Medical Mycology

Omer Ali Hassen

MSc Medical Microbiology, Mekelle University,
Eth.
Tel: +252-63-4420144
Email:omarh431@gmail.com
 Definitions
 General characteristics of fungi
 Morphology of the Fungi
Definitions:
 Mycology is the study of fungi that infect human
Myco = Fungi, logy = the study of
 Fungi are eukaryotic organisms that contain a well-defined
nucleus, mitochondria, Golgi bodies, and endoplasmic
reticulum
◦ They resemble plants but lack the definite root, stem, and
leaves of highly organized plants.
◦ All are eukaryotic, non-photosynthetic organisms usually
enclosed by cell walls composed of chitin
◦ And a cell membrane containing Ergosterol as place of
cholesterol
 Macroscopic fungi
 Often called fleshy fungi

 Are filamentous organisms- Mushroom

 Produce the large reproductive structures

 Microscopic fungi exist as either

 Molds-filamentous that grow on bread, fruits and cheese or

 Yeasts-budding yeas- used in baking

 Presence of cell walls.
 Cell walls are composed of chitin, a polysaccharide of N-
acetyl glucose amine subunits

 Fungi are non-photosynthetic organisms

 Do not contain chlorophyll
 Are unable to manufacture their own nutrients,
 Depend on an external source of organic compounds for
growth and survival.
 Nutrients are usually obtained from dead organisms,
 Some fungi use living a tissue as a food source
 They lack motility
 Fungi are not motile.

 They are eukaryotic (eu=true, Karyote = nucleus)

cells
 Have distinct nucleus surrounded by a membrane that
separates it from the other contents of the cell.

 Is common to the fungi, algae, and protozoa as well as to

more complex multicultural organisms including
humans.
 Fungican be:
- Saprophytic : feed on dead tissues or organic
waste (decomposers)

- Symbionts: mutually beneficial relationship between a

fungus and another organism

- Parasites : feeding on living tissue of a host.

Parasites that cause disease are called pathogens.
 Fungi
 Are generally larger than bacteria
 With individual cell diameters ranging from 1 to 30 µm.
 May be :
 Mono morphic, existing as single celled yeast
 Multi-cellular filamentous mold: or
 dimorphic (di= two, morph = form) existing as
yeast or mold depends on temperature condition
Fungal cell structure
 ◦ Is a microscopic fungus that forms large, multi-cellular
aggregates of long tube like branching filaments called hyphae
and mold spores.

A. Hyphae
◦ is the basic microscopic unit of the molds

◦ responsible for the fluffy appearance of the macroscopic mold

colony.
◦ grow as an intertwined mass of filaments collectively called
mycelium, (penetrates nutrients )
 Are classified and identified partially on the basis of
whether the hyphae are sepatate or aseptate.
 Sepatate hyphae
 filaments with cross-walls or
 septa that partition the hyphae in to individual
cellular compartments.
 have spores that allow the migration of
cytoplasm and many organelles.
 In aseptate hyphae - no physical boundaries to
distinguish individual cells in the hyphae.
(a) septate hyphae (b) aseptate hyphae
Types of hyphae
 Vegetative (mycelium)
 Nutrient absorbing and water exchanging
portion of the fungi is called Grows in or on a
substrate.
 Are actively growing and form the main body
of the colony.
 Arial hyphae,
 Fungal filaments or hyphae that protrude above
the surface
 Produce asexual spore
 Reproductive structures of fungi capable of generating
a new colony in a favorable environment.

 Produced by specialized regions at the end of aerials

hyphae, although some spores are formed from
vegetative hyphae.

 Have the following characteristics:

 They are produced in large numbers
 They are easily disseminated
 Some are resistant to conditions that would
kill the vegetative cells.
 Collective functions of mold spore are;
 Production, dissemination, and protection of the species
against adverse environmental conditions.

 Many fungi can produce both sexual and asexual

spores.

 Fungi that exhibit sexual phase are known as the

perfect fungi

 Sexual spores are rarely agents of human disease.

