Phaeoannellomyces weneckii/ Cladosporium werneckii/ Exophiala werneckii ▪ Tinea nigra (keratomycosis nigra (keratomycosis nigricans palmaris/ Pityriasis nigra/ microsporosis nigra) black nonscaly macules on the palms & soles ▪ Brown to black nonscaly ~melanomas
UNIT VI – VI – FUNGAL FUNGAL AGENTS OF DISEASES AGENTS OF CUTANEOUS MYCOSES SUPERFICIAL MYCOSES No MYCOSES No Ab, no immune response, no inflamm reaction, In vivo = y east & mold Piedraia hortae Trichosporon beigelli/ T. cutaneum ▪ Black piedra ▪ White piedra
Malassezia furfur/ Pityrosporum furfur/ P. orbiculare/ P.ovale ▪ Tinea versicolor/ versicolor / pityriasis versicolor/ liper spot/ dermatomycosis dermatomycosis furfuracea/ chromophytosis
gritty nodules on scalp hair, hair, ▪ hard, dark brown to black gritty nodules beard, moustache, axillary/pubic hairs
yellowish , beige or beige or greenish nodules greenish nodules on hair ▪ Soft, white, yellowish, shafts ▪ soft mycelial mat around facial & genital hair, hair scalp ▪ Nature, normal skin flora ▪ infects horse
lesions/scaling of varying pigmentation “ fawn ▪ patchy lesions/scaling colored liver spots” spots ” on the chest, trunk, abdomen
KOH MOUNTS asci (thick walled rhomboid ▪ nodules crushed to reveal asci (thick cells with 8 ascopores)
KOH MOUNTS ▪ intertwined hyaline septate hyphae ▪ hyphae breaking up into oval/rectangular arthroconidia arthroconidia 2-4um diameter
KOH MOUNT ▪ Skin scraping ▪ yellow fluorescence on fluorescence on wood’s lamp
CULTURE ▪ SDA + antibiotics (room temp) ▪ Colonies: dark brown with brown with dematiaceous septate hyphae ▪ Cycloheximide = inhibitory
CULTURE ▪ Chloramphenicol (cycloheximide Chloramphenicol (cycloheximide = inhibitory) ▪ Colonies: rapid growth, cream colored, colored , soft when soft when young, young, membranous and membranous and wrinkled when wrinkled when age ▪ budding blastoconidia and blastoconidia and arthrocodnidia
CULTURE (not essential) ▪ olive oil + medium incubation 37C ▪ Budding yeast
▪ Found in soil ▪ VIA : Trauma to superficial layer of the skin septae, dematiaceous hyphae ▪ Fungus : long strands of septae, *may contain numerous chlamydospores
CULTURE ▪ SDA : 2-3weeks (slow) Colonies : moist, olive to greenish black , yeast like MICROSCOPIC EXAM ▪ Colonies: Colonies: 1 to 2 celled cylindrical to spindle shaped cells ▪ budding /annelid formation /annelid formation ▪ rounded at 1 end and tapered toward the other ▪ occ’l mycelial
***Conidia & ascopores = not found on routine mycological media TREATMENT ▪ removal of infected hair shafts ▪ applicaton of topical fungicides
DERMATOPHYTOSES ▪ immune response, response, inflammation, inflammation, tissue damage, damage, ring worms Genera: Genera: Microsporum, Trichophyton, Epidermophyton, Epidermophyton, Tinea Barbae
