ANTIGEN

Antigen O0:00:26

Antigen is a foreign substance/molecule which when

enters the body. stimulates the immune system to
mount an immune response

2-properties of a good antigen

.Immunogenicity - property to induce an immune

response
Antigenicity property of an antigen to bind with
the antibody/ immunocompetent cells

JUST AS ALOCK WILL ONLY ACCEPT THE CORRECT KEY

th anigun twili bind d s

loyalty
it vwy impdstankt/\ Fig: 1

Ag-Ab interaction is very specific

This is known as the specificity of Ag-Ab reaction

Epitopepnteni
cleexntinar

pavt o
cwm
Bn Untoct Fig 2

Antigen
 2

Sometimes specificity of Ag-Ab reaction fails which

may lead to disease

Ag-1 Ag-2

Ag-1 should bind to Ab-1

Ag-2 should bind to Ab-2

Due to failure of specificity of Ag-Ab reaction

disease are caused eg: Acute rheumatic fever

This is due to molecular mimicry

Hapten/proantigen/incomplete antigen
OO:15:35

I t is generally a low molecular weight substance which

lacks the property of immunogenicity, but has the

property of antigenicity
I t can be converted into a complete Ag by
tagging/attaching it to a protein carrier

Body response towards hapten:

njected into No imwmune

Hapten a person response

Hapten injected into 1° immune

Tagged to same person response

Antigen
 3

Protein gM against 'H'

carrier 1gM against P

Hapten No

Is 20 immune But 'H binds to

response any pre-existing
possible? gM if it present
(Due to property

of antigenicity)
IV H Is 20 Immune Yes
Plus response lgG formns against
P possible? H

lgG forms against

P

arrier
Hapten Antibodies to hapten

Immunize
rabbit
Antibodies to carier
Hapten-carrier
conjugate

Antibodies to conjugate of
hapten and carrier

Determinants of a
strong/good antigen
O0:21:20
i. Chemical nature

Proteins Carbohydrates > Lipids » Nucleic Acids

ii. Very big or very smal molecules are poor antigens
Antigen
 Midsized molecules good antigens
ii. Degree of foreignness
The more foreign a molecule, the better antigen it is

iv. Susceptibility to tissue enzymes

Ag fully susceptible Very poor Ags

to tissues enzymes very Small siæe

Good Ags

are mid-sized
Ag partially
susceptible Plus newer epitopes are exposed

Specificity of an Ag O0:29:448

i. Species specificity
Ags specifically present in all members of a species
Xenograft: Almost always rejected
i. Organ specificity

Ags specificity present in a specific organ in

different species
Eg: Brain tissue Ag of:
Humans
- Mice

ii. Heterophile specificity

Antigen
 .Similar Ags present in different species & need not

be organ specific

Example:
a. For M.pneumoniae infection tentative diagnosis we
do:
-

Cold agglutinin test

-

Streptococcus MG test

b. Paul Bunnell Test for EBV

c. Weil felix reaction for rickettsiae
iv. individual specificity
All of us are antigenically unique

.Antigens specifically/uniquely present in each

member of species
a

Best example: MHC/HLA proteins

Gene is present on 6p chromosome

v. iso-specificity
.Variation of a group of antigens present in different

members of a species
.Example:
ABO blood group of antigens
- Rh Ag

Antigen
 ANTIBODY PART -

Antibody (Ab) O0:00:41

I t is a substance which combines/reacts with Antigen

(Ag) to eliminate an lnfectious agent/to activate an
Immune cell to generate some response
Antibodies They are Immunoglobulins
When serum proteins are fractionated according to

mass &charge:
albumuin

aBY Globulins

1/AR Alb: Globulin = 1.7:1

Antibody: y- globulin

All Abs are y- globulins but

AllY - gobulins are not Abs
Structurally they are Glycoproteins
Protein part is responsible for most of the functions
of an Ab molecule.
Abs are primarily proteins, with less amount of

sugar

Structure of Monomeric Ab/Ab -monomer

O0:O8:22

Single molecule of Ab
Antibody Part -
.H-Heavy chains
Mol wt. is s0,0oo Daltons
2 'H' chains are identical

2 'L'chains are identical

Molecular weight of i light chain 25000 daltons
.They are connected by disulphide bonds (-S-S-)
2 Terminals are present: NH2 - amino terminal and
COOH carboxyl terminal.
Genes for 'H' chains present on Chromosome 14
.L' chains are of 2 types

Kappa (K) Lambda(a)

Ratio of K: A in human serum 1.5:1

1 Antibody molecule has either

both A light chains or
both K light chains

But never 1 K and 1 7

Genes of k light chain present of chromosome - 2

Genes for A light chain present on chromosome 22

Each light chain has 2
parts
V variable part of L' chain
-

CL -

Constant part of L' chain

Similarly, each heavy chain has many parts

V-Variable part of 'H' chain
CHI, C.2, Ci3 constant parts of heavy chain

Antibody Part I
 3

Classes of Antibodies O0:18:53

lgG
lgM& lgE - Have longer 'H chains

gA . Have and additional 'CH' domain.

C , C2, Cu3, CA4]

gM

gD
gE
l g M & lgE - do not have Hinge region

lgG, lgA, 1gD have 3 CH regions

Antigen
binding
Hinge

No hinge ODC
Biological region
activity C3 Additional-
domain

A Fig:

Hinge region is rich in 2 amino acids Proline &

Cysteine
- It provides flexibility to Ab-molecule, so that Ab can

easily bend & approach the Ag.

Both V & V on one side form the Ag binding site.
-

V alone
Vi alone can't bind to Ag
or

-1 V V region binds to 1 Ag molecule.

Valency of an Ab molecule = No. of V V regions in

the Ab
or

Antibody Part
 Valency of an Ab = No. of Ags an Ab molecule can

bind

Valency of Monomeric Ab 2 =

.Within the variable regions, Hypervariable

regions/Hotspots/Complementary Determining
Regions (CDRS) where the exact/precise bond forms
between Ag and Ab
Bonds between Ag & Ab
Hydrogen bonds
H2
Hydrophobic interactions
-

I -

lonic bonds/Electrostatic force

-

V -

Vander wall forces

No covalent bond is formed they are irreversible

All the above 4-bonds are reversible but forwm firm

interaction between antigen and antibody

Ligh -chain
ypOTvaracio

Tegions

Inturcha
dsullido
bord

Houvy
pevaniabu

Aigon bindng silo

Hypervaria
gn chan heavy h a

Fig 2
Antibody Part
 Fab Fragment Antigen Binding
-

Fe- Fragment crystallisable

Effects of Proteolytic Enzymes (Papain & Pepsin)

on Ab-molecule: O0:39:4O

L. Effect of papain enzyme on Ab:

Papain attacks the antibody molecule above the

Inter H chain disulphide bond

PAPAIN + +

Now Ag is added:

2 3

Fab

Ags bind to This is crystallized

these fragments at the bottom of
Flask

D u e to action of papain = 2 Fab fragnments 1 F

I. Effect or action of pepsin on Ab-molecule:

.Pepsin attacks the Ab below the lnter H chain
disulphide bonds.

