opportunistic mycoses

OPPORTUNISTIC MYCOSIS

• MOLD– ASPERGILLOSIS– ZYGOMYCOSIS

• YEAST– CRYPTOCUCCOSIS– CANDIDIASIS

ASPERGILOSIS

• Aspergillus

• Saprophyte

• Recycling– Carbon & Nitrogen

• Decaying organic material

• 900 species

ASPERGILOSIS

• Opportunistic

• Human & Animal– A.fumigatus– A.flavus– A.niger

• Conidia 2-3 μ Inhalation

• Nosocomial infection

ASPERGILOSIS

• Cystic fibrosis

• Immune compromise

• Atopic Asthma

• Hematological patients

ASPERGILOSIS

• Increase– Diagnosis– Antifungal therapy

ASPERGILOSIS

• Allergic

• Pulmonary

• Cutaneous

• Disseminated

• Miscellaneous

• Iatrogenic

Allergic

• Asthma– IgE & Eosinophil ( increase)

• ABPA– IgE & Eosinophil ( increase)

• Alveolitis – Hypersensitivity type III

Pulmonary

• Invasive– Lymphoma & Leukemia– Secondary infection– Invasive to vessels Infarction & Dead

• Non invasive– Cavity Colonization– Fungus ball (Aspergilloma)– Hemaptosis

Cutaneous

• Rare– 1st

• Onychomycosis

• Burning

• IC

– 2nd • Dissemination

Disseminated

• Brain

• Kidney

Miscellaneous

• Otomycosis

• Keratomycosis

• Sinusitis

Iatrogenic

• Materials

• Instruments

• Aero cells

• Air conditioner

Pathogenesis & Defense factors

• Cell wall

• Melanin

• Catalase

• Fungal metabolites

• Super oxide dismutase

Cell wall

• Interface

• Ag & Enzymes

• Protection

• Cell wall of Conidia

• Cell wall of Hyphae

Cell wall of Conidia

• 2 part– Dense pigmented (out)

• DHN (Dihydroxy Naphthalene Melanin)

– Translucent (in)

• Protection– Phagositosis

Cell wall of Hyphae

• Component – Β 1-3 glucan– Galactomanan– Chitin

• Role– Protection (PMN)– Enzyme (catalase)– Ag (Galactomanan & β1-3 glucan)

Galactomanan

• Special for A.fumigatus

• Serum, Urine, BAL

• Monoclonal Ab

Melanin

• Dihydroxy Phenylalanin (DOPA)

• Dihydroxy Naphthalene (DHN) – Free radicals

Catalase

• Hydrogen peroxide

• Expression– Starvation & Sexual reproduction

Fungal metabolites

• Toxins

• Epithelial damage– Gliotoxin– Fumagilin– Helvolic acid

Super oxide dismutase

• Virulence factor

• Surveillance– Neu– Mac

Cellular immunity

• T cell very important

• Gamma INF ( first cytokine)• IL4, IL2, TNFα

• Cystic fibrosis ABPA

• Innate

Laboratory diagnosis

• Sampling– Sputum, BAL, Serum, Urine

• KOH 10%• ELISA

– Dichotomous

Serology

– ELISA based Ab (galactomann)

Treatment

• Amphotricin B

• 5 flurocytosin

Zygomycosis

• Phycomycosis

• Hyphomycosis

• Mucormycosis

• Rhizopus– R. oryzea, R. arrhizus

• Absidia– A. corymbifera ( 42°- 45°)

• Mucor

Zygomycosis

• Opportunistic

• Very dangerous

• Acute

• Lethal

Zygomycosis

• Para nasal sinuses

• Lung

• Eye

• Ear

• Skin

• Alimentary

Zygomycosis

• Diabetic

• Blood cancer

• Sever burning

• Malnutrition

Zygomycosis

• Rhinocerbral

• Pulmonary

• Gastrointestinal

• Cutaneous

Rhinocerbral

• Diabetic

• Nose & Para nasal

• Discharge– Black & blood

• Eye

Rhinocerbral

Pulmonary

• Like the other pulmonary

• Pain

• Sputum

• Aspiration & inhalation

• Mucoroma

Gastrointestinal

• Diahria

• Haematemsis

• Peritonitis

• Stool (blood)

• Malnutrition

Cutaneous

• Burning

• Rare


• Sampling– Biopsy

• Culture– S

• Direct– Ribbon like

Treatment

• Control

• Amphotricin B

• Autopsy

YEAST INFECTIONS

• Candida

• Cryptococcus

• Malassezia

• Trichosporon

• Rhodotorula

• Geotricum ( Mold )

