Fungal infection

Jantima

Jantima

Tanboon,MD

Yeast

Mold

Diagnosis-�Wood’s

light

-�KOH

preparation-�Periodic

acid-Schiff

(PAS)

-�Gomorimethinaminesilver

(GMS)-�India

ink,

mucicarminestain

-�Calcofluorwhite

staining-�Serologic

test

-�Antigen

detection-�PCR-�Culture

Tissue reaction Tissue reaction

-�Minimal

tissue

reaction

-

Acute

inflammatory

reaction

-

Granulomatousinflammatory

reaction

Minimal tissue reaction

Acute inflammatory reaction

Stratum

corneum,

hair

shaft,

nail

Associated

with

little

or

no

inflammation

-

Pityriasisversicolor

-

Tineanigra

-

Black

piedra

-

White

piedra

-

Synonym:

Pityriasis,

Tineaalba, Tineaversicolor

-

Malasseziafurfur,

M.

sympodialis,

M.

ontusa, M.

globosa,

M.

restricta,

M.

slooffiae,

M.

pachydermatitis-

Asymptomatic:

Scaly

well-delineated

hypo-

hyper

pigmented

macules-

Catheter-related

fungemia

Diagnosis:

-�Wood’s

light:

fluorescence

yellow

green-�Skin

scraping

with

KOH

-�Dermatiaceousfungus-�Hortaeawerneckii(Exophialawerneckii)-�Palms,

any

glabrous

region

-�Tineamanuum-or

Tineacorporis-like

-�Colonizationofthehairshaft

-�Black

Piedra:Piedraiahortae

-�White

Piedra:Trichosporonspp

-�Deeper

layers

of

skin,

hair

and

nails-�Accompanied

by

inflammation

Dermatophytosis

Dermatophytosis1.Trichophyton–skin,

hair,

nails

2.Microsporum–skin,

hair3.Epidermophyton-skin,

nail

Keratinophilic,

“Tinea

Tinea”not

Taenia

-�Ringworm

-�Annular

scaly

patches

with

raised erythematousvesicular

borderswithcentralclearing

-�Interdigitalcracking

scaling

and

maceration, hyperkeratosis

and

peeling

of

soles

-�Diffuse

scaly

scalp

to

scatter

area

of

scales with/without

alopecia

-

Presumtivediagnosis -

Wood’s

light

-

Wet

preparation

(KOH)

-

Nail

infections

-

Dermatophyte(80-90%)

or

Non-dermatophyte

-

Tineaunguium-dermatophyte

-

Molds-Scopulariopsisbrevicaulis.

-

Yeast-Candida

albicans

-�Mycetoma

-

Sporotrichosis

-

Chromoblastomycosis

-�Phaeohyphomycosis,

Hyalohyphomycosis

-�Sporothrixschenckii-�Traumatic

innoculation,

cats,

armadillos

-�Occupational

disease:

Agricultural

Clinical

symptoms:1.Fixed cutaneoussporotrichosis2.Lymphocutaneoussporotrichosis3.Osteoarticularsporotrichosis4.Pulmonary sporotrichosis5.Disseminated sporotrichosis

Diagnosis:Histopathology

HistopathologyCulture

-�Trauma

→Chronic

suppurativeinfection-�Subcutaneous

tissue→fascia,

bone

Synonym:Madurafoot,maduromycetoma,maduromycosis

Clinicalsyndrome:TumefactionDraining

sinuses

Sclerotia(granules,

grains)

(1)

Actinomycotic

mycetoma Actinomycetes,

Nocardia

basiliensis,

Streptomyces

somaliensis,

Actinomaduramadurae, Actinomadurapelletieri

(2)

Eumycotic

mycetoma

(dermaticeous/non) Madurellamycetomatis,

Pseudallascheriaboydii

-

Acremonium

falciforme

(white)- Acremonium

recifei

(white)

- Aspergillus

nidulans

(white)- Exophiala

jeanselmei

(black)

- Leptosphaeria

senegalensis

(black)- Madurella

grisea

(black)

- Madurella

mycetomatis(black)- Neotestudina

rosatii

(white)

- Pseudallesheria

boydii

(white

to

yellow)-

Pyrenochaeta

romeroi

(black)

-�Chromomycosis,

Chronic

subcutaneous

mycosis-�Dematiaceous(brown,

black-pigmented)

fungi

-

Fonsecaeapedrosoi,F.

compacta, Phialophora

verrucosa,Rhinocladiella

aquaspersa

Cladosporium

(Cladophilalophora)

carrionii,-�Soil,

Thorn,

bits

of

vegetation

-�Slow

growing

verrucous

plaques/nodules

Diagnosis:Histology:

Scraping,

biopsy

-�Muriformcells:horizontal

and

vertical

dividing walls

-�Sclerotic

bodies

“copper

pennies”, 5-15 μm, septate

-�Dark-walled

septate/

non

septate

hyphae

Culture

-�Dermatiaceous

fungi

(no

muriform

cells)-�Exophiala

jeanselmei,

Wangiella

dermatitidis,

Bipolaris

spp

Traumatic

implantation4

clinical

forms:1.Superficial2.Cutaneous-corneal3.Subcutaneous4.Systemic

Diagnosis:Histopathology:

