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Opportunistic Mycoses &
Miscellaneous mycoses
OBJECTIVES
• To describe the etiology, morphology, pathogenesis, clinical spectrum of opportunistic mycoses
• To elaborate the laboratory diagnosis and treatment of Opportunistic mycoses.
Introduction
• Opportunistic Mycoses – Fngal infections in Immuno-compromised or Immuno-suppressed individuals
• HIV/AIDS, Diabetes, Patients with Malignancy, Pts. Taking cancer chemotherapy, Prolonged corticosteroid therapy, Infants & young Children, Elderly age, Tuberculosis & Pregnancy
ASPERGILLOSIS
1. Allergic Broncho Pulmonary Aspergillosis – Type I Hypersensitivity reactions (Asthma, Type III (extrinsic alveolitis)
2. Aspergilloma3. Invasive Aspergillosis4. Superficial infections like otomycosis &
Mycotic keratitis or Oculomycosis
ASPERGILLOSIS
1. Aspergillus fumigatus2. Aspergillus niger3. Aspergillous flavus4. Aspergillus terreus
ASPERGILLOSIS
• Laboratory diagnosis: • Microscopy: LPCB stain: Septate hyaline
hyphae is suggestive of Aspergillus infection• Culture: Velvetty or powdery colonies1. Aspergillus fumigatus - Green2. Aspergillus niger - Black3. Aspergillous flavus - Yellow4. Aspergillus terreus - Brown
Aspergillus niger
Aspergillus flavus
Aspergillus fumigatus
PENICILLOSIS
CANDIDOSIS
• CANDIDIASIS• MONILIASIS• Candida albicans, C. dubliniensis• Candida non-albicans • Candida tropicalis, C. glabrata, C. krusei, • C. pseudotropicalis, C. gueillermondii
CANDIDOSIS
• KOH mount: Potassium hydroxide
Candida albicans
Candida albicans
Candida albicans• Reynold – Braude phenomenon – Lady Hand
mirror appearance (Germ tube test positive)
Candida albicans• Corn meal agar – Chlamyospores positive
CRYPTOCOCCOSIS
• TORULOSIS• Cryptococcus neoformans var. neoformans• Cryptococcus laurentii• Cryptococcus albidus• Rapid urease positive
CRYPTOCOCCOSIS Gram stain Negative stain Spherical Gram Positive Clear halo seen (capsule)
CRYPTOCOCCOSISCulture on SDA
ZYGOMYCOSIS
• MUCORMYCOSIS • PHYCOMYCOSIS• Rhino orbito cerebral
Mucormycosis• Diabetes mellitus• H & E Stain
ZYGOMYCOSIS - RHIZOPUS
Rhizopus
ZYGOMYCOSIS - MUCOR
PNEUMOCYSTIS JIROVECII
• Trophozoite – 1-5 µm• Pre-cyst – 5-8 µm• Cyst - >8 µm• Cannot be cultured in SDA• Can be cultured in Complex media• Modified Gomori’s Methanamine Silver stain • Cotrimoxazole (Trimethoprim - Sulfamethoxazole)
PNEUMOCYSTIS JIROVECII
MISCELLANEOUS TOPICS
• OTOMYCOSIS• OCULOMYCOSIS• MYCOTIC POISONINGa. MYCETISMb. MYCOTOXICOSIS• WOOD’s LAMP FLUORESCENCE
OTOMYCOSIS
OCULOMYCOSIS
MYCOTIC POISONING
a. MYCETISMPsilocybe spp.,Produces d-Lysergic Acid & Psilocybinb. MYCOTOXICOSISAspergillus spp., Claviceps purpura
MYCOTIC POISONING
MYCETISM
MYCOTOXINS
• Aspergillus spp., - Aflatoxin• Amanita phalloides – Phallotoxin• Fusarium spp., - Fumonisin• Aspergillus spp., in cereals • Penicllium spp., in Bread• Fusarium graminareum – Zearalenone• Claviceps purpura – Ergotism – ergot alkaloid
Ochratoxin
MYCOTOXICOSIS
WOOD’s LAMP FLUORESCENCE
WOOD’s LAMP FLUORESCENCE
Summary & Take home message
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