Antibody Part
 2

Pepsin H. +

Pepsin

.When Ag is added:

gl

(Fab)
Action of pepsin on Ab molecule
(fab)a + fe

Antibody Part
 1
GRAM NEGATIVE COCCI - NEISS ERfA

Neissevt'a 00:00 :j.0

• ~vaw. ne9ative diplococc i
• Fastidious ovgaVliSW\S
• Strict aerobes
• Cata(ase positive
• Oxidase posit ive
• Sol'V\e species are coW\rAensa{s iV\. oraf cavity and
9eV\ito1A vinav!::J t vact
• NoVl-m oti(e
• .2 iw.povtaVlt species ave patho9eV\.S
- N. MeV't.ity3itid is /MeVlh 1.9ococcus 1

- N. goV't.orrhoeae ICioVlococctAs

N.W\enin9iti'dis N. gonorrhoec:te
• P(o.VtocoV'lvex cocci • KidV\.e~/ beo.Vt si,,,.a.ped
• Co.psu.(o.ted o r-90.v.isMs cocc,
• Utr'(ises botv\ glucose avvl. • NoVt-capsu{ated
V\t\o. (tose O r-9 O.V\.iS V\t\S

• fvlod.e of ,·V\fect ioVt: • Uti( ,·ses OVl(!:j 9(ucose

t it,. r-o u91,,i ve spiv-a to V'!-J
I rout e • fvlode of tVlfectioVl:
• Or9a.Vtism pr-eseYtts (Vt Sex1Ao.( (Yttercourse
v-i.as opl,,ia vy VtX • Str(ct hu"""aV\. patho9eV\
• St rict hu."""a.Vt patJ,,.ogeV\ • Produces - (a.eta.Mo.Se
• Does M produce
t -
la.cta.VVi.ase • Dru9 v-esist o.Vtce - Move
• Dv-u._g r-esist a.Vtce - Less COMW\ OV\.

CO MIN\ OV\ • Viv-u (eVtce fact or. Pd(

I • Vt'vu (eVtc e fo.ctor,r: Capsu le

Qri:u1" ' Negative

Cocci - Ne. i c;<:.evio.
 2

fv1 eV\iV\gococcus 00:0 7: 4C:>

• Site of cav-riage - NasopharyV\X

FroM Nasopharynx

HaeMato_gen.ous v-oute Thv-ou_gti. cv-ibv-ifov-M

(/v1ov-e COVV\W\On.) p(ate via pev-ineuv-af
,J, sheath of o(factory
To v-each w.eVlivtge5
nerve (fess cow.w.on)
.J,
Reaches CNS

• Disease causin.9 sev-otypes - AJ BJ CJ W-135J Y

• Sev-otype - A - fv1ov-e cow.w.on in. ln.d.ia
• Sev-otype - B - fv1ov-e coMw.on in We5t
• Diseases:
:L.fv1eVlivtgitis - in ovev-cv-owd.ed. av-eas
2./v1enin9ococcaew.ia/Puv-puv-a fulw.inans:
Tv-iad.:
- Puv-puv-ic rasti.
- Sti.ock
- /v1eniVlgitis
3. Water-house Frid.ericti.sen S!:JVld.v-ow.e:
- Patient dies in 3 -5 hours
- OV\ autopsy: Bi(atev-a( adrena l ti.aeMov-v-ha,ge

Diagn.osis:
• Sample:
- CSF
- Blood.
1.. 4r-a11V1. stv-aJn:

Qro.wt Ne90.tive
Cocci - Ne isseria.
 3
- Lot of neCAtrophi{s with intrace(fu far &
extr aceUCA {ar 9ram - ne9ative dip{ococci
2.Cufture:
- Bfood a.9ar- ]-
- Choco late a9av- En.riched Media
• Modified Tha!:Jer wi.artiV\ wi.edic..<M - selective
med.iuM
- Otl\e should incubate the culture p(ates in 5 -10%

CO2 because they aJl'e capvtophiles

Tf"eat Met'\t :
• DOC for tr-eatMent & pr-ophylaxis - Ce~r-iaxone

Nolaoorla monJn,gltlctf•

Git c:oae Mo11:oae Sucroao

(1-1 l•ZQO) (ull , , _ , ) (nQI uult.t4QJ

Ncisserlll"!II gon_orrhoeae

w w ffiillID~

G I U00$0 MaUOGO Suoroao

-,,;., 1..,.0C'f) (rtc.> t uflljr..,...-Jl (nne u1'ti.r~l)

F(g. :1.-

Neisseria W1.enin9itid.is p r od.CA ces acid. froW\ oxidation of

9 (u.co.se and Ma (toseJ but not fr-oM sucr ose. The acid t urns
the pH indicator pheno l r ed. fr oM red to ye Uow

l{rall'V\ Negative
Cocci - Neisser-io..
 4

Pet echia( and/or- purpu.ric rash and

neck extension characteristic of
Meniv,-9ococca( Meningitis F,9: 2

.
{.
..
If .

Fig: 3

i. Neissev-ia 90Vlov-v-hoea in cfumps within

po (ym ov-phonu.cfear (eukocyt es in uv-etl-traf exudate.
ii. Neisseria MevtiVl9itidis in cev-ebv-ospina( fluid of
patieVlt with meniVl9it is.

N e,·sseria 90V\orrnoeae/ ~oV\ococcus 00:1- 7 :28

• Disease: l;onovr hoea - a sexua((y t rans Mitted

infect ioVl
Ci V-O.IN\ Negative
Cocc i - Ne isserio.
 5
• I. P: 3 - 5days

• SoW\e st r-a.ins of Cio/1\ ococcus ave Mot i(e - Twitc"'-iY\9

W\Otifity
• Viv(). fevtce Factor- - PILI
- p ;(i - /t,,efp t he ov9aV1.{SW\ to attach to urethra( &
end.ocervica{ ep;t /t\e(i(). M
- Typi"'g of ~ovtococcus is do"'e based o"' the
ttW\ o(,{ nt ldistrlb(,{tioll\ of pNiJ kV\O W V\ as Kelfoa's typffl\9

Clirlical Featur-es:

