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JAMUR-JAMUR PENYEBAB
ENDEMIK MIKOSIS ( SISTEMIK MIKOSIS)
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CoccidioidomycosisCoccidioidomycosis
Valley Fever, San Joaquin Fever, Desert Rheumatism
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CoccidioidomycosisCoccidioidomycosisCoccidioidomycosisCoccidioidomycosis
• Coccidioidomycosis is also known as • Coccidioidomycosis is also known as valley fever, San Joaquin fever, and desert rheumatismdesert rheumatism
Center for Food Security and Public Health Iowa State University - 2004
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OverviewOverviewOverviewOverview
• Organism• Organism• Economic Impact
Epidemiology• Epidemiology• Transmission• Clinical Signs• Diagnosis and Treatmentg• Prevention and Control • Actions to take
Center for Food Security and Public Health Iowa State University - 2004
• Actions to take
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• Coccidioidomycosis results from direct inhalation of the spores of the dimorphic fungus Coccidioides the spores of the dimorphic fungus Coccidioides immitis from the soil or from dust in the air. C. immitis has both a saprophytic and parasitic phase in its life cycle. It grows as a mold in the soil, and when disturbed, the hyphae fragment forms a durable disturbed, the hyphae fragment forms a durable structure called arthroconidia which becomes airborne. When the arthroconidia are inhaled, they transform into thick-walled multinucleate spherules that then separate to produce thousands of
d hi h h d h lp p
endospores, which can then produce a new spherule ands begin the cycle anew. Photo on top hyphae and arthroconidia. Photo on bottom spherules containing endospores. Photo source: http://botit botany wisc edu/toms fungi/jan2002 hthttp://botit.botany.wisc.edu/toms_fungi/jan2002.html
Center for Food Security and Public Health Iowa State University - 2004
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The OrganismThe Organism
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Coccidioides immitisCoccidioides immitisCoccidioides immitisCoccidioides immitis
• Dimorphic fungus• Dimorphic fungus−Saprophytic phase−Parasitic phaseParasitic phase
• From soil or dustArthroconidia become −Arthroconidia become airborne, inhaled
−Transform into Transform into spherule and endospore
Center for Food Security and Public Health Iowa State University - 2004
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CoccidioidesCoccidioides immitis
LifecycleLifecycle phases
Center for Food Security and Public Health Iowa State University - 2004
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ImportanceImportance
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HistoryHistoryHistoryHistory
• 1892: First reported as disease• 1892: First reported as disease• 1920-1930
Soil recognized as reservoir for agent−Soil recognized as reservoir for agent
• 1987CDC dd idi id i t l −CDC adds coccidioidomycosis to annual survey of HIV-associated diseases
1991 1995• 1991-1995− Incidence increases tenfold in San
Joaquin Valley CACenter for Food Security and Public Health
Iowa State University - 2004
Joaquin Valley, CA
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Economic ImpactEconomic ImpactEconomic ImpactEconomic Impact
• Infection is costly• Infection is costly−Time lost from work−Direct medical costsDirect medical costs
• 1990: Kern County, CACost more than $66 million−Cost more than $66 million
• Costly to livestock industryI f ti b id d− Infection can be widespread
−Diagnosis/treatment can be significant
Center for Food Security and Public Health Iowa State University - 2004
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EpidemiologyEpidemiology
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Geographic DistributionGeographic DistributionGeographic DistributionGeographic Distribution
• Endemic areas• Endemic areas−Southwestern U.S.
