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

Laboratory diagnosis

Laboratory diagnosis

Laboratory diagnosis

Laboratory diagnosis

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

Laboratory diagnosis

• Sampling– Biopsy

• Culture– S

• Direct– Ribbon like

Laboratory diagnosis

Laboratory diagnosis

Laboratory diagnosis

Laboratory diagnosis

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

CutaneousIntertrigo

candidiasis

CutaneousIntertrigo

candidiasis

CutaneousIntertrigo

candidiasis

CutaneousIntertrigo

candidiasis

CutaneousIntertrigo

candidiasis

CutaneousIntertrigo

candidiasis

CutaneousDiaper rash

candidiasis

CutaneousDiaper rash

candidiasis

CutaneousDiaper rash

candidiasis

CutaneousDiaper rash

candidiasis

CutaneousOnychomycosis

Paronychia

candidiasis

CutaneousOnychomycosis

candidiasis

CutaneousOnychomycosis

CANDIDIASIS

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

candidiasis

MucocutaneousThrush

candidiasis

MucocutaneousThrush

candidiasis

MucocutaneousThrush

candidiasis

MucocutaneousThrush

candidiasis

MucocutaneousThrush

candidiasis

MucocutaneousThrush

candidiasis

MucocutaneousThrush

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

Lab Diagnosis

candidiasis

Lab Diagnosis

candidiasis

Lab Diagnosis

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

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

Laboratory diagnosis

• 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