Mo.(es FeMo. fes

• Uv-ethr-ftis - ur et hra ( • End.ocevvicit is
d isc~ r-ge • Usu.affy asyMptoMatic
• Usua ((~J StJ m.pt oW\atfo ( Reservoir of (V1.rec tioV\)
• Va9ina( infectiovt does not
occc..t r because st ratified
squaMou.s epitheliu.W\ is
v-esistant to Qonococca(
i"' fectio"'
Corvipfico.t ion.s
1 . Per-ic..t r-et /t\ra l abscess 1..PI O - aon.ococc().5 is an.
2 .Water-call\ peri/1\euW\ iW\portaV\t cau.se of ac'-tte
( /v1ultip le d.iscl1av-gin.g PID
si/1\l,{ Ses i"' perh,ea ( 2.Seco/1\da v-y in.ferHlit!:J
v-e9ioV1.) 3.Ectopic pre&V\aV\C!j
3. OisseMinated 4 .Fit:z. Hugh Cuvtis
CioV\ococcaf IV\fectioV\ S~ll\droMe :
(DC(): - Pev-ihepatitis
Te ll\OS!:fV\.OVitis - Pe riappe"'d ic itis
I Ra.SIA 5.0 Ci l

lfra""' Negative
Cocci - Ne isser-io.
 1

GRAM POSIT IVE NON - SPORING - RODS

CORYNEBACTERIUM DtPHTHERIAE

tn.du.de:
• Cor-yVl.ebacter-iuM diphther-iae
• List eria MOvtocyto9ene5

CorE3vi..ebacterhov1. d(pJt,.t/t,.en'ae 00:0:1- :01--

• C(u.b -sl-\aped) 9vaM +ve rods

• An'"an9eMent: Chinese letter-/ cuneiforM
ar-rangeW\evtt - DC-<e to faifu re of separatiovt of darA9l--lter
ceUs FvoW\ parent ce(fs
• N OV\. - 1-'V\Oti(e

• Facu ltative anaerobes

• These have C!::Jtop fa5w..ic 9ranu(e5 knowVl. a.s :
- /Vlet a.cltlr oVV\atic gr avtu.(es
- Polav bodies
- PolyW\etaphospkates
- Babes -evnst 9vanu (es
- Volutivt 9ravt(A(es
• Theses 9vanu (es ave COWI.W\Ovt in ceUs 9r-owiVV3 uvtd ev
vt{,,(tvitiovta. {l!::J deficient c.0V1.d.ition5

Stain.in.9 of 9r-an.ufes:
1. .Albevt st aivt: WI.05t COMVV\Ovt st ain Fov- staivtin,g
gravtu(es
CirnM Positive Non - Spon'vis
- Ro& COl"tJnebo.ctel"iu wi
n :a,,,I.J-1... ,,. .,:,..,.
 2

• BaciUi -appeav 9veevt) 9vaV\u (es -a.ppeav b(ue (Fi9uv-e

1 c)

13. CivaW\ -5taiV\ed SMeav shows V- ov L- shaped bacilli

wit~ cuV\e ffovM av-ran9ei-vteV\t; C. A lbert's staiV\ shows
davk b(ue Metac hv-oMatic 9vaV\u (es at the en.ds oF t /,,.e
baciUi (scl-teMatic )

.2.. PoV\de v-,s stain

3 .Neissev-'s staiV\ (Not fov Neissevia)

Med io. for- 9r-owth oFC. diphtheviae:

1. En.riched Med ia: Loefflev- 5 seruM slope

1

- CofoVlies appear- eavf!:J ( - 8hovtr5)

- Coo d MediuM to iV\d(). ce granule forMat ioV\

Loefffer's sevc.o'V\. sf ope - Also used

For fv1!jcobacteriuWl tuberctA(osis

2 .Se fect ive & diFfevevttia{ W\edh,< 11v1.: Potassiv< M t effvtvite

blood a9ar
• Se lect ive W\edivtM: Sin.ce it iV\hibits t Mvoat

COW\MeV\sals
Qr"aW\ Positive NoY1. - Sporil'\9
- Rods Coryn.ebacteriuW\
Dip/r,tl,erio.e
 3
• p ;ffev-entia ( Med.iv. 11\1\:

- Because w heV\. C.d iphtl-1eriae 9rows) it chaVl!jeS

Pot a.ssiuVV\ t e(lu r iuW\ iV\. t he Wtediu.w,. t o W\eta(fic
te (/uviuM
- /Vleta ((ic te llurium is theVL iV\cov-pov-ated iVLto the

coioV\ies of Cor~V\ebacteviuM diphtheriae

- 13 (ack co( oVLies av-e forMed.
3. Othev se(ective W\edfo.:
• Ho!::J(e's W\.ed iuM
• /Vlcfeod.'s MediuM

• TfV\Sd.a(e Medi<Am

- 3 biot!jpes - Based on gvowth of C. dipJ.-\theviae

OVL potas.siu M te/(urite blood a.9ar

3 biot!:Jpes

a..-avis InterMedius Mitis

(Civavel Most
severe disease)

I aro.v(s I tltertv\edius M(tis

Co (ov,. g t gpe Do.ivy 1,,,.ea.d Fv-og>s e99 Poacl,,.ed
co /ovi.ies co{oVtfJ egg coloVtfj
I HaelN\o/ysis Va.rio..ble Nov.- Usuall g.,
t-iew.ol!jt ic l--iae w.ol!jtic
Cow.p/icatioVtS HeWiov-rl-\agic HeWim--rl--io.gic Obstruct ive
& po. ro.f !:)tic colNlplico.tiov.s lesiOlt\S iv,.
coW\plicat iovi.s t '-'e. o.ir-
passage.
--- - - --- - - - - ~ - - I..... - - ----- ------
CiraWI Positive Noll\ -Sporil/\9
- Rod> Col"!Jv..ebacteriuw,.
Dipl,,..tl-ierio.e
 4

• Viru (eY'lce Factor- of C. diphtMeriae :

ExotoxiY\ known as diphtheria toxin (is a prot ein)
Cene for- tlt\i5 toxivt is preseV\t in cor!:Jnept,,.agel -
plt\a9e
Disease: occu.vs wheV\ bacteviop/,\a9e attack5
bacteviu1V1. & tvansFevs ,gene to hactevie1.M ) ca. fled as
"L!:Jso9en.ic con.version.' >

• 0 ptfrV\um iron. con.cen.tration. needed

fu r t oxin. production.: 0 .1-W\gl L
• Con.cen.tra.tioYl oF 0 .SWl.g/L or more
is iYlhib it ory

• Mec/,,,.avi.isM of action of tox;n:

It /,,\ as 2 sub e1.nits:
- A (active)

- B (Bin.din9) - Binds t o host ce(( vecept ov

• WMeV\ t oxin is veleased - init ia ((!:J it is inact ive since

tMe active site on. A -su.be1.nit is 111\asked
• Tlt\is active site is e1.nW\asked by proteases in t issue &
ce1. ftur-e Media
• Diphthevia is a toxaew..ia s;nce the toxin acts both
focaffy & 5!:JSteM ica((f:J
• Bu.t hactev-ia ve lN\ain (oca fised

Therefore., diphtl\eria. is a systeWlic

disease but n.ot a systeVv\ic in.Fection.

arAm Positive Non -Sporin9

- Rods Coryr,tbt.lcteritnv\
 5

• Toxin binds t o receptovs OV\. host ce((s via B

t hen A-sCAbuV\.it ent evs the host cell
• NAD - AD P r-ibose coMplex ave sepavated by A -
SCA bunit into :
- NAD
- ADP ribose

l + EF-2 ( Elongation factov-2)

ADP ribose + EF -2
(ADP r ibos!:J latiort of EF-2)
- No pvoteivt synthesis
- Ce(( death

So.W\e M.O.A is .seen with exotoxin

- A of P.seudoW\ortas aeru9irto.sa

• Diphtl-levia toxivt ltlas affiV\.ity for-:

- fv1yocav-diuM
- Ad vevta Is
- Nevve eV\.d ings

00 :27 ::1-0

• UsuaUy ) a childhood disease

• fvl ode of infection: Respiv-atov-y voute
• l. P: 2 - ro days
• /v1 ost COMW\OV\. t~pe of diphthevia : FaCA cia{ diphthev-ia
..1,
Fauces av-e affected

arAW\ Positive Non-Sporing

- Rods-~o~~e~cteriuW\
 6

• IV\ tvH-·oat: Bacteria p roduc e t oxin.