 Structures that contain sexual spores in fungi are

called fruiting bodies.
Types of spores
Basidiospores
 Mush room is a common fungal fruiting body that produces
basidiospores,
 Spores formed at the tip of a club like structure called a
basiduim (plural, basidia). ]
 The underside of the mush room looks like compartments
separated by vertical walls called gills.
 These gills are covered with basidium.
 Beneath the mushroom, in the soil, is the mold colony itself,
consisting of a mat of intertwined hyphae
Ascospore –produced by Ascomycetes
 Ascospore is found in a sac-like structure called an
ascus (plural asci)
 several asci are usually contained in a single large
fruiting body.
Zygospores
 are not associated with well-developed fruiting bodies.

 are encased in a thick, darkly pigmented wall - makes resistant

to extremes in temperature and desiccation.
Oospores
 are also not associated with well-developed fruiting
bodies.

 are large flagellated spores produced by certain

aquatic fungi.
 are usually large

 single cells (5 to 8 µm
in diameter

 rarely form filaments.

 colonies are usually

characterized by a
smooth surface
Yeast structure and reproduction
A. asexual spore - Blastospore

Binary fission:
 is a process of asexual reproduction whereby one cell
divides into cells of equal size.

 Only few yeasts reproduce by binary fission,

 Many yeast reproduce by the asexual process of budding.

Budding:
 progeny arise from protuberance on the surface a
parent cell.

 The parent cell produces a growing bud/ blastospore

that eventually acquires a full complement of cellular
components.

 The bud breaks away from the large parent cell and
grows to full size.

 A scar is formed on the parent cell in the region of bud

detachment.
 No new buds can form in this area, so yeast stops reproducing
when there is no unscarred surface left.

 Some times secondary buds develop on a daughter bud before

it separates from the parent yeast cell.

 Extreme expression of the “bud-on-bud” phenomenon may

account for the occasional development of chains of elongated
yeast cells called pseudohyphae (false hyphae),
Psuedohyphae
 Sexual reproduction in yeast begins when meiosis in a diploid
yeast cell produces four or more thick-walled, dormant
haploid spores inside the parent yeast cell.

 In most yeast, the cell wall of the parent cell becomes an

ascus, a sac containing the spores.

 The sexual spores of most yeasts are therefore ascospores.

 The haploid ascospores join with opposite mating types and

fuse to re-form a diploid, actively budding cells.
 Some fungi grow only in the yeast form; others
grow only as molds.

 Many species can be either molds or yeast,

depending on growth conditions

 For example, many fungi grow as molds at room

temperature (240c) but transforms into yeasts at
human body temperature (370c)

 Most of the more dangerous human pathogenic

fungi are dimorphic
 Dimorphism..

Figure Diagrammatic representation of the saprophytic and invasive

tissue forms of pathogenic fungi 30
Sexual reproduction
A hypha (plural hyphae) is a long, branching filamentous cell.
hyphae are the main mode of vegetative growth, and are
collectively called a mycelium.

Mycelium: the intertwined mass of hyphae that forms the

mold colony. The vegetative mycelium is composed of those
hyphae that adhere to the substrate and absorbs nutrients.
The aerial mycelium is composed of those hyphae that grow
up from the surface and support the spores.

Septate: Cross-walls (septae) that divide hyphae into

segments. If there are few or no cross-walls the hyphae
are considered to be aseptate.
Mold (sometimes spelled ‘mould’): is a morphological term
referring to a filamentous (multicellular) fungus.

Yeast is a morphological term referring to a unicellular fungus.

DIMORPHIC FUNGI: This class of fungi is characterized by two forms of growth:

1. Growth as a mold with septate hyphae in their natural reservoir (e.g. soil) or when
incubated at 25° C. on conventional fungal media (Sabouraud dextrose or potato
dextrose agars).
2. Growth as a yeast in the tissues of an animal/person or when incubated at 37° on
enriched media (Brain heart infusion agar).
Conidia (singular = conidium): asexual spores borne
externally on hyphae or on a conidiophore.

Conidiophore: the specialized hyphal stalk on which

conidia develop either singly or in Clusters.

Conidia

Conidiophore
Sporangia (singular = sporangium): spherical sack within
which asexual spores (sporangiospores) form by
progressive cytoplasmic cleavage.
Sporangiophore - specialized hyphal stalk which bears
sporangia.
Sporangiospores: small spores contained within
sporangia.
Sporangiospores

