3 - Opportunistic Mycoses (LEC)

Superficial (cutaneous/ mucosal) candidiasis Systemic Candidiasis Chronic Mucocutaneous Candidiasis

3 Pathogenesis of Candida

Allergic asthma bronchopulmonary aspergillosis

A. YEAST AND YEAST-LIKE FUNGI ASPERGILLOSIS >> Systemic Aspergillosis - Pulmonary Aspergillosis •____________ ____________: development of IgE antibodies to the surface antigens of aspergillus conidia elicits an immediate asthmatic reaction upon subsequent exposure. • ____________ ____________: conidia germinate and hyphae colonize the bronchial tree without invading the lung parenchyma -phenomenon is characteristic of allergic bronchopulmonary aspergillosis. • Colonizing aspergillosis (aspergilloma): develops in preexisting pulmonary cavities, such as in tuberculosis or cystic disease- referred to as fungus ball. • The fungus grows into large 'balls' (aspergilloma). Cases of aspergilloma rarely become invasive.

Torulosis, European Blastomycosis, Busse-buschke Disease neoformans CNS, lungs AIDS

A. YEAST AND YEAST-LIKE FUNGI CRYPTOCOCCOSIS • Known as _____________, _____________ _____________, ________-_____________ Disease • Is subacute or chronic infection caused by the capsulate yeast cryptococcus _____________ . • Most frequently recognized as a disease of the ________ ________ ________ (_____), although the primary site of infection is the ________. • Disease occurs sporadically throughout the world but it is now seen most often in patients with ________.

Rhibrocerebral mucormycosis sinuses, eyes, cranial bones, brain Thoracic mucormycosis Primary cutaneous Subcutaneous

B. FILAMENTOUS FUNGI Clinical Varieties of Mucormycosis ____________ ____________: a rapidly fulminating infection. • from germination of the sporangiospores in the nasal passages and invasion of the hyphae into the blood vessels. • can progress rapidly with invasion of the _________, __________, __________ __________ and __________. • ____________ ____________: follows inhalation of the sporangiospores with invasion of the lung parenchyma and vasculature. • Other sites of invasion: ____________ ____________ infections have also been reported, but these are extremely rare. ____________ forms of zygomycosis are less serious.

surgical debridement amphotericin B underlying disease

B. FILAMENTOUS FUNGI Mucormycosis Treatment • Aggressive ____________ ____________ • Rapid administration of ____________ ____ • Control of the ____________ ____________

vaccine Trimethoprim-sulfamethoxazole (TMP-SMZ) pentamidine isethionate daily, aerosolized

C. OTHER FUNGAL AGENTS Pneumocystis jirovecii (PJP) Treatment • There is no __________ to prevent PCP • Acute cases of pneumocystis pneumonia are treated with __________ -__________ (_____-____) or __________ __________. • Prophylaxis can be achieved with __________ TMP-SMZ or __________ pentamidine.

Tropicalis Albicans Stellatoidea Krusei Guilliermondii Glabrata Viswanathii Parapsilosis

Important species of Candida found in man are: TASK GG VP

Intertriginous infection Interdigital involvement Onychomycosis Napkin dermatitis

PATHOGENESIS OF CANDIDA B. Skin and Nail Infections ________________ ________________: occurs in moist, warm parts of the body such as the axillae, groin, and intergluteal or inframammary folds. ________________ ________________: between the fingers follows repeated prolonged immersion in water ________________: Candidal invasion of the nails and around the nail plate ____________ ____________ in infants

early childhood immunodeficiency endocrinopathies

PATHOGENESIS OF CANDIDA C. Chronic Mucocutaneous Candidiasis Most forms have onset in _____________ _____________ Associated with cellular __________________ and __________________, and result in chronic superficial disfiguring infections of any or all areas of skin or mucosa.

pseudomembranous Erythematous Candida Leukoplakia Angular chelitis

PATHOGENESIS OF CANDIDA Other Presentation of Candidiasis: • ________________ type- reveals a raw bleeding surface when scraped; • ________________ type—flat, red, occasionally sore areas; • ____________ ___________ —nonremovable white thickening of epithelium caused by candida spp • __________ __________ —sore fissures at the corners of the mouth.

fumigatus, niger, flavus, terreus, nidulans atopic, conidial germinate, hyphae

A. YEAST AND YEAST-LIKE FUNGI ASPERGILLLOSIS Aspergillus species • Are ubiquitous saprophytes in nature, and aspergillosis occurs worldwide. • Most important species are A. ___________, A. ___________, A. ___________, A. ___________and A. ___________. • _________ individuals often develop severe allergic reactions to the ____________ antigens. • Immunocompromised patients, the conidia may _________ to produce _________ that invade the lungs and other tissues.

