Chromoblastomycoses:

What is the general definition?

Chromoblastomycoses:

List commonly related organisms

Pialophora verrucosa

Fonsecaea pedrosoi

Cladosporium carrionii

Rhinocladiella aquaspersa

Chromoblastomycosis:

Generally, what is the first sign of infection?

Chromoblastomycosis:

In what regions of the world is it normally found?

Chromoblastomycosis:

 Are males or females more likely to contract the disease?

(what ratio?)

Males are more likely to contract chromoblastomycoses than females.

(10:1)

Chromoblastomycosis:

Predilection

No radical predilections

Exposed areas of trauma, exposed cuts, thorns/slivers are the most common means of infection. (a puncture/inoculation must be made for infection)

Chromoblastomycosis:

Dissemination

Dissemination is rare

It could take months to years for the disease to spread to sreious levels.

Generally found in feet and legs.

Even most immuno suppressed patients do not exhibit dissemination

Chromoblastomycosis:

Visible characteristics of infection (lesions)

The lesions look like barnacles/corals on the skin (dematiacious fungi -- dark lesions)

Abcess of the skin (fibrous tissues)

Similarities to Blastomycosis and Leishmaniasis

Chromoblastomycosis:

Sclerotic bodies 

Muroform cells (multi-planar septa)

Blastic cells -- look like salmon eggs when dyed red.

Found in infected tissues

Chromoblastomycosis:

3 types of conidia

Phialophora

Acrotheca (Rhinocladiella)

Cladosporium

Chromoblastomycosis:

Phialophoria

Type of conidia

A cup-like brancing from a hyphae that releases conidia (microconidia)

Chromoblastomycosis:

Acrotheca (Rhinocladiella)

Condia that bud off of the end and sides of the conidiophore

Chromoblastomycosis:

Cladosporium

The conidiophore look like broccoli

Conidiophores look highly branched with budding conidia at the ends of the branches (microconidia)

Chromoblastomycosis:

General disease characteristic

Mycetoma (Madura Foot):

Commonly related organisms

Pseudallescheria boydii

Madurella mycetomatis

Madurella grisea

Aspergillus spp.

Fusarium spp.

Acremonius spp.

Aerobic actinomycetes (not true fungi) produce similar symptoms -- Actionmadure spp. and Nocardia spp.

Mycetoma (Madura Foot)

Geographic distribution

Commonly found in tropical and subtropical regions of the world

Sporadically seen in temperate zones

Mycetoma (Madura Foot):

U.S. Distribution

Pseudallescheria boydii and Nocardia predominate in the U.S.

Found mosty in Calif. and Texas

Mycetoma (Madura Foot)

Infection in males vs. females

Males are five times more likely to contract the disease

(5:1)

More common in younger active people, farmers, and cattle hearders

Mycetoma (Madura Foot)

Race Distribution

Mycetoma (Madura Foot)

Dissemination

Common in feet

Can be found on the head, neck, hands and legs

Generally maintained in the area of inection

Mycetoma (Madura Foot)

Mycetoma (Madura Foot)

Disease characteristics

Hypertrophy of the skin if left untreated

Hyphae grow in infected tissues

Swelling of the feet -- hyphae multiply inside if the tissues

Dark lesions appear at the skin surface when the hypae emerge -- compacted hyphae emerge from the surface lesions and form grannules

Fatal in some cases

Difficult to treat

Mycetoma (Madura Foot)

Diagnosis

Isolation of organism

Identification of grannules

Sprorthrichosis (Rose Grower's disease)

Commony associated organisms

Sprorthrichosis (rose grower's disease)

Geographic distribution

Worldwide distribudion

Mainly found in Temperate, warm and tropical climates

Common in North America

Sporothrichosis (rose grower's disease)

Infection profile

Common in persons under 30

Must break the skin to infect

Equal probability in males and females

Increased infection in alcoholics

Tends to infect the outer limbs (cooler)

Sporothrichosis (rose grower's disease)

Disease

First appeaars as a papule on the skin and ulcerates

Follows the lymphatic channels -- ulcers form alonf lymph channels

More invasive in men -- more likely to spread throughout the male lumphatic system

Osteoarthricular sporothrichosis

immuno suppression may lead to spread in bones

Sprorthrichosis (rose grower's disease)

Diagnosis

Antibody response -- asteroid body or Splendore-Hoeppli phenomenon (characteristic antibody responce). Look for a sunflower-like body.