BIOCHEMICAL TEST ▪ Doesn’t ferment CHO & KNO 3 ▪ Assimilates glucose, galactose, sucrose, maltose, lactose ▪ Urease (+)
Tinea Capitis
Tinea Corporis
Tinea Cruris
Tinea Favosa
Tinea Imbricata
Beard/ Barber’s itch
Head/scalp
Body – Body – glabrous skin
Groin
Head
Body
▪ T. mentagrophytes
▪ Gray patch M. auduinii/ M. canis Ectothrix infection in child ▪ Inflammatory ecothrix T. mentagrophytes Animal origin ▪ Black dot (endothrix infection) T. tonsurans ▪ Kerions
▪ T. rubrum, T. tonsurans
▪ E. floccosum ▪ Circinate and serpiginous lession ▪ inflammatory, vesicular, enlarging margins ▪ VIA : clothing, linens, towels shared
▪T. schoenleinii, T. violaceum ▪ cup shaped crusts, prominent honey comb like masses
▪ (distinctive lesion)
▪ Farm workers ▪ Inflammatory lesion
▪ M. canis, M. gypseum Occ’l
▪ Anular leson on the skin ▪ smooth parts of body ▪ spreading, hemorrhagic border
TREATMENT ▪ 1% selenium sulfide (temporary)
CM ▪ Pneumonia/ non specific febrile illness ▪ may cause fatal systemic infection
Keratinophilic: Keratinophilic: grow on layers of hair, nails, skin (contain keratin) ▪ Host reaction to metabolic products of fungus
MICROSCOPIC EXAM ▪ Spaghetti and meatballs ▪ budding yeast along yeast along with septate, septate, sometimes branched hyphae ▪ hyphae are not demonstrated on routine media
Associated diseases: folliculitis, obstructive dacrocystitis, seborrheic dermatitis in AIDS HOST REFERENCES: 1. Zoophilic 2. Anthropophilic Anthropophilic 3. Geophilic Tinea manuum Hand
Adapted to living on animals Adapted exclusively to human hosts Inhabits the soil Tinea Pedis Tinea Unguium
feet
Nails
▪ T. mentagrophytes
▪ T. mentagrophytes ▪ T. rubrum ▪ E. floccosum ▪ Lateral/distal edges of nail plate ▪ paroncychial infection ▪ Thickened nail, brittle with
▪ T. rubrum ▪ E. floccosum
▪ Athlete’s foot, foo t, mocassin foot ▪ itching, scaling, seeping skin lesion on the soles of the feet & cleft betweent the toes
EPIDERMOPHYTON E. floccosum
M. audouinii
▪ Anthrophophilic ▪ infects skin, nail
▪ Antropophilic
▪ CULTURE Colonies: yellow to yellow green (olive drab) and quite wrinkled/folded Microconidia : none Macroconidia: smooth, thin walled, single/cluster Distal end: broad, spatulate/ club shaped (beaver’s tail)
COMMONLY ENCOUNTERED DERMATOPHYTES MICROSPORUM M. canis ▪ Ectothrix infection of the hair ▪ Zoophilic ▪ most common cause of ringworms in cats and dogs
▪ CULTURE Isolate: Chlamydoconidium like swellings terminally on hyphae Favic chandeliers, pectinate bodies Macroconidia : rare, bizaar Doesn’t grow on rice
▪ CULTURE : P otato dextrose agar Colonies: lemon-yellow Macronconidia: spindle shaped, echinulate, thick walls, tapered/curved ends (3-15 cells) Microconidia : rare ***Grows on rice!!
