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    Lec. 10 Opportunistic Mycoses

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    Lec. 10 Opportunistic Mycoses

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    11 views26 pages

    Lec. 10 Opportunistic Mycoses

    Uploaded by

    maznhsyn435

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 26

    Opportunistic Mycoses

    Lec. 10

    Dr. Nadhira Shaban Salih


    Opportunistic mycoses
    • Opportunistic fungal infections are those infections which are found in
    patents with underlying predisposing conditions.

    • Malignancy

    • Immunosuppressive therapy

    • AIDS

    • Burn

    • Diabetes

    • Dialysis patients
    Systemic mycoses
    Cryptococcosis

    • Is an infection caused by encapsulated yeast belonging to genus


    Cryptococcus.
    • Two species are know to cause serious in infections in human begins
    namely Cryptococcus neoformans and Cryptococcus gattii.

    • It is a true yeast.
    • Its opportunistic infection, primarily involve lung, then the infection
    transmitted to other parts of the body through hematogenous route
    especially to Central nervous system.

    • The disease usually occurs between the ages 30 and 60 years and its
    uncommon in childhood.
    Epidemiology

    • The vast majority of patients with cryptococcosis are infected with C


    neoformans. They are usually immunocompromised due to one of the
    following conditions (listed in order of decreasing frequency): -
    • AIDS.
    • Prolonged treatment with glucocorticoids.
    • Organ transplantation.
    • Malignancy (most notably leukemias & lymphomas)
    • Sarcoidosis.
    Virulence factors
    1. Polysaccharide capsule:
    • is anti-phagocytic.
    • inhibits hosts local immune responses.
    2. Ability to make melanin:
    • produces an enzyme (phenyl oxidase)
    • it breaks down caffeic acid to melanin
    3. Other enzymes:
    • example, phospholipase and urease.

    4. Thermotolerant
    • High temperature growth between 37 to 39 oC
    Pathogenesis
    • The yeast spores are deposited into the pulmonary alveoli and evade phagocytic
    efforts by macrophages. The cryptococcal polysaccharide capsule has
    antiphagocytic properties and may be immunosuppressive. These properties of
    the capsule block recognition of the yeast and inhibit leukocyte migration into
    the area of fungal replication.

    • In healthy individual the fungus may remain dormant in lung until immune
    system weakens and then can reactive and disseminate to CNS and other body
    parts.

    • The organism disseminates hematogenously and has a propensity to localize to


    the central nervous system (CNS).

    • In addition to invading the lung and CNS, cryptococci also invade the skin, bone,
    and genitourinary tract, but meninges appear to be the preferred site.
    Life cycle of Cryptococcus neoformans
    Types of Cryptococcosis
    1. Pulmonary Cryptococcosis:

    - Respiratory tract: most common entry.

    - Seen in immunocompetent host.

    - Patient develops asymptomatic or mildly pneumonitis.

    - Results in an encapsulated lung nodule: Cryptococcoma.


    2. Disseminated infections
    - May lead to visceral, cutaneous disease or
    ocular cryptococcosis.

    3. CNS Cryptococcosis Cutaneous cryptococcosis


    The infection of brain and meninges leading
    to meningoencephalitis is the most
    uncounted clinical presentation of
    cryptococcosis.
    It has been thought that selective nutrients for
    pathogen are present in CNS such as
    asparagine and creatinine as a nitrogen
    sources, that used then for melanin Progressive cutaneous
    production. cryptococcosis
    Laboratory diagnosis
    • Specimen collection
    specimens: Sputum, CSF, Blood, skin scrapings.

    1. Microscopy: -

    • Negative staining: India Ink and Nigrosin stain.


    -demonstrates capsule: appears as refractile delineated clear space
    around the cells.

    • KOH Preparation: used for sputum

    • Gram stain: reveals Gram- positive, budding yeast cells.


    - surrounded by a halo or clear area- reveals capsule.
    Laboratory diagnosis
    Laboratory diagnosis
    2. Culture

    • Specimen: inoculated on SDA.


    Plates are incubated at 37°C.
    Blood: inoculated in biphasic blood
    culture bottles.

    • Colonies: mucoid creamy white


    colonies -cream colour becomes
    tannish

    • flat or slightly heaped, shiny,


    smooth edges
    Laboratory diagnosis

    • Niger seed agar, caffeic acid agar and bird


    seed agar
    -demonstrate melanin production: brown
    coloured colonies - C. neoformans breaks
    down caffeic acid to melanin -Growth at 37°C.
    3. Biochemical confirmation
    - urease test: positive.
    - assimilation of inositol, maltose, sucrose,
    dextrose, galactose, xylose and nitrate.
    Treatment & prevention

    • Immune competent – Fuconazole and Itraconazole

    • Immune Deficient – Amphotericin B, Flu cytosine

    • AIDS patients are not totally cured , Relapses are frequent with fatal
    outcome.

