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Transcript of jamur
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FUNGI
dr. S. Yumna T, MSc, MClinSc(Hons)
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5 KINGDOMS
• Animalia : invertebrates, vertebrates
• Planta : flowering plants
• Fungi : yeasts, molds (moulds), mushrooms
• Protista : protozoans
• Monera : bacteria
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Overview
• >200,000 fungal species, most saprophytic• Ubiquitous: water, soil, air, human, animal,plant• Many : decomposer, food production (cheese),
antibiotic (Penicillium notatum)• <200 fungal species : potential pathogenic for
humans• Few species : most clinically important fungal
infection• Fungi can cause infection (mycoses), poisoning
(mycotoxin, aflatoxin), allergy (asthma).4
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Characteristics of major fungal groups
• Structure
• Metabolism
• Reproduction
• Modes of fungal growth
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Structure
• Eukaryotic • Cell wall : chitin
(polymer of N-acetylglucosamine), mannan, glucan
rigidity to cell wall
• Non motile• Fungal
membrane: ergosterol
From: Sherris Medical Microbiology p 632 6
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Metabolism
• Non photosynthetic
• Heterotrophic metabolism heterotrophs
- requires exogenous C for growth- chemotrophic : secrete degradative enzymes soluble nutrient passive or active transport
• Most: obligate aerobes, None: obligate anaerobes
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Reproduction
• Asexual
- forms conidia by mitosis
• Sexual
- genetic recombination
- meiosis forms sexual spores in specialized structure
- spores (ascospores, zygospores, basidiospores)
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A. Aspergillus; B. Penicillium; C. Geotrichum; D. Trichophyton; E. Microsporum; F. Epidermophyton and G. Rhizopus.
From Medical Microbiology, 1990, Murray, et al., p. 300, Fig. 28-2. 10
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Types of conidia…cont’d
• Blastoconidia through a budding process, e.g. Cladosporium sp
• Chlamydoconidia produced from terminal or intercalary hyphal cells
e.g. Candida albicans
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Types of conidia…cont’d
• Phialoconidia produced by ‘vaseshaped’ conidiogenous cells (phialide)
e.g. Aspergillus fumigatus
• Macroconidia : large and complex
• Microconidia : small and simple
• Endospore : conidia are enclosed in a sac (sporangium)
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Modes of fungal growth:
Fungi can be divided into two basic morphological forms, yeasts and molds (moulds).
1. Yeasts
- Unicellular
- Reproduce asexually by blastoconidia formation (budding) or fission
- Larger than bacterial cells (5-8 X)
- ex. ‘baker yeast’ : Saccahromyces cerevisiae
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Modes of fungal growth:
• Yeasts
- Yeast can form pseudohyphae.
as a result of a sort of incomplete budding where the cells remain attached after division.
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Modes of fungal growth:
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Modes of fungal growth:
2. Molds
- Multicellular
- Higher form
- Composed of filaments : hyphae mycelium
- Reproduce sexually or asexually
- Most fungi occur in the hyphae form as branching, threadlike tubular filaments.
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Modes of fungal growth:
- Structure of hyphae/filamentous structure:
1. coenocytic/continuous/aseptate
lack of cross wall
e.g. Zygomycetes
2. septate : have cross wall pores
- clamp connection
e.g. Aspergillus sp
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Modes of fungal growth:
A. Yeast cells reproducing by blastoconidia formation; B. Yeast dividing by fission; C. Pseudohyphal development; D. Coenocytic hyphae; E. Septate hyphae; F. Septate hyphae with clamp connections From Medical Microbiology, 1990, Murray, et al., p. 299, Fig. 28-1.
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Clamp connections are formed by the terminal hypha during elongation
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Modes of fungal growth:
3. Fungi dimorphic (dimorphism)
fungus can exhibit either the yeast form or the hyphal form, depending on growth conditions.
-Very few fungi exhibit dimorphism.
