Pathogenesis and Pathology of Fungal Infections

Principles od diseases and therapeutics2
Objectives
❑Pathogenesis of fungal infections:Sources,Virulent factors

❑Classification of pathogenic fungi
❑Classification of fungal diseases
❑Pathology of Superficial infections
❑ Pathology of Deep infections
Dr Sumaya M.TalbAllah
❑ Source of infections
• Infection from fungi which are eukaryotes that
occurs as filamentous hyphae, yeast or
dimorphic form
• Human sources :
➢ Normal flora
➢ Host in incubation period of disease
➢ Host with overt disease.
➢ Convalescent carrier animals –
➢ Contact carrier or subclinical infections –
• Inanimate sources (fomites)
➢ Contaminated utensils, feed and water troughs,
Virulent factors
• 2 group of virulent factors:

• Virulent factors that promote colonization
• Virulent factors that promote host cell damage
Virulent factors that promote
colonization
• Virulence factors that promote fungal colonization of the
host include the ability to:
• 1. adhere to host cells and resist physical removal;
• 2. invade host cells;
• 3. compete for nutrients;
• 4. resist innate immune defenses such as phagocytosis and
complement; and
• 5. evade adaptive immune defenses.
CONT’S (Examples)
• . A compromised immune system
• The ability to adhere to host cells with cell wall adhesins
• Some fungi produce capsules allowing them to resist
phagocytic engulfment, such as the yeast Cryptococcus
neoformans and the yeast form of Histoplasma capsulatum
• .
Virulence of C.albicans
• Candida albicans stimulates the production of a cytokine called
GM-CSF and this cytokine can suppress the production of
complement by monocytes and macrophages. This may decrease
the production of the opsonin C3b as well as the complement
proteins that enhance chemotaxis of phagocytes.
• C. albicans also appears to be able to acquire iron from red blood
cells.
• C. albicans produces acid proteases and phospholipases that aid in
the penetration and damage of host cell membranes.
Virulent factors that damage host
• Fungi can trigger harmful inflammatory response by
stimulating production of large amount of cytokines
• Production of mycotoxins : if ingested may lead to loss of
muscle coordination, weight loss, and tremors. Some are
mutagenic and carcinogenic such as Aflatoxins produced by
aspergillus flavus
• A mold called Stachybotrys chartarum has been implicated
as one of the causes of "sick building syndrome."Mycotoxin
symptoms in humans include dermatitis, inflammation of
mucous membranes, , cough, fever, headache, and fatigue.
❑ Classification of pathogenic
fungi
•Endemic Fungi
•Opportunistic Fungi
Pathogenesis: host-agent relationship
➢ Endemic Fungi
• Endemic fungi are invasive species that are limited to

geographic regions (e.g., Coccidioides in the
southwestern United States, Histoplasma in the Ohio
River Valley).
➢ Opportunistic Fungi
• Opportunistic fungi (e.g., Candida, Aspergillus, Mucor,

Cryptococcus) are ubiquitous organisms that either colonize
individuals or are encountered from environmental sources.
• In immunodeficient individuals give rise to life-threatening
invasive infections characterized by tissue necrosis, hemorrhage,
and vascular occlusion, with little or no inflammatory response
• Patients with AIDS often are infected by the opportunistic fungus
Pneumocystis jirovecii (previously called Pneumocystis carinii).
• Superficial mycoses
• Cutaneous and Subcutaneous mycoses
• Systemic or deep mycoses
Superficail mycoses
• Involve the skin, hair, and nails.

• They are called dermatophytes
• Infection of the skin is called tinea; e.g tinea pedis is
“athlete’s foot” and tinea capitis is scalp ringworm
• Fungi that invade the subcutaneous tissue, causing
abscesses or granulomas sometimes called
mycetomas.
Cutaneous and subcutaneous
mycosis
• deeper layer of skin e.g is mycetoma
Systemic or deep mycoses
• Deep fungal infections can spread systemically and

invade tissues, destroying vital organs in
immunocompromised hosts, but usually resolve or
remain latent in otherwise, normal hosts.
Pathology of Dermatophytosis
• Not seen in routine H&E stain special stains
are needed such as Gomori’s methenamine
silver and periodic acid-Schiff (PAS)
• Pathology:
➢Unaffected epidermis or mild hyperkeratosis
with patchy parakeratosis
➢Mild to intense perivascular infiltrate with
lymphocytes and plasma cells in dermis
Cutaneous &Subcutaneous
mycoses
• Representative disease: Mycetoma
Chronic, localized, progressive infection of skin, subcutaneous
tissue, muscle, fascia, and bone caused by actinomycetes
(bacteria) or fungi.
• Not contagious but infected from sources in nature by
traumatic percutaneous implantation of the causal organism
into those parts of body (usually foot or hand)
• Most prevalent in tropical and subtropical regions
PATHOLOGY OF
MYCETOMA
• Multiple abscesses in dermis containing neutrophilic

exudates and grains of organism and surrounded by chronic
inflammation with epithelioid histiocytes , multinucleated
giant cells, and fibrosis
Madura foot and grains
Systemic deep mycosis, opportunistic
infections
• Representative diseases:
• Cryptococcosis: local lung infections and
meningoencephalitis(AIDs)
• Candidiasis
• Aspergillosis
• Zygomycosis
• Common in immunocompromised patients
presented as ascute or chronic lung infections or
END

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Principles od diseases and therapeutics2

❑Pathogenesis of fungal infections:Sources,Virulent factors

• 2 group of virulent factors:

• Endemic fungi are invasive species that are limited to

• Opportunistic fungi (e.g., Candida, Aspergillus, Mucor,

• Involve the skin, hair, and nails.

• Deep fungal infections can spread systemically and

• Multiple abscesses in dermis containing neutrophilic

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