Granulomatous lesions (scattered)

 Oval or cigar shaped yeat cells and Globose Cells resembling Cryptococcus neoformans

Candidiasis:

Commonly related organisms

Candida albicans

Other Candida

C. glabrata

C. parapsilosis

C. krusei

C. tropicalis

C. dubliniensis

Candidiasis:

Host Factors

75% of people are carriers (normal flora)

Alcoholism and drug (intravenous) use

Surgery/implants

Imunosuppression

Malignant diseases (cancers)

Diet: those with high protein and low carb. diets are less succeptible

Burns

Candidiasis:

 Notorious anti-fungal resistance

Mostly Candida krusei

and

C. dubliniensis

Candidiasis:

Habitat in humans 

Found in GI and GU tracts

More prevalent in pregnant women (vagina)

Candidiasis:

General happenings in immunosuppressed patients 

Normal flora Candida may overgrow and infect patient

Oral candidiasis may be an initial sign in AIDS patients (Oral Thrush)

Candidiasis (superficial and deep mycoses):

Geographic distribution

Candidiasis superficial and deep mycoses):

Important immunity factors

Candidiasis (superficial and deep mycoses):

Diagnosis

Presence of a germ tube (hyphal protrusion from C. albicans and C. dubliniensis) -- culture in RPMI medium

 Serology is not clinically helpful (long process)

Carbohydrate assimilation profiles (chrom agar)

Look for appropriate levels of Candida spp. (may not be the culprit)

Lysis centrifugation

Candidiasis (superficial and deep mycoses):

Candida morphologies

Candidiasis (superficial and deep mycoses):

Dissemination

Immunosuppressed patients generally experiense great dissemination

Can spread to scalp and lead to permanent hair loss

Spread to organs (deep mycoses)

Cryptococcosis (AIDS defining illness):

Commonly associated organisms

Cryptococcus neoformans

 Var. neoformans (serotypes A and D)

(often in AIDS patients)

Var. gatti (serotypes B and C)

Candidiasis (superficial and deep mycoses):

Candida albicans

(important virulence factors)

Antigenic changes (can switch phenotypes quickly -- changes surface antigens)

In tissues, yeast, pseudohyphae, and true hyphae can form (increases invasiveness)

Thigmotropism -- attracted to changes in surface texture or holes (contact sensing)

Filter experiment showed the migration of Candida in and out of pores.

Hydrophobicity of surface molecules increases adherence to host cells.

Mimicry -- produces surfece antigens similar to host antigens or gathers host antigens.

Undemanding nutrient requirement

Rapid growth rate

Lytic enzymes damage host tissues

Cryptococcosis (AIDS defining illness):

Common reservoir

Cryptococcosis (AIDS defining illness):

Mating types

Cryptococcosis (AIDS defining illness)

AIDS patients v. non AIDS patients

(AIDS positive patients)

Dissemination throughout body/organs

Possible Cryptococcal meningitis

4th leading cause of death of AIDS patients

In the U.S. men have more cases -- Men and women equal in Africa (major AIDS epidemic)

Cryptococcosis (AIDS defining illness):

AIDS v. non-AIDS patients

(non-AIDS patients)

Antibodies detected in pigeon breeders (no differences in infection rate)

High levels of adrenal corticosteroids is a predisposing factor

Sarcoidiosis and Lymphoma are also predisposing factors

All age groups

Cryptococcosis (AIDS defining illness)

Culture characteristics

Yeast cells form muoid colonies

Capsules contribute to appearance

Observation of capsules w/ India ink stain

Can grow as a yeast and mold at room temp.

Cryptococcosis (AIDS defining illness)

Route of aquisition

Cryptococcosis (AIDS defining illness)

Virulence factors

Capsule (the larger the capsule, the more virulent)

Cryptococcosis (AIDS defining illness)

Infection Characteristics

Infects the meninges of the brain

Next most common infection in the lungs

Cryptococcosis (AIDS defining illness)

Cryptococcal cells and diagnosis

Corpuscles observed in infected tissues

Cells are widely separated by capsule

Urease acctivity

Oxidizes Caffeic acid in Niger seed

Inositol assimilation

Agglutination Test

Muci-Carmine stain (capsule)

Cryptococcosis

Other symptoms

Rigidity of head and neck area

Double vision

Light sensitivity

Cryptococcosis

Dissemination

Cryptococcosis:

Treatment

Amphoteracin B is commonly used in disseminated cases

Antifungals have to be taken for the duration of the patient's life

Coccidioidomycosis:

Commonly related organism

Coccidioidomycosis:

Distribution

Endemic to U.S., Mexico, Guatemala, Honduras, Colombia, Venezuela, Bolivia, Paraguay, and Argentina

(restricted to semi-arid or desert-like regions)

Coccidioidomycosis:

 Valley fever

In Kern Co. Calif.

