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  2. 2. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 2 GEHLOT’S REVIEW OF MYCOLOGY FOREWORD It is a privilege for me to write this foreword for GEHLOT’S REVIEW OF MYCOLOGY by Sukharam Gehlot . Mycology is an important part of Medical Microbiology. It is one of the six basic components of Medical Microbiology that the undergraduate students have to study , the remaining five being General microbiology, Immunology, Bacteriology, Parasitology and Virology. The importance of medical mycology has increased in the recent years because of increase in the number of immunocompromised patients. Opportunistic mycoses is an important challenge in the treatment of immunocompromised patients now a days. In such circumstances, it becomes all the more imperative for medical students to perform an in depth and thorough study of medical mycology. Sukharam Gehlot has strived hard to prepare these notes. He has collected important points from various books to make every note wholesome for undergraduate students . Basics of medical mycology have been very nicely compiled in these notes. An assembly of information which can certainly be useful to the students to become thorough with mycology. Dr. PRAVEG GUPTA
  3. 3. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 3 GEHLOT’S REVIEW OF MYCOLOGY ACKNOWLEDGEMENTs Words cannot express the feelings but still they are the only medium of expression for HUMAN beings. With a deep sense of gratitude I am extremely thankful to Dr. PRAVEG GUPTA Sir , Assistant Professor MICROBIOLOGY DEPARTMENT , B.J.Medical College & Civil Hospital , AHMEDABAD for his INSPIRATION , ENCOURAGEMENT , SUPPORT and most off all his immense faith on me that made me come out with this book. I am thankful to him for his selfless and prompt help in completion of this book. I am also thankful to my FRIENDs & FAMiLy for their consistent MOTIVATION & ENCOURAGEMENT for Bringing the edition of this Book. E-mail :- esar.gehlot@gmail.com Q :- Difference b/w Candida & Cryptococcus ? Candida Cryptococcus 1.Example C. albicans Cry. Neoformans 2.Capsule Non capsulated fungi Capsulated fungi 3. Reproduct’n by Hyphae Budding 4.Pseudohyphae (pseudomycelium) Present Absent 5.Spore No sexual spore but vegetative spore produce:-Chlamydospore and Conidiospore/ Conidia/Asexual spore present Basidiospore
  4. 4. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 4 GEHLOT’S REVIEW OF MYCOLOGY 6.Antigen Carbohydrate extract act as a Ag Capsular polysaccharide act as a Ag 7.Culture (in humen serum) Germ tube produced Not produced 8.Source of infection Normal flora of Human Faeces of pigeon 9.Mode of infection Mainly Opportunistic endogenous infection Inhalation 10.Melanin pigment Not produced Produced 11.Pathogenicity Mostly mucosal candidiasis Mostly pulmonary infection 12.Morphological class Yeast like fungi yeast 14. Taxonomical class Fungi imperfecti (C. alb.) Basidiomycetes 15.Morphology Yeast cells, budding cells n pseudohyphae capsulated yeast cells n budding cells 16. 17.
  5. 5. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 5 GEHLOT’S REVIEW OF MYCOLOGY Mycology (Medical Microbiology) Taxonomical classification Thallophyta (a) Fungi (non chlorophyll) (b) Algae (chlorophyll) Fungi are four types:- (a1) Zygomycetes:- Lower fungi Non septate hyphae Form asexual spores called sporangiospores. Form sexual spores called zygospore and oospore. Eg. Rhizopus (bread mould) (a2) Ascomycetes:- Septate hyphae Sexual spores called Ascospore which are present within a sac/ascus Eg. Piedraia hortae, Penicillium, Aspergillus, Curvularia, Alternaria, Sporothrix, Fusarium, Acremonium (a3) Basidiomycetes:- Septate hyphae Sexual spores called Basidiospore which are present on a basidium. Eg. Filobasidiella neoformans, Malassezia, Trichosporon, mushrooms
  6. 6. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 6 GEHLOT’S REVIEW OF MYCOLOGY (a4) Deuteromycetes ( fungi imperfecti ) / Hyphomycetes:- Septate hyphae Lack of sexual stage ( perfect stage )/sexual stage is not known. Form asexual spore and may or may not form spore Eg. Saccharomyces, Candida, Malassezia, Trichosporon, Acremonium, Aspergillus, Blastomyces, Coccidioidis, Fusarium, Penicillium, Alternaria, Exophila, Hortaea, Sporothrix, Trichophyton, Histoplasma, Madurella Morphological classification:- (a) Yeast:- Reproduction by budding Eg. Cryptococcus neoformans (only capsulated yeast pathogenic to man) (b)Yeast like fungi:- Reproduction by pseudohyphae Eg. Candida albicans (c) Moulds:- Reproduction by mycelium / spore Egs. Dermatophytes Aspergillus Penicillium & Rhizopus
  7. 7. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 7 GEHLOT’S REVIEW OF MYCOLOGY (d) Dimorphic fungi:- Reproduction by budding and mycelium. Fungi having two types of morphology in different circumstances are called as dimorphic fungi. Dimorphism may be thermal, nutritional or tissue dimorphism. Ex. Histoplasma capsulatum Blastomyces dermatitidis Coccidioides immitis Paracoccodioides brasiliensis Sporothrix schenckii Penicillium marneffei Ques. Write the types of MYCOSES? 1..SUPERFICIAL MYCOSES:- Pityriasis versicolor:- Malassazia furfur Tinea nigra:- Exophiala werneckii White piedra:-Trichosporon beigelii Black piedra :-Piedraia hortaea
  8. 8. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 8 GEHLOT’S REVIEW OF MYCOLOGY 2..CUTANEOUS MYCOSES ( eg. dermatophytosis ):- Trichophyton spp. Microsporum spp. Epidermophyton spp. 3..SUB-CUTANEOUS MYCOSES::- Mycetoma:-Madurella mycetomatis Rhino sporidiosis:-Rhinosporidium seeberi Sporotrichosis:- Sporothrix schenckii Chromoblastomycosis, Pheohyphomycosis, Lobomycosis 4..SYSTEMIC MYCOSES:- Cryptococcosis :- Cryptococcus neoformans Histoplasmosis :-Histoplasma capsulatum Blastomycosis, Coccidioidomycosis, Paracoccidioidomycosis 5..OPPORTUNISTIC MYCOSES:- Aspergillosis :-Aspergillus flavus , A. fulmigatus. Candidiasis :- Candida albicans.