M. Ferugineum ▪ Ectothrix, Tinea capitis ▪ Anthropophilic Hyphae: thick septa (bamboo)
M. gypseum ▪ Ectothrix, Tinea barbae ▪ WOOD’S LAMP Doesn’t fluoresce Macroconidia : fusiform, thick walled, 6 cells Distal area : thin, filamentous tail, longer than the rest of conidium ***hair baiting
▪ WOOD’S LAMP : Fluoresce green
T. concentricum ▪ T. imbricata ▪ anthropophilic ▪ skin
T. mentagrophytes ▪ Athlete’s foot ▪ Zoophilic, anthropophilic ▪ Most commonly isolated dermatophyte ▪ Infect: skin, hair, nails CULTURE ▪ Spiral hyphae ▪ Macroconidia: thin walled, smooth, cigar shaped 4-5 cell ▪ Microconidia: globose to tear shaped (grape like)
T. rubrum ▪ T. corporis, T. ingium, T. capitis ▪ endothrix ▪ anthropophilic
CULTURE ▪ Colonies: red, + brown mix ▪ Macroconidia: 3-8cell, cylindrical, pencil shaped ▪ Microconidia: clavate, peg
5 DAY UREASE (+)
WOOD’S LAMP ▪ Doesn’t fluoresce
HAIR PENETRATION TEST ▪ Perpendicular penetration peg
HAIR PENETRATION TEST ▪ Surface erosion
MYCOTOXINS – TOXIC METABOLITES PRODUCED BY FUNGI AFLATOXIN A.fla + toxin Molds: A.flavus, A. parasiticus, Penicillium spp, Rhizopus spp Aflatoxifcosis : human, dogs ▪ jaundice, ascites, portal hypertension, high mortality ▪ massive GIT death ▪ pulmonary interstitial fibrosis ▪ factor of reye’s syndrome ▪ carcinogen OCHRATOXIN (A. alutaceus, Penicillium spp) ▪ acute toxicity (kidney), balcan (nephropathy) ▪ carcinogen
VOMITOXIN (Fusarium spp) PATULIN (P. expansum) ▪ ingestion of apple juice
TRICHOPHYTON T. schoenleinii ▪ T. favosa ▪ Favic chandelier and chlamydospores
CULTURE ▪ Colonies: slow (30days) Small, wrinkled, waxy
T. tonsurans ▪ Tinea capitis (black dot)
▪ anthropophilic
CULTURE ▪ SDA ▪ Colonies: rust colored on the reverse side ▪ Thiamine ▪ Macroconidia: teardrop peg ▪ Microconidia: rare, balloon
T. verrucosum ▪ T. corporis, T. barbae, T. capitis ▪ Found in cattle ▪ VIA: fomites
CULTURE 35C ▪ Thiamine ▪ Macroconidia: thin walled, string beans/ rat tails ▪ microconidia: clavate, teardrop WOOD’S LAMP Doesn’t fluoresce
T. violaceum ▪ T. favosa
CULTURE ▪ Colonies: violet/ purple and waxy ▪ Thiamine: enhancer ▪ hyphae: swollen w/ granules
SUBCUTANEOUS MYCOSES CHROMOBLASTOMYCOSIS EPIDEMIOLOGY ▪ Fonsecaea compacta, Phialophora verrucosa, Fonsecaea pedrosoi, Cladophialophora carrioni ,Rhinocladiella aquaspersa ▪ Verrucous dermatitis and chromomycosis
CLINICAL INFECTIONS ▪ Chronic infection of the skin & subcutaneous tissu ▪ Lesion: confined to the extremities (feet, legs), verrucous nodules (may be ulcerated and crusted) ▪ longstanding lesion: cauliflower like surface
EUMYCOTIC MYCETOMA EPIDEMIOLOGY ▪ Pseudallescheria boydii, Acremonium falciforme, Madurella mycetomatis, Madurella grisea, Exophiala jeanselmei ▪ true fungi
CLINICAL INFECTIONS ▪ Lesion: granulomas, tumor like, abscesses drain to the outside through sinus tract ▪ Lesion pus: granules/grains (compact mycelial masses) ▪ initially confied to subcutaneous tissue ▪ frequently proliferate to involve the musculature and can cause severe bone destruction ===GRANULES Fungus P. boydii A. falciforme M. mycetomatis M. grisea E. jeanselmei
LABORATORY DIAGNOSIS Specimen collection ▪ Punch biopsy: affected skin area =====Direct examination ▪ skin biopsy: sclerotic/ copper bodies Microscopic examination Cladosporium carrioni Fonsecaea compacta Fonsecaea pedrosoi Phialophora verrucosa Rhinocladiella aquaspersa