CANDIDIASIS

• Candida species – Yeast like– True hyphae– Reverse dimorph

CANDIDIASIS

• C.albicans

• Normal flora– C.glabrata– C.dubliniensis– C.parapsilosis

• Nature ( soil )

• Lactobacillus

CANDIDIASIS

• Physiologic

• Antibiotic

• Diabetic

CANDIDIASIS

• Clinical manifestation– Disease– Hypersensitivity

CANDIDIASIS

• Disease– Cutaneous– Mucocutaneous– Systemic

CANDIDIASIS

• Cutaneous– Intertrigo– Diaper rash– Paronychia ( onychomycosis )

CANDIDIASIS

• Mucocutaneous– Mouth– Vaginitis– Bronchial & Pulmonary– Alimentary– Chronic mucocutaneous candidiasis (CMCC)

CANDIDIASIS

• Systemic– Endocarditis– UTI– Meningitis – Septicemia

candidiasis

CutaneousIntertrigo

candidiasis

CutaneousDiaper rash

candidiasis

CutaneousOnychomycosis

Paronychia

candidiasis

CutaneousOnychomycosis

CANDIDIASIS

• Mouth– Thrush– Perlech– Black hairy tongue– Chilitis– Denture stomatitis

candidiasis

MucocutaneousThrush

candidiasis

Mucocutaneous

candidiasis

MucocutaneousChilitis

CANDIDIASIS

• Mucocutaneous– Mouth– Vaginitis and Balanitis– Bronchial & Pulmonary– Alimentary– Chronic mucocutaneous candidiasis (CMCC)

CANDIDIASIS

• Systemic– Endocarditis– UTI– Meningitis – Septicemia

CANDIDIASIS

• Hypersensitivity – Candidids– Gastritis– Asthma

CANDIDIASIS

• Pathogenesis

– Endotoxin

– Exotoxin ( canditoxin )

– Phospholipase & lysophospholipase

– Receptors

CANDIDIASIS

• Immunology– T cell deficiency: mucocutaneous– NEU deficiency ( CGD ): dissemination– IgG: mannan ( Ag )

CANDIDIASIS

• Laboratory diagnosis– Sampling– Direct– Culture

candidiasis

Lab Diagnosis

CANDIDIASIS

• Yeast diagnosis– Germ tube– Chlamydiospore– Assimilation– Fermentation

CANDIDIASIS

• Treatment– Nistatin, Miconazol– Ketoconazol, Fluconazol– Amphotricin B

CRYPTOCOCCOSIS

• Opportunistic

• Basidiomycetes

• Filobasidiella

• Pigeon – High temperature– Serum iron

CRYPTOCOCCOSIS

• Capsule – GlucuronoXyloMannan ( GXM )– Heparin & hyaloronic acid

• Urease positive

• Fermentation is negative

• Assimilation is positive

• Bird seed agar– Brown colony

CRYPTOCOCCOSIS

• Cryptococcus– C.neoformans

• Neoformans• Gatti

– C.albidus– C.laurenti

CRYPTOCOCCOSIS

• C.neoformans– Capsular Ag

• A• B• C• D

• A, D: common agent– AIDS

• B,C: pathogen

CRYPTOCOCCOSIS

• Pulmonary

• CNS

• Systemic

CRYPTOCOCCOSIS( pulmonary )

• Fever

• Cough

• Sputum

CRYPTOCOCCOSIS( CNS )

• Aspargin & Creatinine

• Melanin production

• Meningitis

• Menigoencephalitis

• Cryptococcoma

CRYPTOCOCCOSIS(meningitis )

• CSF– Protein – Sugar– Pressure– Cells

• Headache

• Fever

CRYPTOCOCCOSIS( systemic )

• Skin

• Bone

• Heart

• Prostate

• Eye

CRYPTOCOCCOSIS

CRYPTOCOCCOSIS

• Virulence factors– Capsule – Melanin– Urease– Protease

Virulence factors( capsule )

• Environment • Basidiospore ( Aero cell )• Polysaccharide

– Glucuronoxylomannan ( 88% ): – Galactoxylomannan– Mannoprotein

CRYPTOCOCCOSIS

• Virulence factors– Capsule – Melanin– Urease– Protease


• Sampling

• Direct

• Culture

Sampling

• Sputum

• CSF

• Biopsy– Bone marrow, Spleen & liver

• Skin

• Urine & Blood

Direct

• KoH

• Gimsa

• Writh

• India ink

Culture

• S

• Sc

• 37°

• 24-48h

Serology

• Capsular Ag– Latex agglutination

• Ab– Indirect immunofluorescent

Treatment

• Amphotricin B

• 5-flurocytosin

opportunistic mycoses

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