Fungal infection Jantima Jantima Tanboon,MD
Yeast
Mold
Diagnosis -Wood s light -KOH preparation -Periodic acid-schiff (PAS) -Gomorimethinaminesilver (GMS) -India ink, mucicarminestain -Calcofluorwhite staining -Serologic test -Antigen detection -PCR -Culture
Tissue reaction Tissue reaction -Minimal tissue reaction - Acute inflammatory reaction - Granulomatousinflammatory reaction
Minimal tissue reaction
Acute inflammatory reaction
Stratum corneum, hair shaft, nail Associated with little or no inflammation - Pityriasisversicolor - Tineanigra - Black piedra - White piedra
- 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
Diagnosis: -Wood s light: fluorescence yellow green -Skin scraping with KOH
-Dermatiaceousfungus -Hortaeawerneckii(Exophialawerneckii) -Palms, any glabrous region -Tineamanuum-or Tineacorporis-like
-Colonizationofthehairshaft -Black Piedra:Piedraiahortae -White Piedra:Trichosporonspp
-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
-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
- Presumtivediagnosis - Wood s light - Wet preparation (KOH)
- Nail infections - Dermatophyte(80-90%) or Non-dermatophyte - Tineaunguium-dermatophyte - Molds-Scopulariopsisbrevicaulis. - Yeast-Candida albicans
-Mycetoma - Sporotrichosis - Chromoblastomycosis -Phaeohyphomycosis, Hyalohyphomycosis
-Sporothrixschenckii -Traumatic innoculation, cats, armadillos -Occupational disease: Agricultural Clinical symptoms: 1.Fixed cutaneoussporotrichosis 2.Lymphocutaneoussporotrichosis 3.Osteoarticularsporotrichosis 4.Pulmonary sporotrichosis 5.Disseminated sporotrichosis
Diagnosis: Histopathology Histopathology Culture
-Trauma Chronic suppurativeinfection -Subcutaneous tissue fascia, bone Synonym: Madurafoot,maduromycetoma,maduromycosis Clinicalsyndrome: Tumefaction Draining sinuses Sclerotia(granules, grains)
(1) Actinomycotic mycetoma Actinomycetes, Nocardia basiliensis, Streptomyces somaliensis, Actinomaduramadurae, Actinomadurapelletieri (2) Eumycotic mycetoma (dermaticeous/non) Madurellamycetomatis, Pseudallascheriaboydii
- 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)
-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
Diagnosis: Histology: Scraping, biopsy -Muriformcells:horizontal and vertical dividing walls -Sclerotic bodies copper pennies, 5-15μm, septate -Dark-walled septate/ non septate hyphae Culture
-Dermatiaceous fungi (no muriform cells) -Exophiala jeanselmei, Wangiella dermatitidis, Bipolaris spp Traumatic implantation4 clinical forms: 1.Superficial 2.Cutaneous-corneal 3.Subcutaneous 4.Systemic
Diagnosis: Histopathology: Cyst, fibrous capsule, Granulomatouswall, necrotic center Culture
-Melanin-free molds -Fusarium, Scopulariosis, Paecilomyces, Acremonium, Scedosporium -Clinical: Same as Phaeohyphomycosis
- Candida albicans, C. guilliermondii, C. krusei, C. parapsilosis, C.,tropicalis, C. kefyr,, C. lusitaniae, C. dubliniensis,,c. glabrata - Ubiquitos - Blastospore, hyphae, pseudohyphae
Mucocutaneous candidiasis -Oralthrush(CD4 200-500/ 500/μl) - Vulvovaginal candidiasis (CD4 >500/ μl) - Esophageal candidiasis (CD4 <100/μl) - Cutaneous candidiasis: Chronic mucocutaneous ccandidiasis Deeply invasive candidiasis
Diagnosis: -Wet mount (Saline and 10% KOH) -Gram s stain, PAS, GMS -AbsenceonH+E DOES NOTexclude -β-glucantest (research)
-Yeast -Inhalation clearance or latent state -Polysaccharide capsule, melanin, enzymes -Little or no inflammatory response
-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
- 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
-Profound neutropenia, glucocorticoid use, neutrophil and/or phagocytic dysfunction CD4 <50/μl
-Invasive pulmonary aspergillosis -Invasive sinusitis -Disseminated aspergillosis -Cerebral aspergillosis -Aspergillus endocarditis -Cutaneous aspergillosis -Chronic pulmonary aspergillosis
-Aspergilloma -Chronic sinusitis -Allergic bronchopulomonary aspergillosis -Severe asthma with fungal sensitization (SAFS) -Allergic sinusitis -Superficial aspergillosis
Diagnosis: -Histopathology -Culture -Aspergillusantigen test (galactomannan) -Serologic study
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
- 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
-Rhinocerebral mucormycosis -Pulmonary mucormycosis -Gastrointestinal mucormycosis -Cutaneous mucormycosis
- Histoplasma capsulatum var. capsulatum - Histoplasma capsulatum var. duboisii - Moist surface soil, birds/bat dropping - Mycelia Microconidia/macroconidia Yeast - Intensity, immune status, underlying lung disease
Immunocompetent: - Asymptomatic, mild, self-limited, - Smoker: Chronic cavitary histoplasmosis Immunocompromised: - CD4<200/μL, extremes of ages, drugs - Progressive Disseminated Histoplasmosis (PDH) Complication: Fibrosing Mediastinitis
Diagnosis: -Histopathology, Cytopathology -Culture -Histoplasmaantigen detection in serum, CSF -Histoplasmaantibody detection in urine, serum
-Penicillium marneffei - Immunocompromised, CD4<100/μl - Clinical: similar to disseminated histoplasmosis - Skin lesion: papules similar to molluscum contagiosum - Abscess, Granuloma Diagnosis: - HistopathologyCulture
-P. jirovecii(human),p. carinii(rat) -Immunocompromisedhost, CD4 <200/μl -Air-borne, Person-Person -Alveolar macrophages -Pulmonary pneumocystis infection -Disseminated pneumocystis infection
-CXR: Bilateral diffuse infiltrate begin at perihilar, pneumothorax -High-resolution CT: Ground-glass opacities