New Mexico, Texas, New Mexico, Texas, California, Arizona
−Northern Mexico−Central America−Argentina
• 10-50% skin test positive
Center for Food Security and Public Health Iowa State University - 2004
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Morbidity/MortalityMorbidity/MortalityMorbidity/MortalityMorbidity/Mortality
• Two forms in humans• Two forms in humans−60% asymptomatic
Only identified with positive skin testOnly identified with positive skin test
−40% mild to severe diseaseCan be fatalImmuno-compromised persons highly susceptible to serious infection
Diffi lt t bidit i • Difficult to assess morbidity in animals
Center for Food Security and Public Health Iowa State University - 2004
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TransmissionTransmission
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Animal TransmissionAnimal TransmissionAnimal TransmissionAnimal Transmission
• Direct inhalation of C immitis spores • Direct inhalation of C. immitis spores from soil or dust−Rare animal-to-animal transmissionRare animal to animal transmission
Placental infection reported in horses
− Incidence increases after disturbance
• Dusty conditions−Most bovine infections contracted from Most bovine infections contracted from
dusty feedlot
Center for Food Security and Public Health Iowa State University - 2004
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Human TransmissionHuman TransmissionHuman TransmissionHuman Transmission
• Direct inhalation of C immitis spores• Direct inhalation of C. immitis spores−Present in contaminated soil and dust−Only established mode of transmissionOnly established mode of transmission
• Not person-to-personNot animal to person• Not animal-to-person
• Increased incidence after disturbance
Center for Food Security and Public Health Iowa State University - 2004
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Human TransmissionHuman TransmissionHuman TransmissionHuman Transmission
• Natural disturbances• Natural disturbances−Dust storms−EarthquakesEarthquakes
• Human disturbancesConstruction sites
http://vfce.arl.arizona.edu
−Construction sites−Archaeological digs
Center for Food Security and Public Health Iowa State University - 2004
http://griefnet.org
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C.immitisC.immitis
Center for Food Security and Public Health Iowa State University - 2004
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Animals and Coccidioidomycosis
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Clinical SignsClinical SignsClinical SignsClinical Signs
• Disease varies in severity and • Disease varies in severity and species affected
• Incubation period: 1-3 weeks• Incubation period: 1 3 weeks• Asymptomatic to disseminated
Si f i f• Signs of primary form−Fever (104-105°F)
h−Lethargy, inappetence−Dry, harsh cough
M b f d ith k l hCenter for Food Security and Public Health
Iowa State University - 2004
May be confused with kennel cough
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Clinical Signs: DogsClinical Signs: DogsClinical Signs: DogsClinical Signs: Dogs
• Signs of disseminate form• Signs of disseminate form−Fever, anorexia, weight loss− Infection of the bonesInfection of the bones
Lameness, limpingJoint swellingg
−Chronic coughing−Abscesses and draining skin lesionsg−Diarrhea
Center for Food Security and Public Health Iowa State University - 2004
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Clinical Signs: Other AnimalsClinical Signs: Other AnimalsClinical Signs: Other AnimalsClinical Signs: Other Animals
• Cats• Cats−Draining skin lesions, abscesses,
subcutaneous granulomatous massesg−Fever, loss of appetite, weight loss−Dyspnea, lameness, neuropathiesysp ea, a e ess, eu opat es
• Horses−Abortion osteomyelitisAbortion, osteomyelitis
• Pigs and ruminantsUsually asymptomatic
Center for Food Security and Public Health Iowa State University - 2004
−Usually asymptomatic
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Post Mortem LesionsPost Mortem LesionsPost Mortem LesionsPost Mortem Lesions
• Gross lesions• Gross lesions−Disseminated or limited to lungs,
mediastinum, thoracic lymph nodes, y p
• Resemble tuberculosis lesions−Discrete variable sized firm grayish Discrete, variable sized, firm, grayish
on cut surface
• Pyogranulomatous lesionsPyogranulomatous lesions−Contain purulent exudates and fungal
spores
Center for Food Security and Public Health Iowa State University - 2004
p
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DiagnosisDiagnosisDiagnosisDiagnosis