Erect conidiophores (branched, 1 cell, brown blastoconidia) Conidium close to tip of conidiophore (shield cell) Fragile chains ~F. pedrosoi More compact conidial heads Conidia are subglobose Primary 1 cell conidia on sympodial conidiophores Primary conidia : conidiogenous cell secondary conidia Condiogenous cells dematiaceous Flask shaped phialides w/ collarettes Conidia oval, 1 cell, in balls at tips of phialides Conidiophores erect, dark, bearing conidia only on upper portion near the tip Conidia elliptical, 1 cell, sympodially
Culture
▪ darkly pigmented / dematiaceous molds ▪ slow growth ▪ velvety to wooly, gray bron to olivaceous black
Black
Size mm 0.5-1.0 0.2-0.5 0.5-5.0 0.3-0.6 0.2-0.3
Texture Soft Soft Hard Soft soft
LABORATORY DIAGNOSIS Specimen collection ▪ Granules: color, size, texture Direct microscopic exam ▪ Hyphal elements: seen ▪ easily distinguished from the branching filamentous rods in actinomycotic mycetomas Culture
P. boydii
A. falciforme
M. mycetomatis M. grisea E. jeanselmei
EXO ANTIGEN TEST Isolate + BHI broth
Color White
SPOROTRICHOSIS EPIDEMIOLOGY ▪ Sporothrix schenckii ▪ Found in soil ▪ Asso : gardener’s disease ▪ VIA: exposure to rose throns (rose handler’s dse) and sphagnum moss CLINICAL INFECTIONS 1. Extracutaneous/ Disseminated sporotrichosis ▪ for the immunocompromised 2. Fixed cutaneous ▪ infection is confined to the site of innoculation 3. Lymphocutaneous ▪ Nodular & ulcerative lesion along lymph channels ▪ Drain the primary site of inoculation 4. Mucocutaneous 5. Primary and secondary pulmonary sporotrichosis
LABORATORY DIAGNOSIS Specimen collection ▪ Aspirates: cutaneous nodules, pus, exudate ▪ Swabs: open lesion ▪ Curettage material Direct microscopic exam ▪ small cigar shaped yeast Culture
PDA 25C & 35C Rapid, white to dark gray **S.apiospermum (anamorph) = oval conidia, single, tips of annelids **Teleomorphs = cleistothecia w/ ascopores Moniliaceous/lightcolored mold Slow, grayish brown graying violet Mucoid clusters of 1 or 2 cell Slightly curved conidia borne from phialides Conidiophores: long, unbranched, multiseptate 37C & 40C Slow, white yellow, olivaceous/brown, diffusable brown Conidia: half of isolate from the tips of phialides Half of isolate : sterile 30C Slow, olive brown to black Reddish brown pigment Doesn’t grow at 40C Olivaceous to black color, initially yeast like, mature to velvety Conidia: born from annellides aggregating in masses Nitrate (+)
▪ dimorphic 25C and 37C incubation ▪ Cycloheximide a) 25C ▪ initially : white, glabrous, yeast like ▪ later: darker, mycelial ▪ hyphae: thin, delicate with conidia in rosette/flowerette pattern at the ends of conidiophores ▪ Conidia: dark walled/dematiaceous, along the sides of hyphae, sleeve arrangements b) 37C ▪ BA tubes 37C ▪ require several subcultures ▪ cigar shaped yeast cells
SUBCUTANEOUS PHAEOHYPHOMYCOSIS EPIDEMIOLOGY ▪ Exophiala jeanselmei, Wangiella dermatitidis, Cladosporium trichoides, Phialophora spp, Dreschlera spicifera, Hormodendrum spp ▪ Dermatiaceous fungi CLINICAL INFECTION 1. Deep tissue invasion ▪ most serious ▪ deep draining systemic abscess ▪ serebral chromoblastomycosis 2. Ethmoid invasion ▪ massive invation ▪ subsequent erosion of ethmoid bone 3. Subcutaneous cysts ▪single, firm, discrete, well defined nodule ▪ little pain ▪ foreign body – first impression ▪ lesions: spread, verrucous, simulate chromomycosis LABORATORY DIAGNOSIS Specimen collection ▪ Biopsy : dematieous hyphae Microscopic exam ▪ GMA, H&E, PAS, Masson fontana stains ▪ detect melanin in the cell wall Culture a) Exophiala jeanselmei ▪ doesn’t grow at 40C ▪ nitrate (+) b) Wangiella dermatitides ▪ Grow at 40C ▪ Nitrate (-) ▪ have phialides without c olarettes
