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Pathology
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FMS 2_Fungus_2015
1 Pathology of common fungal infections
Fundamental Medical Sciences 2 Pathology of common fungal infections ..
1. 2. 3. 4.
FMS 2_Fungus_2015
2 Pathology of common fungal infections
FUNGAL COLONIZATION AND DISEASES
protective barriers
- Dermatophytes ( )
keratinase - Yeasts genus Candida
pseudohyphae - dimorphic fungi yeast
form mold form - Cryptococcus neoformans mucopolysaccharide capsule
virulence factor subcutaneous
layer superficial mycoses subcutaneous mycoses systemic mycosis
FMS 2_Fungus_2015
3 Pathology of common fungal infections
SUPERFICIAL MYCOSES
epidermis, ,
:- - (anthropophilic) - (zoophilic) - (geophilic) dermatophytes (), pityriasis versicolor (
), onychomycosis () superficial candidiasis tinea nigra, black white piedra Onychomycosis
dermatophyte, non-dermatophyte fungi, yeasts dermatophyte Tinea unguium
, , , , (peripheral vascular diseases) , ,
1. Distal subungual onychomycosis
(hyponychium) (subungueal area)
2. White superficial onychomycosis
3. Proximal subungual onychomycosis (proximal nail fold)
4. Total dystrophic onychomycosis epidermis minimal dermal inflammatory response
FMS 2_Fungus_2015
4 Pathology of common fungal infections
Superficial Candidiasis (Candidosis)
Candida spp normal flora Candida albicans host tissue, secretory aspartyl proteases phospholipase enzymes yeast hyphae
Predisposing factors superficial candidiasis 1. (primarily T cell phagocytosis)
- Primary immunological disease chronic granulomatous disease - Secondary immunodefects 2.
2. 3. , , hypoadrenalism 4. Physiological changes , , 5.
1 onychomycosis
FMS 2_Fungus_2015
5 Pathology of common fungal infections
2 () oropharyngeal candidiasis () Candida budding yeast pseudohyphae Candida budding yeast cells (blastoconidia), pseudohyphae septate hyphae Tinea nigra rare superficial fungal infection Hortaea werneckii epidermis (tinea nigra palmaris) (tinea nigra plantaris) Central South America, Africa, Asia, North America. direct inoculation 1 1.5 .. (hyperkeratosis) stratum lucidum elongated budding cells 3 X 10 m dark hyphae
FMS 2_Fungus_2015
6 Pathology of common fungal infections
3 () tinea nigra Palmaris () yeast Hortaea werneckii Piedra
2 1. Black Piedra Piedraia hortae
spores
2. White Piedra Trichosporon beigelii , hyphae, arthrospores (spores hyphae) blastospores (budding yeast cells) 4 () Black Piedra () White Piedra
FMS 2_Fungus_2015
7 Pathology of common fungal infections
SUBCUTANEOUS MYCOSES
subcutaneous tissue dermis, subcutaneous tissues, muscle, fascia
Chromoblastomycosis (or Chromomycosis)
cutaneous suppurative granulomas sclerotic cells muriform cells hypha formation (dematiaceous fungi) Fonsecaea pedrosoi Exophiala dermatitidis microabscesses epidermis 5-12 m cross septum neutrophil
5 () chromoblastomycosis verrucoid lesion () histopathology chromoblastomycosis granulomatous inflammation Langhans giant cell yeasts
FMS 2_Fungus_2015
8 Pathology of common fungal infections
Mycetoma (or Madura foot) subcutaneous tissue
colonies ( granules grains) dematiaceous non-dematiaceous fungi
sinus tract grains (granules) mononuclear cell fibrosis
Sporotrichosis
Subcutaneous sporotrichosis dimorphic fungus; Sporothrix schenckii,
1. Fixed type (solitary cutaneous ulcer) (nodule) 2-4 cm
6 eumycotic mycetoma (1) (tumorous lesion) (2) sinus opening (3) grains granules
FMS 2_Fungus_2015
9 Pathology of common fungal infections
2. Lymphocutaneous disease (lymphangitis) (lymphadenopathy)
granulomatous inflammation cental suppuration
Periodic acid-Schiff staining cigar-shaped yeast forms, subglobose ovoid 3-5 m hyphal forms stellate eosinophilic material asteroid bodies asteroid bodies 10 m 7 sporotrichosis histopathology PAS budding yeast cells
FMS 2_Fungus_2015
10 Pathology of common fungal infections
SYSTEMIC MYCOSES
1. Endemic mycoses (opportunistic infection) 2. Opportunistic mycoses normal flora normal flora Systemic mycoses
- hosts immune system , AIDS - steroid, ,
, -
8 systemic mycosis
FMS 2_Fungus_2015
11 Pathology of common fungal infections
Histoplasmosis dimorphic fungi, Histoplasma capsulatum
North South America North American Histoplasmosis ( small-form histoplasmosis).