  9. 9. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 9 GEHLOT’S REVIEW OF MYCOLOGY Q :- Culture media which are used for fungal culture ? Ans :- 1. Sabouraud’s dextrose agar Ph-5.6 Contains: 4% dextrose 1% peptone 2% agar 50mg/L Chloramphenicol: to minimize bacterial contamination 500mg/L Cycloheximide: to minimize the contamination of saprophytic fungi 2. Brain heart infusion agar ( Histoplasmosis ) 3. Routone media ( Candidiasis ): 4. Corn-meal agar ( Candidiasis ): nutritionally poor media 5. Czapek-dox media 6. Sheep blood agar 7. Human blood ( serum )agar 8. Niger seed agar Q:- Non cultivable fungi ? Ans:- Rhinosporidium seeberi Pneumocystis carinii Lacazia loboi
  10. 10. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 10 GEHLOT’S REVIEW OF MYCOLOGY Q :- Stains which are used in fungal diagnosis ? Ans :- 1. KOH stain 2. Indian ink stain 3. Lactophenol cotton blue ( LPCB ) 4. Nigrocin stain 5. Gram stain 6. Periodic acid Schiff stain 7. Gomori-methenamine silver stain 8. Calcoflour white stain 9. Mucicarmine stain 10.Giemsa stain 11.Haematoxylin & Eosin stain Q :- Define the Fungi imperfecti /Hyphomycetes /Deuteromycetes ? Ans :- It is a provisional group consisting of fungi whose sexual phase ( perfect stage ) have not been identified. They form septate hyphae and asexual spores or no spores. Most of the fungi pathogenic for humans are in this class. Egs. (See above) Q:- Direct microscopic examination ? Ans:- 1. specimen wet mount with KOH. 2. wet film stained by lactophenol cotton blue. 3. smear stained by gram/giemsa/H&E stain etc…………………
  11. 11. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 11 GEHLOT’S REVIEW OF MYCOLOGY Q :- Explain the Dimorphic fungi Ans :- Dimorphic fungi exist either as a yeast or as a filament ( mycelia ), depending upon the condition of growth medium:- 1…Yeast form ( parasitic phase):- occurs in host tissue and on culture media at 37°c 2... Filamentous form ( mycelial/ hyphae /saprophytic phase ):- occurs in soil and in culture media at 22°c Fungi responsible for systemic infection are mostly dimorphic. Ex. Histoplasma capsulatum , H. duboisii, B.hominis, C.immitis …….etc. Q:- Give name of Dimorphic fungi & diseases caused by them ? FUNGI DISEASE TARGET ORGAN 1.Exophiala werneckii Tinea nigra Skin 2.Histoplasma capsulatum Histoplasmosis Lung 3.Histoplasma duboisii African histoplasmosis Lung 4.Blastomyces dermatitidis North American blastomycosis Lung & Skin 5. Sporothrix schenckii Sporotrichosis Skin & subcutaneous tissue
  12. 12. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 12 GEHLOT’S REVIEW OF MYCOLOGY Q :- Examples of Anti Fungal Agents ? Ans :- Most of antifungal agent are used only topically Ex . 1- Amphotericin-B 2. Nystatin 3.Miconazola ,Ketoconazole ,Fluconazole , itraconazole 4.Fluorocytosine 5.Griseo-fulvin 6. Naftifine 7. Terbinafine 8.KI saturated solution Q: Explain the ARTHROSPOREs ? Ans :- These are formed by production of numerous cross septa into haphae resulting in production of rectangular thick walled vegetative spores. The spores are united in the form of a string of beads. Diag…
  13. 13. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 13 GEHLOT’S REVIEW OF MYCOLOGY Q :- Reynold’s Braude Phenomenon/Germ Tube test /germ tube ? Ans :- When Candida albicans is grown in human serum agar at 37°c for 2- 3 hrs, a filamentous out growth occurs which is demonstrated by wet mount with KOH stain - called germ tube. It is rapid method of identification of C. albicans within 2 hrs. This phenomenon is called Reynold’s Braude phenomenon. The germ tube differentiates, grows and develops by mitosis to create somatic hyphae. The germtube is found in candida albicans and candida dubliniensis only. Diag … Q :-Explain the CHLAMYDOSPOREs ? Ans :- These are large thick walled resting spores developed from rounding up of cells in an hyphae ( modified hyphal cells) for existence during long period of dormancy.
  14. 14. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 14 GEHLOT’S REVIEW OF MYCOLOGY Chlamydospores can be 1.intercalary 2.terminal 3.lateral Eg. Candida, histoplasma Diag…
  15. 15. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 15 GEHLOT’S REVIEW OF MYCOLOGY Q :- Dermatophytes causing infection in human Ans :-1. Trichophyton genus :- T.rubrum , T. schoenleinii, T. violaceum T. tonsurans 2. Microsporum genus :- M.audouini 3. Epidermophyton genus :- E. floccosum Q :- Endothrix hair infection ? Ans :- Causative organism :- Trichophton violaceum ,T. tonsurans It form Arthospores which occurs entirely with-in the hair shaft resulting BREAK OFF of hair . It is called endothrix of hair infection. Diag….
  16. 16. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 16 GEHLOT’S REVIEW OF MYCOLOGY Q :- Difference b/w Actinomycotic & Eumycotic mycetoma ? Actinomycotic mycetoma Eumycotic mycetoma 1.Caused by Bacteria Fungi 2.Filament Bacilli Hyphae 3.Tumour Multiple tumour masses with ill defined margins Single tumour with well defined margins 4.Sinuses Appear early & numerous Appear late & few 5.Discharge Purulent Serous 6.Granules White/Red & thin Black / White & broad 7.Bone Osteolytic lesion Osteo-sclerotic lesion 8.Ex. Actinomadura medurae. Nocardia. Actinomyces. Streptomyces. Madurella mycetomatis. Exophiala jeanselmei. Aspergillus. Fusarium spp. Q :- Write short note on “SUPERFICIAL MYCOSES“ ? Ans :- “PITYRIASIS VERCICOLOR” 1. Introduction :- Tinea vercicolor is chronic superficial fungal infection ( skin infection) which is characterised by blotchy hypopigmented /hyperpigmented macular lesions that may be accompanied by itching. It is non inflammatory & chronic recurrent infection. 2. Causative organism:- Malassezia furfur. 3. Classification:- Many species of Malassezia identified but M.furfur is common clinical spp.
