Lecture 4

Mycology
There are thousands species of fungi. Most of them are saprophytes.
Few species cause disease in man.
Fungi are eukaryotic organisms.
Their cell wall consists primarily of chitin and their cell membrane
contains ergosterol, in contrast to human cell membrane that contains
cholesterol.

They can be classified morphologically or clinically:

I-Morphological classification:
 Yeasts: These are oval or round cells that reproduce by asexual
budding and may form pseudohyphae e.g. Candida

 Filamentous fungi: These are branching filaments (hyphae) which

may be septate or non-septate. They reproduce by asexual spores
(conidia), which may be unicellular and called microconidia or
multicellular and called macroconidia e.g. the dermatophytes

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  Dimorphic fungi: These occur in 2 forms; a yeast form in tissues or
when grown at 37°C; and a filamentous form (hyphea) when
grown at 22°C, e.g. Histoplasma

II- Clinical classification:

1- Superficial mycoses:
 These are fungal infections that are confined to the stratum
corneum without tissue invasion e.g. pityriasis versicolor or tinea
versicolor caused by Malassezia furfur.
 It is a superficial chronic skin infection of the stratum corneum,
characterized by superficial brownish scaly areas on light-skinned
persons and lighter (depigmented) areas on dark-skinned persons.
 It has a world wide distribution and is caused by Malassezia furfur
and is of cosmetic importance.

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 2- Cutaneous mycoses:

 These are fungal infections that involve the skin, nail or hair
with tissue destruction and immunological reaction e.g.
dermatophytes.
 These organisms affect the keratinized tissues; skin, hair and
nails.
 They spread peripherally from foci to produce ring-like
lesions. Hence, the name ringworm or tinea.
 Infection does not spread to deeper tissues.

3- Subcutaneous mycoses: These are infections confined to the

subcutaneous tissue without dissemination to distant sites e.g.
mycetoma

4- Systemic (endemic) mycoses: These are primary pulmonary lesions

that may disseminate to any organ mainly in immunocompromised
patients. They are caused by the dimorphic fungi.
5- Opportunistic mycoses e.g. systemic candidiasis

In addition to the above mentioned mycotic infections there are two

other kinds of fungal diseases:

1- Allergies to fungal spores, particularly those of Aspergillus,

Alternaria and others. They cause mainly type I hypersensitivity
reactions or atopy manifesting as bronchial asthma, hay fever,
urticaria .. ..etc.

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 2- Mycotoxicosis: These are diseases due to the consumption of food
containing fungal toxins e.g.
 Amanita mushrooms produce fungal toxins, when ingested, they
cause severe fatal damage to the liver and kidney. A disease called
mycetismus.

 Another mycotoxicosis, ergotism, is caused by the mould

Claviceps purpura, which infects grains and produces alkaloids that
cause neurologic effects.
 Other toxins ingested with spoiled grains and peanuts are the
aflatoxins which are metabolized in the liver to epoxide, a potent
carcinogen. Aflatoxins are coumarin derivatives produced by
Aspergillus flaws; they are hepatotoxic, cause tumours in animals
and are suspected of causing hepatic carcinoma in man. Aflatoxin
Bl induces loss of growth control in the hepatocytes.

Candida albicans
Opportunistic fungi which fail to induce disease in most normal persons.
But can do so in those with impaired host defenses.
Is the most important species of Candida.
C. albicans are Gram positive oval budding yeasts which produce
pseudohyphae.
It is part of the normal flora of mucous membranes of the upper
respiratory, gastrointestinal and female genital tract.

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In these sites, it may predominate and cause superinfection.
Predisposing factors to Candida infections are diabetes mellitus,
general debility, immunodeficiency, indwelling urinary catheters,
intravenous drug abuse, prolonged treatment with broad-spectrum
antibiotics, and corticosteroids.
Clinical affections include:
In the mouth, overgrowth of C. albicans produces white patches i.e. oral
thrush or moniliasis.

Vulvovaginitis with itching and discharge which is favoured by

prolonged use of antibiotics and diabetes.

Skin invasion occurs in warm moist areas, which become red and
weeping such as the axilla most common in obese and diabetics.
Nails become involved when repeatedly immersed in water; as in persons
involved in dish washing. Painful redness and swelling of nail folds,
thickening and loss of nail i.e. paronychia.

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Systemic candidaisis and chronic mucocutaneous candidiasis may occur
in debilitated children, diabetics, immunosuppressed patients or drug
addicts.
ANTIFUNGAL DRUGS
Selective toxicity is very limited in antifungal drugs due to the fact that
fungi, like human cells are eukaryotes.The available drugs are those
which bind to ergosterol in the cell membrane or inhibit its synthesis.
Others act by inhibiting chitin synthesis in the cell wall.

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