• Clinical• Clinical−C. immitis infection should be suspected
In endemic areasIn endemic areasWith characteristic clinical signs
• Laboratory TestsLaboratory Tests−Fungal spores found in exudates−SerologySerology
Complement-fixing antibody tests
Center for Food Security and Public Health Iowa State University - 2004
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Treatment Treatment Treatment Treatment
• Should be initiated immediately• Should be initiated immediately• For disseminated infections
Long term therapy for at least one year−Long-term therapy for at least one year−Antifungal agents
Likelihood of recovery• Likelihood of recovery−Primary form: Good prognosis
Di i t d f G d d i−Disseminated form: Guarded prognosis
Center for Food Security and Public Health Iowa State University - 2004
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Coccidioidomycosis in Humans
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Clinical Signs: Primary FormClinical Signs: Primary FormClinical Signs: Primary FormClinical Signs: Primary Form
• Incubation period: 1-4 weeks• Incubation period: 1 4 weeks• Usually subclinical
Fever chills cough sore throat• Fever, chills, cough, sore throat• Chest pain• Nodular lesions• Nonspecific respiratory symptomsp p y y p• Complications less common−Pneumonia, pleural effusion
Center for Food Security and Public Health Iowa State University - 2004
Pneumonia, pleural effusion
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Clinical Signs: Clinical Signs: Disseminate FormDisseminate Form
• Severe form of diseaseSevere form of disease• Weeks to months to years after
primary infectionp y• Symptoms include
− Low-grade fever, anorexia, weight loss− Muscle aches and stiffness, weakness− Excessive sweating
Widespread focal lesions− Widespread focal lesions
• In HIV-infected personsMucopurulent or bloody sputum
Center for Food Security and Public Health Iowa State University - 2004
− Mucopurulent or bloody sputum
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Post Mortem LesionsPost Mortem LesionsPost Mortem LesionsPost Mortem Lesions
• Skin lesions• Skin lesions−Exanthems, maculopapular lesions
• Pulmonary signs• Pulmonary signs−Bronchitis, pneumonia, pleural effusion
Bone and joint lesions• Bone and joint lesions• Lymphadenopathy• Abdomen−Masses, hepatomegaly, splenomegaly
Center for Food Security and Public Health Iowa State University - 2004
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SamplingSamplingSamplingSampling
• Before collecting or sending any • Before collecting or sending any samples, the proper authorities should be contactedshould be contacted
• Samples should only be sent under • Samples should only be sent under secure conditions and to authorized laboratories to prevent the spread of laboratories to prevent the spread of the disease
Center for Food Security and Public Health Iowa State University - 2004
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DiagnosisDiagnosisDiagnosisDiagnosis
• Differentials• Differentials−Tuberculosis
• Clinical• Clinical−Coccidioidomycosis should be
considered considered In endemic areasFollowing a dust/soil disturbancegWith characteristic clinical signs
Center for Food Security and Public Health Iowa State University - 2004
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DiagnosisDiagnosisDiagnosisDiagnosis
• C immitis spherules visualized in• C. immitis spherules visualized in−Sputum, pleural fluid, cerebrospinal
fluid or exudates from draining lesionsg
• Complement fixation− IgG anticoccidioidal antibodiesIgG anticoccidioidal antibodies
Titer ≥1:4 = current or recent infectionTiter ≥1:32 = increased risk of extrapulmonary dissemination
• Skin test of epidemiological value
Center for Food Security and Public Health Iowa State University - 2004
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Treatment Treatment Treatment Treatment
• Primary coccidioidomycosis• Primary coccidioidomycosis−Treatment generally unnecessary
• Severe/chronic coccidioidomycosis• Severe/chronic coccidioidomycosis−Antifungal agents effective
Prognosis generally good−Prognosis generally good
• Disseminate coccidioidomycosisM i i i l t −May require invasive or long-term therapyPrognosis poor to guarded
Center for Food Security and Public Health Iowa State University - 2004
−Prognosis poor to guarded
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Public Health SignificancePublic Health SignificancePublic Health SignificancePublic Health Significance
• Reportable disease • Reportable disease −Humans in endemic areas