"'
Death of epitMe(ia( ce (/5

"'
lnfla MW\at ov-y ;V\fift vate

"'
Dead epithet ia( ceUs + dead
n.eutrophifs -1-- Dead bacteria.

• Pseudo W\eMbv-ane :
- Bleeds on r-eW\ova f
- If detached. } ;t call\ block the vespivatovy passa9e

Causes asphyxia
• Death occuvs in d.iphthevia due to :

- A5phyxia
- Car-d.iogenic shock

Dia.gn.osis:
• SaM p le: Thr-oat swa b
• Sta iV\s like :
1. .~ vaM staiV\
2 .A fbevt 5tain
Do V\Ot est abfish diagV\osis because
- C. diph t!Aeviae caV\ be thr-oa.t coW\W\en.sa.f

QraW\ Pos it ive Non-Sporing

- Rods CorynebacteriuW\
Dipl-.theriae
 7
- C. diphtheriae Wtay not have been (ys o9enica((!:J
converted
- PseCAd.ocavriers: Harbou r non-pathogenic variant oF
an or_ganisWt. in tl-te bodf:J
3 .Cu(tu re : Not cov,Hr-W\atory
4 .To>d9enicit!J tests: Establish diagnosis

Toxi9en.icity tests

ln.- vitro In-vivo rn an.iWta.(s

Elek's 9ef Tissue/cefl ClAftuve

pr-ecipitation test C!:Jtotoxicit!:J assa!:J
(Fi9uve .2) - SaW\ple is added
- tf ce(( death
Toxi9enic strain

To1 1ue111c. Non-tollgemt

C d1phll1crt•a C dlp/11/tart•o

Fig: 2

• E(ek's 9e ( pv-ec ipitatioV\ test (fi9u re 2 )

- Arrow ~ead precipitates

QrtHM Posit:ivt Nolf\ -SporiY19

- Rods Cot'!jritbacteriwm
Dipl-cthtn'at
 8
Tr-eo.tMen.t:
• fv1aivtstay:

- AVltitoxiV\. ad.MiV'listv-atioV\
- Not toxoid
• Otl'ter Measures: AVltibiotics
- DOC -PeVlici {(iV\S/ Ev-ythroMyciV\.

- A(tev-V\atives - RifaW\piciV'l/ CfiVldaW\ydV\

Dipl"ltVlevoids 00 :40:0 7

• Refers to a(( species of ,geV\uS Cor~V\ebacteriuw. other-

tl1aV\ C. dipl1tl1ev-iae
• TMey are skiV\. aV\.d tl'lroat COW\W\eV\.sals

I C. d iphther-iae Diphtheroids
r ,meifo rw,/ Chilllese Pa (is cul.iV\9 o. rro.V\9e VV\e V\ t
ettev o.rro./l\gei.-·v1.eV\t
-
1
LOV\ger) s(eVtder Shorter ) stouter
More VlUIN\bev of Less VtUW\ber of 9raV1.u(es
J 9ro.vl/J,(es
I

Less UV\iforW\ sto.iV1.iV\9 Mo re iu·"iforW\ sto.iV\iV\9

Eg: 1- . C. VV\ tV\U tissillVl.u W\:
I
Cause skiV\-V-tA.SV\ - ev~tvwaSVV\a.
'1-,
Cov-a.( ved Ff uovesce/1\ce u/1\der-
Wood (aVV\p exo.VV\iV\o.tioV\
2. C. jekiuW\:
Co.uses s~steW1.ic i~,.fectioV\
(sept,·ceWtia) iVl 1W\VV\.uV\e -
coW\pvoW\ised 1'V\.d.ivid.uo.(s
I Eg : (HIV)

Qrall\l\ Positive Novt - Sporin9

- Rods Co~ne.bacttriuw,.
 TRE MATODES - BLOOD FLUKES

Tv-eMatodes/F(ukes 00:0 0 :1-4

• Flat wov-M5 - uVlsegMeVlted. body

• Based on the site where adult wovl-'V\5 live ) they ave
divided. into types.
• TreMatodes av-e hevMaphvodites except scti.istosoMes;
wl-teve Male and Fe Ma( e sexes ave separate

B (ood Flu kes/ Sc0JstosoW\eS 00:0 0:38

• DH : fv1an
• IH: Snail
• In fect ive fov-M: Cev-cav-iae
• tvtode of infecUon: Skin penetv-ation

.3 iW\portan.t spec ies:

1.SchistosoMa haeWlatobiuW\ -lives iVl vesical vevtous
pfexu.s
2.Scvi.istosoMa japoVliCuM }
live in ""'l.Sen.ter-ic venous plexus
3.Scvi.istosoMa Mansoni

Schi.stosoW\a haeMatobiuM: causes painless bi.eMatuvia

and squ.aMou.s cell cav-cinoWla of u. v-inav-y bfaddev-
• Eggs are excveted in urine
• Eggs of S. japonicuM and S.W\an.son i are excv-eted in
faeces

T v-evv\O.todes - Blood
Fluke s
 2

• Eggs:
- s. heMatobiCAM - iV\ uriVle) with posteriov
/ter-W\tV\a( spine
- S. japaV\iCuW\ - in faeces, V\O spiVl.e/rud.iW\eV\tavy
.
sprV\e
- S. Man.soVli - iV\ Faeces ) with later-a( spiVl.e

• DiagV\ostic stage - eggs

• IV\Fective stage - cercariae larvae

Schistoson1a, in copula

male

• Egg of S. heMatobiuW\

terminal spine ~
posterior
miracldlum
inside egg

Schistosoma
20um haematobiu,n
.......... Fi9 : :2.

• 3 kiV\d.5 of e99s:

Tre~t\todes - Bfood
Flukes
 3
S. monsonl S. h3cmatobium
Stool Urine ., ..._

Fiff 3

• S. japanicCAM and S.w.ansoni - caCA5e5 abdolN\ina f

pa tn.
• DOC : Praz.iquantel

Tr-el/ll\~todes - Blood
F
 1

TREMATODES - INTESTI NAL FLUKES

fV\testt'V\a( F(ukes 00:00 :1-1-

• Fa.sc io(opsis bCAski - Ciia.V'i.t IV\testiV\a. ( ffCAke - la.r9est

t reMa.tode
- DH - /v1a.V\
- IH - First: SV\a.i(

SecoV'i.d : AqCAa.tic p(a.V\tS

- /v1ode of iV'i.fectioV\: IV\9estioV\
- IV\fective fon'V\: /v1eta.cerca.ria.e (arva.e

Life C!:Jcfe :

1,t-excy,1Jln
duodorun.,.,
- . .. lnletll.-1 ....

