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SYSTEMIK AND OPPORTUNISTIC MYCOSIS L13 - Coggle Diagram
SYSTEMIK AND OPPORTUNISTIC MYCOSIS L13
COCCIDIOIDOMYCOSIS
Other names: "Valley fever", "California fever", "desert rheumatism",and "San Joaquin Valley fever"
Caused by: Coccidioides immitis or Coccidioides posadasii
Usually self-limiting
Arthrospores can live years and highly infectious
Systemic disease affected by:
• Hereditary/racial
• Male > female
• Immunocompromised (CMI)
Age (the young and the aged)
Diagnosis
Fresh specimen --> find spherules
Culture --> highly infectious
Serology test
Therapy
Azoles : fluconazole, ketoconazole, itraconazole; amphotericin B
HISTOPLASMOSIS
Other name : "Cave disease,"Darling's disease,"Ohio valley disease,“
Morphology: mold, brown in color, tuberculated macroconidia
Most prevalent of fungal pulmonary infection in human and animals
Pathogenesis
Spore --> per inhalation --> acute pulmonary histoplasmosis --> either chronic pulmonary histoplasmosis --> calcification
Or spread by lymphogenous to extra pulmonary tissues, e.g.: liver, kidney, bone marrow, lymph nodes --> focal necrosis, granulomatous lesions that may fatal
SIGNS & SYMPTOMS
Asymptomatic
Fever, cough (days – weeks), pulmonary infiltrate (Xray), (+) skin test after 3 weeks
Severe case: malaise, chest pain, shivers, nodules & pulmonary infiltrates resembles neoplasm
Progressive pulmonary infection: tbc-like, chronic, relapse (+)
Spread: RES, CNS, GI tract, adrenal gland
Diagnosis
Direct examination of sputum, urine, bone marrow aspirates
Culture on Sabouraud’s agar or glucosecysteine blood agar
Biopsy: HE, Wright stain
Skin test: histoplasmin skin test
Therapy: Itraconazole, Amphotericin B
BLASTOMYCOSIS
Other name : "North American blastomycosis",
"Blastomycetic dermatitis", and "Gilchrist's disease"
Caused by: Blastomyces (Ajellomyces)dermatitidis
Double-wall yeast cells, Ø 8-15 μm
Pathogenesis: spore per inhalation --> acute pulmonary blastomycosis: PMNs infiltration, granulomas & giant cells --> spread hematogenous to skin, bone, urogenetalia tract
SIGNS & SYMPTOMS
In pulmonary blastomycosis: fever, productive cough, chest pain; X-ray: nodules and infiltrates
In UG tract: prostatitis, epididymitis
In cutaneous blastomycosis: ulcerated, verrucous granulomas
Diagnosis:
1.Direct examination: broad-based budding yeast cells
Specimens: sputum, pus, urine, CSF
Culture
Serology
Therapy: Ketoconazole, Itraconazole, Amphotericin B
PARACOCCIDIOIDOMYCOSIS
Chlamydospores (+), in rich medium, at 37 C --> large yeast cells with multiple budding
Pathogenesis: spores per inhalation --> pulmonary lesion--> progressive or spread --> mucocutaneous, liver, adrenal gland
Sign & symptoms
Juvenile type: age < 30 years, acute or sub acute, short incubation period, affect lymph nodes in lungs
Adult type: age 30-60 years, 90% in males, activation of latent infection, can spread to organs and tissue.
In lung: granulomatous nodules, cavities, no calcification
Diagnosis
Specimen: sputum, exudates, tissue biopsy
Culture: sputum, blood, bone marrow
Biopsy: HE, Wright stain
Serologic: CFT, immunodiffusion test
Skin test: paracoccidioidin skin test
Therapy
Amphotericin B
Itraconazole, ketoconazole
Cotrimoxazole
CANDIDIASIS
Usually caused by Candida albicans (90%)
Normal flora of skin, mucous membrane (mouth, vagina), GI tract
Can be acute or chronic infection
Morphology: yeast cells, Ø 2-6 μm, may produce pseudohyphae
CLINICAL MANIFESTATIONS
Cutaneous & mucosal candidiasis:
Oral thrush: affect tongue, lips, gums, or palate--> white lesions - pseudomembrane
Diaper rash in infants: macular erythematous
Vulvovaginal thrush: in pregnancy, diabetes mellitus, antibacterial agent that alter microbial flora. Yeast invasion in vaginal mucous --> vaginal discharge: white; irritation, pruritus
Candida onychomycosis:
Infection starts from proximal part of the nail
Painful, erythematous swelling of the nail fold
Systemic candidiasis:
May occurin patients receiving immunosuppressants, hematologic diseases,patients using prosthetic heart valves
Infect several organs : heart, kidney, lung, meninges
Chronic mucocutaneous candidiasis :
Usually have onset in early childhood
Chronic superficial infection of any or all areas of skin and mucous membrane
Diagnosis:
Germ tube test: inoculate mammalian serum with C. albicans --> pseudohyphae (+)
Therapy:
Nystatin, gentian violet 1% --> oral thrush
Flucytosine, amphotericin B, fluconazole --> for systemic infections
CRYPTOCOCCOSIS
Agent: Cryptococcus neoformans
Yeast cells, Ø 4-6 μm, with thick capsules polysaccharides glucorono-xylomannan, Ø ≥ 25
μm
Diagnosis:
Specimens: CSF, sputum, blood, urine
Direct examination using India ink --> thick capsule
Culture: medium + cycloheximide
Serology
Major clinical findings: chronic meningitis, with spontaneous remissions and exacerbations; may resemble brain tumor, brain abscess
Therapy:
Amphotericin B, flucytosine, fluconazole
Aspergillosis
Common cause: A.flavus, A.niger, A.fumigatus
Rapid growing fungi, septate hyphae, asexual spores with conidiophores
Clinical manifestations: allergic bronchopulmonary aspergillosis
Usually affect people with atopic allergy, is an asthma syndrome, marked by eosinophilia and IgE,
Invasive aspergillosis --> an be fatal, but seldom occur, from paranasal sinus to brain & orbital, from lungs through diaphragm to gaster, liver; heart, and pericardium
Fungus ball aspergillosis (aspergilloma) --> colonization of fungal mass in paranasal sinuses, lung cavities, meatus acusticus
Diagnosis:
Direct examination + KOH
Culture
Therapy:
Allergic type: corticosteroid & antifungal
Aspergilloma: antifungal & surgery