Sinusitis Mycotic keratitis Otomycosis

A. YEAST AND YEAST-LIKE FUNGI ASPERGILLOSIS >> Localized Infections • _________: A. flavus and A. fumigatus. • _________ _________: A. flavus and A. fumigatus. • _________: A. niger.

disseminated, brain, kidney

A. YEAST AND YEAST-LIKE FUNGI ASPERGILLOSIS >> Systemic Aspergillosis - Invasive aspergillosis: • Form occurs in severely immunocompromised individuals. • ____________ aspergillosis involving the ____________, ____________ and other organs is a fatal complication.

inhalation asymptomatic, influenza pneumonitis compromised meningoencephalitis skin, eye, prostate gland

A. YEAST AND YEAST-LIKE FUNGI CRYPTOCOCCOSIS Infection is by ____________ but may sometimes be through skin or mucosa Primary pulmonary infection may be ____________ or may mimic an ____________-like respiratory infection - resolving spontaneously Pulmonary cryptococcosis may lead to a mild ____________. • ____________ patient - yeasts may multiply and disseminate to other parts of the body • Central nervous system - cryptococcal ____________________. • Include the ______, ________, and __________ ___________.

neoformans hematologic malignancies, corticosteroids

A. YEAST AND YEAST-LIKE FUNGI CRYPTOCOCCOSIS Is worldwide in distribution Bird droppings - pigeon droppings- enrich for the growth of C. ____________- serve as a reservoir of infection. > Organism grows luxuriantly in pigeon excreta. > Birds do not appear to become infected, probably because of their high body temperature. In addition to patients with AIDS or ____________ ____________, patients being maintained on ____________ are highly susceptible to cryptococcosis.

grubii neoformance gattii

A. YEAST AND YEAST-LIKE FUNGI CRYPTOCOCCOSIS Adsorbed antisera have defined five serotypes: (A-D and AD) and three varieties • C. neoformans var ________ (serotype A), • C. neoformans var ________ (serotype D), • C. neoformans var ________ (serotype B or C) • Most infections are caused by C. neoformans var. neoformans - found in the excreta of wild and domesticated birds throughout the world.

amphotericin B, flucytosine Fluconazole

A. YEAST AND YEAST-LIKE FUNGI CRYPTOCOCCOSIS TREATMENT • Combination therapy of ______________ ____ and ________________ has been considered the standard treatment for cryptococcal meningitis. • _______________ offers excellent penetration of the central nervous system.

Cryptococcal meningitis tuberculosis cancer bones, joints cutaneous

A. YEAST AND YEAST-LIKE FUNGI CRYPTOCOCCOSIS ____________________ ____________________ the most serious type of infection Resemble tuberculous or other chronic types of meningitis. Predominantly a disease of the CNS, lesions of the skin, mucosa, viscera and bones may also occur. Visceral forms simulate _____________ and _____________ clinically. _____________ and _____________ may be involved _____________ cryptococcosis varies from small ulcers to large granulomas.

MARRC Mucor, Absidia, Rhizopus, Rhizomucor, Cunninghamella thermotolerant, saprophytes

B. FILAMENTOUS FUNGI Mucormycoses (Zygomycosis) • leading pathogens among this group of fungi are species of the genera ____________, ____________, ____________, ____________ and ____________. • Fungi are ubiquitous, ____________ ____________.

Talaromycosis marnefei penicillosis, keratitis, otomycosis AIDS, Southeast asia

B. FILAMENTOUS FUNGI ___________ (Penicilliosis) B. FILAMENTOUS FUNGI T. marneffei used to be called Penicillium marneffei, and ____________(2) used to be called penicillios more than 150 known species of the genus Penicillium - are caused by Penicillium ___________. > causes ___________, ___________, ___________ and rarely deep infections. > causes serious disseminated disease with characteristic papular skin lesions in _________ patients in ___________ _______.