.,. ~::ltnl
I Man (Definitive host)

~--\·
0pettu1a1e<1

,)~
UIS •-Ile
"'-' •"" CU>tr he<t>1VO<U
pla<\U wl'1I
enc)"lleO rnetac:ert.ar\ff •
Wator plants
Water (i
(2nd Intermediate egg emt>,yoneto•
hoat) ~ w11a< ond m~addlum

(1st ln~:~odlote ••co1pnoot

MetaGorcena
' ' , host)

Free~
\-~~=-~:
terelflil HCapn
Moo<ki•um i>gutod
by .... 1

•=;::m ~ ~D~-=9
~ w t l f t h'\ IIMI
(flrlt lnltOMdllll Ml ~
I Sc,otoc:y,t
2. F"nl gtn«at>on re<kl
3. S6cxw\d oanom1ion rodLa
• C..canao

• E99 is opercCA (a.ted

Trell'\l\o.todes - lv-.testiv-.o.
Flukes
 2

Cfinica( Features :

• fv1ost(y asyWlptoW\at;c
• SoMetiMe5:
- U(cev-
- Abscess
- HeMon,·ha9e

Al( these occuv- due to W\ucosal da.Ma9e by the

adu (t flukes

Dia9nosis :
• Faeces exaMiV\ation fov e99s
• DOC: Pv-aziquaV\te(

Su mma.r-f:j of treMa.todes 00 :04- :~0

• Fov a(( ffukes/trematodes

- Definitive Host: /v1an

- ln.ter-Mediate Host: SV\ail

• If 2 inter-Mediate hosts ar-e pv-esen.t:

- Fiv-st f H is Snail
• Infective forW\: /vtetacer-cav-iae larvae
- Except Schi5tosoW\e5 ➔ cercar-iae larvae are the
infective fo rM
• Mode of ;V\fection: Ingestion of iV\fec tive forM except
Schisto5oMe5 wl,\ev-e skivt peV\.etv-atiovt by cevcav-iae is
the Mode oF iVlFectioV\.

Tr-ew.a.todes - IV\testi vial

Flukes
 1

MUCOR/v1YCOSIS

/V1 UCOV"W\t)COSt'S 00:00:1-:L

• C(ass: ZygoMycetes I PhycoW\ycetes (o {der-

cfassification)
• Appeavavtee:
- Wide (~ 6 - 30f.A-n

- Th ick-wa.Ued
- Ribbovt- fike
- Aseptat e (Coenocyt ic)
- Hyphae bvanching ·a.t vight ang fes
Pny(uW\ Ci {oW\eroW\!:}Cota.

Mucon~coti/1\t>. Entowt0phthoro mycotina

i Diseases caused are i Diseases caused are
/\11ucov-mycosis EV\tow.opt-.tt-.oromy cos is
Or

Su bcutaneous W\u corW\!:JCos is

• Basidiobo(ow.~cosis
• CoV1.idiobo/oW1f1cosis

Mucor~~cosis
 2

Ov-der- Mucora.(es: orgo.n.isW\S included are

• Rhizopus arrl-1i:z.us (Most comMon)

• R/tl.i;z.opus Wticrospovu.s var rhi:z.opodiforMis
• /vlu.co v raceMo.su..s
• Rhizoww.cor pusiUus
• Apoph!::J.sow..~ce.s .species
• Cunv.J.9"'a w,..e ({a. bertho Hetiae
• Co kevoMyces recu vvatu.s
• Saksenaea species
• S~ncepl,,.a(astvuw,.. vecew,.osuw,..
• Lichtheiw,.ia. covyw,.bifera I Ab.sidia covy1-vtbifeva

Or-der- en.toWlopnt '°'o rra{es:

• 13a.sidiobofus r-anaru.M
• Co nidiobo lus coronatus
• Conidiobo(us iV\COV\.9ruus
• Conidiobolus laMprau9es
• tv-oV\. is the iMpovt~vtt gvowth Factov for this Fw,,.gu.s
• Souvces of froV\:
- Dtabetic ketoacidosis (DKA)
- Ir-oV\ therapy
- Desfervioxa.wliV\e therapy

DKA:

• IV\ DKA) tvoV\. FvoM t!tte .sevuwi. pv-otein.s i.s dissociated

and becoW\eS a.vai(ab(e Fov the fungi
• Also} there is dee r-ease in ser~M p H iV1.. DKA

fv1 UCO t""W\ ~COS iS

 3

DecV"ease .seV"uW\ pH iV\. DKA

J
T/1\15 leads to:
Deer-ease ;/I\ pha9oc !:}t;c act;v;ty
DecV"ease ill\ CV\eW1.ota.ctic effect
Deer-ease i/1\ oxidative bur-st of pkagocytes

ls b{ack fun.gus r-eo.t{y b(o.ck?

• Th i5 fc.<n9u5 ls AYl9iolnvaslve
• This fu Yl9US has affinity foll' Elastic La.Pvlina of $WI.a((
and LaV"9e Arter-ies
• Due to this An9ioinvasive pr-oper-ty., seveV"al
vv,.a.nlfestation.s can occc.<V":
- ThroMbosis
- HeMorrha9e
- Infarction
- Necvosis

• Neutrophils t-lave speciaf fuV\9icida.f activity against

zy90W\yceter

Mucor-m~cosis
 4

•• • • •
•

Fig: 2

Risk Factov-s:
- Stevoids
- PvoteiV\ calovie W\a (Vl.utvitioV\.
- LeukeW\ia
- IW\W\(,(V\od.eficieV\.CH
- tn.tvaveV\ou.s dvu.9 abusers
- Neutr-openia
- TvaV\.splaV\t (solid organ) boV\e W\av-v-ow)
• fv1ost COW\Monlt1 evtcouvttered ovgaV\iSW\ iV\ Rl-1i:z.opus
avrhi:z.us also kV\own. as RhizoplAS oryzae

Beca.u.5e:
- AV\gioinvasive
- Civowtl-1 at /above 37°c
- Destructive. enzyW\eS
- DonV\aV\t spores
- Active ketoV1.e ved.uctase 5f:i5teM
- HydroxaMate sidev-ophores

Mucorw.~cosis
 5

Modes of in.Fectiof'\.:

• tnha{ation of spoves - Most COMW\on

• tn,gestion of spoves

• IV1.ocu.fatfoV1. of spov-es

Rh,·nooYbita( ce.v-ebv-a{ /v1ucoYMycost's (ROCM )

00 :1-~ :58

• It is the Most COMW\On and fu.lMinatin,g type

• Risk factors:

- DKA
- Leu.keWlia and ff:JMphoWta

• Ov-der- of spr-ead:
Nasa l Mucosa

Tuv-biV1.ate bones, PNS orbit and palate

1

Bvain

(Fvontaf lobe nec..o'"osis., abscess)