  17. 17. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 17 GEHLOT’S REVIEW OF MYCOLOGY M.furfur is a lipophilic fungi which found as a commensal in sebaceous gland rich areas of body. Taxonomically it is classified in class Basidiomycetes. Because of its ability to hydrolyse urea, a positive reaction to staining with Diazonium blue B (DBB) and laminar ultrastructure of cell wall the genus is classified in Deuteromycetes. 4. Source of infection:- sebaceous gland rich areas of human body 5. Mode of infection:- direct contact 6. Morphology & reproduction:- yeast cell are oval & reproduce by unipolar budding In culture:- bottle shaped budding yeast cells. 7.Clinical diseases :- It is chronic superficial infection of skin which is characterised by blotchy hypo / hyper - pigmented macular lesion accompanied with itching but remain asymptomatic and giving dry & chalky appearance to affected area. 8. Lab. Diagnosis :- (a.) Specimen :- skin scale , scraping of lesion (b.) Method :- (A) Direct microscopy :- ->Skin scale mount with KOH -> Cluster of round yeast cell with short curved stout - hyphae ( non branched ). Bottle shaped budding yeast cells.
  18. 18. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 18 GEHLOT’S REVIEW OF MYCOLOGY Characteristic “banana and grapes” or “Spaghetti and meat balls appearance” is diagnostic of Malassezia furfur infections. (B) Urease test :- positive (C) Culture :- -> Scraping inoculated in Sabouraud’s dextrose agar (SD’s agar) overlaid with a film of olive oil at 37’c for 2-4 days . -> Creamy fried egg colony with bottle shaped budding yeast cells appear (9.) Treatment :- ketoconazole……….etc. “TINEA NIGRA” 1. Introduction :- Tinea nigra is a superficial asymptomatic , painless skin disease which characterized by light-brown /black macular patches on thickly keratinized region of palm & sole. 2. Causative organism:- Exophila werneckii which is dimorphic fungi. 3. Source of infection:- Soil 4. Mode of infection:- Direct contact with soil 5. Morphology:- E. werneckii also known as Hortaea werneckii has brown septate branching hyphae and budding yeast like cells. 6. Clinical feature:- it is asymptomatic skin disease of mainly sole & palm area where light-brown/black macular patches are seen. 7. Lab.diagnosis:- (a) Specimen :- skin scraping
  19. 19. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 19 GEHLOT’S REVIEW OF MYCOLOGY (b)Method:- (A) Direct microscopy :- -> specimen mount with KOH -> brownish branched septate hyphae and budding cells are seen. (B) Culture :- --> incubated in SD’s agar --> light to gray colony appear 8. Treatment :- miconazole …etc. “WHITE PIEDRA” 1. Introduction :- It is disease of hair which characterized by formation of white nodules on the hair shaft which composed of fungus elements. 2. Causative organism:- Trichosporon beigelii. 3. Clinical feature:- white nodules on hair shaft of axilla. 4. Lab. Diagnosis :- (a): Specimen:- infected plucked hair from affected area. (b) Method:- (A) Direct microscopic:- --> mount with KOH --> It show branched hyphae & arthrospore within & outside the hair.
  20. 20. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 20 GEHLOT’S REVIEW OF MYCOLOGY (B) Culture:- --> On SD’s agar show Mycelium, Arthrospores & Blastospores. “BLACK PIEDRA” 1.Introduction:- It is disease of hair which is characterised by formation of black nodules on the hair shaft which is composed of fungus element. 2. Causative organism:- Piedra hortaea. 3. Clinical feature:- Black nodules on hair shaft of beard & scalp. 4. Lab. Diagnosis:- (a) Specimen:- infected plucked hair from affected area. (b) Method:- (A) Direct microscopy:- --> mount with KOH --> It show Club shaped asci which contain 8- fusiform ascospores. (B) Culture:- In SD’s agar P. hortaea produce Asci & Ascospores.
  21. 21. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 21 GEHLOT’S REVIEW OF MYCOLOGY Q:-write short note on “CUTANEOUS MYCOSES” ? “DERMATOPHYTOSIS“ 1..Introduction:- Cutaneous mycoses / Tinea / Ring-worm are fungal infection of keratinized tissue (hair/nail/skin) of human. 2..Causative organism:-  group of mould fungi called Dermatophytes like Trichophyton, Microsporum, Epidermophyton spp… T. rubrum, M. audouinii E. floccosum T. schoenleinii M. canis T. violaceum 3… Source of infection:- keratinized tissues of animals & it’s products and soil. 4… Mode of infection:- Close contact , Direct exposure to soil born keratinized debris. 5… Morphology:- Hyphae & Arthrospore of Dermatophytes present in lesion. Septate hyphae & asexual spores are present in Culture
  22. 22. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 22 GEHLOT’S REVIEW OF MYCOLOGY 6…Classification:- It is based on nature of macroconidia:- 7…Epidemiology:-  Habitat & mode of transmission. (a) Antrophilic/anthropophilic Dermatophytes:-  exclusively infect Humans. -->Transmission from person to person by close contact…(eg. comb). (b) Zoophilic Dermatophytes:- Are non human mammal’s associated organism. ->transmition to human from animal by close contact. (c) Geophilic Dermatophytes:- these are soil associated organisms and transmitted to Human by Direct exposure to soil borne keratinious debris. Genus Shaped of macroconidia Trichophyton pencil shaped Microsporum Multi-cellular & spindle shaped Epidermophyton club shaped
  23. 23. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 23 GEHLOT’S REVIEW OF MYCOLOGY 8..Etiopathogenesis:- (a) Trichophyton:- It infect the Skin , Hair , Nails. T. rubrum is most common spp.. T. violaceum& T. tonsurans produce Arthrospore within the Hair shaft & caused BREAK OFF of Hair called Endothrix. M. audouinii & M.canis grow around but outside the Hair and produce Arthrospore called Ectothrix. Both Ectothrix & Endothrix fungi destroy the keratin of Hair & Broken the Hair. T. schoenleinii cause FAVUS , fungal activity minimal inside the Hair shaft but intense growth occurs within & around follicle which ( FAVUS ) is characterised by by HONEY COMB appearance on scalp. (b) Microsporum:- --> Infect the Skin & Hair. They are Ectothrix fungi & penetrate the Hair & Extend down. (c)Epidermophyton:- infect the Skin & Nail only. Dig…. (a) Ectothrix (b) Endothrix (c) Favus
  24. 24. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 24 GEHLOT’S REVIEW OF MYCOLOGY 9..Clinical form:- Symtoms& appearance of lesion are variable according to site of infection. Typically lesion are circular which spread with scaling & inflammation. Dermatophytes grow only on the keratinized layer of epidermis & its appendage . Local inflammation is due to irritation by fungal product & hypersensitivity reaction . 10..Lab. Diagnosis:- (a) Specimen:- -> scraping of skin/ nail. -> short length of plucked hair from infected area of scalp. Hair brush sampling technique also used. (b)Method:- (A) Direct microscopy:- keratinized specimen mount with KOH which show filamentous branching Hyphae. Arthrospore formation is seen in Hair. (B)Culture:- specimen incubated into SD’s agar with cycloheximide& chloramphenicol & inoculated aerobically at 27’c for 3 weeks.
