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OPPORTUNISTIC MYCOSES. 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 - PowerPoint PPT Presentation
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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