Mycoses: Generalities

Dr. Frederick Kechia (PhD) Senior Lecturer

Objectives
to assist you in diagnosing mycotic disease to raise your index of suspicion for mycotic diseases. clinical knowledge

REVIVED INTEREST IN MYCOLOGY

1. 2. 3. 4. 5. 6. Increased frequency of mycotic diseases Increased awareness by physicians Better trained laboratory personnel More invasive procedures used on patients Increased use of immunosuppressive drugs Increase in immunosuppressive disease

Clinical Groupings for Fungal Infections

The following clinical groupings may be recognized:

The Superficial Mycoses The Cutaneous Mycoses The Subcutaneous Mycoses The Systemic Mycoses: Dimorphic and opportunistic

The Superficial Mycoses These are superficial cosmetic fungal infections of the skin or hair shaft. No living tissue is invaded and there is no cellular response from the host. Essentially no pathological changes are elicited. These infections are often so harmless that patients are often unaware of their condition.

Disease Causative organisms Incidence Pityriasis versicolor Seborrhoeic dermatitis including Dandruff and Follicular pityriasis Malassezia furfur (a lipophilic yeast) Common
Tinea nigra Exophiala werneckii Rare

White piedra Trichosporon beigelii

Black piedra Piedraia hortae

Common
Rare

The Cutaneous Mycoses These are superficial fungal infections of the skin, hair or nails. No living tissue is invaded, however a variety of pathological changes

occur in the host because of the presence of

the infectious agent and its metabolic

products.

Disease - Causative organism - Incidence Dermatophytosis,Ringworm of the scalp, glabrous skin and nails. Dermatophytes (Microsporum, Trichophyton, Epidermophyton) Common Candidiasis of skin, mucous membranes and nails. Candida albicans and related species. Common Dermatomycosis Non-dermatophyte moulds Hendersonula toruloidea Scytalidium hyalium Scopulariopsis brevicaulis Rare

The Subcutaneous Mycoses These are chronic, localized infections of the skin and subcutaneous tissue following the traumatic implantation of the aetiologic agent. The causative fungi are all soil saprophytes of regional epidemiology whose ability to adapt to the tissue environment and elicit disease is extremely variable.

Disease Causative organisms Incidence Sporotrichosis Sporothrix schenckii Rare Chromoblastomycosis Fonsecaea, Phialophora, Cladosporium etc. Rare

Phaeohyphomycosis Cladosporium, Exophiala, Wangiella, Bipolaris, Exserohilum, Curvularia Rare

Mycotic mycetoma Pseudallescheria, Madurella, Acremonium, Exophiala etc. Rare Subcutaneous zygomycosis (Entomophthoromycosis) Basidiobolus ranarum , Conidiobolus coronatus Rare

Subcutaneous zygomycosis (Mucormycosis) Rhizopus, Mucor, Rhizomucor, Absidia, Saksenaea etc. Rare
Rhinosporidiosis Rhinosporidium seeberi Rare Lobomycosis Loboa loboi Rare

Dimorphic Systemic Mycoses These are fungal infections of the body caused by dimorphic fungal pathogens which can overcome the physiological and cellular defenses of the normal human host by changing their morphological form. They are geographically restricted and the primary site of infection is usually pulmonary, following the inhalation of conidia.

Disease Causative organisms Incidence Histoplasmosis Histoplasma capsulatum Rare* Coccidioidomycosis Coccidioides immitis Rare* Blastomycosis Blastomyces dermatitidis Rare* Paracoccidioidomycosis Paracoccidioides brasiliensis Rare* *more common in endemic areas.

Opportunistic Systemic Mycoses These are fungal infections of the body which occur almost exclusively in debilitated patients whose normal defense mechanisms are impaired. The organisms involved are cosmopolitan fungi which have a very low inherent virulence. The increased incidence of these infections and the diversity of fungi causing them, has paralleled the emergence of AIDS, more aggressive cancer and posttransplantation chemotherapy and the use of antibiotics, cytotoxins, immunosuppressives, corticosteroids and other macro disruptive procedures that result in lowered resistance of the host.

Disease Causative organisms Incidence Candidiasis Candida albicans and related species. Common

Cryptococcosis Cryptococcus neoformans Rare/Common Aspergillosis Aspergillus fumigatus etc. Rare Pseudallescheriasis Rare Pseudallescheria boydii

Zygomycosis (Mucormycosis) Rhizopus, Mucor, Rhizomucor, Absidia etc. Rare Hyalohyphomycosis Penicillium, Paecilomyces, Beauveria, Fusarium, Scopulariopsis etc. Rare
Phaeohyphomycosis Cladosporium, Exophiala, Wangiella, Bipolaris, Exserohilum, Curvularia. Rare

DIAGNOSTIC DES MYCOSES