➢ produces many small, delicate,

Reverse: nonpigmented to yellow single microconidia

➢ occasional long, thin, irregular
macroconidia shaped like STRING
BEANS or RATS’ TAILS

MICROSPORUM SPP. Microsporum audouinii ➢ anthropophilic (infecting humans) ➢ Moderate ➢ Surface is flat, downy to silky, with ➢ Septate hyphae
dermatophyte ➢ Mature in 7–10 days a radiating edge ➢ PECTINATE (COMBLIKE) HYPHAE
⚫ Macroconidia ➢ caused widespread epidemics of tinea capitis in ➢ ➢ grayish or tannish white. are commonly seen.
numerous, thick children Reverse: light salmon with reddish ➢ almost devoid of conidia
walled, rough. ➢
brown center ➢ distinguished from poorly
⚫ Microconidia sporulating isolates of M. canis by
usually present. its lack of ability to grow on
(M. audouinii is an polished rice grains
exception; it seldom Microsporum canis var.
forms conidia.)
EPIDERMOPHYTON SPP Epidermophyton
flocculosum
⚫ Macroconidia
numerous, thin and
thick walled,
smooth.
⚫ Microconidia are
not formed
➢ zoophilic dermatophyte ➢ Moderately rapid ➢ Surface is whitish, coarsely fluffy, ➢ Septate hyphae
canis ➢ causes infections of scalp (tinea capitis) and ➢ Mature within 4–8 hairy to silky or furlike
skin (tinea corporis) Most days ➢ yellow pigment at periphery microconidia
➢ prevalent in children. ➢ ➢ Few
➢ closely spaced radial grooves
➢ one of the most commonly recognized causes ➢ club shaped
Reverse: deep yellow (turns brownish
worldwide of tinea capitis and other ➢ smooth walled
yellow with age)
dermatophytoses ➢ form along the hyphae
➢
Most infections in humans are acquired from:
- infected dogs Macroconidia
- cats ➢ numerous
- other animals in an agricultural ➢ long
➢
environment common cause of ➢ spindle shaped
dermatophytosis in patients who may have ➢ rough and thick walled
➢ lived and worked in a rural or farm setting ➢ Characteristically taper to
CLASSICAL ECTOTHRIX PATHOGEN - destroys beaklike ends.
➢ the hair shaft from the cuticle inward. ➢ >6 compartments
Causes: ➢ Moderate ➢ Surface is brownish yellow to ➢ Septate hyphae
➢ tinea corporis, ➢ Mature within 10 days olive-gray or khaki ➢ NO MICROCONIDIA
➢ tinea cruris ➢ lumpy and sparse , then folded in ➢ Older cultures commonly
➢ Onychomycosis the center and grooved radially, develop white sterile hyphae
becoming velvety
➢ DOES NOT INFECT HAIR Macroconidia
After several weeks ➢ Smooth
➢ FLUFFY WHITE STERILE ➢ both thin and slightly thick
MYCELIUM covers the colony walled,
Reverse: Orange to brownish ➢ club shaped with rounded ends
➢ Contain 2-6 cells
(sometimes with a thin yellow border) ➢ Singly or in characteristic clusters
➢ Arthroconidia are also
commonly formed with age.
➢
 SUBCUTANEOUS FUNGI

⚫ Results of trauma

⚫ Etiological agents commonly found in soil/decaying vegetation

⚫ Commonly chronic

⚫ Hypomycetes

⚫ Many are phaeoid

PATHOGENICITY RATE OF GROWTH COLONY MICROSCOPIC MORPHOLOGY

MORPHOLOGY
Exophiala jeanselmei complex Causes: ➢ Slow ➢ Surface is at first brownish black ➢ Young culture - many yeastlike
➢ Mycetoma ➢ Mature within 14 days or greenish black and skinlike budding cells
➢ Phaeohyphomycosis when incubated at 25– ➢ then becomes covered with ➢ septate hyphae form with
➢ Chromoblastomycosis 30°C short, velvety, grayish hyphae numerous conidiogenous cells
➢ Grows more slowly or Reverse: black that are:
➢ posaconazole and itraconazole have the lowest not at all at 37°C. - slender
MICs - tubular
➢ - sometimes branched
- characteristically
tapered to a narrow, elongated
tip.
Conidia
➢ oval
➢ gather in clusters at the end and
sides of the conidiophore

➢ Chlamydospores may be present.