    • Avoid contact with Birds


    Candidasis
    • Candidiasis is the commonest fungal disease found in human
    affecting mucosa, skin, nail and internal organs.
    • Caused by various species of yeast like fungi belonging to the genus
    Candida with Candida albicans as the representative species.

    • It is found mainly as secondary infection in individuals with some


    underlying immunocompromised condition and very rarely as the
    primary disease.
    • Candida is component of normal flora. Commonly found on skin,
    female genital tract during pregnancy.
    Morphology of Candida

    • Ovoid shape or spherical


    budding cells and produces
    pseudo mycelium.

    • A mixture of yeast cells and Candidiasis (or candidosis) refers to a diverse group of
    infections caused by Candida albicans or by other
    pseudo mycelium and true members of the genus Candida. These organisms
    typically infect the skin, nails, mucous membranes, and
    mycelium are seen in Vivo and gastrointestinal tract, but they also may cause systemic
    disease.
    Nutritionally poor media.
    Epidemiology
    • Over 75% of women suffer from a C. albicans infection, usually vulvovaginal
    candidiasis, in their lifetimes, and 40-50% of them will have additional
    occurrences.

    • Interestingly, C. albicans are the third leading cause for nosocomial infections in
    patients’ bloodstreams.

    • This could result in an extremely life-threatening, systemic infection in hospital


    patients with a mortality rate of 30%.

    • A variety of factors are known to predispose both superficial and deep-seated


    candidiasis. All of these factors act either by altering the balance of normal
    microbial flora of the body or lowing the host resistance.

    • The two most predisposing factors that noticed during the last century are the
    advent of antibacterial antibiotics and their indiscriminate use led to the increase
    incident of candidiasis and also the emergence of pandemic of AIDS.
    Virulence factor
    1. Adhesins

    2. Polymorphism

    3. Biofilm

    4. Invasins

    5. Secreted hydrolases

    6. Metabolic adaption
    Pathogenesis
    • Candidiasis is caused by the abnormal growth in C. albicans, which is usually
    due to an imbalance in the environment.

    • Usually, this imbalance occurs in a woman’s vagina – this infection less likely
    to occur for men.

    • Several events can spark an imbalance. For example, antibiotic use can
    decrease the amount of lactobacillus bacteria, which decreases the amount
    of acidic products and the pH of the vagina. Other events are pregnancy,
    uncontrolled diabetes, impaired immune system, and irritation of the
    vagina.

    • C. albicans are able to take advantage of the conditions and outcompete


    the normal microflora, resulting in candidiasis or a yeast infection
    Clinical manifestation

    1. Mucous membrane infections:


    • Thrush (oropharyngeal)
    • Esophagitis
    Thrush
    • Vaginitis
    2. Cutaneous infections: Onychomycosis

    • Paronychia (skin around nail bed)


    • Onychomycosis (nails)
    • Diaper rash

    Diaper rash
    Clinical manifestation

    3. Disseminated (systemic) infection:

    • Endophthalmitis (eye), Liver and spleen, Kidneys , Skin,


    Brain, Lungs, Bone.

    Disseminated skin lesion


    Endophthalmitis
    Laboratory diagnosis
    1. Specimens
    • Blood, urine, CSF, skin, respiratory secretions.
    2. Direct microscopy: -
    - KOH mount, Gram stain
    Laboratory diagnosis

    2. Culture

    • The specimen can be cultured on SDA

    • with antibacterial antibiotics and incubated at


    25°c & 37°c.

    – Colonies are cream coloured and smooth

    – CHROME agar media also used


    CHROME agar
    • CHROMagar Candida is a selective medium for the
    isolation and presumptive identification of yeast
    and filamentous fungi and differentiation of
    Candida albicans, C. krusei produce different colors,
    thus allowing the direct detection of these yeast
    species on the isolation plate.
    • uses chromogenic substances based on the reaction
    between specific enzymes of different species and
    chromogenic substrates, which results in the
    formation of differently colored colonies rapid
    presumptive identification of C. albicans, C. krusei
    and C. tropicalis .
    Laboratory diagnosis
    3. Germ tube formation:
    - inoculation of yeast in human serum incubated at 37 0C for 2 to 4
    hours

    4. Sugar assimilation and fermentation

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