Fungi in the soil become airborne (inhalation of spores)

Outbreaks associated with earthquakes and wildfires

Associated with rodents

Rains bring molds to the surface

Coccidioidomycosis:

 Vectors/reservoirs

Coccidioidomycosis:

Occupational hazard

People that work around soil in dry regoins are succeptible.

(construction, farming, phone-post diggers, archaeologists)

Coccidioidomycosis:

Conidia

Coccidioidomycosis:

Host profile

No racial, sex or age differentiation

However, once infected, those with darker skin seem to experience more serious infection.

Males are four times more likely to be infected except in pregnant women (high levels of estradiol and progesterone)

Prevelance in B type blood (in patients witth disseminated infection)

Coccidioidomycosis:

 Growth in agar v. tissues

Mycelial growth on agar

Spherules form in tissues (spore forming)

Coccidioidomycosis:

In other animals

Dogs are highly susceptible to the disease

A wide variety of wild and domestic animals are succeptible.

Coccidioidomycosis:

Mode if infection

Enteroarthric conidia are inhaled

when in the body they swell and become spherules

Spores are released in tissues

Coccidioidomycosis:

 Symptoms

in 40% (acute) -- cough, headache, fever, pleuritic chest pain, rashes

60% are asymptomatic

Coccidioidomycosis:

Diagnosis

Isolation of organism (biohazard)

X-rays may reveal images similar to that of a person with lung cancer.

Coccidioidomycoses:

Life Cycle

Has two life cycles -- saprophytic and parasitic

Saprophytic -- it forms hyphae and the arthro conidia

Parasitic -- formation of spherules and release of spores

Coccidioidomycosis:

In AIDS patients

Mostly dissminated

Mostly pulmonary infecitions

Histoplasmosis:

Commonly associated organisms

Histoplasma capsulatum

var. capsulatum and var. duboisii

Histoplasmosis:

Classic cause of

Histoplasmosis:

Geographic distribution

Temperate and Tropical climates throughout the world

Higher concentrations in Eastern U.S. and Latin America

(Histoplasmic skin test surveys)

H. duboisii is found in the tropical areas of Africa

Histoplasmosis:

 Risk factors

Old age

The immunosuppressed

AIDS patients at high risk for disseminated disease

Lab acquired forms (pulmonary infection -- inhalation)

Histoplasmosis:

Associated organism habitat

Soils enriched with bat guano and bird droppings

Commonly acquired in city parks

Histoplasmosis:

Reproduction of related organisms

Heterothallic/perfect state is seen in Ajellomyces capulatus

(Acsomycota, produces Cleistothecia ascocarps)

Produces macro and microconidia

(the macroconidia contain large lipd drops)

(Tuberculate macroconidia)

(microconidia -- blastoconidia)

Histoplasmosis:

Life Cycles

Conidia are inhaled and develop into yeasts

Var. capsulatus is intracellular (generally in macrophages)

Var. duboisii is extracellular

Yeast cells multiply by polar budding.

Histoplasmosis:

Infections

Inhalation of spored generally leads to Acue pulmonary infection or Chronic or Disseminated histoplasmosis

(associated with chronic bronchitis)

Histoplasmosis:

Organism physiological characteristics

Urease positive

Produce ammonia and bicarbonate (adaptations in macrophages)

neutralization of phagolysosome

Histoplasmosis:

Acute Pulmonary infection

95% of cases

Generally asymptomatic

Serology diagnosing

Histoplasmosis:

Chronic pulmonary infection

Progressive histoplasmosis

Damage to lung tissues

May cough blood

May be confused with tuberculosis

Histoplasmosis:

Disseminated

Generally in immuno suppressed of infants

Common spread to tongue and organs

Infection of adrenal glands (the related steroid treatment decreases immunity)

Blastomycosis:

Commonly related organisms

Ascomycete

Blastomyces dermatitidis

Yeast

Blastomycosis:

Reproduction

Overlap with Histoplasmas -- Ajellomyces dermatitidis (telomorph)

Blastomycosis:

Geographic distribution

South East U.S.

Mississippi River area

Wide areas in Africa (endemic)

Blastomycosis:

Habitat of organisms

Found in Dogs

Unsuccessful recoveries from soil

Blastomycosis:

Host profile

Male are 9 times more likely to develope chronic infection

Acute infection rates are equal in males and females

No racial distinction

Dissemination in AIDS patients

Blastomycosis:

Diagnosis

Isolation

X-rays

Serological testing is poor