Sporangium

Sporangiophore
Germ-tube: The initial hyphal outgrowth of a germinating
spore or yeast; especially important for identification of
Candida albicans.
Pseudohyphae (or Pseudomycelium):
chains of successively budding
yeast cells that have complete cell
walls, but have not detached from
one another.
Rhizoid: rootlike branched hyphae which
anchor the mycelium to the substrate;
characteristic of certain Zygomycetes
(Rhizopus and Absidium).
Generally fungi do not cause acute infection like bacteria
and viruses.
Relatively few fungi are sufficiently virulent
Most fungi are opportunistic pathogens, however some
fungi are primary pathogens.
Some Fungi that cause infection to healthy individuals
including:
Blastomyces dermatitidis, Concidioides immits (and
concidioides posadisii), Histoplasma capsulatum and
Paracoccidioides bransiliensis.
Transmission is mainly through respiratory route.
Others cause only when host defense decreases such as:
Candida spp, Cryptococcus neoformans and
Aspergillus spp.
1. Dimorphism- e.g Histoplasma capsulatum, C.
immitis reach alveoli as an alternate (yeast or
spherule form)
- Aids fungi to cope with hostile environment of host
- Surface proteins – present in yeast but not in the conidia
(example, C. immitis has 120 kDa GP present expressed
in the yeast form that plays role in its pathogenecity by
facilitating adherence to the cells
2. Resistance to phagocytic killing- e.g. Surface structure
of B. brasileinsis
3. Production of extra-cellular enzymes (protinases) –
breaks down human collagen, elastin and heamoglobin

4. Cell wall antigens- 1,3, alpha-glucan of P.bransiliensis

5. Capsule production- Cryptococcus neoformans – anti-phagocytic

6. Production of toxin – Aspergillus spp-

 Immunity defense against fungi mainly relies on innate
immunity

 Cellular Medicated Immunity (CMI) is important.

 Humoral Immunity (HI) has little role although in

some infections, certain type of antibody responses are
protective (Crytococcal infection)
There is no routine fungal vaccine due to:

1. Little knowledge on how our IS recognize and

protect from fungal infection.

2. Cause to self limiting infections (tinea pedis)

3. Most of those affected with systemic or life

threatening fungal infections are
immunocompramized individuals thus giving
vaccine is ineffective.
❑ Fungi are Ubiquitous - found every where (soil, air, water) and
worldwide
❑ Generally they do not cause acute or serious disease like
bacteria and viruses but mainly damage the skin or affect body’s
cosmetic
❑ Like humid environment

❑ Transmission to human mainly occur:

1. Inhalation – Respiratory
2. Dermal inoculation through (trauma, insect bite, open wound)
3. Close contact (sharing of clothes and cosmetics)
❑ With the increasing of immunosuppression conditions fungi
become important pathogens worldwide
 Fungus classified in to five categories based on
 spore types
 morphology of hyphae,
 sexual cycles.

 These groups are:

 oomycetes,
 zygomycetes,
 ascomycetes,
 Basidiomycetes
 deuteromycetes.
 Except for the deutermycetes, all fungi produce sexual
spores‘

 asexual spores that are generally responsible for

initiating human infection.
 Characterized by the production of flagellated asexual zoospores.
 Chemtactic and can direct themselves toward suitable nutrients
within their local environment.
 Following germination, the flagella are lost and non- motile
vegetative cells develop.
 Many are unicellular; others are composed of asptate hyphae.
 Eg. Phytophthora infestans- it is the etiologic agent of potato
blight.
 Are characterized by aseptate (coenocytic) hyphae asexual
sporangiospores, and sexual zygospores.

 For example, Rhizopus nigricans (black bread mold) and

Mucor - common soil fungi.

 are usually harmless to humans but cause Allergic reaction

and asthma

 occasionally they cause serious disease in diabetic individuals

and other people with lowered resistance to infection.
 used in the industrial production of
 tempeh (an Asian food)

 the enzyme rennet, which is used in cheese

production

 beta-carotene (nutrional supplement coloring

agent for margarine)

 in the synthesis of steroids.

 Includes yeasts, morels, truffles, and many of the
common molds that can produce ascospores.

 The word “ascus” means a bag or sac- like structure,

 Include many fungi beneficial to man, such as the

yeasts of the genus saccharomyces that leaven bread
and ferment alcoholic beverages.

 Ascomycota account for more than 60% of the known

fungi and about 85% of the human pathogens
They include fungi as:
Pencillum notatum
 mold that used to produces the antibiotic
penicillin.

A mold Aspergillus
 common microbial contaminants.

 causes a fatal pulmonary disease

(Aspergillosis) in people with lowered
resistance.
➢ Dermatophytes- Cuteneous mycosis
➢ Histoplasma- systemic fungal infection
➢ Fusarium- keratitis, allergic diseases (Sinusitis)

➢ Blastomyces- blastomycetic dermatitis

➢ Candida albican- vulvovagintis, Oral trash

➢ Claviceps purprea (ergot fungus)

 Produces a potent toxin that causes
spasm of the smooth muscle.
 consists of higher fungi that produce exogenous
sexual basidiospores on a basiduim or base and
separate hyphae.

