Fungal infection. Jantima Jantima Tanboon,MD

Transcription

1 Fungal infection Jantima Jantima Tanboon,MD

2 Yeast

3 Mold

4 Diagnosis -Wood s light -KOH preparation -Periodic acid-schiff (PAS) -Gomorimethinaminesilver (GMS) -India ink, mucicarminestain -Calcofluorwhite staining -Serologic test -Antigen detection -PCR -Culture

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6 Tissue reaction Tissue reaction -Minimal tissue reaction - Acute inflammatory reaction - Granulomatousinflammatory reaction

7 Minimal tissue reaction

8 Acute inflammatory reaction

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10 Stratum corneum, hair shaft, nail Associated with little or no inflammation - Pityriasisversicolor - Tineanigra - Black piedra - White piedra

11 - Synonym: Pityriasis, Tineaalba, Tineaversicolor - Malasseziafurfur, M. sympodialis, M. ontusa, M. globosa, M. restricta, M. slooffiae, M. pachydermatitis - Asymptomatic: Scaly well-delineated hypohyper pigmented macules - Catheter-related fungemia

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13 Diagnosis: -Wood s light: fluorescence yellow green -Skin scraping with KOH

14 -Dermatiaceousfungus -Hortaeawerneckii(Exophialawerneckii) -Palms, any glabrous region -Tineamanuum-or Tineacorporis-like

15 -Colonizationofthehairshaft -Black Piedra:Piedraiahortae -White Piedra:Trichosporonspp

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17 -Deeper layers of skin, hair and nails -Accompanied by inflammation Dermatophytosis Dermatophytosis 1.Trichophyton skin, hair, nails 2.Microsporum skin, hair 3.Epidermophyton-skin, nail Keratinophilic, Tinea Tinea not Taenia

18 -Ringworm -Annular scaly patches with raised erythematousvesicular borderswithcentralclearing -Interdigitalcracking scaling and maceration, hyperkeratosis and peeling of soles -Diffuse scaly scalp to scatter area of scales with/without alopecia

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21 - Presumtivediagnosis - Wood s light - Wet preparation (KOH)

22 - Nail infections - Dermatophyte(80-90%) or Non-dermatophyte - Tineaunguium-dermatophyte - Molds-Scopulariopsisbrevicaulis. - Yeast-Candida albicans

23 -Mycetoma - Sporotrichosis - Chromoblastomycosis -Phaeohyphomycosis, Hyalohyphomycosis

24 -Sporothrixschenckii -Traumatic innoculation, cats, armadillos -Occupational disease: Agricultural Clinical symptoms: 1.Fixed cutaneoussporotrichosis 2.Lymphocutaneoussporotrichosis 3.Osteoarticularsporotrichosis 4.Pulmonary sporotrichosis 5.Disseminated sporotrichosis

25 Diagnosis: Histopathology Histopathology Culture

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27 -Trauma Chronic suppurativeinfection -Subcutaneous tissue fascia, bone Synonym: Madurafoot,maduromycetoma,maduromycosis Clinicalsyndrome: Tumefaction Draining sinuses Sclerotia(granules, grains)

28 (1) Actinomycotic mycetoma Actinomycetes, Nocardia basiliensis, Streptomyces somaliensis, Actinomaduramadurae, Actinomadurapelletieri (2) Eumycotic mycetoma (dermaticeous/non) Madurellamycetomatis, Pseudallascheriaboydii

29 - Acremonium falciforme (white) - Acremonium recifei (white) - Aspergillus nidulans (white) - Exophiala jeanselmei (black) - Leptosphaeria senegalensis (black) - Madurella grisea (black) - Madurella mycetomatis(black) - Neotestudina rosatii (white) - Pseudallesheria boydii (white to yellow) - Pyrenochaeta romeroi (black)

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32 -Chromomycosis, Chronic subcutaneous mycosis -Dematiaceous(brown, black-pigmented) fungi - Fonsecaeapedrosoi,F. compacta, Phialophora verrucosa,rhinocladiella aquaspersa Cladosporium (Cladophilalophora) carrionii, -Soil, Thorn, bits of vegetation -Slow growing verrucous plaques/nodules

33 Diagnosis: Histology: Scraping, biopsy -Muriformcells:horizontal and vertical dividing walls -Sclerotic bodies copper pennies, 5-15μm, septate -Dark-walled septate/ non septate hyphae Culture

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35 -Dermatiaceous fungi (no muriform cells) -Exophiala jeanselmei, Wangiella dermatitidis, Bipolaris spp Traumatic implantation4 clinical forms: 1.Superficial 2.Cutaneous-corneal 3.Subcutaneous 4.Systemic

