FUNGAL INFECTIONS

By: Laith Hattab

Supervised by: Dr. Hassan Addi

Step up to medicine
Outline

• Candidiasis

• Aspergillus

• Cryptococcosis
Candidiasis
General Characteristics
1. Candida species are oval, budding yeasts known for their
formation of hyphae and long pseudohyphae.They normally
colonize humans, and it is the overgrowth of these organisms that
results in the clinical pathology of candidiasis.

2. Candida albicans is the most common cause of candidiasis

3. Risk factors for candidiasis

a. Antibiotic therapy
b. Diabetes mellitus
c. Immunocompromised hosts (increased risk for
both mucocutaneousand systemic candidiasis)
Candidiasis
Clinical Features
1. Typical presentation is the mucocutaneous growth. The most common
affected areas are:
a. Vagina—“yeast infection”
This results in a thick, white, “cottage cheese-like” vaginal discharge .The
discharge characteristically is painless but does cause pruritus

b. Mouth, oropharynx—“thrush”
This causes thick, white, scrapable plaques that adhere to the oral mucosa
usually painless unexplained oral thrush should raise suspicion of HIV
infection

c. Cutaneous candidiasis
This causes erythematous, eroded patches with “satellite lesions”. It is more
common in obese diabetic patients; it appears in skin folds (e.g.,
axilla, groin, underneath breasts) and in macerated skin areas
Candidiasis
d. GI tract (e.g., esophagus)
Candida esophagitis may cause significant odynophagia
It may also be asymptomatic

2. Disseminated or invasive disease may occur in

immunocompromised hosts. Manifestations include
sepsis/septic shock, meningitis, and multiple abscesses in
various organs.
Candidiasis
Diagnosis
1. Mucocutaneous candidiasis diagnosis is primarily clinical; KOH
preparation demonstrates yeast.
2. Invasive candidiasis is diagnosed by blood or tissue culture.

Treatment
1. Remove indwelling catheters or central lines.
2. Acceptable treatments for oropharyngeal candidiasis.
a. Clotrimazole troches (dissolve in the mouth) five times per day.
b. Nystatin mouthwash (“swish and swallow”) three to five times per day;
only for oral candidiasis.
c. Oral ketoconazole or fluconazole for esophagitis.
3. Vaginal candidiasis—miconazole or clotrimazole cream.
4. Cutaneous candidiasis—oral nystatin powder, keeping skin dry.
5. For systemic candidiasis, use amphotericin B or fluconazole. New,
Candidiasis

Oral thrush
Aspergillus
General Characteristics
1. Aspergillus spp. spores are found everywhere in the
environment. Typically, disease occurs when spores are
inhaled into the lung.

2. There are three main types of clinical syndromes

associated with Aspergillus

3. Invasive aspergillosis is usually limited to severely

immunocompromised patients.
It should be considered in any immunocompromised patient
with fever and respiratory distress despite use of broad-
spectrum antibiotics.
Aspergillus
Clinical Features
1. Allergic bronchopulmonary aspergillosis.
a. A type I hypersensitivity reaction to Aspergillus.
b. It presents with asthma and eosinophilia. Recurrent
exacerbations are common.

2. Pulmonary aspergilloma.
a. Pulmonary aspergilloma is caused by inhalation of spores into
the lung. Patients with a history of sarcoidosis, histoplasmosis, TB,
and bronchiectasis are at risk.
b. It presents with chronic cough; hemoptysis may be present as
well.
c. It may resolve spontaneously or invade locally.
Aspergillus
3. Invasive aspergillosis.
a. This occurs when hyphae invade the lung vasculature,
resulting in thrombosis and infarction.
b. Hosts are typically at-risk patients with acute leukemia,
transplant recipients, and patients with advanced AIDS.
c. It usually presents with acute onset of fever, cough,
respiratory distress, and diffuse, bilateral pulmonary
infiltrates.
d. It is transmitted via hematogenous dissemination, and
may invade the sinuses, orbits, and brain.
Aspergillus
Diagnosis
1. CXR reveals a dense pulmonary consolidation and
sometimes a fungus ball.
2. Definitive diagnosis of invasive aspergillosis is by tissue
biopsy, but diagnosis is presumed when Aspergillus is
isolated from the sputum of a severely
immunocompromised/neutropenic patient with clinical
symptoms.
3. Blood cultures are usually not helpful because they are
rarely positive.
Aspergillus
Treatment
1. For allergic bronchopulmonary aspergillosis, patients should
avoid exposure to Aspergillus; corticosteroids may be
beneficial.

2. For pulmonary aspergilloma, patients with massive

hemoptysis may require a lung lobectomy.

3. For invasive aspergillosis, treat with IV amphotericin B,

voriconazole, or caspofungin.

4. Suspicion of head or brain involvement warrants prompt

evaluation (imaging studies). Surgery may be required.
Cryptococcosis
General Characteristics
1. Caused by Cryptococcus neoformans, a budding, round
yeast with a thick polysaccharide capsule

2. Associated with pigeon droppings

3. Most commonly seen in patients with advanced AIDS

4. Infection is due to inhalation of fungus into lungs.

Hematogenous spread may involve the brain and meninges
Cryptococcosis
Clinical Features
1. CNS disease—meningitis or meningoencephalitis; brain
abscess is also possible
a. CNS disease is a life-threatening condition that requires
aggressive treatment.It should always be on the differential
diagnosis of an HIV-positive patient with a fever and
headache. If untreated, it is almost invariably fatal.
b. Symptoms include fever, headache, irritability, dizziness,
confusion, and possibly seizures. The onset may be
insidious.
2. Isolated pulmonary infection may also occur.
Cryptococcosis
Diagnosis
1. LP is absolutely essential if meningitis is suspected.
a. Latex agglutination or ELISA can detect cryptococcal
antigen in the CSF.
b. India ink smear shows encapsulated yeasts.
c. Culture yields cryptococcal colonies in 3 to 7 days.

2. Tissue biopsy is characterized by lack of inflammatory

response.

3. The organism may also be present in urine and blood.

Cryptococcosis
Treatment
1. Use amphotericin B with flucytosine for approximately 2
weeks, followed by oral fluconazole.

2. The duration of therapy varies depending on follow-up

CSF cultures.
Cryptococcosis