CaliforniaCaliforniaNew Mexico Arizona
−Notify state department of health
• Serious threat to immunocompromised persons−High mortality rate
Center for Food Security and Public Health Iowa State University - 2004
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Prevention and Control
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Recommended ActionsRecommended ActionsRecommended ActionsRecommended Actions
• Notification of Authorities• Notification of Authorities−Federal:
Area Veterinarian in Charge (AVIC) Area Veterinarian in Charge (AVIC) www.aphis.usda.gov/vs/area_offices.htm
−State veterinarian www.aphis.usda.gov/vs/sregs/official.htm
• State or local health department
Center for Food Security and Public Health Iowa State University - 2004
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Quarantine and DisinfectionQuarantine and DisinfectionQuarantine and DisinfectionQuarantine and Disinfection
• Quarantine not necessary• Quarantine not necessary−Coccidioidomycosis not communicable
• Disinfection• Disinfection− Iodine
Chlorine−ChlorineHypochlorite (5.25% is household bleach)
−Phenolics: Tek-Trol®−Phenolics: Tek Trol®−Quaternary ammoniums
Di-Quat 10-S and Roccal®-D Plus
Center for Food Security and Public Health Iowa State University - 2004
Di Quat 10 S and Roccal® D Plus
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VaccinationVaccinationVaccinationVaccination
• No effective immunization available• No effective immunization available−Efforts being made to develop vaccine
• Precautionary measures should be • Precautionary measures should be taken to avoid infection
Reduce exposure to soil and dust−Reduce exposure to soil and dustMan and animalOf particular importance in endemic areasO pa t cu a po ta ce e de c a eas
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AcknowledgmentsAcknowledgments
De elopment of this Development of this presentation was funded by a grant from the by a grant from the Centers for Disease Control and Prevention to the Center for Food Security and Public Health at Iowa State UniversityState University.
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AcknowledgmentsAuthor: Jean Marie Gladon BS
AcknowledgmentsAuthor:
Co author:
Jean Marie Gladon, BS
James Roth DVM PhDCo-author:
i
James Roth, DVM, PhD
d C SReviewer: Bindy Comito Sornsin, BA
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Lecture 3: Endemic FungiLecture 3: Endemic FungiLecture 3: Endemic FungiLecture 3: Endemic Fungi
• Dimorphic Fungi with mold forms found in o p c u g t o d o s ou dsoil, spores inhaled, yeast forms producing disease in lungs or disseminated. Specific geographical niches All can cause disease geographical niches. All can cause disease in normal hosts but more problematic in patients with altered CMI. Cause disease pin animals as well as humans. Environmental, not person-to-person spreadspread.
• Coccidioides immitis, Histoplasma capsulatum, Blastomyces dermatitidis,
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capsulatum, Blastomyces dermatitidis, and Paracoccidioides brasiliensis are most important species.
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Coccidioidomycosis ( ll )
Coccidioidomycosis ( ll )(Valley Fever)(Valley Fever)
• Coccidioides immitis: Dimorphic fungus Cocc d o des t s o p c u gusliving as mold (saprophytic) form in soil in semiarid regions of southwestern US, Central America South America In US Central America, South America. In US, greatest incidence in Arizona and Central Valley of California. Cases outside endemic yarea generally related to travel or shipping of contaminated materials from endemic area Arthroconidia spread through air area. Arthroconidia spread through air, with higher incidence of infection after heavier than usual spring rains and during
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dust storms. Other animals may be infected. Epidemic after Northridge earthquake
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Cocci in SW USCocci in SW USCocci in SW USCocci in SW US
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Pathogenesis of C.immitisPathogenesis of C.immitis• Arthroconidia inhaled into lungs,
transform into spherules filled with endospores (the yeast or parasiticform) Spherules rupture release form). Spherules rupture, release endospores more spherules. Histology: Granulomas. Most cases are
i d di bl l b asymptomatic and diagnosable only by skin testing, but roughly 40% develop pulmonary or extrapulmonary pulmonary or extrapulmonary symptoms.