PRESH ~
Ot-JSef VI"
lfcA)/1018

(JJl\l:XVNC.T I
svm,s,o~, p~ Fig : 3

J 1sw
 6
• St.<dden onset of dip{opia. iV\ diabetics - think r r
W\t.<C on'"\!:JC osis

Pu {W\OV\av-y zy90W\f:JC0s(5

Gu/Hf
.,_...-? f'liaJA '
~ ~ ~ '"? &rJ_rJ.idfJ/;;,v

~ ~ Nod.uJ,,

J~uL
Fi9: 5

• It is the second Most type of zy90Mycosis

• Patient presents with cough) chest pa.iv,.., dyspv,.ea.)
fever
• Very ra.reft] - fuV\9a.{ ba.((

l.<COt"VV\~Cosi s
 7
• HyperseV1.sit ivit!::) pV\euMOV\itis due to Rl,,\i:i.opu.s l,,\a.s beeV\.
v-eported. iV\. Scand.iV\avian sawW\i{I workev-s (woo d
tiriMW\ev->
5 d isease ) and. in fan,'V\ wov-ker-5

CiastrofVltestt'Vla( M ucorW\ycosis 00:;2 0:55

• Most COW\W\OV\. site: .stOVV\Cl.CV\

• 7% of a{ { cases
• Risk factov-.s: extv-eMe Ma(V\utv;tioV\
• It is acquired by in9e.stioV1. of food COV\tainin9 spores
Other- sites of CilT involved:
- Colon. - seen in abdomin.af sur9ev-y
- lfeuM - coV1.taW\inated. ifeostoWly
- esopha9us
• Si,gvt5 aV\.d syMptoW\:
- Abd.oM ivta.{ paivt
- Diav-rl,,\ea
- HeMateMesis
- Malena

fso(°'t ed reV\.a{ W\UCOV'W\fJCos is 00:;2;2 :53

• Pathoph!:Jsio fo9y - aVlgioinvasion

• There is:
- F{avtk paiV\
- Fever
- P!:JCA v-ia
- HeMatuvia
• Case Fata ffty rate: toSo/o

Mucor ~~cos is
 8

CutaVleous fv1ucov-Mycost's 00:23 :48

• It caV\ be priW\ary or d. isseWtinated

• PriMav-y cutaV\eous MucorMycosis occurs iVl
- Su.pe v-flcio. l v. fcevs in diabetics
- ~tV'\.9renous ce lfCA {itis iVl trauMa patieVltS
- CoV\t aminated elasticized wound d.ressin9s

C(in.ica( features :
• Pustules
• Vesic fe.s
• Necv-otic wou.nds

It\ eo.y{y st ages: (es iortS r-eseM b{e EcthyMo. Cio. h.gr-eh.osuM

• Ther-e MO.tJ be appeo.raV\.ce of'' Hair-tJ pusJ1

• Lesions are painful
• Lesions 9vad.ually becoVV1.e nod.ulav- ecchyVV1.otic areas
• Necvoti:zin,g Fa.sciiti.s caV\ occuv iV\ cutaVleou.s and.
subcutaneous W\U.COV'M!::JCOsis. It "'as hi_gti. CFR
- LichtheiVV1.ia cov~:fVV1.bifera and
- Saksenaea
• Tt--ie.se ave W\O.St iW\povtant ovgaVli.SMS ve.spon.sib(e fov
cut aneous W\UCOV'Wl!:JCO.sis in d.labetic patients

Fi9: 6
D ia911\05(5

St,H'V\p( e coUection.:
• ROCM:

- Scv-apinalexudate fv-owi. nares

- Hav-d. palatal lesioV\.5) sinus Wt.o.terio.() biopsy froi-,,,,
extracted tooth socket av-ea
- Endoscopic coUection of debrided tissue/biopsy
Dv-y nasaf swabs - ave V\Ot useful
• Pc,.tfMOntH"tJ VV\UCOV'W'l.!:JCOS is:

- Sputc,,tf/11\.
- 13v-oll\chial bv-c,,ts/,\ was /,,\ill\9/BAL
- LuV\t} biopsy
- Ffv.or-oscope - guided transthoracic 11\eed(e
aspir-ation or- open fun,g blopsy
Sa (iva safine wash - ave not recoMMended
• QIT MuCOY'f'V\tjCOSis:

- Endoscopic biopsy of lesion

- Faeces - not recoMMended
• Ren.al MucorW\ycosis:
- Biopsy of the (esf ons
- Uv-ine - V\.Ot v-ecoW\Wl.end.ed.
Cut aneous MUCOV'Wl!:JCOSis:
- Aspiv-ate f v-oM t-<ndrained abscess (with sterile
vteed{e and syv-i"'t]e)
- Pus expvessed fv-oW\ abscess opened with scalpe l

Muc ot'l'\'\ !jC osis

 10
- Tv-aVlsp ovt to {ab in stev-i{e contaiVlev-lSf:JVilll9e a
Vleedfe
- Tissue FvoM bot/It Cevtt v-e aV\d ed9e of lesion st-tov< fd.
be co llected
Swab ov- Mat erials froM open wouVld.s J d.r!:1 swabs
av-e vtot v-ecoMMend.ed
• The tissue shou (d not be hoM09evtiz.ed.J other-wise
h:Jphae bv-eak aV\d cov-rect Mov-phofo9tJ caV\V\Ot be
appreciated

Microscopic exo.Mino.tion:
• KOH fv1ouV\t
• PAS stain - best
• HV\E st aivt
• CMS stain
• ~vaM st aiV\:
- Al( fun9i ave Civ-aW\ positive
- Fi{aMeV\t0(,{5 f<Avt9i take up FaiV\t bfue color (Missed
soMetiMes)
- /v1(ACO r OV\ Cifvl S sta.iV\:

- KOH W\OUV\t

f./r UCO V-VV\ y co sis

 - Rhizopus in t issue = HnE

Culture:
• CottoV\ caV\dy 9r-owth
• Saft an.d. pepper- appearaV\ce of Rhfaopus

Fig : 1..0

Lid (i~er-s (because of aerial ,growth)

• M i:z.oids - root fike str-CActu v-es a.septate Jt,.y phae

MucorVV\ycosis
 12

Fig : 1-2

• SpovaV\9iophove: stafklst eM with sporaV\9iuW\. OIi\ the

steW\.
• Spora.V\9iophores: Asexual spores
• fv1lACOr} LPCB W\.OUV\t

SPORll~10P110Re
OtNOC.'fO C. / ~ r f ; l1YP1t~ €. Fig : 1-3

• No vhi:z.oids
• They also pvoduce sexual spores - :z.y9ospores aV\d
oo5pores

Tr-ea.tMen.t:
• fv1aiV\sta.y is sur9ica.l debr-ideW\.eV\t
• AvttifuV\9a.ls:
- AW\.photeviciV\ ~

