OPPORTUNISTIC MYCOSES

OPPORTUNISTIC MYCOSES
General features
CAUSATIVE AGENTS
Saprophyte in nature/found in normal flora

HOST
Immunosupressed /other risk factors
 OPPORTUNISTIC MYCOSES
• Candidiasis
• Cryptococcosis (discussed)
• Aspergillosis
• Zygomycosis
• Other: Trichosporonosis, fusariosis,
penicillosis……
***ANY fungus found in nature may give rise
to opportunistic mycoses ***
 CANDIDIASIS

• Most commonly encountered opportunistic mycoses

worldwide
• Cellular immunity protects against mucocutaneous
candidiasis, neutrophiles protect against invasive candidiasis
• Endogenous infection.
• Etiology: Candida spp. Most common:
1. C. albicans
2. C. tropicalis
3. C. glabrata
 Candida

MORPHOLOGICAL FEATURES

• Micr. Budding yeast cells

Pseudohyphae, true hyphae
• Macr. Creamy yeast colonies (SDA)
• Germ tube (C. albicans, C. dubliniensis)
• Chlamydospore (C. albicans, C. dubliniensis)
• Identification Germ tube, fermentation
 Macroscopic Morphology
Yeast colony. Sabouraud Dextrose agar (DSA)
Candida albicans
 Yeast cells and pseudohyphae in
Candida albicans material from the oral cavity, KOH
Microscopic Morphology preparation,
phase-contrast microscopy
 Candida
PATHOGENICITY
• Attachment (Germ tube is more
adhesive than yeast cell)
• Adherence to plastic surfaces
(catheter, prosthetic valve..)
• Protease
• Phospholipase
 CANDIDIASIS
Risk factors
• Physiological. Pregnancy, elderly, infancy

• Traumatic. Burn, infection

•
• Hematological. Cellular immune deficiency, AIDS, chronic
granulamatous disease, aplastic anemia, leukemia, lymphoma...

• Endocrinological. DM

• Iatrogenic. Oral contraceptives, antibiotics, steroid,

chemotherapy, catheter...
 CANDIDIASIS
Clinical manifestations-I

1. CUTANEOUS and SUBCUTANEOUS

• Oral
• Vaginal
• Onychomycosis
• Dermatitis
• Diaper rash
 Candida albicans
Clinical Presentation
The white material are masses of the yeast
The presence of satellite lesions help makes the
diagnosis of diaper rash.
 CANDIDIASIS
Clinical manifestations-II

2. SYSTEMIC • Peritonitis
• Esophagitis • Hepatosplenic
• Pulmonary inf. • Endophthalmitis
• Cystitis • Osteomyelitis
• Pyelonephritis • Menengitis
• Endocarditis • Skin lesions
• Myocarditis
 CANDIDIASIS
Clinical manifestations-III

3. CHRONIC MUCOCUTANEOUS
• Candida inf. of skin and mucous
membranes
• Verrucose lesions
• Impaired cellular immunit
• Hypoparathyroidism, iron deficiency
 Candida albicans
Granulomatous lesions involving the hands.
 CANDIDIASIS
Diagnosis
• Direct micr.ic examination
Yeast cells, pseudohyphae, true hyphae
• Culture
SDA, routine bacteriological media
• Serology
Detection of mannan antigen
(ELISA, RIA, IF, latex agglutination)
 CANDIDIASIS
Treatment
• CUTANEOUS
Topical antifungal: Ketoconazole, miconazole,
nystatin
• SYSTEMIC
Amphotericin B
Fluconazole, itraconazole
• CHRONIC MUCOCUTANEOUS
Amphotericin B
Fluconazole, itraconazole
Transfer factor
 Aspergillosis
Causative Agent
• Aspergillus fumigatus
Systemic infection
• Aspergillus flavus
• Aspergillus niger- mostly local infection; otomycosis
• Are molds that have septate hyphae with V-shaped
branches (Fruiting body of Aspergillus)
Source of infection
• Widely distributed in environment
• Transmitted by air-borne light spores
• High environmental load is associated with sick
building syndrome & contaminated AC system
Aspergillus
 Aspergillosis
Pathogenesis & Clinical features
Aspergillus can colonize and invade:
• Lungs
• Wounds, burns
• Cornea
• External ear
• Paranasal sinuses
 Aspergillosis