Phialophora verrucosa Causes: ➢ Moderate ➢ Surface is dark greenish brown to ➢ Hyphae are brown, branched,
➢ Chromoblastomycosis (SECOND MOST ➢ Mature in 7–12 days. black and septate
COMMON ETIOLOGIC AGENT WORLDWIDE) ➢ Close, matlike, olive to gray ➢ VASE SHAPED with a flared,
➢ Etiologic agent of phaeohyphomycosis mycelium cuplike collarette
➢ Mycetoma (rare) ➢ Colonies become embedded in ➢ have distinct septum at the base
the medium.
Reverse: black Conidia
➢ Round to oval
➢ accumulate at the apex of the
phialide
➢ gives the appearance of a vase of
flowers.

In tissue with chromoblastomycosis

➢ appears as dark,
➢ round cells
➢ 5–12 mm in diameter
➢ with horizontal and vertical
septa.

Foncecaea pedrosoi ➢ MOST COMMON WORLDWIDE CAUSE OF
CHROMOBLASTOMYCOSIS
➢ lesions on the lower extremities
➢ Slow ➢ Surface is dark green, gray, or
➢ Mature in 14 days black
➢ covered with silvery, velvety
mycelium
Colonies
➢ usually flat
➢ then develop a convex, cone
shaped protrusion in the center.
➢ Colony becomes slightly
embedded in the medium.
➢ Hyphae is septate, branched, &
brown.
➢ Conidia - dark
➢ Conidiophores are septate, erect,
and compactly sympodial
- asterisklike appearance
➢

Reverse: black
Curvularia spp. ➢ Etiologic agents of opportunistic infections ➢ Rapid ➢ dark olive-green to brown ➢ Hyphae are septate and dark
➢ most commonly causing keratitis and ➢ Mature within 5 days. ➢ Or black w/ pinkish gray, woolly ➢ Conidiophores are simple or
allergic/chronic sinusitis. surface branched and bent or knobby at
Also cause: Reverse: dark points of conidium formation
➢ Onychomycosis ➢ Usually contain 4 cells
➢ Mycetoma ➢ Distinct characteristic: Conidia has
➢ Phaeohyphomycosis (subcutaneous & deep a DARKER CENTRAL CELL
tissue)

➢ Dissemination to the brain is known to occur

occasionally, often following sinusitis.

Bipolaris spp. ➢ Most commonly cause allergic sinusitis ⚫ Rapid; ⚫ Surface is at first grayish brown, ➢ Dark, septate hyphae
➢ In immunocompromised patients, may ⚫ Mature within 5 days. becoming black with a matted ➢ KNOBBY, ZIGZAG APPEARANCE.
progress to invade bone and cause lesions in the center and raised grayish
brain ➢ Known to cause Phaeohyphomycosis (eye, periphery.
skin, peritoneum, aorta, lung,CNS) Reverse : dark brown to black.

Three Most Common Species Recovered From Human

Specimens :
1. B. spicifera
2. B. hawaiiensis
3. B. cynodontis

Alternaria spp. ➢ saprobic contaminants ➢ Rapid ➢ Surface is at first grayish white ➢ Dark, septate hyphae
Cause ➢ Mature within 5 days and woolly ➢ sometimes have a zigzag
➢ Phaeohyphomycosis - most commonly in ➢ later becomes greenish black or appearance
subcutaneous tissue of immunocompromised brown with a light border. ➢
patients.

