Fungal infections

ALMA E. MALILONG, MD, FPSP

Fungal infections
• Infections termed mycoses • Eukaryotes that grow by budding (yeasts) or filamentous extensions (hyphae) • Dimorphic fungiyeast at human body temperature mold form at room temp

Yeasts CANDIDIASIS
• • • • Normal flora of skin, mouth, GIT, vagina Versatile commensals Superficial lesions in healthy persons Disseminated infections in immunocompromised hosts • C. albicans grows best on warm, moist surfaces oral thrush, diaper rash, vaginitis • Diabetics & burn patients susceptible

Yeasts CANDIDIASIS • Introduced via IV lines. DIC . catheters • Associated with neutropenia due to leukemia or anticancer therapy • Course of sepsis less rampant than that of bacterial etiology leads to shock.

morphogenesis.pathogenesis • Phenotypic switching to adapt to changes in host environment • Adhesins for adherece.bind to complement receptor 3 (CR3) and Fcγ receptor • Complex immune response .bind to mannose receptors • Candida hyphae. signalling • Candida yeast.

T-cells.vs cutaneous & mucosal infection • Neutrophils & MN phagocytes. adenosine .pathogenesis • Innate immunity.vs systemic infections • Dendritic cells • Hyphae escape from phagosomes & enter cytoplasm • Enzymes for invasiveness: 9 aspartyl proteinases.

morphology • Blastoconidia. true hyphae (with septae) *pseudohyphae.budding yeast cells joined end-to-end at constrictions. pseudohyphae. thus simulating true hyphae • Special “fungal” stains: Gomori methenamine Ag periodic acid-Schiff .

morphology • Most common. debilitated & immunocompromised patients .superficial infection of oral cavity (thrush) gray-white. dirty-looking pseudomembranes composed of matted organisms & inflammatory debris --mucosal hyperemia deep to the surface -children.

morphology Candida esophagitis • AIDS. pregnant. hematolymphoid malignancies • Endoscopy: white plaques Candida vaginitis • Common vaginal infection • Diabetic. OCPs • Intense itch. thick curdlike discharge .

intertriginous skin • Balanitis.nail folds • Folliculitis.hair follicles • Intertrigo.nail proper • Paronychia.morphology Cutaneous candidiasis • Onychomycosis.penile skin • Diaper rash .

nails • Underlying T-cell defects • Endocrinopathies. hair. hypoparathyroidism. refractory • Skin. Addison’s disease • Dissemination is rare .morphology Chronic mucocutaneous candidiasis • Chronic.

endocarditis • Brain • Endophthalmitis • Hepatic abscesses • Candida pneumonia .morphology Invasive candidiasis Blood-borne dissemination to various organs • Renal abscesses • Myocardial abscesses.

Yeasts CRYPTOCOCCOSIS • • • • • • Cryptococcus neoformans Encapsulated yeast Meningoencephalitis in normal individuals Opportunistic infection.more frequent High-dose corticosteroids a major risk factor Soil & bird droppings inhaled .

Yeasts CRYPTOCOCCOSIS Virulence factors: • Polysaccharide capsule • Melanin production • Enzymes.yeast cells persist within macrophages .laccase • Granulomatous reaction.

thick gelatinous capsule (stains an intense red with PAS & mucicarmine) • Detected by Ab-coated beads. India ink .morphology • Only yeast forms (no hyphal or pseudohyphal forms) • 5-10 μm.

Histopathology of lung shows widened alveolar septum containing a few inflammatory cells and numerous yeasts of Cryptococcus neoformans. . neoformans surrounded by a characteristic wide gelatinous capsule.India ink preparation of CSF showing a typical yeast cell of C. The inner layer of the yeast capsule stains red. Mucicarmine stain. Cryptococcosis of lung in patient with AIDS.

morphology • Lung is the primary site of localization. gray matter.solitary pulmonary granuloma • Major lesions are in CNS— meninges.granulomatous reaction • May disseminate to other organs . basal nuclei • Variable response • Immunocompromised.may have no inflammatory reaction • Healthy patients.

X-ray showing pulmonary cryptococcal infection [right upper lobe]. . MRI scan showing multiple cryptococcomas [white masses] in the brain.

Molds ASPERGILLOSIS • Allergies (brewer’s lung) • Sinusitis.most common species to cause disease . fungemia in immunocompromised patients • Neutropenia. corticosteroids • Saprophytic sporulates to produce conidia (asexual spores)aerosolized • Immune status of host more important than fungal pathogenicity • Aspergillus fumigatus. oneumonia.

Conidia of Aspergillus .

superoxide dismutase enzymes toxins .melanin.pathogenesis • • • • • Transmitted by airborne conidia Major portal of entry: LUNG Small spores (2-3μm) reach alveoli Killed by alveolar macrophages Virulence factors: adhesins antioxidants.

carcinogen made by aspergillus on surface of peanuts—liver CA • TH2 reaction.alveolitis • Allergic bronchopulmonary aspergillosisasthmatic patients– results in COPD .pathogenesis • Aflatoxin.

abscesses.morphology Colonizing aspergillosis (aspergilloma) • Growth in pulmonary cavities with tissue invasion (including nose) • Pre-existing Tb. or chronic inflammation with fibrosis • Recurrent hemoptysis . bronchiectasis. old infarcts • Fungus balls (masses of hyphae) lying free within cavities • Sparse inflammation.

Aspergillosis. or fungus ball in the upper lobe of the right lung. nasal cavity of deer Aspergillus pneumonia in lung . or fungus ball.This chest radiograph shows probable aspergillosis with an aspergilloma. The fungus can then begin secreting toxic and allergic products. Lung diseases that damage a lung can cause cavities that can leave a person more susceptible to developing an aspergilloma.

Human mouth.Aspergillosis. Gomori's silver methenamine stain Lung: Aspergillus hyphae in fungal pneumonia .

morphology Invasive aspergillosis • Opportunistic infection. immunosuppressed & debilitated hosts • Widespread hematogenous spread • Heart valves. brain. rounded gray foci with hemorrhagic borders (target lesions) . kidneys common • Lung: necrotizing pneumonia with sharply delineated.

morphology • Forms fruiting bodies & septate filaments. branching at acute angles (400) • Invade blood vessels hemorrhage & infarction superimposed on necrotizing tissue reaction • Rhinocerebral infection similar to that of mucormycosis . 510μm.

corticosteroids. DM. breakdown of cutaneous barrier (wounds) . class Zygomycetes Rhizopus. Cunninghamella.Molds ZYMYCOSIS (mucormycosis) • • • • • • Opportunistic infection “bread mold fungi”. Mucor Widely distributed in nature Infected immunosuppressed hosts Neutropenia. Absidia.

lungs • Infection following percutaneous exposure or ingestion • Initial defense: macrophages • Neutrophils have a key role in killing during established infection • Proteolytic and lipolytic enzymes • Thermotolerant spores .pathogenesis • Transmitted by airborne asexual spores • Infection in sinuses.

sometime cerebral infarction . GIT • Rhinocerebral mucormycosis spread from nasal sinuses to orbit to brain Local tissue necrosis. arterial wall invasion. irregularly wide (6-50μm) fungal hyphae. sinuses. penetration of periorbital tissues and cranial vault followed by meningoencephalitis. frequent right angle branching • 10 sites of invasion: lungs.morphology • Nonseptate.

distal infarctions .morphology • Lung involvement may be 20 to rhinocerebral disease or primary in immunocompromised hosts Hemorrhagic pneumonia. vascular thrombi.

Lung parenchyma with hyphae .

Involvement of nose. sinuses and orbit Endarteritis caused by mucormycosis .

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