Subject: Microbiology and Parasitology Topic: Lecturer: Dr. Eleanor P.

Padla Date of Lecture: Sept 1, 2011 Transcriptionists:pinkyred :) Editor: pinkyred Pages: 4

OPPORTUNISTIC MYCOSES
   Portal of entry: respiratory, mucocutaneous Infectious particles: conidia, mycelia Agents: o Widely distributed (as saprophytes, normal flora) o Invade only in the presence of some underlying predispositions and mainly immunocompromised individuals

I.

Candidiasis
a. Considered the most common systemic/ opportunistic fungal infection worldwide b. Mostly endogenous; occasionally exogenously acquired (hospital setting) c. Clinical spectrum extremely diverse (from skin irritation to life-threatening infections) d. Leading fungal infection in patients with HIV-AIDS e. Occurs as: i. Cutaneous and subcutaneous (diseases of the skin and mucosal surfaces) ii. Systemic/ disseminated/ invasive 1. Candidemia (e.g. catheter related) 2. Acute/ chronic disseminate candidiasis 3. Deep organ candidiasis f. Host factors predisposing to candidiasis: i. Physiological (pregnancy, age) ii. Trauma (burns, infection) iii. Hematological (neutropenia, cellular immunodeficiency) iv. Endocrinological (DM, hypothyroidism, Addison’s disease) v. Iatrogenic (chemotherapeutics, corticosteroids, oral contraceptives, catheters, etc.) vi. Others (IV drug addiction, malnutrition)

g. Caused by Candida spp.: i. C. albicans- most common agent, most pathogenic ii. Normal flora of skin, vagina, mucous membrane, stool, GIT( major colonizing habitat) iii. Ascomycete iv. Dimorphic, reproduce by budding v. Infectious particles: yeast cells, pseudohyphae h. Laboratory Diagnosis: i. Gram Stain/ KOH/ histopath exam: - small budding yeast cells (4-5 um) and psuedohyphae ii. Culture at room temp/ 37OC : -pseudohyphae with clusters of round blastoconidia -chlamydospores, yeast cells and pseudohyphae on Chlamydospore/ Cornmeal Agar iii. Germ tube test (for C. albicans) iv. Others: 1. Assimilation tests 2. Biotyping 3. Immunofluorescence 4. Immunohistochemistry 5. DNA probes, PCR 6. Mannan antigen detection (RIA, ELISA, LAT) v. Treatment and prevention 1. Cutaneoustopical nystatin, ketoconazole, fluconazole 2. Systemic- ketoconazole, fluconazole,

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itraconazole, flucystosine, ampho B 3. Avoid disturbing the normal balance of microbial flora and intact host defense

II.

Aspergillosis

vii. treatment and prevention - Allergic form- itraconazole, corticosteroids - Aspergillomasurgery, Ampho B - Disseminated- itraconazole, fluconazole, ampho B - Avoid/ minimize exposure to conidia - Prophylactic low-dose Ampho B or itraconazole

III.

Cryptococcosis

a. Acquired following inhalation of infectious conidia b. Occurs as: i. Allergic form (allergic bronchopulmonary aspergillosis or ABPA) ii. Colonizing form/ pulmonary (aspergilloma) iii. Invasive/ disseminated iv. Mycotoxicosis v. Caused by Aspergillus spp.: 1. Most common causeA. fumigates, A. flavus 2. Ascomycetes 3. Natural reservoir- soil, air 4. Ubiquitous, frequent laboratory contaminants vi. Laboratory Diagnosis: 1. KOH/ HIstopath -wide, septate, dichotomously branching(45O) hyphae, conidial heads may be seen 2. Culture: -conidiophore supports swollen vesicle covered with rows of phialides bearing radial chains of conidia 3. ID of cultures -depends on difference of conidial heads 4. Others: -serology -immunohistochemisrty - glactomannan antigen detection in serum

a. Aka Busse- Buschke’s disease/ Torulosis b. Believed to be acquired following inhalation of non-encapsulated/ minimally encapsulated yeast, or Basidiospores c. Primary site of infection: lungs d. One of the most common lifethreatening infections in patients with AIDS e. Occurs as: i. Pulmonary (acute, chronic)

ii. Disseminated 1. Meningitismost frequently diagnosed form iii. Neurotropism related to phenoloxidase activity iv. Cutaneous form: rare f. Caused by basidiomycete yeasts: i. Cryptococcus neoformans