• Pulmonary cocci-Flu-like illness with fever, cough, arthralgias known as valley fever. May have associated erythema nodosum (tender red
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erythema nodosum (tender red nodules on lower extremities) as sign of vigorous CMI response. Chest X-ray f d l d f l h l
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Disseminated Coccidioidomycosis
Disseminated CoccidioidomycosisCoccidioidomycosisCoccidioidomycosis
• Overall, <1% of patients have disseminated disease with skin, bones, and meninges (with granulomatous basilar meninges (with granulomatous basilar meningitis) key areas of spread. Dissemination may be soon after exposure or late (reactivation) Risk factors include or late (reactivation). Risk factors include altered CMI (e.g. AIDS, organ transplant) and pregnancy (the latter due to altered immune function and trophic effects of estrogen/progesterone for cocci). Patients with dissemination typically have high yp y gcomplement fixation antibody titers and negative skin tests.Striking racial/ethnic differences in rate of
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• Striking racial/ethnic differences in rate of dissemination, with Filipinos>African Americans>Native
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Cocci spherule with d
Cocci spherule with dendosporesendospores
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ArthroconidiaArthroconidiaArthroconidiaArthroconidia
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Coccidioides immitis spherules i l i
Coccidioides immitis spherules i l iin lung tissuein lung tissue
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Saprophytic form of C i i i
Saprophytic form of C i i iC.immitisC.immitis
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ArthroconidiaArthroconidiaArthroconidiaArthroconidia
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Cocci osteomyelitisCocci osteomyelitisCocci osteomyelitisCocci osteomyelitis
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Disseminated cocci Disseminated cocci Disseminated cocci Disseminated cocci
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CoccidioidomycosisCoccidioidomycosisCoccidioidomycosisCoccidioidomycosis
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Chronic cutaneous coccidioidomycosis Chronic cutaneous coccidioidomycosis Chronic cutaneous coccidioidomycosis showing granulomatous lesions of the face,
neck and chin (Courtesy of John Rippon, USA
Chronic cutaneous coccidioidomycosis showing granulomatous lesions of the face,
neck and chin (Courtesy of John Rippon, USA
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Domingo EzcurraDomingo EzcurraDomingo EzcurraDomingo Ezcurra
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Erythema nodosumErythema nodosumErythema nodosumErythema nodosum
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Cocci treatment/preventionCocci treatment/prevention
• Low risk patients with mild localized pulmonary disease may not need treatment.
• High risk patients with pulmonary disease or all patients with disease or all patients with disseminated disease (defined clinically or by high CF titer) treated, usually with y g ) , yfluconazole.
• Meningitis treated with intrathecal h t i i ( f ) amphotericin (some cases of cure) or
lifelong high dose fluconazole, often following induction with IV
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following induction with IV amphotericin.
• AIDS patients need lifelong therapy
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HistoplasmosisHistoplasmosis
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HistoplasmosisHistoplasmosisHistoplasmosisHistoplasmosis
• Histoplasma capsulatum: Dimorphic Histoplasma capsulatum: Dimorphic fungus with mold (saprophytic) form found in soil, bird/bat droppings , / pp gworldwide. Most cases in Missouri, Mississippi, Ohio river valleys. As
ith i t id with cocci, cases may occur outside of endemic areas due to travel, shipping Infectious microconidia shipping. Infectious microconidia spread through the air. Other animals may be infected Hazard for
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animals may be infected. Hazard for spelunkers (exposure to bat guano).
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H.capsulatumH.capsulatum
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Histo pathogenesisHisto pathogenesisHisto pathogenesisHisto pathogenesis• Conidia inhaled, develop into yeast cells,
engulfed by alveolar macrophages. engulfed by alveolar macrophages. INTRACELLULAR, resistant to lysosomal killing. Replication by budding in macrophages with dissemination though macrophages, with dissemination though R-E system. In endemic areas up to 90% have positive skin test indicating exposure. Of th 95% t ti t ll d Of these, >95% asymptomatic, controlled by CMI but with later evidence of calcified granulomas especially in lungs/ spleen.g p y g p
• Acute pulmonary histoplasmosis-with large inoculum, acute flu-like illness with fever myalgias cough Hilar and
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fever, myalgias, cough. Hilar and mediastinal adenopathy, pulmonary infiltrates/nodules. Usually resolves
t l
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Histo: Shakespeare, Scheiffelin Starlings Stool
Histo: Shakespeare, Scheiffelin Starlings Stool Scheiffelin, Starlings, Stool,
and SpreadScheiffelin, Starlings, Stool,
and Spread• In 1890 Eugene g
Scheiffelin introduced 100 European starlings into Central Park, NYC as part of an effort to bring part of an effort to bring all of the birds mentioned by Shakespeare to the US. (I Henry IV I.iii, 218-226)
• Now there are 200M-1B starlings in N. America. h d Their droppings are a
major route of transmission for
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histoplasmosis.