- Posa.COV\a.:z.O (e
- lsa.vucoV\a.:z.o le
• CytokiV\es: IFN - oc Ci/vl - CSF

f-,/1 UCO t'°II\I\ ~ CO Si5

 Fi9 :
Diaper rash b9 C.albical'\S
 OPPORTUNISTIC MYCOSES - ASPERulLLOSIS

Aspev-91'((osis 00:00 ::1-0

• By 9en1As AspeV'9itf1As
• Mo{d/fifaWt.entous Fun9(AS with septate hyphae
• Acute an9led./dichotoWt.ou.s braV'i.chin9 of hyphae
• Saprophytes
• IWt.pov-tant species:
- A. fuW1.i9atus Wt.Ost COW\W\OV\. species infecting
hu W\aV'l.5
- A. N osocoMia{ patho9ell\.
- A. nigev
• Mode of infection: Inhalation of sporeslhypha( fovms
- Most COMW\OV\. mode
• Risk factovs: Neutv-openia
• NOTE: fn HIV: CD4 +ve T -ce{fs/TH cells av-e affected
Neu.tv-oph;f count- r-eMains nor-Wt.a( u.nti( (ate
stages of disease so Aspev9iUosis is c.<V'i.comw,.on.

Clin.ical Features:
1..A{(ergic Bv-onchopu.(Wtonar!.1 Aspev9iUosis [ABPA]:
- fn patients with cystic fibV'osis) asthma

- Characterized. btJ - Pu. (Wtonar-H }inEfJf!f4°t:~~~

- Centv-a( Bvond,Jectasis
- Whe,e:z.in9 pv-esent
- tncV'eased tgE in 'blood agaiV\5t specific species

OpportuVtist.ic M~
- Asperq;//osil
C:-
es
 2
- Eosivtophi(ia
:2.Aspergitlow,.a/Funga( Baff:
- Aspev-9i{(us co(ovtises the (uvtg cavity (Tb, Cavtcev-)
3. fvtva.sive p1A(Monar!J asper9iffosis:
- fvt people with profouvtd vte.1Atropevtia. or
IMW\uvtocoWtprow,.ised peop(e
- Diffuse pu(Wtovta.ry ivtfiftrates
- HALO sigvt
- AIR CRESCENT si9vt

4.0titis extervta.: A. vti9er

s.KeratoWtycoses - fn Fav-Wters durivt9 ha.rvestivt9
seasovt
G.AFfatoxicosis: Not infectiovt, its intoxication

ARA

F{avus
Asper9illus

• A. f{avus produces AFfa.toxiVl.5 which a.re hepa.totoxic

• CovttaWtivtates stored 9V'aiV1.S - AffatoxiVl.5 aV'e

produced ivt hw·Vlid covtditiovts

Dia9nosis:
:1..fv1aivtsta}:J of dia.9vtosis: HPE of biops}:J speciWtevt
- Staivts with H & E staivt

OpporttAll\.istic M!:JC 5
- Asper-9;/(osis
 3

,
~l . -...»....~.:.~~.; : ~ ~ ' .

_'s's; ,

· ~_, _4,.,
t ~O, ..
. -,~ ' 't
1, -:- ·,: ·~ '}\ '\ ii .,
II. ~ '.,.Q_!',I../J,.:.~ -
(,-!' , ,,.Y .. _./IL . ...
,. ~ . I ' ....
Fiff 2
Asper9ilfus Hyphae

:2..C<Aft<Are: H~pha( forw,.

3.fv1icroscop!j:

c:,

pW/4

• Phiafides - cells which give rise to conidia

- Present in 1 or :2. rows
• rf :2. rows preseV\t: 15t row is ca.Ued Met<Aiae

OpportlAV\.istic M~coses
- Asper,gillosis
 4
N,.IA ( Afl.tSE 1-«lt'I
l,pP€~ l/lrd pJ , K
\'£~IC 1,11111 t ~1Stnof'I 6 1:iblA (Al?lSE ff/(jtl
E;N11 RE VE~l<l.1:)
AUi '"- .___,uvt,VL"'1
PHlAI.IIE~ (.9 Ro:,>$)
at t&ic1e
L· U9'1<1~
~I>)
1oo1<oR E co111•>•0WOIIE

- J'trnl~ _:::c:=-..=,-._,«PrMe ----- I:;

~En At E
1'11•• """"~ liY,..~

Ctsrt.T il/W r,,i Fig: 4-

Fig: s
Asper-_gu{(us cofon.ies

a. A. fc..tW1.i9atc..ts - SWl.oky 9reeV1., reverse - white

cofovties
b. A. ffavus- yeUow 9reeV1. cofovties, reverse - white
c. A. V1.i9er - black colored co(oV1.ies, reverse - wl,,.ite

l•
LPCB MOUNT Fig: 6

a. A. fc..tW1.i9atus
b. A. f{av{),s
c. A. Vli9er
TreatMen.t:

Opport,,u"-istic M~crs;s
- Asper·9illosis ~
 5

• Invasive disease: VovicontUofe

• ABPA : ltr-acontUofe

• Chv-onic pufwi.onav-y aspeirti((osis:

ftvacona.zofe/VovicontUofe

OppovtuVtistic. ~!:}coses
- Aspergillosis
 OPPORTUNISTIC MYCOSES - ZYGOMYCOSIS

ZygoM!JCos is/PhycoWlycosis 00:00:1-0

• Cau.sed by Members of class

Z!:JBOM!JCetes/ Ph!Jc oMycetes
!I IMpovtant 9evter"a-: Rh.izopu.s
Absidicr.
fv'lc..<cor
• fv1ost coMW\Ovt species : Rhiz.opMs arrh.iz.u.s
• Risk factors: Diabetic ketoacidosis
Desferrioxawtine thevapy
• Sapv-ophytes
• fv1ode of infection: Inhalation of spores
• fv1 ost dreaded disease : Rhinocer-ebr-a.l Wlucor-W\ycosis
• An9ioinvasive fu.n9us
NOTE: Asper9ilfus is a(so an an9ioinvasive fw•1-9u.s.

Dia.9n.os is:
Biopsy speciW1.en
i. HPE with H & E. staiV\.: Broad., Aseptate., Ribbon. like.,
lrregu(a.r hypha.e

Opportul'\i5tic fvl!:JC05es
- Z!:JBOW\!::)COSiS
 2

;) Brnad aseptate,
ribbon like , irre.9u(ar
1,-.ypi,-.ae

Fi.9: 1..