  25. 25. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 25 GEHLOT’S REVIEW OF MYCOLOGY Identification (in culture):- Genus Macroconidia Microconidia 1..Epidermophyton Numerous , smooth-walled, clubbed shaped Absent 2..Trichophyton Spare thin-walled , smooth septate pencil shaped Abundant 3..Microsporum Numerous thick walled , rough, spiny, multicellular, spindle shaped ( on scalp, infected hair show Bright- Green appearance with ultraviolet wood’s lamp on direct observat’n but not in culture. ) Rare 11..Treatment:- In mild infection:- clotrimazole / miconazole……etc. In severe infection:- tab. Griseofulvin for 4-6 weeks for skin inf..& 1yr for nails inf..
  26. 26. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 26 GEHLOT’S REVIEW OF MYCOLOGY 12..Diag..of:- Macroconidia of Microsporum spp.. Macroconidia of Trichophyton spp..
  27. 27. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 27 GEHLOT’S REVIEW OF MYCOLOGY Macroconidia of Epidermophyton spp… Q:- Write the short note on “SUBCUTANEOUS MYCOSES” “MYCETOMA” 1…Introduction:- Mycetoma is a localized granulomatous infection of subcutaneous tissue which most often affect the foot. It is also called madurafoot/ maduramycosis. 2..Causative organism:- -> Filamentous bacteria: Actinomycetes & Nocardia. -> Filamentous fungi:- The four most common species of fungi responsible for Eumycetoma are:
  28. 28. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 28 GEHLOT’S REVIEW OF MYCOLOGY Acremonium falciforme-> white grain Madurella mycetomatis -> black grain Exophiala jeanselmei -> white grain Pseudo-allescheriaboydii ->white grain 3..Source of infection :- soil 4..Mode of infection:- acquired by direct inoculation of soils particles on minor trauma (remain localized to feet & leg ). Botryomycosis is caused Staphylococcus aureus which is similar to mycetoma. Madura foo t = Padavalmika = Foot-anthill. 5..Pathogenesis:- Disease=> Mycetoma / Madura foot / Maduramycosis . Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissues with involvement of underlying fasciae and bones usually affecting the extremeties. The disease is defined by a triad of tumefaction of affected tissue, formation of multiple draining sinuses and presence of grains (granules). --> mycetoma is localized swollen condition that begins as small subcutaneous LESION of foot. --> LESION burrow into deeper tissue and produce characteristic ABSCESS.
  29. 29. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 29 GEHLOT’S REVIEW OF MYCOLOGY --> organism multiply in center of ABSCESS & form GRANULAR COLONY with push cell and proteinaceous suppurative material . It is called GRANULAR ABSCESS . -> Abscess brusts and form CHRONIC SINUS which discharging the Seropurulent fluid which contain Granules . -> Granules may be White/Black/Brown depending upon causative organism . 6…Lab. Diagnosis.:- (a)Specimen:- Biopsy material with granules. / Pus / Exudate from draining sinus. (b) Method:- (A)Macroscopy:- granular size & color are variable. (B)Direct Microscopy:- -> specimen is mount with KOH . -> GRAM staining help to differenciat b/w Actinomycetoma & Eumycetoma. (01) Actinomycotic granules:- made of gram positive , interwoven thin filamentous along with some Coccoid & Bacillary forms . (02) Eumycotic granules:- made of broad interwoven , septate hyphae with firmly large numbers of Bizarrely shaped swollen cells. (C) Culture :- -> specimen is incubated in SD’s agar at 25’c & 37’c. -> Specimen is also culture on Blood agar for Actinomycetes .
  30. 30. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 30 GEHLOT’S REVIEW OF MYCOLOGY IDENTIFICATION:- (oa)…. Fungi producing white granules in tissue are generally produce Hyaline mycelia & conidia whereas M. mycetomatis produce Black granules in tissue. (ob)… Mycelial phase slowly develop at 25-30’c. Identification confirmed by SUBCULTURE at 37’c to convert it into the Yeast phase. (oc) Eumycotic mycetoma agents are composed of Hyphae with conidia. (D) Biopsy :- Mycetoma’s granules often elicit an immunogenic response in tissue called SPLENDORE – HOEPPLi Reaction which Histologically characterized by deposition of Eosinophilic material around the Granules. (E) Serological Test :- ELISA Test used for detection of Ag which is 90% specific .
  31. 31. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 31 GEHLOT’S REVIEW OF MYCOLOGY “RHINOSPORIDIOSIS” 1..Introdution:- It is subcutaneous mycosis . Rhinosporidiosis is chronic granulomatous disease ( lesion produce hoga ) of muco-cutaneous tissue of mostly nasal &naso-pharynx of mostly male who frequently contact with stagnant water / aquatic life. 2…Causative organism:- Rhinosporidium seeberi. 3…source of infection:- water & aquatic life. 4…mode of infection:- frequent contact with stagnant water / aquatic life. 5…Epidemiology:- Habitat::- normal habitat of these fungi is water / aquatic life. 6…Clinical feature :- Rhinosporidiosis is a chronic granulomatous disease which characterized by formation of Friable pedunculated / sessile polyp or wart like Lesions in the nasal & nasopharyngeal mucosa. Mostly that infection occurs in males. 7…Lab. Diagnosis:- (a)Sample:- TISSUE section , Exudate of lesion , Mucosal scraping. (b)Method:- (A) Direct microscopy:- Tissue section is examined with H&E Stain and show large number of mature& immature spores within sporangia in a stroma which infiltrated with lymphocyte , plasma cells & macrophages.