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Histoplasmosis Geography in Histoplasmosis Geography in USUS
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Histo pathogenesisHisto pathogenesisp gp g• Conidia inhaled, develop into yeast cells, engulfed by
alveolar macrophages. INTRACELLULAR, resistant to l l killi R li ti b b ddi i lysosomal killing. Replication by budding in macrophages, with dissemination though R-E system. In endemic areas up to 90% have positive skin test indicating exposure. Of these, >95% asymptomatic, d ca g e posu e O ese, 95% asy p o a c,controlled by CMI but with later evidence of calcified granulomas especially in lungs/ spleen.
• Acute pulmonary histoplasmosis-with large i l t fl lik ill ith f l i inoculum, acute flu-like illness with fever, myalgias, cough. Hilar and mediastinal adenopathy, pulmonary infiltrates/nodules. Usually resolves spontaneously.
• Chronic thoracic histoplasmosis-may have • Chronic thoracic histoplasmosis-may have progressive pulmonary fibrosis, pericarditis, mediastinitis. Dormant disease can reactivate.
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Disseminated HistoplasmosisDisseminated HistoplasmosisDisseminated HistoplasmosisDisseminated Histoplasmosis
• In patients with impaired CMI (e g • In patients with impaired CMI (e.g. AIDS, immunosuppressives) severe dissemination with multiorgan dissemination with multiorgan involvement and sepsis syndrome may occur. Yeasts seen in ymacrophages in spleen, liver, bone marrow, blood, skin, etc. Poor granuloma formation.
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Diagnosis of HistoplasmosisDiagnosis of
HistoplasmosisHistoplasmosisHistoplasmosis• Stains of tissue showing yeast cells in
macrophages.l f k l bl d• Culture of sputum, urine, skin lesions, blood,
bone marrow. At 25˚C for mold, at 37˚C for yeast. Hyphae have macroconidia and microconidia. Like cocci, LAB HAZARD.
• Skin test with histoplasmin mycelial antigen—used only for epidemiology, not individual y p gy,diagnosis. May lead to false positive antibody tests.
• Antibody assays-CF and ID tests available with • Antibody assays CF and ID tests available with H and Y antigens. Cross reactions with other fungi. Rise in titer helpful.Serum/urine antigen detection (done in
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• Serum/urine antigen detection (done in Indiana)-very helpful to diagnose disseminated disease
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Mycelial form of H. l
Mycelial form of H. lcapsulatumcapsulatum
• Note larger • Note larger, tuberculate macronidiamacronidia(with bumps) and smaller microconidia.
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Histo yeast cells in peripheral bl d
Histo yeast cells in peripheral bl dblood WBCblood WBC
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Histo in lymph nodeHisto in lymph nodeHisto in lymph nodeHisto in lymph node
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Ocular HistoplasmosisOcular HistoplasmosisOcular HistoplasmosisOcular Histoplasmosis
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Pulmonary/Mediastinal Histo
Pulmonary/Mediastinal HistoHistoHisto
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Splenic calcifications in HistoSplenic calcifications in HistoSplenic calcifications in HistoSplenic calcifications in Histo
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Histoplasmosis of the lower gum showing
Histoplasmosis of the lower gum showingshowing
ulcer around base of the teeth.showing
ulcer around base of the teeth.