Histoplasmosis true systemic mycosis severe case chronic cavitary histoplasmosis
conidia
1. Asymptomatic infection endemic areas skin test
2. Primary pulmonary histoplasmosis 12-21 diffuse reticulonodular infiltrates mediastinum calcification
3. Chronic pulmonary histoplasmosis
4. Disseminated histoplasmosis histoplasmosis reticuloendothelial system diffuse reticuloendothelial involvement shock, respiratory distress, , yeast macrophage reticuloendothelial system intracellular budding yeasts 3 m well-developed granuloma
FMS 2_Fungus_2015
12 Pathology of common fungal infections
central area caseation tuberculosis. Solitary pulmonary nodules ("coin lesion")
9 macrophage Histoplasma capsulatum H&E GMS (Gomoris-Methenamine Silver) stain Cryptococcosis
encapsulated yeast Cryptococcus neoformans virulence factor polysaccharide capsule phenol oxidase
systemic T-cell lineages AIDS steroid
cryptococcosis 1. Pulmonary cryptococcosis
pulmonary infiltration
2. Cryptococcal meningoencephalitis subacute chronic
FMS 2_Fungus_2015
13 Pathology of common fungal infections
lymphocytes neutrophils glucose protein India ink capsule yeast cell
Cryptococci
yeast cell mucoid capsule yeast 4-6 m capsule 1-30 m yeast mucicarmine capsule
10 Cryptococcus neoformans budding yeast cells () mucicarmine Systemic candidiasis (or candidosis)
Candida transient candidemia disseminated invasive disease body cavity
C. albicans 1. Disseminated candidiasis
2.
FMS 2_Fungus_2015
14 Pathology of common fungal infections
- -
(chronic disseminated candidiasis) - -
superficial candidiasis Aspergillosis
Aspergillus
1. Aspergilloma fungal ball cavity
2. Invasive aspergillosis A. fumigatus, A. Flavus (hyaline, septate, dichotomously branched hyphae of uniform diameter) conidial head purulent, necrotizing inflammation
11 Aspergillus Hyaline septated hyphae with dichotomous branching GMS stain
FMS 2_Fungus_2015
15 Pathology of common fungal infections
Zygomycosis Zygomycosis class Zygomycetes
Mucorales, Mortierellales Entomophthorales mucormycosis AIDS (angioinvasive)
1. Rhinocerebral zygomycosis involvement
2. Cutaneous zygomycosis
3. Pulmonary zygomycosis neutrophil segmental consolidation
4. Gastrointestinal zygomycosis ileum acute suppurative inflammation granulomatous inflammation (broad, thin-walled, hyaline, often aseptate or sparsely septate hyphae) 6-15 m
FMS 2_Fungus_2015
16 Pathology of common fungal infections
Penicilliosis
P. marneffei Penicillium dimorphic fungi AIDS (bamboo rat) cell-mediated immunity
Penicilliosis marneffei
necrotizing granulomas microabscess formation slide Wrights stain biopsy H&E macrophages internal septation binary fission P. marneffei H. capsulatum internal septation Gomoris Methenamine Silver stain (GMS stain) 13 internal cross septation Penicillium ()
12 zygomycosis hyaline nonseptated hyphae with perpendicular branching