ENDEMIC MYCOSES (SYSTEMIC/DEEP SEATED) Blastomyces dermatitidis / Ajellomyces dermatitidis EPIDEMIOLOGY ▪ Blastomycosis disease (Gilchrist dse, NA blastomycosis, Chicago dse) ▪ From soil, decaying wood ▪ Affect human, dogs, horses CLINICAL INFECTION 1. Pulmonary ▪ initial mild respiratory symptoms: fever, cough, hoarseness ▪ progression: few months: productive cough, fever, weight loss 2. Systemic ▪ extension ▪ common site: liver, spleen ▪ granulomatous lesions & abscess 3. Cutaneous ▪ either from direct inoculation or systemic dse
LABORATORY DIAGNOSIS Specimen collection st ▪ 1 morning sputum ▪ bronchial washign ▪ pulmonary secretion Direct Microscopic exam ▪ Large, spherical, refractile yeast cell (8- 15um) ▪ double contoured wall ▪ buds connected by a broad base Culture ▪ Inhibitor: cycloheximide ▪ Heavily contaminated = plate on media with antibacterial a) 25C ▪white, tan, brown ▪ fluffy to glabrous in concentric rings ▪ raised areas (spicules/prickles) in the centers of colonies ▪ anamorphic : conidia born/short lateral branches, ovoid to dumb bell shaped. Short conidiophores~ lollipops ▪ teleomorphs (A.dermatitidis) : doesn’t occur in routine ---produce gymnothecia w/ ascopores
GEN CHAR: All dimorphic, VIA: inhalation of infectious conidia, all lab procedure: biologic safety cabinets Coccidiodes immitis & Coccidiodes posadasii Histoplasma capsulatum var capsulatum / Emmonsiella capsulata EPIDEMIOLOGY EPIDEMIOLOGY ▪ Coccidiomycosis (Posada dse, coccidiodal granuloma, ▪ Histoplasmosis (reticuloendothelial cytomycosis, cave valley fever, desert rheumatism, valley bumps, California dse, spelunker’s dse, darling dse) dse, San joaquin valley fever) ▪ From soil with high nitrogen content (heavily contaminated with bird & bat guano) CLINICAL INFECTION CLINICAL INFECTION ▪ most virulent of all mycotic agent Inhaled microconidia phagocytosis by macro in ▪ primary dse: resolves w/o therapy, confers a strong pulmonaryparenchyma specific immunity (Coccidiodin skin test) 1. Primary acute ▪ symptomatic/flu like symptoms, chest pain, shortness of 1. Asymptomatic pulmonary dse breath, hoarseness 2. Allergic manifestation ▪ diffuse/discreet lung lesion : calcify -toxic erythema ▪ almost always skin test (+) -erythema nodosum (desert bumps) 2. Chronic cavitary -erythema multiforme (valley fever) ▪ large pulmonary lesion after discomfort -arthritis (desert rheumatism) ▪ ~~tuberculosis 3. Symptomatic dse ▪ may progress to disseminated form a) Primary 3. Severe disseminated ▪fever, respiratory distress, cough, anorexia, headache, ▪ organ involved malaise, myalgias (6 weeks/longer) ▪ fatal in massive dissemination b) Secondary dse ▪ nodules, cavitary dse, progressive pulmonary dse Others: mediastinitis, pericarditis, mucocutaneous lesion ▪ single/multisystem dissemination 1% ▪ Filipinos, African american ▪ 9:1 female:male LABORATORY DIAGNOSIS LABORATORY DIAGNOSIS Specimen collection Specimen collection ▪ Sputum ▪ sputum ▪ tracheal aspirates ▪ bronchoscopic fluid ▪ lung biopsy tissue ▪ BM aspirates ▪ CSF ▪ peripheral blood smear ▪ Blood ▪ exudate from mucocutaneous lesion ▪ exudate