Talaromycosis Bumps Itraconazole

B. FILAMENTOUS FUNGI ___________ (Penicilliosis) Cutaneous lesions and subcutaneous abscesses have been reported. ___________ on the skin are a common symptom - usually small Healthy people rarely get talaromycosis ___________ - most commonly used medicine - but healthcare providers also can prescribe other antifungal medicines.

hyaline, foamy alveolar exudate honeycomb interstitial infiltrate

C. OTHER FUNGAL AGENTS Pneumocystis Pneumonia • The multiplication of the parasite in the lungs induces a ________ or ________ ________ ________ • Stained sections, the exudate filling the alveoli shows a characteristic ________ pattern. • Chest radiographs may be normal or show a diffuse ________ ________.

protozoan carinii Trophozoites trophozoite precyst cyst

C. OTHER FUNGAL AGENTS Pneumocystis jirovecii (PJP) • Until recently, P. jirovecii was thought to be a ______________. • Molecular studies indicate that Pneumocystis _________ is a fungus with a close relationship to ascomycetes. • used to be called Pneumocystis _________(2) - some people considered using the abbreviation "PJP," but to avoid confusion, Pneumocystis jiroveciii pneumonia is still abbreviated "PCP. P. carinii has three stages: • ____________ thin walled (1-4 μm). • ________: It is 5-8 μm. • ____________ are thick-walled and spherical (4-6 μm) and contains 4 to 8 nuclei.

moniliasis skin, mucosa, internal organs diabetes normal flora (skin, mucous membrane, GIT)

Candidosis (candidiasis, ___________) - infection of the ________, ____________, and rarely of the __________ _________, caused by a yeastlike fungus Candida albicans, and occasionally by other Candida species. Several species of the yeast genus Candida are capable of causing candidiasis. An opportunistic endogenous infection, the commonest predisposing factor being ____________. Members of the _________ ________ of the skin, mucous membranes, and gastrointestinal tract.

Cryptococcus Candida Torulopsis Aspergillus Mucor Absidia Rhizopus Cephalosporium Fusarium Penicillium Geotrichum Scopulariopsis Pneumocytis jirovecii

Causative Fungal Agents: A. . Yeast and yeast-like fungi: CCT B. Filamentous fungi: AMARC FPGS C. Others:

opportunistic fungi

Key Points • Patients with compromised host defenses, which are susceptible to ubiquitous fungi, are referred to as _____________ __________. • Candida albicans, Aspergillus fumigatus, Aspergillus niger, Penicillium spp., Rhizopus spp. and Mucor spp. are some examples of opportunistic fungi

lungs aspergilloma allergic bronchopulmonary (aspergillosis) chronic necrotizing aspergillus pneumonia invasive (aspergillosis)

Key Points Aspergillosis Aspergillus species most frequently involved in human infections are A. fumigatus, A. flavus and A. niger In immunocompetent hosts, Aspergillus species may primarily affect the ________ causing four main syndromes including ________ ___________________ aspergillosis, ________ ________ ________ ________ , ________ and ________ aspergillosis

skin, mucosa albicans

Key Points Candidiasis • Candidosis (candidiasis, moniliasis) is an infection of the _____, __________, and rarely of the internal organs, caused by a yeast-like fungus Candida __________, and occasionally by other Candida species. • It causes (a) Mucocutaneous lesions (Oral thrush); 2. Vulvovaginitis, conjunctivitis keratitis; Skin and nail infections

Pneumocystis carinii pneumonia Inhalation HIV

Key Points Pneumocystis jirovecii • Pneumocystis jirovecii, is the causative agent of __________ __________ __________ (PCP). • Transmission of infection occurs by __________ • PCP is the most common opportunistic infection in ________ patients

mucormycosis, phycomycosis Mucor, Absidia, Rhizopus rhinocerebral, pulmonary, gastrointestinal