A. Asper-gif{l,(s B. fv1l,(C0t'" Fi,q: ;i.

fv1 l,(cor- species

Opportu,cistic M~c~ s
- Z1:3go1No.1:3cosis
 3 I

Fig: 4
/vi [.(COt'"W\!jCOS is

Tr-eatMe rlt

1. Rhinocev-ebrn( w..uconvt!:JCosis Suv-9ica.{

debv-idew..ent ( w..ainsta!:J)
DOC: Aw..pl-totevicin - B
A(temate drn9s : Posaconaz.o(e/lsavuconaz.o(e

A-Aspev-gi Uus B-fvfucov

Fig ; 5

Opportunistic M9t
- Z!:J90m!:JCosisl
C.-
OPPORTUNISTIC MYCOSES - PNEUMOcYSTOSIS

Pneu Mocystos,·s 00 :00 :1-0

• Cal.,{sed b!:J Pnew•V\OC!:JStis jiv-ovecii

• Eaviiey- coV\SideY-ed a protozoan; now a fun91.,{s
• Basis of cfassificatioV\ of Pnec;.w\Ocystis jirovecii uV\der
fon9i is Nucfeic acid studies
• P.cav-inii Rat species

• PJirovecii Non cu{tivah{e fl.,{ngtAs

• Movpl,,.ofogica{ forMs Cyst: sp"'-er-ica{: has 8

intv-acystic bodies
Tr-ophozoite: Aw..oeboid Fov-w..
• C!:Jsts - Pvesent in tne evwivonMe/1\.t
- Infective Fov-w..
- Mode of infection inhafatio/1\. of cysts
• In huMans: Both cysts + tv-opno:zoites ave pv-esent

• Disease: pneuW\OV\ia iV\:

HIV ir..Fected: people, when

Pre l'Vltlture
CD;i. - T cell falls below
babies
:Z.00/fA-W\

• No disease occc.,0"5 in lw..MtAV\0C0Wl.petent peop(e.

• Afveo(av- w..acvopha9es - Pvincipfe "'-ost effectov- ceUs
• Fungus attaches to Type - I pn.euMocytes - r-eMaiV\5
extvacel{ufar & daMages tl,,.eM
• Fw,'t9us - cac,,cses profifev-atioll\ of type - II

s,
p/1\.eu Moc !:Jtes

Opportunistic 1-1~
- P~euw,.oct1st0W e
 - $(.,(dactant abnov-wi.a(ities
2 I
• BAL ff(.,(id.: lncv-eased. /L-8 and ner.ttv-ophifs

• Tv-opho:i.oites - car.tse inflawi.wi.atov-y v-espovt5e in t/t\e

fr.tn9s
-J.,
pfaswi.a ce({s av-e v-ecirr.tited.
-J.,
Fr-oth!:J exudate Fiffin.9 afveofi: Pfaswi.a cert

Dia.9n.osis:
• Best saMp(e: BAL
• Spr.tfotwi. - tnfeviov- saMpfe
i. Ciowi.ov-i wi.ethanaMine sifvev- stain: Crushed pin.9
pon.9 ba{{s-a.ppearo.n.ce of cysts against a gv-eenish
back9v-o(.,(n.,i. Cyst>s stain black (fi9r;.v-e 1-)

. , IL: ..~ -- - ~
"· . .
' . -

- .' -i'.:,,,, , ·_
,

,,..,
a,.; •
, . ..
i
;; .
a

ii. CiieMsa stain:

- Stains intiraC!:JStic bodies & not the C!:JSt wart

Opportunistic M~(
- Pl'leUWI.OC!jSto~
 3

iii. Direct ftuorescent antibody (DFA) stain: The best

stain
(Hi9hfy sensitive and specific stain)
iv. /vlost seV\Sitive and specific W\ethod of dia9nosis:
PCR

TreatW\ent:
• Cotv-iW\oXaz.o(e - both Fov tv-eatW\ent & prophtJfa.xis

Oppovtu ni stic /Vl~coses

- Pl'leuflV\oc~stosis
 OPPORTUNI STIC MYCOSES - CRYPIOCOCCOSIS

Cryptococcos/s/Eu ropeaV1. b(astow-..ycosi's OO:OO::1-:1-

Cr-Hptococcus (Qenus)

2. species

C. "'eofor-Mal'\S C. 9atti

C. ..-.eoForWltlns C. ..-.e0Pon1110.V1.S
variety 9ru.bii variety 111eofonw.i~
(Serotype - A) (Serotype - D)

c. 90.tti

Serotype - f.l Serot!Jpe - C

• "Cvyptococcu.s vteofov-mavts" - Evtcapsu fated yeast

- T..-CAe yeast
- Pofysacchav-ide capsule
• Resevvoiv-s Eucalyptus tv-ees
Soi( contamivtated with pi9eoV\ excv-eta
• Mode of infection: lvthalatioVl
• Infective fov-m : Aev-osolized. yeast cells, Basidiospores
(sexuaf state)
• Most common site of infecti ovt: luV\9s
Most infectiovts ave asymptomatic
• Fungus cv-osses BBB eithev-- directfy ov- "Trojan horseJ'
- carded withiV\ W\acropha.9es

Opport"~isticM9cc ,
- Cr~wtococcost
 2 G
- Usua{f!::l seen in iMMunocoMpv-oMised peop(e

specia.({!::l HIV- infected patients Meningitis

'1r
(S11.bacute to chv-onic)
Chv-oVlic headache

• DisseMiVlated iVlfection ctm occuv- to boVleS and skiVl

• IVlvofveMevtt of skiVl : "pv-oof of disseMiVlated ivtfecti0Vl' 1

• Vir-u (eV\Ce Facto vs : i. Capsule - Po fysti.ccv,.aride

Antipv,.agocytic
ii. Abil ity to produce f.1elavt ivt because of pv,.evt!jf oxidase
iii. En;z.yl'Vtes { Urease
LPv,.osp/,,.o/ipo.se
Dia,gnos(s:

• SpeciMens : 1 . CSF
2 . Ser-11.M
1 .s SDA: Cvea.M!::J white i,-.,,.11.coid./shivt!::) cofovties

.• ·2.' -
0
A Negative stain of Cr:1ptococcus
B. Culture of Cr:1ptococcus on SDA Fifi' :1,.

Opport1,H·1.istic M!jcoses
- Cr~jptococcosis
 3 I

Fig: 2
5til'Yll'Yl"f'!1 of Cr-gptococcus r.eoFot'"l'Vl.ah.S

:2..C(.,{(t(.,{v-e OV\ Bini. seed agav-} Black - ~rowf\. co/oflies

Niger seed agar

3. Urease test

4. "fvla(tese Crosse'' appearaV\Ce:

• Refers to the arraV\geMeV\t of capsu(ar wi..ateria(

seen under po(ari:i.ing wi.icroscope

s.Assiwi.i(ation of IV"losito(, Nitv-ate
ro. M 0lASe pathogeV"licity test

TreatMent:
• For Cryptococcosis without CNS iV\.vofvew.eV\.t: DOC

- F{uCOV\.a:t.Ofe
Cryptococcosis with CNS invo(veMent (foe
exawi.p(e in HIV patieV\t5)
w
IV\.d.uction therapy x 2 weeks with Aw.photericiV\. 13 ±

ffucytosine.

Opportuvi.istic Mt3coses
- Cr!:jptococcosis
 4

,J., fo((owed by
Ov-a( f(CAcovtazofe tti.ev-apy tiff CD4 T - cell coCAvtt
>200/Micv-o(itv-e for- at (east 6 W\Ovttti.5

OpportuVtistic M~c~ses
- Cr4ptococcosis