  32. 32. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 32 GEHLOT’S REVIEW OF MYCOLOGY (B) Culture:- Its cultivation is not possible because it don’t grow in culture media. 8… Treatment:- Amphotericin-B is the drug of choice . 9…Dig…….. Rhinosporidiosis :- tissue showing mature sporangium with numerous Endospore & several developmental stage of sporangium.
  33. 33. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 33 GEHLOT’S REVIEW OF MYCOLOGY Q:- Write the short note on “SYSTEMIC MYCOSES” ? “CRYPTOCOCCOSIS” 1.. Introduction:- Cryptococcosis is sub-acute / chronic infection caused by CAPSULATED yeast Cryptococcus neoformans. 2…Epidemiology :-  Reservoirs:- wild birds (pigeon & chicken) & soil. Cryptococcal infection is now seen most frequently in Immuno-compromised patient (ex..AIDS ). 3…Morphology:- C. neoformans is a spherical budding cell having a prominent polysaccharide capsule which has antigenic property. 4…Reproduction:- It is reproduced by Budding. The single buds are characteristically narrow at the base. It does not produce Pseudomycelium. 5…Source of infection :- dust particles of soil & wild Birds which are reservoirs ( faeces of pigeon). 6…Mode of infection :- usually by Inhalation of infected dust particles from environment. 7…Classification:- On the basis of Antigenicity C. neoformans are four type : A , B , C , D . Infection due to serotype A & D is more common. 8…Virulence factors:- Antiphagocytic polysaccharide capsule is major virulence factor.
  34. 34. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 34 GEHLOT’S REVIEW OF MYCOLOGY  MELANIN pigment: It produce melanin which deposit on inner surface of cell wall which protect itself from oxidant agents which release by phagocytic cells. 9…Pathogenecity( clinical disease ):- Disease = Cryptococcosis . It is primary & symptomless granuloma of the Lungs . C. neoformans is pathogenic for Human & animals. (a) Cryptococcal meningitis:- Haematogenous spread , resulting in sub-acute / chronic meningitis. (b) Skin & other infection:- (b) Lung infection:-  Pulmonary disease is mostly found in Immuno - compromised host.  Reactivation of old healed lesion may be occurs. 10…Lab. Diagnosis:- (a)Specimen: CSF ,Biopsy material , Urine & Blood. (b)Method:- (A) Examination of CSF :- Biochemical examination of CSF show : ^es Proteins level ^es Glucose level ^es Leucocyte ( especially LYMPHOCYTE ) (B) Microscopy:- INDIAN Ink preparation show Capsulated yeast cells in CSF , Urine & Exudates.
  35. 35. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 35 GEHLOT’S REVIEW OF MYCOLOGY (C) Culture:- specimen incubated in Sabouraud’s Dextrose agar for 24-48 hrs , creamy white & mucoid colony appear. C. neoformans is identified by :- 1...Urease production. 2… Carbohydrate assimilation test & confirm by . 3… Direct immuno-fluorescence test. (D) Detection of Ag :- by LATEX Agglutination Test . Ag = cryptococcal polysaccharide capsule. (E)Serological Test ( detection of Ab ):- By --> Agglutination Test --> Immunofluorescence Test 11…Treatment:-  therapy of Amphotericin-B combined with 5-Fluorocytocine 12…Diag…
  36. 36. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 36 GEHLOT’S REVIEW OF MYCOLOGY “HISTOPLASMOSIS” 1.. Introduction:- Histoplasmosis is a primarily a disease of the Reticulo-Endothelial system . It is most frequently seen as asymptomatic or relatively mild , self limiting Pulmonary infection . 2…Causative organism :- Histoplasma capsulatum . 3..Source of infection :- soil enriched with the dropping of Birds /Bats. 4..Mycology ( morphology ):-  H. capsulatum is Dimorphic fungi. Grow well in soil & artificial culture as Septate Mycelium ( filamentous) at 22’c. in animal tissue grow as INTRACELLULAR yeast at 37’c . In culture the Mycelial phase produce two type of unicellular ASEXUAL Spore . Microconidia:- smaller elliptical . Macroconidia:- large rounded tuberculate . 6..Epidemiology :- Reservoirs/ Habitat:- is soil enriched with the dropping of Birds /Bats. 7..Virulance factor :- Ability of organism to survive & proliferate INTRACELLULARLY in Phagocytic cell & resistance to Intracellular killing . 8.. Clinical syndrome :- Lesion are produced . (a). Acute Pulmonary Histoplasmosis :- It is acute infection like self- limited – illness (fever ) & non-productive cough .
  37. 37. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 37 GEHLOT’S REVIEW OF MYCOLOGY (b). Chronic Pulmonary Disease :- Formation of cavity in Lung either due to primary lesions or reactivation of healed old lesion . Clinical features resembling close to PULMONARY TUBERCULOSIS but chest radiological graph show BILATERAL INFILTRATEs which are usually not found in T.B. . (c)..Disseminated Disease :- Fungus first estabilise the pulmonary infection then disseminated in other organ particularly in old pts , immunocompromised pts . (d).. Ocular Histoplasmosis:- It is Hypersensitivity reaction in endemic area but not a true infection . 9..Lab. Diagnosis :- (a)Specimen:- Blood , Sputum , Biopsy material from pulmonary , Exudates of LESION . (b) Method :- (A) Direct Examination :- Specimen is stain with GIEMSA Stan . It appear small oval yeast cells packed with in macrophage / monocyte . (B) Culture :- Media:- Saubouraud’s Dextrose agar  Brain Heart infusion agar . White cottony mycelium yield when incubated at 25’c for 4 weeks Whitish colony produced with small & oval yeast cells when incubated at 37’c .
