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Crisologo, Ferrer, Sorveto,

Kalon, De Luzon

SYSTEMIC MYCOSES

DE LUZON, ANA ROSE D.

Histoplasma

• H. capsulatum is a dimorphic fungi• H. capsulatum causes histoplasmosis

– reticuloendothelial cytomycosis– caver’s disease– spelunker’s disease–Darling’s disease

Histoplasma capsulatum

• Morphology

Macroscopic Microscopic

Slow growth White to dark tan

Woolly, cottony or granular

Microconidia small, one-celled,round, smooth-walled

(2-5µm)

Tuberculated macroconidia w/ typical thick walls , fingerlike

projections (7-12µm)


• Infects RES – bone marrow specimen of choice

• Primary focus pulmonary• may be confused with Sepedonium


• Identification Techniques1. Wrights and Giemsa stain

yeast cells are commonly seen w/in monocyte and macrophages

2. Sabourauds dextrose Agar shows typical structure e.g. tuberculate

macroconidia


• MOT endemic in Ohio, Missouri and Mississippi

river valleys grows in soil, particularly if the soil is heavily

contaminated w/ bird droppings Histoplamosis is acquired by the inhalation

of microconidia of H. capsulatum


• Prevention and Control Asymptomatic or mild primary infection –

no therapy needed With progressive lung lesion – oral

ketoconazole In disseminated diseases – amphotericin B There are no means of prevention except

avoiding exposure in endemic area


• Pathology• Chronic pulmonary histoplasmosis in patients

w/ chronic obstructive pulmonary disease may occur

» Other manifestations of the disease are mediastinitis, pericarditis, and mucocutaneous lesions.

Sorveto Dayle Daniel G.

• habitat-soil of many arid regions

• infectious form- arthroconidia

• MOT-inhalation

• virulence- extracellular proteinase

• Difficult to convert from mold to yeast phase

• Endemic in desert southwest and semi rid regions

Coccidiodes imitis

• Dimorphic fungi

• Mould phase/saprophobic (soil)– Spherule (40C)

• Yeast phase/parasitic phase(tissue)– Sperules containing endospores

• Tissue from large, rough walled spherule containing endospores

• Barrel shaped

C.Immitis morphology

Coccidiomycosis

• Primary in pulmonary disease

• “Valley fever”(San Joaqin Valley California) or desert rheumatism (Arizona)

pathogenesis

• Clinical specimens include

• Sputum

• pus from skin lesions

• gastric washings

• CSF

• biopsy material from skin lesions.

• Grows on SDA 25 celsius

Specimen collection:

Al-hadad Kalon

Paracoccidioides brasiliensis

• Central and South America (Brazil, Venezuela, Colombia)

• High humidity and temperature

MORPHOLOGY• YEAST• The yeast forms consists of Oval or

globose cells 2- 30 microns, in diameter, with small buds attached by a narrow neck encircling the parent cells.

• “Mariners Wheel”• MOLD

• Similar to Lollipopforms

Pathology

• P. brasiliensis is the causative agent of

– Paracoccidiomycosis (South American blastomycosis, Brazilian blastomycosis, Lutz-Splendore-Almeids disease and paracoccidiodalgranuloma)

– Is pulmonary and infection is usually asymptomatic, subsequent dessimenation leads to the formation of ulcerative granulomatous lesions of the buccal, nasal and occasionally gastrointestinal mucosa.

• Disease presentation:– Pneumonia– Disseminated infection– Extrapulmonary lesions on the face and oral

mucosa

• Lymphatic system spleen, Intestines, Liver involvement

Mode of Transmission

• Transmitted by inhalation of

the spores• Restricted to South

and Central America• Isolated in acidic soil

and its growth requires increasedhumidity

Identification techniques

• Endemic in Central and South America (Brazil, Venezuela, Colombia) – In soil (High humidity and

temperature ~23°C.)

• Serological findings (detection of specific antibodies)

• Microscopy – Sputum , Pus,• Biopsy of glaucomatous lesions• Direct histopathologic examination

of infected tissue• Yeast

Multiple buds resembling “mariners wheel”These daughter cells are connected by a narrow base, giving the appearance of a “Mickey Mouse Cap”

Identification techniques

• Culture– kept for 6 weeks– 25 c moulds– 37 c yeasts

– Saboraud’s agar– At room temperature it grows a

non spore forming septate fungus– Brain Heart Infusion at 35° C– It produces yeast that is seen in

tissue

• Direct Microscopy– 10-20% KOH– 1-2 drops are used– demonstration of multiple

budding yeast

• Others – Paracoccidioidin skin test– Complement fixation test– Immunodiffusion test

Treatment and Prevention

• Amphotericin B

• Itraconazole

• Long term therapy is required

• Prevent inhalation of dust in endemic area

Mollie Carl Ferrer/Zenaida Crisologo

Morphology

• Yeast form:

– Large yeast cells (8-12 µm)

– Blastoconidiaattached by broad base

– Double contoured wall

• Mold phase:

– Lollipop forms

Macroscopic Morphology

• Slow to moderate growth– White to dark tan

• Young colonies– Tenacious

• Older colonies– Glabrous to wooly

• Oval ,pyriform, to globusesmooth conidia borne on short, lateral hyphalikeconidiophores

Mode of Transmission & Epidemiology

• Presumably owing to men’s greater occupational and recreational exposure to the soil

• It grows in moist soil rich in organic material, forming hyphae with small pear-shaped conidia

• Inhalation of the conidia *

Epidemiology

• North America and parts of Africa*

• Mississippi and Ohio River basins

– St. Lawrence River basin*

Identification Technique

• KOH (10%) or Calcofluor white –use to aid for examination of yeast cell

• 22 C – colonies may be white tan or brown and may be fluffy or glabrous

• Spicules- seen in the center of colonies

• 37 C (blood Agar) – broad base budding yeast cell

Prevention & Control

• Ketoconazole

• Surgical excision

• There are no means of prevention

Pathology

• Primary infection: Flulike symptoms

• Asymptomatic and cannot accuratety define the time of onset

• Pulmonary disease (cough,weightloss, chest pain and fever)

• Progressive pulmonary or invasive disease may follow.(ulcerative lesions of bone and skin)

• ** immunodeficientpatient : multiple organ system

• Blastomycosis

- Gilchrist disease, North American Blastomycosisand chicago disease

- Occurs primarily: North America and Parts of Africa

• United States(endemic)- Mississipi , Ohio river basins and St. Lawrence River basin

** Dogs and Horses

Sporotrichosis

• Sporothrix schenckii

– Cutaneous inoculation of fungus from penetrating injury with a spore or thorn (rose bush)

– Initial skin lesion w/wo ulceration

– Lymph-cutaneous spread – bone – systemic

– Pulmonary and CNS infections are rare but reported

Starts as one ulcerative lesion and then chains

Up the lymphatics – can involve lymph nodes

and bone

Sporothrix schenckii

• Dimorphic fungus

• MOLD PHASE

– 30*˚C growth in 3 -5 days

– Turns brown to black over time

– Septate hyphae with conidia in daisy wheel pattern

• YEAST PHASE

– At 37˚C small oval yeast cells,

elongated 2 – 5 µM, described as cigar bodies


• Histology –

– Pyogenic – to – granulomatous inflammation

– Hard to find yeast in human tissue

– Asteroid body known as Splendore-Hoeppli phenomenon can be seen – also seen in:

• Zygomycetes (mucorales)

• Aspergillus

• Blastomycosis

• Candida

Daisy like spore arrangement


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