36 Diagnosis: Histopathology: Cyst, fibrous capsule, Granulomatouswall, necrotic center Culture

37 -Melanin-free molds -Fusarium, Scopulariosis, Paecilomyces, Acremonium, Scedosporium -Clinical: Same as Phaeohyphomycosis

38 - Candida albicans, C. guilliermondii, C. krusei, C. parapsilosis, C.,tropicalis, C. kefyr,, C. lusitaniae, C. dubliniensis,,c. glabrata - Ubiquitos - Blastospore, hyphae, pseudohyphae

39 Mucocutaneous candidiasis -Oralthrush(CD / 500/μl) - Vulvovaginal candidiasis (CD4 >500/ μl) - Esophageal candidiasis (CD4 <100/μl) - Cutaneous candidiasis: Chronic mucocutaneous ccandidiasis Deeply invasive candidiasis

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42 Diagnosis: -Wet mount (Saline and 10% KOH) -Gram s stain, PAS, GMS -AbsenceonH+E DOES NOTexclude -β-glucantest (research)

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44 -Yeast -Inhalation clearance or latent state -Polysaccharide capsule, melanin, enzymes -Little or no inflammatory response

45 -Chronic meningoencephalitis -Pulmonary cryptococcosis -Skin infection in disseminated infection Diagnosis: -Histopathology: GMS, mucicarminestain -India ink (CSF) -Culture -CSF examination (mononuclear, protein ) -Cryptococcalpolysaccaharideantigen (CRAg) in serum and CSF

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48 - Aspergillous fumigatus, A. flavus, A. niger, A. nidulans, A. terreus - Mold with septate, acute angle,branching hyphae - Dead leaves, stored grain, compost piles, hay, other decaying vegetation

49 -Profound neutropenia, glucocorticoid use, neutrophil and/or phagocytic dysfunction CD4 <50/μl

50 -Invasive pulmonary aspergillosis -Invasive sinusitis -Disseminated aspergillosis -Cerebral aspergillosis -Aspergillus endocarditis -Cutaneous aspergillosis -Chronic pulmonary aspergillosis

51 -Aspergilloma -Chronic sinusitis -Allergic bronchopulomonary aspergillosis -Severe asthma with fungal sensitization (SAFS) -Allergic sinusitis -Superficial aspergillosis

52 Diagnosis: -Histopathology -Culture -Aspergillusantigen test (galactomannan) -Serologic study

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54 Mucormycosis - Rhizopus, Rhizomucor, Cunninghamella - Apophysomyces, Saksenae, Mucor, Absidia Air- borne - Percutaneous exposure, ingestion - Paranasal sinuses, nose - lung - GI tract Entomophthoramycosis - Basidiobolus, Conidiobolus - Subcutaneous or paranasal sinus infection Decaying vegetation, dung, foods with high sugar

55 - Uncommon, confined to pt with preexisting diseases diseases - Neutropenia eutropenia, corticosteroid use, diabetes mellitus mellitus and breakdown of the cutaneous barrier (e.g., as a result of burns, surgical wounds, trauma) - Poorly controlled DM, organ transplant, hematologic malignancy,, deferoxamine therapy

56 -Rhinocerebral mucormycosis -Pulmonary mucormycosis -Gastrointestinal mucormycosis -Cutaneous mucormycosis

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58 - Histoplasma capsulatum var. capsulatum - Histoplasma capsulatum var. duboisii - Moist surface soil, birds/bat dropping - Mycelia Microconidia/macroconidia Yeast - Intensity, immune status, underlying lung disease

59 Immunocompetent: - Asymptomatic, mild, self-limited, - Smoker: Chronic cavitary histoplasmosis Immunocompromised: - CD4<200/μL, extremes of ages, drugs - Progressive Disseminated Histoplasmosis (PDH) Complication: Fibrosing Mediastinitis

60 Diagnosis: -Histopathology, Cytopathology -Culture -Histoplasmaantigen detection in serum, CSF -Histoplasmaantibody detection in urine, serum

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62 -Penicillium marneffei - Immunocompromised, CD4<100/μl - Clinical: similar to disseminated histoplasmosis - Skin lesion: papules similar to molluscum contagiosum - Abscess, Granuloma Diagnosis: - HistopathologyCulture

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64 -P. jirovecii(human),p. carinii(rat) -Immunocompromisedhost, CD4 <200/μl -Air-borne, Person-Person -Alveolar macrophages -Pulmonary pneumocystis infection -Disseminated pneumocystis infection

65 -CXR: Bilateral diffuse infiltrate begin at perihilar, pneumothorax -High-resolution CT: Ground-glass opacities

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