from liver and spleen Direct microscopic examination ▪ Spherules w/ endospores Direct microscopic exam (produced by inhaled barrel shaped arthroconidia) ▪ small yeast cell ▪ common within monocytes and macrophages Culture ▪ non encapsulated, looks l ike encapsulated ▪ initial: 3-4 days, white to gray, moist, glabrous ▪ mature: abundant aerial mycelia, enlarged colony in a Culture circular bloom. Become tan to brown to lavander ▪ 2 Sets of SDA, BHI/ inhibitory mold agar ▪ 25C & 37C ▪ hyaline arthroconidia: separated by disjunctor cells ▪ white to brownish mold ▪ Exoantigen test ▪ young: round to pyriform microconidia (2-5um) ▪ mature: large echinulate to tuberculate macroconidia ▪ confirm: BHI 37C, conversion of mold to yeast ▪ Exoantigen detection: detect H & M antigen
Paracoccidiodes brasiliensis EPIDEMIOLOGY Paracoccidioidomycosis (SA blastomycosis, Brazilian blastomycosis, lutz splendore almeida dse, paracoccidiodal granuloma) ▪ sex distribution 9:1 CLINICAL INFECTION ▪ Primary infection: asymptomatic, may disseminate leading to ulcerative lesion of the buccal, nasal, GI mucosa ▪ Lymph node is involved ▪ Dissemination to other organs: adrenals, diminished host defenses
LABORATORY DIAGNOSIS Specimen collection ▪ Sputum ▪ Bronchoalveolar lavage ▪ Pus from draining lymph nodes ▪ scrapings from ulcers ▪ biopsy tissue Direct microscopic exam ▪ budding yeast (15-30 um) with multipolar ▪ budding at the periphery (mariner’s wheel) ▪ daughter cell : connected by narrow base ▪ mickey mouse cap appearance Culture a) 25C ▪ colonies: flat, glabrous to leathery, wrinkled to folded, floccose to velvety, pink to biege to brown with yellowish brown reverse ▪ small 1 cell conidia ▪ exoantigen test
OPPORTUNISTIC MYCOSES = Can’t produce disease in immunocompetent Gen char: ubiquitous agent, part of normal flora, monomorphic mostly, px: immunocompromised Aspergillus spp Candida albicans Cryptococcus neoformans Hyaline, Septate, Monomorphic Penicillium marneffei A. fumigatus, A. flavus, A. niger, A. terreus C.tropicalis,C.parapsilosis,C.glabrata Teleomorph Filobasidiellaneoformans molds EPIDEMIOLOGY EPIDEMIOLOGY EPIDEMIOLOGY EPIDEMIOLOGY EPIDEMIOLOGY ▪ Aspergillosis ▪ Candidiasis (moniliasis, mycotic ▪ Cryptococcosis (torulosis, ▪ Asso – fungemia, disseminated ▪ Dimorphic fungus endemic in southeast asia ▪ Found worldwide vulvovaginitis, thrush, european blastomycosis) infection, mycotic keratitis, ▪ Normal saprophyte in soil candidiosis, candida ▪ Found in soil (pigeon droppings) endopthalmitis, skin infection, ▪ asso with bamboo rat ▪ Carcinogenic hapatoxin: endocarditis) endocarditis ▪VIA：UNKNOWN aflatoxin ▪ most frequently encountered ▪ abundant in environment ▪ may be normal flora
CLINICAL INFECTION 1. Allergic forms a) allergic bronchopulmonary aspergillosis b) extrinsic allergic alveolitis 2. Aspergilloma (fungus ball) ▪ inhaled conidia enter exisiting cavity ▪ rarely invasive ▪ found in lungs 3. Extrapulmonary colonization 4. Invasive aspergillosis 5. External otomycosis, mycotic keratis, onychomycosis 6. Eye & hair infection
CLINICAL INFECTION 1. Cutaneous & Mucosal candidiasis Risk factor: AIDS, pregnancy, diabetes, young/old age, birth control pills, trauma, burns, skin maceration ---oral thrush, onychomycosis, intertrigenous infection (most/warm parts of body), interdigital infection, vulvovaginitis
