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Systemic mycoses

 Dimorphic
 Systemic
 Endemic
 All causes pulmonary infections
 Histoplasmosis
 Blastomycosis
 Coccidioidomycosis
 Paracoccidioidomycosis
 Penicilliosis marneffei

 Causative agents –
 H.capsulatum var capsulatum
 H.capsulatum var duboisii
 Both the varieties are thermally dimorphic ie as
mould in nature and in culture at 250C and as an
intracellular budding yeast in tissue and in culture at
 MOULD –white or brown hyphal colonies;two types
of conidia –tuberculate macroconidia and small
oval microconidia
 YEAST-small oval budding yeast for capsulatum and
larger budding yeast for duboisii
 Yeast phase
 Pathogenesis
Geographical regions-
 Histoplasma cap var cap

the eastern half of US ,Latin America
 Histo cap var dub

Tropical areas of Africa
Source- soil containing bird feces
Mode of acquisition –inhalation
The microconidia which is inhaled is converted to the yeast phase within the
pulmonary macrophages (reticuloendothelial cells)
Clinical syndromes-
Var capsulatum

 Large majority of infections are asymptomatic
 In some acute pulmonary histoplasmosis- flulike illness
 In a few ,lymphadenopathy ,arthritis ,mediastinal fibrosis
 In a very few ,disseminated histoplasmosis –higher in children and
immunocompramised adults -weight loss, oral ulcers , hepatosplenomegaly,
anemia, fever
var duboisii-
-African histoplasmosis
-Pulmonary lesions are uncommon
-Lesions of skin and bone
-disseminated form only in the immunodeficient
marked by fever, lymphadenopathy, anemia
 Lab diagnosis
Blood ,bone marrow, scrapings from lesions, urine,
BronchoAlveolarLavage, tissue, sputum
Microscopy-Giemsa, PAS demonstrates the yeast phase
Culture-on Sabouraud’s agar
-presence of tuberculate spores diagnostic
Serology-Ag AND antibody detection-CF,ID,EIA

Amphotericin B followed by oral itraconazole

 Causative agent –Blastomyces dermatitidis
 Dimorphic fungus
 Also called North American Blastomycosis
 Morphology
Exist as mould at 25oC and as yeast in tissue and in
culture at 37oC
MOULD –white to tan filamentous colonies with conidia
located on hyphal branches
YEAST-spherical and reproduce by the formation of
blastoconidia .The buds are single and attached to
the parent cell by broad bases
 Mycelial form
 Yeast phase
 Pathogenesis
 Geographic distribution-North America
(ohio and Mississippi river valleys ),Africa
 Source decaying organic matter
 Mode of acquisition –inhalation of conidia
 Clinical syndromes-
 pulmonary blastomycosis -asymptomatic or mild flu like
illness; Primary infection in the lung and may resemble
tuberculosis or histoplasmosis.
 From the lungs the fungus spreads and form multiple
abscesses in various parts of the body. The ulcerative
lesions are usually on the skin of the face or other exposed
 Lab diagnosis
 Specimens –sputum,BAL,pus ,skin
scrapings ,tissue
 Microscopy –GMS,PAS,Giemsa –typical
broad based budding yeast forms
 Culture-Mycelial form has to be converted to
the yeast at 370C
 Amphotericin B,ITRACONAZOLE

 Causative agents-Coccidioides
 Morphology –
MOULD –INITIALLY white to gray then
matures to brown or lavender;the vegetative
hyphae fragment into arthroconidia
YEAST-endosporulating spherule
 Mycelial form
 Yeast phase
 Pathogenesis –
 Geographical distribution-south western
US,northern mexico
 Source –soil,rodents
 Mode of acquisition-inhalation of
 In most cases asymptomatic infection results
 Many persons develop influenza like fever
 Less than one percent develop ,chronic disseminated
disease(coccidiodal granuloma)
 Lab diagnosis-
 Specimens –sputum,BAL,tissue
 Microscopy –KOH ,H and E,GMS,PAS-
endosporulating spherules
 Culture –
 Serology –ID,LA,CF
 Amphotericin B,ITRACONAZOLE

 Causative agent-Paracoccidiodes
 Also called South American blastomycosis
 MOULD –white colonies,also brownish
colonies –septate hyphae with
 YEAST-oval to round yeastlike cells, multiple
buds (blastoconidia )-mariners or pilot
 Mycelial phase
 Yeast phase
 Pathogenesis
 Geographical distribution –south America
 Source soil likely
 Mode of acquisition –inhalation or
 Clinicalsyndromes-
 May be asymptomatic
 Pulmonary forms
o A chronic granulomatous disease of the skin,
mucosa, lymph nodes and internal organs
 Lab diagnosis-
 Specimens –sputum, BAL, Scrapings of
ulcer, pus, CSF, Tissue
 Microscopy –calcofluor fluorescence,H and
E,GMS-Charac. Multiple budding yeasts
 Culture
 Serology –ID ,CF
 Itraconazole ,amphotericin B