➢ Onychomycosis Reverse: black

➢ Keratitis
➢ Noninvasive rhinositis

➢ play an important role in asthma and

hypersensitivity pneumonitis.
 Scedosporium spp. complex ➢ found in soil and polluted or stagnant waters. ➢ Moderately rapid ➢ spreading, white, cottony aerial ➢ septate hyphae
(Scedosporium apiospermum complex) ➢ agent of Phaeohyphomycosis ➢ Mature in 7 days mycelium ➢ Conidia are unicellular and fairly
➢ Infection occurs most often in the upper and ➢ Asexual state - grows ➢ later turns gray or brown. oval or clavate
lower extremities on media containing ➢ ➢
➢ cycloheximide
Most common cause of eumycetoma in North Reverse : first white , becomes gray/
4 Clinically encountered species : ➢ Cleistothecia of the
America. black over time
➢ sexual state are often
1. S. apiospermum - most Most common cause of fatal lung and CNS
common infections complicating near drowning inhibited Scedosporium aurantiacum
2. S. Boydii 3. S. Aurantiacum accidents in immunocompetent victims. ➢ produce pale yellow, diffusible
➢
4. S. dehoogii. Disseminated infection is most commonly pigment.
➢ seen in immunocompromised patients. Reverse: yellow-orange
➢ LOWEST MICs TO VORICONAZOLE
HIGH MICs TO AMPHOTERICIN B

Madurella grisea ➢ Causes BLACK GRAIN MYCETOMA ➢ Moderately slow
➢ Mature in 12 days
➢ Best growth at 25–
30°C does not grow
➢ well, if at all, at 37°C.
➢ somewhat folded in the center
➢ Radial grooves toward the
periphery
➢ Very short, tan or gray aerial
hyphae cover a dark gray or
olivebrown mycelial mat.
➢ May form diffusible pigment
Reverse: dark
➢ Hyphae are septate - mostly wide
branched, and dark.
➢ Conidia are not commonly formed.
➢ chlamydoconidia are occasionally
produced.
➢

Acremonium spp. (formerly
Cephalosporium spp)
➢ etiologic agents of WHITE GRAIN MYCETOMA ➢ Moderately rapid ➢ At first - compact, glabrous ➢ Extremely delicate
➢ Localized infections of the nails and cornea. ➢ Mature within 5–7 ➢ Later - feltlike, powdery, or ➢ Hyphae are septate
➢ Disseminated infections have been reported in days. cottony.
immunosuppressed patients. ➢ white, yellowish, light gray, or Phialides
➢ ➢ Erect
May also be encountered as contaminants. pale rose in color.
➢ Colony does not spread. ➢ Unbranched
➢ Tapering
Reverse : colorless, pale yellow, or
➢ no conspicuous collarette
pinkish
➢ Conidia are oblong (
➢ Usually one celled but

occasionally two celled

➢ conidia form easily disrupted
clusters at the tips of the
phialides
 Fusarium spp. ➢ common worldwide causes of MYCOTIC
KERATITIS.
➢ Immunocompetent Patients - also cause
mycetoma, sinusitis, septic arthritis, and
onychomycosis.
➢ increasingly the cause of sinopulmonary and
disseminated infections in profoundly
neutropenic patients
➢ 2.
Sporothrix schenkii ➢ Causes sporotrichosis
- due to Sporothrix schenckii sensu stricto
chronic infection that frequently begins as a lesion
of the skin and subcutaneous tissue and then
involves the lymphatic channels and lymph nodes
draining the area.
Initial introduction into the body
➢ puncture by contaminated plant material
(Sporothrix braziliensis infects predominantly cats)
➢ Rapid ➢ At first - white and cottony
➢ Mature within 4 days. ➢ Quickly develops - pink or violet
center with a lighter periphery.
F. solani
➢ blue-green or bluish brown
Reverse:usually light, but may be
deeply colored.
➢ Moderately rapid ➢ Thermally dimorphic
➢ Mature within 7 days
@ 25–30°C
➢ At 1st - small and white or pale
orange to orange-gray with no
cottony aerial hyphae.
➢ Later - e moist, wrinkled,leathery,
or velvety and often darken to a
salt-and-peppery brown or black
with a narrow white border.
➢ forming a
➢ Septate hyphae.
2 TYPES OF CONIDIA
1. unbranched or branched
conidiophores w/ phialides that
produce large sickle- or canoe-
shaped macroconidia
long or short simple
conidiophores bearing smal loval,
one- or two-celled conidia 3.
@ 25–30°C,
➢ hyphae are very narrow, septate,
and branching, with slender,
tapering conidiophores rising at
right angles.
➢ apex of the conidiophore -
slightly swollen , bears many
small, tearshaped or almost
round hyaline conidia on
delicatethreadlike denticles,
“ROSETTELIKE” cluster in young
cultures
 SYSTEMIC MYCOSES
Thermally dimorphic (Slow growers)
• Histoplasma capsulatum (Slowest growerersinationism; 15-20 days)
• Blastomyces dermatitidis (14 days)
Yeasts & Yeastlike Organisms (Rapid growers; 3 days)
• Cryptococcus neoformans
• Candida albicans
• Candida glabrata complex (3-5 days)
Hyaline Hyphomycetes (Rapid growers; 3 days)
• Aspergillus fumigatus complex
• Aspergillus niger complex
• Coccidioides species (Moderate; 10 days)
PATHOGENICITY & OTHER INFO PATHOPHYSIOLOGY RATE OF GROWTH COLONY MORPHOLOGY MICROSCOPIC MORPHOLOGY