CLINICAL INFECTION 1. Acute/ Chronic pulmonary -transitory/pass unrecognized -asymptomatici infection 2. Systemic/ meningeal ▪ most common ▪ from meningitis
2. Systemic Candidiasis ▪ via indwelling catheters, surgery, IV drug abuse, damage to skin/GIT ▪ Asso with chronic admin of immunosuppressive drugs
3. Chronic mucocutaneous candidiasis ▪ chronic superficial disfiguring infeaction of sking & mucosa area ▪ onset : early childhood
LABORATORY METHODS ==Specimen Collection== ▪ Sputum ▪ Respiratory specimen ▪ Blood (rarely (+)) ==Direct microscopic exam== ▪ Hyphae & hyaline = septate ==Culture== ▪ incubation = room temp ▪ ID: morphology of conidial stucture ▪ dark to brown spores
LABORATORY METHODS ==Specimen collection== ▪ Swabs & scrapings: superficial lesion ▪ blood ▪ spinal fluid ▪ tissue biopsy ▪ urine ▪ exudate ▪ material from removed IV catheter
==Direct Microscopic exam= ▪ gram stained smears: Pseudohyphae, budding cells ▪ skin/nail scrapping + 10% KOH ==Culture== 37C BHI/MH ▪ non selective agar media ▪ yeast colony = pseudohyphae ▪ Germ tube test (+) Serum + Rg (2-4hr)
LABORATORY METHODS ==Specimen collection== ▪ CSF = most common ▪ serum/CSF for Ag detection (Latex agg.test) = most sensitive ==Direct Microscopic exam= ▪ encapsulated yeast in india ink ==Culture== 37C ▪ Mucoid colonies ▪ inhibitor : cycloheximide ▪ Urease (+) ▪ Yeast ID system
1. Acremonium ▪ Septate hyphae ▪ unbranched, tube like phialides ▪ produce clusters of 1 cell & 2cell oblong conidia 2. Fusarium spp ▪ 1 cell microconidia ▪ sickle /boat shaped macroconidia + septation 3. Geotrichum ▪ septate hyphae ▪ barrel shaped non alternating arthroconidia, no blastoconidia 4. Paecilomyces ▪ long, delicate penicillus ▪ produce numerous chains of small, oval conidia, easily dislodged 5. Scopulariopsis ▪ produce penicillus with large, flat based, rough walled conidia
CLINICAL INFECTION 1. Focal Cutaneous infection 2. Mucocutaneous infection 3. Disseminated infection
Pneumocystis jiroveci (P. carinii) EPIDEMIOLOGY ▪ immunocompromised px ▪ dissemination : rare ▪ only in AIDS ▪ prev : protozoan ▪ cell membrane: cholesterol
CLINICAL INFECTION Morphologic forms: 1. Trophozoltes – predominant ▪ difficult ti ID 2. Cysts ▪ pingpong ball 10:1 Troph:cysts
LABORATORY METHODS ==Specimen collection== ▪ Infected tissue/exudate
LABORATORY METHODS ==clinical presentation==
Zygomcetes Rhizopus, Mucos, Absidia EPIDEMIOLOGY ▪ Sparsely septate, hyaline monomorphic molds ▪ immunocompromised px ▪ diabetes melitus px ▪ foundin decaying vege matter and soil ▪ VIA: inhalation of spores ▪ common bread molds CLINICAL INFECTION 1. GI 2. Perineural invasion 3. Rhinocerebral form ▪massive necrosis with vascular invasion and infarction 4. Respiratory 5. Skin & subcutaneous infections
LABORATORY METHODS ==Direct Microscopic exam= ▪ branching coenoctic hyphae
==radiographic studies== ==Direct Microscopic exam= ▪ Small yeast like cells wi th internal crosswalls ▪ no budding cells produced ==Culture== SDA ▪ blue-green to yellowish colonies ▪ Soluble red to maroon pigment on reverse side of colony ▪ Mycelial to yeast conversion (2 weeks) ▪ mycelial produces brushlike conidiophores (penicillus)
==Direct Microscopic exam= ▪ respiratory spn ==Culture== No growth
==Culture== 1. Absidia ▪ pyriform sporangia + funnel shaped apophysis 2. Mucor ▪ no rhizoids/stolons 3. Rhizopus ▪ unbranched sporangiospores with rhizoids appearing at the point where stolon arises
