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Opportunistic Fungi

Opportunistic fungi are able to causes disease in immunocompromised patients.

Opportunistic fungi includes:

  • a. Candida albicans.

  • b. Cryptococcus neoformans.

  • c. Aspergillus fumigatus.

  • d. Mucor & Rhizopus species.

  • e. Pneumocystis carinii.

Candida albicans

Characteristics:

● Normal flora of mucous membranes of upper respiratory tract, gastrointestinal tract and genital tract.

● Yeast as normal flora, Pseudohyphae and hyphae when invade tissue.

Candida albicans

Transmission: As part of normal flora, no need of transmission.

Clinical findings:

Thrush: Over growth of C. albicans occurs in the mouth and produces white patches. Common in infants, immunocompromised patients.

Vulvovaginitis: Itching and whitish discharge.

Candida albicans

Skin lesion: Warm & moist areas become red and weeping. Fingers and nails of persons employed as dish washers are involved.

Disseminated infection: Such as endocarditis, esophagitis, & endophthalmitis can occur.

Chonic mucocutaneous candidiasis: Occurs in children with T- cell defect immunity.

Candida albicans Skin lesion: Warm & moist areas become red and weeping. Fingers and nails of

mucocutaneous

candidiasis

Laboratory diagnosis

Sample: According to the site of lesion. Microscopy: Microscpic examination of tissue reveals yeast and pseudohyphae. The yeast is gram-positive. Culture: On sabouraud’s agar media colonies are formed. Germ tube formation and production of chlamydospores distinguish C. albicans from other species of Candida.

Laboratory diagnosis  Germ tube test:  Inoculate yeast into serum  Results in germinated hyphae

Laboratory diagnosis

Germ tube test:

Inoculate yeast into serum

Results in germinated hyphae (within 2 hrs at 37 O C for C.albicans)

Specific for C.albicans although C.tropicalis sometimes (rarely) produces germ tubes

Laboratory diagnosis  Germ tube test:  Inoculate yeast into serum  Results in germinated hyphae

Germ tube test

Candida albicans

Candida albicans Colony on SDA

Colony on SDA

Candida albicans

Candida albicans Mycelium and Vaginal swab blastospores in urine
Candida albicans Mycelium and Vaginal swab blastospores in urine

Mycelium and

Vaginal swab

blastospores in urine

Cryptococcus neofornans

Characteristic:

Oval budding yeast.

Have a wide polysaccharide capsule.

Habitat in the soil containing bird dropping.

Transmission: by inhalation.

Cryptococcus neofornans  Characteristic:  Oval budding yeast.  Have a wide polysaccharide capsule.  Habitat

Cryptococcus neofornans

Clinical feature:

٭ Lung infection is often asymptomatic or may produce flu-like disease or pneumonia.

٭ They spread via blood stream to the meninges and other system in patients with reduced cell mediated immunity.

٭ But some cases of meningitis may occur.

Laboratory Identification

Microscopy: Visualization of encapsulated yeast in India ink preparation. Gram stain is unreliable but stains such as methenamine- silver, periodic acid-Schiff will allow the organism to be visualized.

Culture: On sabouraud’s agar produces colonies of yeast.

Serlogy: Capsular polysaccharide antigen can be detected by latex-agglutination test.

Cryptococcus neoformans
Cryptococcus neoformans

Colonies on SDA

CSF, India ink, capsule

Cryptococcus neoformans CSF, India ink, capsule Lung section, ecapsulated cells
Cryptococcus neoformans CSF, India ink, capsule Lung section, ecapsulated cells

Lung section, ecapsulated cells

India ink, phase contrast

Aspergillus

Common species: A. fumigatus, A. flavus, A. niger.

Medical importance: Aspergillus species especially, A. fumigatus cause infections of skin, ears, eyes, “fungus ball” in the lungs.

Aspergillus

Transmission: Inhalation of airborne spores.

Clinical feature: Can colonize and invade abraded skin, wound, burn, cornea, ear and paranasal sinuses.

In immunocompromised persons invade blood vessels causing thrombosis and infarction.

A person with lung cavity e.g; from tuberculosis may develop a fungal ball.

Laboratory Identification

Microscopy: Biopsy specimen shows septate, branching hyphae.

Culture: On sabouraud’s agar produces colonies with characteristic radiating chains of conidia from central stalk.

Colony on SDA
Colony on SDA
Hyphae in lung section
Hyphae in lung section
Aspergillus  Detection of antibody: Patients with allergic bronchopulmonary aspergillosis have high titer of specific IgE

Aspergillus

Detection of antibody: Patients with allergic bronchopulmonary aspergillosis have high titer of specific IgE antibody.

Detection of antigen: Patients with invasive aspergillosis, their may be high titer of galactomannan antigen.

Pneumocystis carinii  Trophozoite and cyst forms, therefore thought to be a protozoan  Responds to

Pneumocystis carinii

Trophozoite and cyst forms, therefore thought to be a protozoan

Responds to protozoan drugs, not to fungal drugs

But now classified as a fungus (by rRNA sequencing)

Pneumonia-like disease, especially in immunocompromised Common killer in AIDS