-Yeast: enriched medium
-Mold : requires minimal nutrients
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Yeasts and Molds
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Yeast form
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Classification of fungal phyla and class
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Fungi imperfecti : lack of sexual reproduction
rRNA genes analysis : for classification
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Medical grouping
• Superficial fungi : skin and its appendages • Subcutaneous : skin subcutaneous or
lymphatic spread• Opportunistic : environmental or ‘normal’
fungi that can cause infection in immunocompromised host
• Systemic fungi : not part of ‘normal microorganism, most virulent,systemic/visceral infection
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Mycoses
• Superficial
• Cutaneous
• Subcutaneous
• Opportunistic
• Systemic
Infection from environment or endogenous
Only dermatophytic infections are communicable
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Pathogenesis
• Host – pathogen interaction
• Pathogenesis :
- adherence, e.g. C. albicans (mannoprotein adhesin) >< fibronectin receptor in host epithelial cells
- invasion, e.g. trauma : Sporothrix schenckii
Coccidioides immitis : airborne 28
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Pathogenesis
- invasion : C. albicans (hyphal form) specific enzymes
-tissue injury
- no classic toxin produced in vivo
- host inflammatory immune response
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Laboratory diagnosis
• Specimen collection
• Equipment
• Transport
• Criteria for rejection
• Types of examination
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Specimen collection
Good collection :• Sterile technique• Area most likely to be infected:
- edge ringworm- broken hair- sputum ; not saliva, etc
• Adequate• Deliver promptly and process quickly• Avoid overgrowth of bacteria• Label : name, DOB, site, etc
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Specimen collection
A. Adequate collection sufficient for microscopy and culture
B. Inadequate collection
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Equipment
• Bone curette • Blunt scalpel• Spoon excavator• Scissors• Forceps• Nail clippers • Sterile cotton
swab All equipment must be cleaned and sterilized
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Equipment
• Collection container
sealed with parafilm. Don’t use sticky tape
• Black collection cards
• Media
• Inoculating needles
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Mycology specimen collection-1
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Mycology specimen collection-2
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Skin scraping
• Require epidermal scales
• Scrape margin or edge• Active border – red
scaly raised• Several lesions –
separate samples• Blister wall (dinding
vesikel)
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Nails
• Larger sample• Discoloured,
dystrophic, brittle (rapuh)
• Scrape under nail plate
• Collect all debris• Separate samples
from different nails (do not pool)
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Hair
• Hair roots NOT cut hair
• Fluoroscence with woods lamp
• Crusts or scales use scalpel
• Swab exudate if kerion
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Transport
• Skin, Hair, Nail
- room temperature NOT refrigerated
• Sputum, urine, swabs, tissues
- refrigerate if delay in reaching laboratory
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Criteria for rejection
• No ID/label
• Sputum with >25 epi/lpf
• Dry swab
• Insufficient specimen
• 24 hours urine/sputum
• Improper container (leaking/unsterile)
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Direct microscopic examination
• Direct smears, using several types of reagents or stains
- 10 % KOH (in glycerol) : clear away tissue cells and debris, dissolves keratin.
spec: nails, hair, skin scrapings, fluids or exudates
- Glycerol stops drying
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Direct microscopic examination
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Direct microscopic examination
-Calcofluor white
• binds to cellulose and chitin fungal wall fluoresce blue-white or apple green depend on filter
• Dye fluoresces on exposure UV light
•Mix in equal parts with 10% KOH glycerol
•Fluorescent microscope – correct filter
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Types of examination
• Direct microscopic examination
- from clinical specimen (sputum, spinal fluid, skin scraping, etc)
• Culture
• Fungal identification
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Direct microscopic examination
India ink
Detects capsule around yeast cells
Cryptococcus sp in CSF
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Direct microscopic examination
• LP light brown or LPCB (lactophenol catton blue) blue
• Wright, Giemsa : intracellular yeast form of Histoplasma capsulatum
• Gram stain : positive (yeasts)• ZN : negative, except Nocardia sp
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• PAS (periodic acid shift) : red with yellow/light green background
• etc• Histologic examination : biopsy
HE, methenamine silver
Methenamine silver stain of sinus biopsy
(100). All of the black material represents
the invading fungus, Aspergillus flavus.
Two of the characteristic sporebearing
structures can be seen on the nasal cavity side
(arrows).
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Culture
• Slow, days - weeks
• Sabouraud’s dextrose agar (SDA)/SA
- glucose and peptones as nutrients.
- pH is 5.6
• Selective media : plus antibiotic, e.g. chloramphenicol, gentamicin
• Antifungal cycloheximide in SDA: inhibit contaminating molds from environment and some pathogens
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Culture
• Incubation 25-30º C:all fungi will grow
• Paired with 30-75 º C: pathogenic fungi will grow
• Aerobic incubation
• Sterile site, e.g CSF: no need selective agents
• Blood sheep : dimorphic fungi
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Chromogenic agar
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Fungal identification
• For yeast
- germ tube test : for Candida albicans
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Yeast colony inoculated into 1 ml horse erum incubation for 2 hours, 35 ºC
> 2 hours : can be false (+)
- biochemical tests
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Fungal identification
• Molds
depends on growth rate, colonial appearance, metabolic properties.
- macroscopic : examine both side, including reverse (bottom)
surface structure: velvety,cottony,etc
topography: flat, raised, wrinkled,etc
pigmentation in surface and reverse: white, brown, etc
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Trichophyton rubrum
surface
bottom/reverse appearance
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Fungal identification
• - microscopic :
conidia/spores: shape, size, structure arrangement
hyphae : size, septate, clamp connection
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Mold form • Hypha (e)
Elongated cells or filaments
• Septate and nonseptate hyphae (continuous)
• Myceliummass of hyphae
• Vegetative mycelium : acts as root : nutrients/moisture collector
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…continued• Aerial mycelium
bears conidia or spores : fluffy character (seperti kapas)
• Conidiophore
a hyphae bearing conidia which bears at its tip or sides,
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Superficial mycoses
• Skin (str.corneum) and hair shaft
• Host cellular responses : minimal
• Harmless except cosmetically
Pityriasis versicolor : Malassezia furfur
Tinea nigra : Hortaea werneckii
Piedra (hair shaft): Piedraia hortai
• Dx. Skin scraping microscopic exam.
