Systemic mycosis

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  • 1. Crisologo, Ferrer, Sorveto, Kalon, De Luzon

2. SYSTEMIC MYCOSES 3. DE LUZON, ANA ROSE D. 4. Histoplasma H. capsulatum is a dimorphic fungi H. capsulatum causes histoplasmosis reticuloendothelial cytomycosis cavers disease spelunkers disease Darlings disease 5. Histoplasma capsulatum Morphology MacroscopicSlow growth White to dark tan Woolly, cottony or granularMicroscopic Microconidia small, one-celled, round, smooth-walled (2-5m) Tuberculated macroconidia w/ typical thick walls , fingerlike projections (7-12m) 6. Histoplasma capsulatum Infects RES bone marrow specimen of choice Primary focus pulmonary may be confused with Sepedonium 7. Histoplasma capsulatum Identification Techniques 1.Wrights and Giemsa stain yeast cells are commonly seen w/in monocyte and macrophages2. Sabourauds dextrose Agar shows typical structure e.g. tuberculate macroconidia 8. Histoplasma capsulatum 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 9. Histoplasma 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 10. Histoplasma capsulatum Pathology Chronic pulmonary histoplasmosis in patients w/ chronic obstructive pulmonary disease may occur Other manifestations of the disease are mediastinitis, pericarditis, and mucocutaneous lesions. 11. Sorveto Dayle Daniel G. 12. Coccidiodes imitis 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 13. C.Immitis morphology 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 14. Coccidiomycosis 15. pathogenesis Primary in pulmonary disease Valley fever(San Joaqin Valley California) or desert rheumatism (Arizona) 16. Specimen collection: Clinical specimens include Sputum pus from skin lesions gastric washings CSF biopsy material from skin lesions. Grows on SDA 25 celsius 17. Al-hadad Kalon 18. Paracoccidioides brasiliensis Central and South America (Brazil, Venezuela, Colombia) High humidity and temperatureMORPHOLOGY 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 Lollipop forms 19. Pathology P. brasiliensis is the causative agent of Paracoccidiomycosis (South American blastomycosis, Brazilian blastomycosis, Lutz-SplendoreAlmeids disease and paracoccidiodal granuloma) 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 20. Mode of Transmission Transmitted by inhalation of the spores Restricted to South and Central America Isolated in acidic soil and its growth requires increased humidity 21. Identification techniques Endemic in Central and South America (Brazil, Venezuela, Colombia) In soil (High humidity and temperature ~23C.) 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 22. Identification techniques Culture kept for 6 weeks 25 c moulds 37 c yeasts Saborauds 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 23. Treatment and Prevention Amphotericin B Itraconazole Long term therapy is required Prevent inhalation of dust in endemic area 24. Mollie Carl Ferrer/Zenaida Crisologo 25. Morphology Yeast form: Large yeast cells (8-12 m) Blastoconidia attached by broad base Double contoured wall Mold phase: Lollipop forms 26. Macroscopic Morphology Slow to moderate growth White to dark tan Young colonies Tenacious Older colonies Glabrous to wooly Oval ,pyriform, to globuse smooth conidia borne on short, lateral hyphalike conidiophores 27. Mode of Transmission & Epidemiology Presumably owing to mens 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 * 28. Epidemiology North America and parts of Africa* Mississippi and Ohio River basins St. Lawrence River basin* 29. 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 30. Prevention & Control Ketoconazole Surgical excision There are no means of prevention 31. 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) 32. ** immunodeficient patient : multiple organ system Blastomycosis - Gilchrist disease, North American Blastomycosis and chicago disease - Occurs primarily: North America and Parts of Africa 33. United States(endemic)- Mississipi , Ohio river basins and St. Lawrence River basin ** Dogs and Horses 34. 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 35. Starts as one ulcerative lesion and then chains Up the lymphatics can involve lymph nodes and bone 36. 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 37C small oval yeast cells, elongated 2 5 M, described as cigar bodies 37. Sporothrix schenckii 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 38. Sporothrix schenckiiDaisy like spore arrangement 39. THANKS FOR LISTENING AND GODBLESS!