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Skin lesion in disseminated h
Skin lesion in disseminated hhistohisto
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Treatment/prevention of h l
Treatment/prevention of h lhistoplasmosishistoplasmosis
• Asymptomatic or mild pulmonary sy pto at c o d pu o a ydisease in immunocompetent-no specific treatmentM l di• More severe pulmonary disease-itraconazole
• Severe disseminated disease in • Severe disseminated disease in immunocompromised-initial amphotericin followed by itraconazole. Lifelong in AIDS patients.
• Mediastinal, pericardial involvement may require surgery stents etc
Center for Food Security and Public Health Iowa State University - 2004
may require surgery, stents, etc. Possible role for steroids for fibrosis—use caution!!
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BLASTOMYCOSISBLASTOMYCOSIS
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BlastomycosisBlastomycosisBlastomycosisBlastomycosis
• Blastomyces dermatitidis: Dimorphic fungus-a o y d a d o p u gumold with thin hyphae and ovoid conidia (infectious form) at 25˚C, thick walled budding yeast with broad attachment to budding yeast with broad attachment to single bud in tissue at 37˚C. Difficult to isolate from nature; reservoir not clear but soil likely with cases somewhat clustering around river banks. No good skin test; frequency of asymptomatic disease unknown frequency of asymptomatic disease unknown. In North America, geography similar to histo, with somewhat more extension into Southern C d Cli i ll t di l
Center for Food Security and Public Health Iowa State University - 2004
Canada. Clinically apparent disease less frequent than histo. Some cases from other continents.
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Blastomycosis GeographyBlastomycosis GeographyBlastomycosis GeographyBlastomycosis Geography
Center for Food Security and Public Health Iowa State University - 2004
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Blasto pathogenesisBlasto pathogenesisBlasto pathogenesisBlasto pathogenesis
• Inhalation of conidia Primary • Inhalation of conidia. Primary pulmonary disease may present with fever, cough, myalgias. May lead to fever, cough, myalgias. May lead to chronic pneumonia. Host response both neutrophils, granulomas.p , g
• Dissemination more common in immunocompromised. Key sites: immunocompromised. Key sites: skin, bone, genitalia, CNS.
Center for Food Security and Public Health Iowa State University - 2004
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Diagnosis of BlastomycosisDiagnosis of BlastomycosisDiagnosis of BlastomycosisDiagnosis of Blastomycosis
• Stains of sputum, pus, urine, tissue-Stains of sputum, pus, urine, tissuecharacteristic yeast forms, rarely hyphal forms.yp
• Culture-Mold at 30˚C, conversion to yeast on rich medium at 37˚C.y
• Skin test-not worthwhile• Serology-Some role for CF, ID, EIA Serology Some role for CF, ID, EIA
antibody detection. Problems with cross reactivity with other fungi.
Center for Food Security and Public Health Iowa State University - 2004
y g
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Blastomyces dermatitidis hyphae form (room temp Blastomyces dermatitidis hyphae form (room temp hyphae form (room temp
culture)hyphae form (room temp
culture)
Center for Food Security and Public Health Iowa State University - 2004
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Blasto Yeast forms with b d b d b dd
Blasto Yeast forms with b d b d b ddbroad-based buddingbroad-based budding
Center for Food Security and Public Health Iowa State University - 2004
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Blasto Yeast forms with b d b d b dd
Blasto Yeast forms with b d b d b ddbroad-based buddingbroad-based budding
Center for Food Security and Public Health Iowa State University - 2004
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Blasto Yeast forms with b d b d b dd
Blasto Yeast forms with b d b d b ddbroad-based buddingbroad-based budding
Center for Food Security and Public Health Iowa State University - 2004
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Extensive lung involvement l
Extensive lung involvement lin Blastoin Blasto
Center for Food Security and Public Health Iowa State University - 2004
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Pneumonia in BlastoPneumonia in BlastoPneumonia in BlastoPneumonia in Blasto
Center for Food Security and Public Health Iowa State University - 2004
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Cutaneous BlastomycosisCutaneous BlastomycosisCutaneous BlastomycosisCutaneous Blastomycosis
Center for Food Security and Public Health Iowa State University - 2004
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Bone involvement in BlastoBone involvement in BlastoBone involvement in BlastoBone involvement in Blasto
Center for Food Security and Public Health Iowa State University - 2004
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Blastomycosis /
Blastomycosis /treatment/preventiontreatment/prevention
• Mild or localized disease treated with • Mild or localized disease treated with itraconazole.