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Case 1
Case•A 25-year-old Caucasian male from Darwin, presented with non-inflammatory, brown pigmented, non-scaling lesions on the palmar aspects of his hands. Direct microscopy showed the presence of fungal elements and the fungus shown below was isolated
60http://www.mycology.adelaide.edu.au/virtual/2007/ID2-Feb07.html#top
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Case 1
• Clinical Presentation:
Brown to black, non-scaling macules on the palmar aspect of the hands. Note there is no inflammatory reaction.
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Case 1
• Direct Microscopy :Skin scrapings mounted
in 10% KOH : pigmented brown to dark olivaceous (dematiaceous) septate hyphal elements and 2-celled yeast cells producing annelloconidia
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Case 1
• Culture:Colonies are slow growing,
initially mucoid, yeast-like and shiny black. With age they develop abundant aerial mycelia and become dark olivaceous in color.
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Conidia of Hortaea werneckii
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• What is the diagnosis ?
Tinea nigra
• Causative fungi?
Hortaea werneckii.
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Cutaneous mycoses
• = dermatophytoses
• Infect superficial keratinized tissue (skin, nail, hair). Keratin nutrients
• Causative fungi: dermatophytes
Trichophyton : skin, nails, hair
Epidermophyton : skin, nails. NOT hair
Microsporum: skin, hair. NOT nails
• Habitat : anthropophilic, zoophilic, geophilic66
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Cutaneous mycoses
• Transmission : infected skin scales
1.Tinea pedis (athlete’s foot)
Trichophyton rubrum
Trichophyton mentagrophytes
Epidermophyton floccosum
Tinea pedis caused by T. rubrum.
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"Moccasin-type" tinea pedis caused by E. floccosum (left)
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• toe web spaces are the major reservoir on the human body for these fungi
• individuals with chronic or subclinical toe web infections are carriers and represent a public health risk to the general population, in that they are constantly shedding infectious skin scales.
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Cutaneous mycoses
2. Tinea corporis (ringworm)
Epidermophyton floccosum
Trichophyton sp
Microsporum sp
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Most occur on non hairy areas of the trunk
Periphery of ring : active fungal growth "Tinea barbae" caused by T. rubrum .
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Cutaneous mycoses
3. Tinea capitis (scalp ringworm)
Trichophyton sp
Microsporum sp
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Predominant species depends on the geographic location of the patiente.g. in the USA : T. tonsurans
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3 types of hair invasion in tinea capitis:•Ectothrix invasion is characterised by the development of arthroconidia on the outside of the hair shaft. •M. canis, M. gypseum, T. equinum and T. verrucosum
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• Endothrix hair invasion is characterised by the development of arthroconidia within the hair shaft only.
• T. tonsurans and T. violaceum.
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• Favus usually caused by T. schoenleinii, produces favus-like crusts
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Cutaneous mycoses
4. Tinea cruris (jock itch)
Epidermophyton floccosum
Trichophyton rubrum
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Similar to ringworm but most occur in the moist groin area
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Tinea of the buttocks caused by T. rubrum granular strain
Tinea of the buttocks caused by T. rubrum downy strain.
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Cutaneous mycoses
5. Tinea unguium (Onychomycosis)
Trichophyton rubrum
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Case 2
• Case
A 59 year old male presented with suspected onychomycosis of the toe nail.
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Case 2
• Direct microscopy of nail scrapings (KOH mount) revealed the presence of septate fungal hyphae breaking up into arthroconidia.
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Case 2
• Culture:
Colonies (SDA) are flat to slightly raised, white to cream, suede-like to downy, with a yellow-brown to wine-red reverse.
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Case 2
• MicroscopyMost cultures show scanty
to moderate numbers of slender clavate to pyriform microconidia. Macroconidia are usually absent
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Case 2
• What is the pathogen causes the disease?
Trichophyton rubrum
Trichophyton rubrum is an anthropophilic dermatophyte.
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Etiology
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Management of dermatophytoses
• Is dependant on clinical setting
• Topical or systemic agent?
• Mycological confirmation
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Other mycoses
Subcutaneous mycoses
•Chronic, localised (skin, connective tissue, bone, muscle)
•Deep tissue involvement rare
•Traumatic implantation
•Sporotrchosis, chromomycosis (chromoblastomycosis), mycetoma
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Systemic mycoses
•Pathogenic fungi
•Deep tissue and organs
•Dimorphic fungi
•Geographically restricted
•Airborne : inhalation of conidia
•Coccidioidomycosis, blastomycosis, histoplasmosis
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Other mycoses
Opportunistic mycoses
•Opportunistic fungi
•Candidiasis (candidosis), cryptococcosis, aspergillosis
•Now increasing:
immunosuppressive
corticosteroid, etc
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Anti fungal
• Amphotericin B and nystatin : bind to ergosterol, form pores that disrupt membrane function cell death
• Imidazole (clotrimazole, ketoconazole, miconazole) dan triazole (fluconazole and itraconazole) : interact with C-14 -demethylase to block demethylation of lanosterol to ergosterol
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