 Cryptococcus, Malassezia, Trichosporan)

 Also includes mushrooms, toad stools, and puffballs
are considered fleshy fungi;

 their sexual spores are borne in usually fleshy

fruiting bodies.
 Some fungi have no known sexual cycle of
reproduction called the” imperfect stage”.

 These organisms are all grouped with the

deuteronmycetes.

 Since sex is either non existent or undiscovered in

these organisms, they are commonly called the
imperfect fungi.
Classification
Example

KINGDOM Fungi
PHYLUM Ascomycota
CLASS Saccharomycetes
ORDER Saccharomycetales
FAMILY Saccharomycetaceae
GENUS Candida or Candida
SPECIES albican

57 57
 Some fungi acquire nutrients by attacking live animals or
plants.

 Of the 5 Million known species of fungi, about 300 have been

associated with human infection.

 The disorders are usually slowly progressing and range from

very mild disease of the skin and hair that most people know
of as a ring worm to overwhelming invasion of the entire
body
1.7.1 Fungal Allergies
 Fungal allergies are common;

 Molds grow on any damp/moist organic surface, and spores

are constantly in the air.

 Spores and volatile fungal toxins may play a role in “sick

building syndrome”.

 Generally occurs in individuals with other allergies.

 Some fungi produce toxic substances that poison a person who
ingest them get poisoned.

 These poisonous substance are collectively called

mycotoxicosis (myco= fungus, toxin= poison).

 Mycotoxcosis may result from ingestion of fungal

contaminated foods. Example – Poisonous mushroom,
Apergillus toxins.

 Most fungal toxins are produced when the fungus grows in

moist environment at relatively high temperature.
 Fungi cause some of the most persistent and disfiguring
disease still prevalent through out the world.
 Diseases caused by fungi are collectively called mycoses
(singular, mycosis).
 The incidence of the disease (infection) is related to the
degree of exposure to fungi in living conditions, occupation,
and leisure activities and to immune status.
 There are four general categories on the basis of the primary
tissue affinity of the pathogen.

 There are 5 types of fungal infection

◦ Are fungal infections confined to the outer most
dead layers of skin, hair and nails

◦ Symptoms - discoloration, scaling, or de-

pigmentation of the skin.

◦ Do not elicit a cellular response from the host.

◦ Infections are generally painless.

 Restricted to keratinized layer of the skin
(epidermis), hair, or nails.

 Elicit an inflammatory response, resulting in more

serious skin diseases with uncomfortable painful and
sometimes even crippling symptoms.

 Symptoms - include
 Itching, Scaling or ring like patches of the skin;
 Brittle or broken hairs;
 Thick discolored nails.
• Are infections confined to :
• The subcutaneous tissue (dermis or fatty tissues)

• The deeper layer of the skin

• Symptoms include :
• Ulcers, that progress and do not heal and the
presence of draining sinus tracts.
 Are caused by pathogenic and/or opportunistic fungi
affect internal organs or tissues of the body.

 Symptoms
 very general as fever, and fatigue;
 a chronic cough and chest pain.

 Are infections caused by a group of fungi which

cause infections in patients who are
immunocompromised,
 Infections due to fungi of low virulence in
patients who are immunologically compromised
Increased moisture
◦ It creates a more hospitable environment for
proliferation of pathogens.

◦ Use absorbent powders and cloths made of fabrics

that allow evaporation to keep surface dry to
prevent the disease.

Obesity
◦ Obesity promotes accumulation of surface moisture
in body folds.
Invasive medication procedures
◦ It disrupts the physical integrity of the skin.
◦ To prevent the disease, always follow aseptic
technique.

Wounds
 Exposes the underlying tissue to environment that
facilitates their development of skin infection.

 Disease can be prevented by practicing good hygiene

and sanitary habit to prevent wound colonization.
Tight clothing
 It also disrupts the physical integrity of skin through continual
abrasion.
Underlying debilitating disease
◦ Cause malfunction of the immune system
◦ Decrease phagocytic function.
 Diabetics
 Impairs granulocyte function
 May prevent protective cells in circulation from
reaching local tissues
 HIV infection
 Defect in cells of the immune system lead to practical
or complete loss of immunity
Prolonged administration of corticosteroids or antibiotic or
chemotherapy
 It decrease rate of surface shedding.
 Discontinue the medication to allow normal epithelial shedding to
resume.
Malnutrition
 It impairs immunologic system.

Burns
 Expose the underlying tissue, diminish immunologic capacity.