  38. 38. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 38 GEHLOT’S REVIEW OF MYCOLOGY Diag….. (C)Histoplasmin Skin Test :- Histoplasmin is culture filtrate Ag of mycelial phase of H. capsulatum . A positive skin test indicate past/present infection . (D)Serological Test (detection of Ab ):- By CFT , Precipitation Test , Latex Agglutination Test . Ag used = Histoplasmin / Killed whole Yeast cells . (E)Histopathological Test :- Tissue section stained with H&E and GRAM stain then H. capsulatum (yeast form) seen with in mononuclear cell in a Back-ground of chronic granuloma. 10.. Treatment :- Ampotricin-B
  39. 39. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 39 GEHLOT’S REVIEW OF MYCOLOGY Q: Write the name of fungi which cause opportunistic infection in Human? Ans:- Fungi which normally don’t produce but under special condition such as in immune-compromised patient ; Treatment stage of chronic disease condition ; in AIDS patient & with Antibiotic / steroid / immunosuppressive drugs used patients cause Fungi called Opportunistic Fungi & infection called Opportunistic Infection . Group:- Yeast like fungi:- Candida , Torulopsis , Cryptococcus…etc.  Filamentous fungi :-Aspergillus. , Mucour. , Rhizopus ,Fusarium , Penicillium , Cephalosporium …..etc. Q:-Write the short nort on “OPPORTUNISTIC MYCOSES” ? “CANDIDIASIS” 1… Introduction:- Candidiasis are usually superficial infection of Mucous membrane , Nails & Skin but internal organs are occasionally affected. 2…Causative organism:- mainly Candida albicans .
  40. 40. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 40 GEHLOT’S REVIEW OF MYCOLOGY 3…Classification:- mainly eight types medically important species of Candida found in Human but C. albicans is most important & infectious species in Human . 4…Morphology & Reproduction :- two form of C. albicans are present in specimen & culture and both are Gram positive . (a) Spherical / oval Budding cells :- These are Yeast / Y-form cells. Diag… C. albicans. (b)Elongated filamentous cells :- Resembling Hyphae ( pseudomycelium) and produce Buds ( Blastospores ) both are seen in tissue & culture media .
  41. 41. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 41 GEHLOT’S REVIEW OF MYCOLOGY Diag….. 5…Source of infection:- Immuno-compromised patient itself because Candida is normal flora of Human intestine. 6…Mode of infection :- Opportunistic Endogenous infection.
  42. 42. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 42 GEHLOT’S REVIEW OF MYCOLOGY 7…Epidemiology:- HABITAT: -> C. albicans is present in normal flora of intestine in Healthy peoples . 8…Predisposing factor:- -> Diabetes mellitus , -> Premature baby , Immunodefficiency with AIDS & malignancy -> immunocompromised person due to wide use of antibiotic / steroid / immunosuppresant drugs . 9…Pathogenecity:- superficial Candidiasis is usually Opportunistic- Endogenous infection under certain condition but may cross infection from mother to baby & baby to baby . Candidiasis is characterized by mainly LESION . 10…Type of Candidiasis:- (A)Superficial candidiasis:- It is superficial lesion (infection ) of Mucous membranes , Skin & Nails . (oa)…. Mucous membrane :-  infection of mouth occurs most frequently in infants & old age .  characterized by descrete White patches on mucosal surface .  vaginal thrush (lesion) is characterized by typical White lesion on epithelial surface of vulva , vagina & cervix . (ob)… Skin :- Infection of Skin occurs at abnormally moist & warm site of Axillae , Groin , Perineum & Toe clefts . (oc)…. Nails :- Infection of finger webs , nails & folds are associated with frequent immersion of Hands and feet in water . (od)….Chronic mucocutaneous candidiasis is sign of deficient CMI.
  43. 43. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 43 GEHLOT’S REVIEW OF MYCOLOGY (B) Systemic Candidiasis:- It is encountered with serious abnormality of host and in Hospitalized patients . (oa)…Candidal Endocarditis :- due to surgery of Heart valve . (ob)…Internal Organs :- like Lungs , Kidney and other organs may be invaded secondarily by C. albicans when person already suffer from T.B. / cancer etc …. 11…Lab. Diagnosis:- (a)…Specimen:- scraping from skin lesions and Blood . (b)….Method:- (A)Direct microscopy:- Specimen is wet mount with KOH / GRAM staining and see under microscope . Gram positive & Budding yeast cells like appearance show and form Pseudo-mycelium . (B)Culture:- Media:- Routone media & Sabouraud’s dextrose agar . (Ba) ..Routone agar:- colony are white with foot like extensions from margins . (Bb)..Sabouraud’s dextrose agar:- colony are smooth creamy white with yeast odour .
  44. 44. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 44 GEHLOT’S REVIEW OF MYCOLOGY IDENTIFICATION of C. albicans :- (0b1)… GERM TUBE Test/ REYNOLDs BRAUDe Phenomenon:- In Human serum ; Candida form filamentous outgrowth (germ- tube) at 37’c . Diag…. (0b2)…Clamydospores develop in Nutritionally Poor medium such as CORN MEAL Agar at 28’c. Blastoconidial germination with constriction of C. tropicalis but not found with germ tube of C. albicans. Diag…
  45. 45. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 45 GEHLOT’S REVIEW OF MYCOLOGY (C)Serological Test (Detection of Ab) :- PRECIPITATION Test with carbohydrate Extract of group- A Candida show positive result in 50% normal individuals & 70% individuals with mucocutaneous candidiasis . (D).. Ag detection :- By ELISA , Radio-immuno assay . (E)..Skin Test :- Candida show universal positive SKIN Test and it is useful as an indicator of deficient CMI . 12…Treatment :-  superficial infection =>Nystatin / Miconazole. systemic infection =>Ampotericin-B along with 5-Fluorocytosine . “ASPERGILLOSIS” 1..INTRODUTION:- Aspergillosis are opportunistic infection which usually affect respiratory system , para-nasal sinus , external ear & other organ and produce spectrum of disease from Superficial to invasive lesions which affecting all tissue . 2..Causative organism:- Aspergillus fumigatus , A. niger , A. flavus….etc. 3..Source of infection:- Soil , Food , Paint , Airvents . 4..Mode of infection:- Opportunistic Exogenous infection .  Inhalation of spore of Aspergillus .
  46. 46. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 46 GEHLOT’S REVIEW OF MYCOLOGY 5..Epidemiology:- Habit : Extremely common in the environment such as Soil , food , paint , airvent . 6..Predisposing factor :- T.B. , Immunocompromised host , Bronchiectaticpts ,  Diabetes mellitus . 7..Morphology :- It is Filamentous fungi . Aspergillus show non pigmented septate Hyphae (mycelium) with characteristic DICOTOMOUS branching & produce Conidiophores and Conidiospores . 8.. Clinical syndrome :- (0A) Respiratory Disease :- (a)Aspergillus Asthma :- It is a Hypersensitivity state to Aspergilli. (b)Bronchopulmonary Aspergillosis :- Fungus grow in lumen of Bronchiole and produce plugs of mycelium & mucus that occlude the lumen . (c)Aspergilloma = Fungus Ball :- In which the fungus colony occurs in pre-existing cavity like in T.B. (0B) Disseminated (invasive) Aspergillosis :- fungus first establise the Pneumonia and then disseminates in other organs particularly in immune- compromised host .