Histoplasma capsulatum Histoplasmosis Disseminated: ➢ Slow ➢ Thermally dimorphic 25-30°C (SDA) mold phase:
➢ Sites of infxn: ➢ Inhalation ➢ Mycelial forms usually • Septate hyphae w/ round to pear-
2 varieties: ✓ Lung ➢ Infxn mature w/in 15–20 days @ 25-30°C (SDA): shaped, smooth or occasionally
• H. capsulatum var. ✓ Blood ➢ Immune rxn but may take up to 8 ➢ White to brown or pinkish; spiny microconidia
capsulatum ✓ BM ➢ Symptoms: weeks cottony structure • Might be confused w/ small form
➢ Elaborates a CHO ✓ Multiple systemic sites ✓ Fever ➢ Does NOT survive well ➢ Reverse: White sometimes of Blastomyces dermatitidis
antigen, w/c can ➢ Tissue rxns: ✓ Cough in clinical specimens yellow or orange-tan • Macroconidia: large, thick-walled,
be identified in the ✓ Acute pulmonary infections ✓ Fatigue ➢ If suspected in spx, must ➢ Enriched agar is recommended round macroconidia after several
urine for the ✓ Parenchymal necrosis ✓ Chills be processed for initial isolation weeks
diagnosis of Pathogenicity ✓ Headache immediately
pulmonary and ➢ Immunocompetent patients: ✓ Chest pain
disseminated Asymptomatic or mildly ✓ Myalgia @ 37°C on BHIA or other enriched
histoplasmosis symptomatic infxn Diagnosis: agar:
• H. capsulatum var. ➢ may cause 2o infxn ➢ Blood and urine samples, x- ➢ Colonies are moist, white and
duboisii ➢ May develop as 1o infxn as an acute, ray, and CT yeastlike
➢ Endemic only in benign pulmonary disease or maybe ➢ Yeast phase is inhibited by
tropical Central chronic or progressive and fatal Treatment cycloheximide 37°C (BHIA) yeast phase:
Africa ➢ May be localized or disseminated, ➢ Azole medications
• Small, round, or oval budding cells
➢ Differs from var life threatening infection (Itraconazole, fluconazole,
• Occasional abortive hyphae are
capsulatum by ➢ Involve various tissues and organs voriconazole)
formed
producing thick- of the body, particularly in ➢ Amphotericin B
walled, larger immunocompromised patients
yeast cells in (transplantation or HIV/AIDS)
infected tissue
Blastomyces dermatitidis Blastomycosis ➢ Inhalation ➢ Slow; mycelial forms ➢ Thermally dimorphic 25-30°C (SDA) mold phase:
➢ Sites of infxn: Lungs, skin bones, ➢ Infxn mature within 14 days • septate hyphae form with short or
multiple systemic sites ➢ Immune rxn ➢ Some strains are slower 25-30°C: long conidiophores
➢ Tissue Rxn: ➢ Symptoms: ➢ Cultures should be held ➢ At first, yeast like, then, prickly, • round or pear-shaped conidia
• Evokes a suppurative and/or • Pulmonary for 8 weeks if and finally cottony develop at the apex of the
granulomatous response manifestation w/: blastomycosis is ➢ white aerial mycelium that turns conidiophore or directly on
• Young lesions: neutrophils ✓ fever suspected tan with age hyphae
dominate ✓ cough ➢ Should be cultured • Lollipop-like appearance
• Old lesions: suppurative ✓ dyspnea immediately 35-37°C • Older cultures: thick-walled
reaction decreases, ✓ night sweats ➢ Cream to tan color, waxy in chlamydoconidia
granulomas predominate ✓ pulmonary appearance
• Long standing infections show infiltrates ➢ Grows best on BHIA or other
fibrosis • progress to chronic enriched agars
• Skin – hyperplasia occurs infection with ➢ Yeast phase is inhibited by