In lungs can cause:

a) Hypersensitivity Reaction:
Spores colonise RT without invasion and lead to
allergic asthma, rhinitis, bronchopulmonary aspergillosis
b) Aspergilloma (fungus ball):
the spores colonise paranasal sinuses or a pre-existing cavity
in lung (TB cavity)
The radiological appearance may be similar to malignancy.
c) Invasive Aspergillosis
In immunocompromised can invade lungs causing hemoptysis &
granuloma and disseminate to other organs
Fatality rate 100% if not diagnosed and treated promptly.
 Aspergillosis

Lab Diagnosis
Specimens : sputum, BM aspirate, biopsy
Direct Microscopy
• Shows branching septate hyphae
Cultures : Microscopy shows radiating chains of spores
Serology
• In allergic condition: high levels of specific IgE
• Galactomannan in invasive aspergillosis
Treatment
• Invasive aspergillosis
Amphotericin B
• Allergic conditions
Steroids & antifungals
 Zygomycosis
Mucormycosis
• Causative agents; saprophtic molds
• Rhizopus, Mucor & Absidia
• Have broad, aseptate hyphae
• Have large no. of asexual spores inside a sporangium

• Risk factors Diabetic ketoacidosis,

immunosuppression

• Pathogenesis Inhalation of sporangiospores

• Infected tissue vascular invasion,

thrombus, infarct,
 ZYGOMYCOSIS
Clinical manifestations
I. RHINOCEREBRAL
• Nose, paranasal sinuses, eye, brain and meninges are
involved
• Orbital cellulitis
II. THORACIC
• Pulmonary lesions, parenchymal necrosis
III. LOCAL
• Posttraumatic kidney inf.
• Skin inf. following burn or surgery
 ZYGOMYCOSIS
Diagnosis

• Samples Sputum, BAL, biopsy of

paranasal sinuses..

• Direct exam. Nonseptate, ribbon-like

hyphae which branch at right angles,
sporangium

• Culture SDA (cotton candy appearence)

Rhizopus
 Zygomycosis
Mucormycosis

Diseases
• Rhinocerebral zygomycosis
o Extensive cellulitis of nasal mucosa, paranasal sinuses,
orbit & brain
o Rapidly fatal
• Pulmonary & disseminated infections
Treatment
• Surgical debridement

• Amphotericin B

***High mortality rate

 Fusariosis

• Fusarium species, have been increasingly

recognized as lethal pathogens
• ~50 different species of the Fusarium
• Only a few human pathogens
• The skin and respiratory tract are the
primary portals of entry for Fusarium
infection
• Fusarium spp. are angiotropic and
angioinvasive molds that lead to hemorrhagic
infarction, low tissue perfusion, and resultant
tissue necrosis
 Fusariosis

Infections in normal hosts

• Are typically localized like skin, eye infections and
osteomyelitis
• Frequently do not require systemic therapy
Infections in immunocompromised patients
Manifest in four major patterns:
• Refractory PUO
• Pulmonary infection or pneumonia
• Disseminated infection
• A variety of focal single-organ infections
 Fusariosis

• Fusarium is one of the most resistant

fungi to the arsenal of modern antifungal
agents
• The mainstay in the treatment is Ampho-
B
• In vitro susceptibility of Fusarium spp. to
Ampho-B is, at best, mediocre
Invasion of the cornea by a Fusarium
species
Endophthalmitis due to a Fusarium species
Macroscopic Morphology of Fusarium species