Cyst,

fibrous

capsule,

Granulomatouswall,

necrotic

centerCulture

-�Melanin-free

molds

-�Fusarium,

Scopulariosis,

Paecilomyces, Acremonium,

Scedosporium

-�Clinical:

Same

as

Phaeohyphomycosis

-

Candida

albicans,

C.

guilliermondii,

C.

krusei,C.

parapsilosis,

C. , tropicalis,

C.

kefyr, ,

C.

lusitaniae,

C.

dubliniensis, , C.

glabrata��-

Ubiquitos

- Blastospore,

hyphae,

pseudohyphae

Mucocutaneous

candidiasis- Oral thrush (CD4

200-500/

500/μl)

-

Vulvovaginal

candidiasis

(CD4

>500/

μl)-

Esophageal

candidiasis

(CD4

<100/μl)

-

Cutaneous

candidiasis:Chronic

mucocutaneous

ccandidiasis

Deeply

invasive

candidiasis

Diagnosis:-�Wet

mount

(Saline

and

10%

KOH)

-�Gram’s

stain,

PAS,

GMS-�Absence on H+E DOES

NOTexclude-�β-glucantest

(research)

-�Yeast-�Inhalation

→clearance

or

latent

state

-�Polysaccharide

capsule,

melanin,

enzymes-�Little

or

no

inflammatory

response

-�Chronic

meningoencephalitis-�Pulmonary

cryptococcosis

-�Skin

infection

in

disseminated

infection

Diagnosis:-�Histopathology:

GMS,

mucicarminestain

-�India

ink

(CSF)-�Culture-�CSF

examination

(mononuclear,

protein

�)

-�Cryptococcalpolysaccaharideantigen

(CRAg)

in serum

and

CSF

�-

Aspergillous

fumigatus,

A.

flavus,

A.

niger,

A.

nidulans,

A.

terreus

-

Mold

with

septate,

acute

angle,branching

hyphae

-

Dead

leaves,

stored

grain,

compost

piles,

hay, other

decaying

vegetation

-�Profound

neutropenia,

glucocorticoid

use, neutrophil

and/or

phagocytic

dysfunction

CD4

<50/μl

-�Invasive

pulmonary

aspergillosis-�Invasive

sinusitis

-�Disseminated

aspergillosis-�Cerebral

aspergillosis

-�Aspergillus

endocarditis-�Cutaneous

aspergillosis

-�Chronic

pulmonary

aspergillosis

-�Aspergilloma-�Chronic

sinusitis

-�Allergic

bronchopulomonary aspergillosis

-�Severe

asthma

with

fungal

sensitization (SAFS)

-�Allergic

sinusitis-�Superficial

aspergillosis

Diagnosis:-�Histopathology-�Culture-�Aspergillusantigen

test

(galactomannan)

-�Serologic

study

Mucormycosis-

Rhizopus , Rhizomucor, Cunninghamella - Apophysomyces , Saksenae, Mucor, Absidia Air-

borne

-

Percutaneous

exposure,

ingestion- Paranasal

sinuses,

nose

- lung-

GI

tract

Entomophthoramycosis- Basidiobolus, Conidiobolus-

Subcutaneous

or

paranasal

sinus

infection

Decaying

vegetation,

dung,

foods

with

high

sugar

- Uncommon,

confined

to

pt

with

preexisting

diseasesdiseases

-

Neutropenia

eutropenia,

corticosteroid

use,

diabetes mellitus

mellitus

and

breakdown

of

the

cutaneous

barrier

(e.g.,

as

a result

of

burns,

surgical

wounds,

trauma)

-

Poorly

controlled

DM,

organ

transplant,

hematologic

malignancy,,

deferoxamine

therapy

-�Rhinocerebral

mucormycosis-�Pulmonary

mucormycosis

-�Gastrointestinal

mucormycosis-�Cutaneous

mucormycosis

�-

Histoplasma

capsulatum

var.

capsulatum

-

Histoplasma

capsulatum

var.

duboisii

-

Moist

surface

soil,

birds/bat

dropping

-

Mycelia

→Microconidia/macroconidia

→Yeast

-

Intensity,

immune

status,

underlying

lung

disease

Immunocompetent:

-

Asymptomatic,

mild,

self-limited,-

Smoker:

Chronic

cavitary

histoplasmosis

Immunocompromised:- CD4<200/μL,

extremes

of

ages,

drugs

-

Progressive

Disseminated

Histoplasmosis

(PDH)

Complication:

Fibrosing

Mediastinitis

Diagnosis:-�Histopathology,

Cytopathology

-�Culture-�Histoplasmaantigen

detection

in

serum,

CSF

-�Histoplasmaantibody

detection

in

urine,

serum

-�Penicillium

marneffei�-

Immunocompromised,

CD4<100/μl�

-

Clinical:

similar

to

disseminated

histoplasmosis�

-

Skin

lesion:

papules

similar

to

molluscum

contagiosum�-

Abscess,

Granuloma

Diagnosis:�- Histopathology�Culture

-�P.

jirovecii(human),P.

carinii(rat)-�Immunocompromisedhost,

CD4

<200/μl

-�Air-borne,

Person-Person-�Alveolar

macrophages

-�Pulmonary

pneumocystis

infection-�Disseminated

pneumocystis

infection

-�CXR:

Bilateral

diffuse

infiltrate

begin

at

perihilar, pneumothorax

-�High-resolution

CT:

Ground-glass

opacities