Pathogenicity extrapulmonary cycloheximide
➢ Found in waterbeds, rivers, soil, manifestation
trees, also within animals • Skin lesions present as
➢ Aerosolized in the soil or in the erythematous papules
forest and are inhaled with ulcerating center
➢ Pulmonary infection to chronic • Epithelial hyperplasia
37°C (BHIA) yeast phase:
infection ➢ Diagnosis:
• Spx for culture and • bud on a broad base
➢ Characterized by suppurative and
microscopic • appear to be thick walled and
granulomatous lesions of the
examination: double contoured
lungs, bone, and skin but
potentially of any part of the body ✓ Lower respiratory
➢ Commonly begins in the lungs and tract
is disseminated to the skin and ✓ Long bones
bones ✓ Skin and mucous
membranes
3 Clinical Forms: ✓ Prostate
➢ Pulmonary blastomycosis ✓ CSF or brain
➢ Disseminated blastomycosis
 ➢ Rare primary cutaneous form
Cryptococcus neoformans Cryptococcosis
➢ Sites of infxn:
• Lung, meninges and CSF,
blood, skin, mucous
membranes, multiple
systemic sites
➢ Tissue Rxn:
• Immunocompetent pxs:
− Mixed and suppurative
and granulomatous
reaction or purely
granulomatous
− Cryptococcomas due to
chronic pulmonary
infection
• Immunosupressed pxs:
− rxn may be minimal or
absent
− yeasts proliferate
abundantly, creating
mucoid “cystic” lesions
with round, encapsulated
cryptococci (most
frequently in the brain)
− No. of organisms present
in the tissue is inversely
proportional to the no.
of inflammatory cells
➢ Direct Microscopic • bud often remains attached until it
Examination becomes the same size as the
✓ May provide earliest parent cell
diagnosis
✓ KOH
✓ Broad-based budding
yeast cells seen
✓ Gram stain
➢ Inhalation ➢ Rapid; mature in 3 days ➢ Colonies are flat, shiny and 25°C (Cornmeal-Tween 80)
➢ Primary – exposure is recent; usually mucoid • round, dark walled, and budding
develops an infection ➢ Color is cream, later tannish • NO HYPHAE
➢ Latent – due to reactivation ➢ 25°C and 37°C – C. neoformans • Capsules are often discernible by
of infection grows well the spaces between the yeast cells
➢ Infection enters the blood • India ink: capsules
stream and disseminated to
other organs
➢ Humans are dead end hosts
Immune Response
➢ Alveolar macrophage – main
effector cell
➢ Opsonization
➢ Cryptococcus phagocytosed
➢ CD4+ (T-helper cell) activates
macrophages
➢ Macrophage is activated
through pro-inflammatory
cytokines (Th1 cytokines
including IFN-y)
➢ Induces granuloma
(lymphocytes and
macrophages)
➢ Good response:
Cryptococcoma
➢ Bad: Advanced HIV; infection
is not contained becomes
disseminated (brain lesions)
 Pathogenicity
➢ Cryptococcosis – most involves the
CNS but occasionally producing
lesions in the skin and other
internal organs
➢ Meningitis – extremely common in
HIV/AIDS patients
➢ Other species are nonpathogenic
EXCEPT for C. gattii
➢ Most common environmental
source of C. neoformans is pigeon
droppings
Candida albicans ➢ Most common cause of candidiasis
➢ Candidiasis is an acute, subacute,
or chronic infection involving any
part of the body
➢ Found as part of the normal flora
in:
✓ skin
✓ mouth
✓ vaginal tract
✓ GI tract
Candida glabrata complex ➢ Causes infections usually occurring