• Severe disease treated with • Severe disease treated with amphotericin.
• No specific means of prevention• No specific means of prevention.
Center for Food Security and Public Health Iowa State University - 2004
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PARACOCCIDIOIDO MYCOSIS
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Paracoccidioidomycosis Paracoccidioidomycosis (South American Blastomycosis)(South American Blastomycosis)
• Paracoccidioides brasiliensis-Paracoccidioides brasiliensis• Dimorphic fungus with characteristic yeast
form with large multiply budding cells with ˚
g p y gnarrow attachments in tissue and 36˚C rich medium culture. F d i C l d S h A i • Found in Central and South America. Probable soil source but not clear. Men>>Women (?Exposure) Worst • Men>>Women (?Exposure). Worst problem in Brazil—death rate up to 1.5/1000.
Center for Food Security and Public Health Iowa State University - 2004
1.5/1000.
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Paracocci GeographyParacocci GeographyParacocci GeographyParacocci Geography
Center for Food Security and Public Health Iowa State University - 2004
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Diagnosis of d d
Diagnosis of d dParacoccidioidomycosisParacoccidioidomycosis
• Yeast forms in fluids or tissues• Yeast forms in fluids or tissues• Culture with appropriate conversion
to yeast form at 36 C rich mediumto yeast form at 36 C, rich medium• Rising titer of CFT or
immunodiffusion antibody (helpful immunodiffusion antibody (helpful, correlate with severity of disease)Skin testing for epidemiology not • Skin testing for epidemiology, not diagnosis
Center for Food Security and Public Health Iowa State University - 2004
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Multiply budding yeast forms in Paracocci-(”Mariner’s /Pilot wheel )
Multiply budding yeast forms in Paracocci-(”Mariner’s /Pilot wheel )
Center for Food Security and Public Health Iowa State University - 2004
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Multiply budding yeast forms in Paracocci-(”Mariner’s /Pilot wheel )
Multiply budding yeast forms in Paracocci-(”Mariner’s /Pilot wheel )
Center for Food Security and Public Health Iowa State University - 2004
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Multiply budding yeast forms in Paracocci-(”Mariner’s /Pilot wheel )
Multiply budding yeast forms in Paracocci-(”Mariner’s /Pilot wheel )
Center for Food Security and Public Health Iowa State University - 2004
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Mucosal lesion in ParacocciMucosal lesion in ParacocciMucosal lesion in ParacocciMucosal lesion in Paracocci
Center for Food Security and Public Health Iowa State University - 2004
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Skin lesions in ParacocciSkin lesions in ParacocciSkin lesions in ParacocciSkin lesions in Paracocci
Center for Food Security and Public Health Iowa State University - 2004
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Lung disease in ParacocciLung disease in ParacocciLung disease in ParacocciLung disease in Paracocci
Center for Food Security and Public Health Iowa State University - 2004
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Genital Paracocci resembling h l
Genital Paracocci resembling h lsyphilissyphilis
Center for Food Security and Public Health Iowa State University - 2004
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Mucocutaneous paracoccidioidomycosis
Extensive destruction of facial featuresExtensive destruction of facial features
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Treatment/prevention of d d
Treatment/prevention of d dParacoccidioidomycosisParacoccidioidomycosis
• Mild-moderate disease treated with • Mild moderate disease treated with itraconazole. Interestingly, trimethoprim-sulfa has activity, but trimethoprim sulfa has activity, but tendency to relapse.
• Severe disease treated with • Severe disease treated with amphotericin.
• No known means of prevention• No known means of prevention.
Center for Food Security and Public Health Iowa State University - 2004
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Center for Food Security and Public Health Iowa State University - 2004