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ii. Cryptococcus gattii g. Encapsulated yeasts h. replicate by budding i. Do not produce hyphae/ psuedohyphae j. Cryptococcus neoformans (Filobasidiella neoformans) i. common in temperate climate ii. affects immunocompromised patients iii. environmental reservoir: pigeon droppings iv. infectious particles: unencapsulated yeast, basidiospores v. includes serotypres A, D, AD hybrid 1. C. neoformans var. neoformans (Serotype D) 2. C. neoformans var. grubii (serotype A) vi. Clinical disease: meningitis k. C. gattii (Filobasidiella bacilliospora) i. In tropical/ subtropical climates ii. Effects immunocompetent individuals iii. Environmental reservoir: Eucalyptus trees iv. Infectious particles: basidiospores v. Includes: Serotypes B, C vi. Clinical disease: pneumonia l. Virulence factors: i. Capsule 1. Wide capsule 2. Antiphagocytic 3. 5 Serotypes: A,B,C,D,AD ii. Production of phenoloxidase 1. Converts phenolic compounds to melanin 2. Survival mechanism within phagocytes

3. Growth on Lcanavarine-glycinebromthymol blue (CBG) n. Treatment i. Ampho B. ampho B-5 FC combination ii. Fluconazole prophylaxis following primary treatment (in AIDS patients)

IV.

Zygomycosis
a. Aka mucormycosis/phycomycosis b. Acquired following exposure to sporangiospores c. Risk factors: diabetic acidosis, immunosuppression d. Occurs as: i. Rhinocerebral (most frequent form)

Pulmonary Cutaneous Gastrointestinal Disseminatedaggressively angio-incvasive, predominantly infarctive e. Caused by filamentous fungi (e.g. Rhizopus, Mucor, Absidia) i. Belong to order Mucorales, Class Zygomycetes ii. Natural reservoir: soil, air, water iii. Ubiquitous, frequently encountered as contaminants f. Laboratory Diagnosis:

ii. iii. iv. v.

m. Laboratory Diagnosis i. KOH/ India ink/ histopath 1. Yeast cells with wide capsule ii. Culture (37oC) 1. Creamy, mucoid yeast colonies 2. Brown to black colonies on Niger/Bird Seed Agar iii. ID of cultures 1. Biochemical tests (e.g. urease production) 2. Caffeic acid testphenoloxidase production

i. KOH/Histopath 1. Wide (ribbon-like), aseptate hyphae branching at right angles ii. Culture at RT 3

1. Cotton-candy appearance of colonies 2. Morphologic features identify species 3. Caution in interpreting results g. Treatment and prevention i. Amphotericin B ii. Surgical debridement iii. Control of predisposing factors (e.g. Diabetes/ underlying disease V. Table 1. Characteristics of Species causing Zygomycosis

Absidia

_______END OF TRANX__________ Hi to reych, arabels, anabels, eloh, jez, and to gempot! Happy birthday to Quen! And to Ramone, hehehe…hi din to Cuz! And to my dear roommate maan…to Hannah, and rr! ^_^ Happy studying!

CHARACTERISTICS Sporangia Sporangiosp ores Columellae Rhizoids Collarettes

Rhizopus Round Unbranched, nodal Hemispherical Well developed None remains when sporangial wall is dissolved

Mucor Round Branched, internodal Round to oval Absent Present when sporangial wall is dissolved

Absidia Pyriform Branched, internodal Conical Rudimentary

Rhizopus

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