Key Points Zygomycosis • Zygomycosis (______________ or __________) is an infection caused by saprophytic molds of the class Zygomycetes (mainly __________, __________ and __________) • Zygomycetes can cause __________ zygomycosis, __________ zygomycosis and __________ zygomycosis

Otomycosis Keratomycosis

Key Points __________ • is a fungal infection of the external ear • usually caused by species of A. niger, A. fumigatus, Penicillium, Candida albicans, C. tropicalis and C. krusei __________ • or mycotic or fungal keratitis • most frequently caused by A. fumigatus, A. flavus, A. glaucus and A. niger.

neoformans pulmonary, CNS disseminated

Key Points Cryptococcosis Cryptococcosis is caused by the encapsulated yeast Cryptococcus _____________ It causes ___________ cryptococcosis in immunocompromised hosts. (______) cryptococcosis. _____________ nonpulmonary non-CNS cryptococcosis

external ear A. niger, A. fumigatus, penicillium, C. albicans, C. tropical, C. krusei itching, pain, deafness pseudomonas, proteus scarpings, culture

OTHER OPPORTUNIST FUNGI Otomycosis • fungal infection of the __________ _______ • very common disease and is usually caused by species of • symptoms are __________, __________ and __________ • Secondary bacterial infection- due to __________ and __________, causes suppuration. • Diagnosis can be made by demonstration of the fungi in __________ and by __________.

Fusarium species Trichosporon beigelii Pseudallescheria boydii culture serological

OTHER OPPORTUNIST FUNGI • __________ __________, __________ __________ and __________ __________ have been reported. • Diagnosis is made by __________ of the causative organism from clinical specimens and __________ tests play little part.

Keratomycosis cornea, bacterial, steroids saprophytic fumigatus, flavus, glaucus, niger Curvularia, Candida, Acremonium, Alternaria, Paecilomyces, Penicillium, Pseudallescheria, Fonsecea, Aureobasidium, Drechslera

OTHER OPPORTUNIST FUNGI _____________ (Mycotic Keratitis or Fungal Keratitis) • Invasive fungal infection of the _____________ , secondary to injury, _____________ infection and treatment with antibacterial agents and _____________. • Occur most often in hot climates and are caused by common _____________ molds. • Frequently caused by • A. _____________, A. _____________, A. _____________ and A. _____________ • In addition, species of CCAAPPP FAD

Oral thrush bottle-fed, aged, debilitated white patches, red oozing Vulvovaginitis Balanitis Conjunctivitis Keratitis

PATHOGENESIS OF CANDIDA A. Mucocutaneous Lesions 1. ________ ________: can occur on the tongue, lips, gums or palate. Found commonly in ________-______ infants and the ______ and ____________. Creamy ________ ________ appear on the tongue or buccal mucosa, that leave a ______ ________ surface on removal. 2. ________ - its wall, described as cottage cheese 3. ________ 4. ________ 5. ________

Intestinal candidiasis Bronchopulmonary candidiasis Septicemia Endocarditis Meningitis Kidney Infection Urinary Tract Infection

PATHOGENESIS OF CANDIDA B. Systemic Candidiasis 1. ________________ ________________: a frequent sequel to oral antibiotic therapy and may present as diarrhea not responding to treatment. 2. ________________ ________________- form of pulmonary fungal infection and refers to an opportunistic infection of the lung with the fungus Candida albicans. 3. _____________ 4. _____________ 5. _____________ 6. __________ _____________ 7. _____________ _____________ _____________

Nystatin Azole Fluconazole, itraconazole amphotericin B, fluconazole deap-seated (fluconazole)

PATHOGENESIS OF CANDIDA TREATMENT Management is mainly by removing the predisposing causes. All Candida strains are sensitive to _____________. Mucosal and cutaneous infections - number of different topical creams, lotions, ointments, and suppositories containing various _____________ antifungal agents Oral systemic therapy - accomplished with either _____________ or _____________ . Bladder colonization or cystitis - instillation of ___________ ___ directly into the bladder (bladder wash) or by oral administration of _______________. More _________-___________ infections require systemic therapy oral fluconazole

Opportunistic Fungi

Patients with compromised host defenses, who are susceptible to ubiquitous fungi, are referred to as ___________ ___________. Healthy people, if exposed to ubiquitous fungi are usually ___________.