in the bloodstream or urogenital
tract
➢ Occasionally disseminated disease
➢ Macrophage within the blood
stream may be vehicles of
disseminated infection
➢ Rapid; mature in 3 days ➢ Cream colored, pasty, smooth
➢ BAP/CAP: extensions commonly
called feet develop at the border
of the colony
➢ CHROMagar Candida – colonies
are green
➢ Rapid; mature in 3-5 ➢ Small
days ➢ Yeast like colonies; pasty smooth,
white, to cream
Primary media
➢ round to oval
25°C Cornmeal-Tween 80
➢ pseudohyphae (and some true
hyphae) form with clusters of round
blastoconidia at the septa
➢ Chlamydospores: Large, thick-
walled, usually single terminal
➢ Chlamydospore formation is
inhibited at 30–37°C
25°C Cornmeal-Tween 80
➢ small, oval yeast cells with single
terminal budding
➢ NO PSEUDOHYPHAE
 ➢ May colonize healthy individuals
➢ Reports of increasing frequency of
resistance to echinocandins
Aspergillus fumigatus ➢ Most common species of Aspergillus
complex to cause invasive pulmonary
aspergillosis, disseminated
aspergillosis, allergic
bronchopulmonary aspergillosis,
fungal sinusitis, and mycotic keratitis
➢ susceptible to antifungal triazoles
and amphotericin B
➢ Recent studies - resistance of A.
fumigatus to triazoles
Aspergillus niger complex ➢ Ubiquitous in nature
➢ Isolated from the external ear,
causing otomycosis
➢ Grows a bit more slowly ➢ on rare occasion a few short chains
than the other species of ovoid cells may be seen
of Candida
➢ Enhanced by, or
dependent upon
cholesterol for growth
➢ MacConkey: may
appear as tiny colonies
➢ Rapid; mature in 3 days ➢ Surface is velvety or powdery ➢ Septate hyphae
➢ Ability to grow @ 45°C ➢ Turns dark gray with age ➢ Phialides are uniseriate, close
➢ Reverse: white to tan together (compact), forming only on
the upper two-thirds of the vesicle,
parallel to the axis of the conidiophore
(known as columnar formation)
➢ Conidia are round, smooth, or slightly
rough
➢ Rapid; mature in 3 days ➢ Surface is black with white border ➢ Septate hyphae
➢ Reverse white to cream. ➢ Phialides radiate around entire vesicle
and are biseriate, with the metulae
twice as long as the phialides
 ➢ Agent of aspergilloma (fungus balls) ➢ Conidia are rough, and dark.
in preexisting pulmonary cavities
➢ Causes acute and chronic invasive
pulmonary and disseminated
disease.

Coccidioides spp. ➢ C. immitis has been found to consist
of 2 separate species:
✓ C. immitis- grows more
rapidly than C. posadasii in
high salt concentrations
✓ C. posadasii- more
widespread
Pathogenicity
➢ Causes Coccidioidomycosis
➢ May be acute but benign, self-
limiting respiratory disease
➢ Chronic, malignant, sometimes fatal
infection involving the CNS
➢ Moderate; mature SDA at 25°C or 37 °C ➢ Coarse, septate, branched hyphae
within 10 days ➢ Colony often is at first moist, that produce thick-walled, barrel-
➢ Growth occurs in 3-5 grayish, and membranous shaped arthroconidia
days but production of ➢ Soon develops, a white cotton ➢ Racquet hyphae are formed in
arthroconidia may take aerial mycelium which becomes young colonies
1-2 weeks gray
➢ Reverse: white to gray,
sometimes yellow to brownish
➢ Special Converse medium with
increased CO2 at 37 °C-40 °C