  47. 47. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 47 GEHLOT’S REVIEW OF MYCOLOGY (0C) Superficial infection :- A. flavus & A. fumigatous colonies in Para-nasal sinus = sinusitis ; Eye = Mycotic- keratitis ; External ear = oto-mycosis . 9..Lab. Diagnosis:- (a) Specimen:- Sputum , Blood , Scraping of lesion , Broncho-alveolar lavage . (b) Method :- (0A) Direct Microscopy :- specimen mount with KOH which show non-pigmented septate mycelium of fungus with characteristic DICHOTOMOUS branching & irregular outline & also seen Conidiophore and conidiospore . (0B) Isolation:- colony in SD’s agar show a valvety to powdery surface & are coloured . (0C) Skin Test :-  Intradermal skin test to Aspergillus Ag extracts is used for pts with suspected allergic Bronchopulmonary Aspergillosis . (0D) Serological Test (detection of Ab ):- Ab to A. fumigatous can be detected by :- .Precipitation Test .Immunodiiffusion Test .ELISA Test . 10…Treatment:- surgical drainage / Excision and Ampotericin-B.
  48. 48. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 48 GEHLOT’S REVIEW OF MYCOLOGY Q:- Write the sort note on “TOXICOSIS” / “MYCOTOXICOSIS’’ ? ?? “MYCOTOXICOSIS” Ans: (A) Mycotoxicosis:- Mycotoxicosis is most often the result of the accidental consumption of feeds and food products contaminated by toxin producing fungi . The toxins are by-products of fungal metabolism on the substrate. The alkaloids cause marked peripheral vasoconstriction leading to necrosis and gangrene. 1.Ergot alkaloids :- are produced when grain is infected with Claviceps purpura Several outbreaks of mycotoxicosis occurring following consumption of bread and backery products made with contaminated rye. 2. Aflatoxins:- metabolites produced by A.flavus resulted in Turkey-X disease. Contaminated feed was the cause of outbreak. P.M examination revealed gross haemorrhage and necrosis of liver.
  49. 49. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 49 GEHLOT’S REVIEW OF MYCOLOGY (B) Mycetismus :- Caused by ingestion of fungi containing preformed toxin (mushroom) Mycotoxin producing fungi  Mycotoxin Fungus Aflatoxin A.flavus Mycotoxin Fusarium graminarium Mycotoxin Mushroom (toad stools) Fumagatin A.fumigatus Muscarine Amnitamuscaria Penicillic acid Penicillumpuberulum Ergot alkaloid Claviceps species
  50. 50. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 50 GEHLOT’S REVIEW OF MYCOLOGY VIROLOGY Ques :- Write a short note on SEVERE ACUTE RESPIRATORY SYNDROME. “SARS” (SEVERE ACUTE RESPIRATORY SYNDROME) 1. SARS is emerging viral infective disease which presents with severe atypical pneumonia. 2. Causative virus is SARS –corona virus-4 3. Portal of entry-Respiratory tract epithelium 4. Incubation period is <10 days. 5. Source of infection – respiratory secretions as droplet/aerosol 6. Mode of transmission- inhalation of virus particle present in droplets/aerosol of respiratory secretion of patient and close contact with patient. 7. Properties of SARS co-v-4  Virion: – spherical/helical neucleocaspid  Genome:- ss-RNA , Linear , nonsegmented , positive sense , infectious .  Protein: - Two glycoprotein , one Phosphoprotein , Hemagglutinin esterase  Envelope:- enveloped with petal shaped spikes.  Replication:- in cytoplasm. 8. Clinical and radiological features:-  Onset symptoms:- Fever(Temp: >38’c) , Chills , Rigor , Headache , Dizziness , Malaise , Myalgia
  51. 51. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 51 GEHLOT’S REVIEW OF MYCOLOGY  After 3-8days (moderate respiratory illness):- Dry and non productive cough , Dyspnea , Shortness of Breath , Hypoxia and Diarrhea .  Radiological:-  Pneumonia like evidence Finally death due to respiratory failure. 9. Lab diagnosis of SARS-Co-V  Non-specific investigation :- Lymphopenia Thrombocytopenia  Elevated level of LDH Normal to decrease total WBC Elevated level of CPK and Hepatic transaminase.  Specific Investigation  PCR – RT-PCR Specific for viral RNA Specimen:- >10 day after onset of illness . Specimen:- Serum , Faeces , Nasal secretion / Body tissue. Method:- Reverse transcriptase-PCR Confirmed by second PCR with new sample and primers.  SARS-Co-V isolation:- In Vero cell culture lines  Detection of ab to SARS-Co-V:- Specimen:- during acute illness: > 21 days after onset of illness. ELISA Test IFA(Indirect fluorescent Ab)
  52. 52. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 52 GEHLOT’S REVIEW OF MYCOLOGY  Histopathological finding:- Diffuse alveolar damage Denudation of bronchial epithelium Loss of cilia Squamous metaplasia Secondary bacterial infection Infiltration of giant cells 10.Management of suspected SARS:-  Isolate the patient  Perform diagnostic studies.  Provide treatment Ques:- Write the diff. b/w Herpes Simplex Virus-1 and 2 ?. HSV-1 HSV-2 BIOLOGICAL:- Neurovirulance Less More Site of latency Trigeminal ganglion Sacral CLINICAL:- Primary infection  Gingivostomatitis  Pharyngotonsilltis  Keratoconjuctivitis + + + - - - Eczema herpeticum + -
  53. 53. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 53 GEHLOT’S REVIEW OF MYCOLOGY Herpes encephalitis + - IN GENERAL:- ->Lesion above waist ->Lesion below waist ->Oral facial infection ->Genital infection + - More common Less common - + Less More Perinatal infection during delivery 30% 70% Reactivation of oral-facial site More common Less Replication in chick embryo- fibroblast Poorly Well Resistant to antiviral drug Less More Heat labile Less More Congenital infection Less More Bell’s palsy Occurs Not Sacral neuralgia No Yes Epidemiology Age of primary infection Young child Young adult Transmission Contact Sexual Effect of Temp. on infectivity Less sensitive More sensitive
  54. 54. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 54 GEHLOT’S REVIEW OF MYCOLOGY Ques :- Write Diff b/w Orthomyxovirus and Paramyxovirus ?. Orthomyxo-virus Paramyxo-virus Size of virion 80-120nm 100-300nm Shape Spherical,filamentous Pleomorphic , variable Genome Segmented- 8 piece RNA Single linear RNA Nucleocapsid Diameter 9nm 18nm Site of synthesis of Riboneucleo-protein Nucleus Cytoplasm Genetic resortment dependent RNA synthesis Common (Required for - multiplication) Absent Effect of actinomycin-B Inhibit multiplication No effect Antigenic stability Variable Stable Hemolysin Absent Present Haemagglutinin, Present (++++) Mostly present (+++-) neuraminidase, Present (++++) Mostly prsnt (++--) pathogenecity, Respiratory tract infection Measles , Mumps, Pneumonia, sudden infant death syndrome
  55. 55. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 55 GEHLOT’S REVIEW OF MYCOLOGY Lab diagnosis:- Ag detection Virus isolation Serology Test  1. Indirect - fluorescence Ab 2. Influenza A - enzyme – immunoassay 1. IF 2. ELISA Egg inoculation Animal inoculation Cell culture (Human embro- kidney n MDCK) Cell culture (Hela n Hep-2 cell) 1. CFT 2. HAEMAGLUTIN- ATION Inhibition 1.CFT 2.ELISA
  56. 56. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 56 GEHLOT’S REVIEW OF MYCOLOGY Ques : Difference between Enterovirus and Rhinovirus ? Enterovirus Rhinovirus Pathogenicity Infantile paralysis Common cold Acid labile Less More Heat stable Less More Experiment animal Monkey Chimpanzee Tissue culture cell Neural tissue Human/Simian origin Source of infection Fecal matter Nasal secretion Route of infection Faeco-oral route Droplet infection Vaccination Possible Not yet possible Incubation period Long Short Symptoms progress to paralysis. Self limiting Websites : www.slideshare.net www.authorstream.com www.facebook.com:- esar.gehlot@gmail.com
  57. 57. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 57 GEHLOT’S REVIEW OF MYCOLOGY Index :- A Actinomycotic 16 Aflatoxins 49 Antiphagocytic 33 Antrophilic 22 Anthropophilic 22 Anti Fungal Agents 12 ARTHROSPOREs 12 Ascomycetes 5 Aspergillosis 8 45 46 Aspergillus fumigates 45 B Ball 46 Basidiospore 3 Basidiomycetes 3 4 5 BLACK PIEDRA 20 Botryomycosis 28
  58. 58. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 58 GEHLOT’S REVIEW OF MYCOLOGY C Candida 3 Candida albicans 3 8 Candidiasis 8 Capsulated 3 33 34 CHLAMYDOSPOREs 3 13 Conidiophores 3 Constriction 44 CRYPTOCOCCOSIS 33 Cryptococcus 3 33 Cryptococcus neoformans 3 33 Culture media 9 CUTANEOUS MYCOSES 8 21 D Dermatophytosis 21 Dimorphic fungi 7 11 DICOTOMOUS 46 47 Duteromycetes 6 10 15 22 E Ectothrix 23
  59. 59. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 59 GEHLOT’S REVIEW OF MYCOLOGY Endothrix 15 23 Enterovirus 56 Epidermophyton 23 27 Ergot 47 Eumycotic 16 Exophiala werneckii 11 F FAVUS 23 Fungi imperfecti 3 6 10 G Geophilic 22 Germ Tube test 13 44 Gingivostomatitis 52 GRANULAR 29 H Histoplasma capsulatum 36 Histoplasmosis 36 HONEY COMB 23 Hyphomycetes 6 10
  60. 60. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 60 GEHLOT’S REVIEW OF MYCOLOGY i INTRACELLULAR 36 K Keratoconjuctivitis 52 L Lymphopenia 51 M Macroconidia 22 25 26 36 Madurella 16 Madurella mycetomatis 16 28 Malassazia furfur 16 Melanin 4 34 Microsporum 22 23 25 26 Microconidia 36 Mycetismus 48 Mycetoma 16 27 28 Mycotoxin 48 MYCOTOXICOSIS 48 N Nutritionally 44
  61. 61. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 61 GEHLOT’S REVIEW OF MYCOLOGY O Opportunistic 39 OPPORTUNISTIC MYCOSES 39 Orthomyxovirus 54 P Piedraia hortaea 20 Paramyxovirus 54 Pharyngotonsilltis 52 PITYRIASIS VERCICOLOR 16 PRECIPITATION 45 R Reynold’s Braude Phenomenon 13 44 Rhinovirus 56 RHINOSPORIDIOSIS 31 32 Rhinosporidium seeberi 31 S Seropurulent 29 SPLENDORE – HOEPPLi Reaction 30 Sporotrichosis 11 Stains 10
  62. 62. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 62 GEHLOT’S REVIEW OF MYCOLOGY Stout – hyphae 17 SUPERFICIAL MYCOSES 7 16 SUB-CUTANEOUS MYCOSES 8 27 SYSTEMIC MYCOSES 8 33 T TOXICOSIS 48 Thrombocytopenia 51 TINEA NIGRA 18 Trichosporon beigelii 19 Trichophyton 22 23 26 U Urease 18 V Vasoconstriction 48 W WHITE PIEDRA 19 Z Zoophilic 22 Zygomycetes 5.
  63. 63. SUKHARAM GEHLOT BATCH 2010 B.J.MEDICAL COLLEGE AHMEDABAD 63 GEHLOT’S REVIEW OF MYCOLOGY Short forms:- LPCB:- Lectophenol cotton blue SDA agar:- Sabouraud’s dextrose agar ELISA :- enzyme linked immunosorbent assay SARS-Co-V:- SARS –corona virus-4 SARS:- SEVERE ACUTE RESPIRATORY SYNDROME CMI:- cellular mediated immunity IFA:- Indirect fluorescent Ab HSV:- Herpes Simplex Virus References: THE TEXT BOOK OF MICROBIOLOGY, ANANTHNARAYAN AND PANIKER’s 2009; 8th edn . India: Universities Press Private Limited. THE TEXT BOOK OF MICROBIOLOGY, P.CHAKRABORTHY 2O10; 2nd edn. KOLKATA: New central Book Agency (P) Limited. TEXT BOOK OF MEDICAL MYCOLOGY, JAGDISH CHANDER 2009: 3rd edn. Mehta Publishers.