Systemic mycosis

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Systemic mycosis

  1. 1. Crisologo, Ferrer, Sorveto, Kalon, De Luzon
  2. 2. SYSTEMIC MYCOSES
  3. 3. DE LUZON, ANA ROSE D.
  4. 4. Histoplasma • H. capsulatum is a dimorphic fungi • H. capsulatum causes histoplasmosis – reticuloendothelial cytomycosis – caver’s disease – spelunker’s disease –Darling’s disease
  5. 5. Histoplasma capsulatum • Morphology Macroscopic Slow growth White to dark tan Woolly, cottony or granular Microscopic Microconidia small, one-celled, round, smooth-walled (2-5µm) Tuberculated macroconidia w/ typical thick walls , fingerlike projections (7-12µm)
  6. 6. Histoplasma capsulatum • Infects RES – bone marrow specimen of choice • Primary focus pulmonary • may be confused with Sepedonium
  7. 7. Histoplasma capsulatum • Identification Techniques 1. Wrights and Giemsa stain  yeast cells are commonly seen w/in monocyte and macrophages 2. Sabourauds dextrose Agar  shows typical structure e.g. tuberculate macroconidia
  8. 8. Histoplasma capsulatum • MOT  endemic in Ohio, Missouri and Mississippi river valleys  grows in soil, particularly if the soil is heavily contaminated w/ bird droppings  Histoplamosis is acquired by the inhalation of microconidia of H. capsulatum
  9. 9. Histoplasma capsulatum • Prevention and Control  Asymptomatic or mild primary infection – no therapy needed  With progressive lung lesion – oral ketoconazole  In disseminated diseases – amphotericin B  There are no means of prevention except avoiding exposure in endemic area
  10. 10. Histoplasma capsulatum • Pathology • Chronic pulmonary histoplasmosis in patients w/ chronic obstructive pulmonary disease may occur » Other manifestations of the disease are mediastinitis, pericarditis, and mucocutaneous lesions.
  11. 11. Sorveto Dayle Daniel G.
  12. 12. Coccidiodes imitis • • • • • • habitat-soil of many arid regions infectious form- arthroconidia MOT-inhalation virulence- extracellular proteinase Difficult to convert from mold to yeast phase Endemic in desert southwest and semi rid regions
  13. 13. C.Immitis morphology • Dimorphic fungi • Mould phase/saprophobic (soil) – Spherule (40C) • Yeast phase/parasitic phase(tissue) – Sperules containing endospores • Tissue from large, rough walled spherule containing endospores • Barrel shaped
  14. 14. Coccidiomycosis
  15. 15. pathogenesis • Primary in pulmonary disease • “Valley fever”(San Joaqin Valley California) or desert rheumatism (Arizona)
  16. 16. Specimen collection: • • • • • • • Clinical specimens include Sputum pus from skin lesions gastric washings CSF biopsy material from skin lesions. Grows on SDA 25 celsius
  17. 17. Al-hadad Kalon
  18. 18. Paracoccidioides brasiliensis • Central and South America (Brazil, Venezuela, Colombia) • High humidity and temperature MORPHOLOGY • YEAST • The yeast forms consists of Oval or globose cells 2- 30 microns, in diameter, with small buds attached by a narrow neck encircling the parent cells. • “Mariners Wheel” • MOLD • Similar to Lollipop forms
  19. 19. Pathology • P. brasiliensis is the causative agent of • – Paracoccidiomycosis (South American blastomycosis, Brazilian blastomycosis, Lutz-SplendoreAlmeids disease and paracoccidiodal granuloma) – Is pulmonary and infection is usually asymptomatic, subsequent dessimenation leads to the formation of ulcerative granulomatous lesions of the buccal, nasal and occasionally gastrointestinal mucosa. Disease presentation: – – – Pneumonia Disseminated infection Extrapulmonary lesions on the face and oral mucosa • Lymphatic system spleen, Intestines, Liver involvement
  20. 20. Mode of Transmission • Transmitted by inhalation of the spores • Restricted to South and Central America • Isolated in acidic soil and its growth requires increased humidity
  21. 21. Identification techniques • Endemic in Central and South America (Brazil, Venezuela, Colombia) – In soil (High humidity and temperature ~23°C.) • Serological findings (detection of specific antibodies) • Microscopy – Sputum , Pus, • Biopsy of glaucomatous lesions • Direct histopathologic examination of infected tissue • Yeast Multiple buds resembling “mariners wheel” These daughter cells are connected by a narrow base, giving the appearance of a “Mickey Mouse Cap”
  22. 22. Identification techniques • Culture – kept for 6 weeks – 25 c moulds – 37 c yeasts – Saboraud’s agar – At room temperature it grows a non spore forming septate fungus – Brain Heart Infusion at 35° C – It produces yeast that is seen in tissue • Direct Microscopy – 10-20% KOH – 1-2 drops are used – demonstration of multiple budding yeast • Others – Paracoccidioidin skin test – Complement fixation test – Immunodiffusion test
  23. 23. Treatment and Prevention • Amphotericin B • Itraconazole • Long term therapy is required • Prevent inhalation of dust in endemic area
  24. 24. Mollie Carl Ferrer/Zenaida Crisologo
  25. 25. Morphology • Yeast form: – Large yeast cells (8-12 µm) – Blastoconidia attached by broad base – Double contoured wall • Mold phase: – Lollipop forms
  26. 26. Macroscopic Morphology • Slow to moderate growth – White to dark tan • Young colonies – Tenacious • Older colonies – Glabrous to wooly • Oval ,pyriform, to globuse smooth conidia borne on short, lateral hyphalike conidiophores
  27. 27. Mode of Transmission & Epidemiology • Presumably owing to men’s greater occupational and recreational exposure to the soil • It grows in moist soil rich in organic material, forming hyphae with small pear-shaped conidia • Inhalation of the conidia *
  28. 28. Epidemiology • North America and parts of Africa* • Mississippi and Ohio River basins – St. Lawrence River basin*
  29. 29. Identification Technique • KOH (10%) or Calcofluor white –use to aid for examination of yeast cell • 22 C – colonies may be white tan or brown and may be fluffy or glabrous • Spicules- seen in the center of colonies • 37 C (blood Agar) – broad base budding yeast cell
  30. 30. Prevention & Control • Ketoconazole • Surgical excision • There are no means of prevention
  31. 31. Pathology • Primary infection: Flulike symptoms • Asymptomatic and cannot accuratety define the time of onset • Pulmonary disease (cough,weightloss, chest pain and fever) • Progressive pulmonary or invasive disease may follow.(ulcerative lesions of bone and skin)
  32. 32. • ** immunodeficient patient : multiple organ system • Blastomycosis - Gilchrist disease, North American Blastomycosis and chicago disease - Occurs primarily: North America and Parts of Africa
  33. 33. • United States(endemic)- Mississipi , Ohio river basins and St. Lawrence River basin ** Dogs and Horses
  34. 34. Sporotrichosis • Sporothrix schenckii – Cutaneous inoculation of fungus from penetrating injury with a spore or thorn (rose bush) – Initial skin lesion w/wo ulceration – Lymph-cutaneous spread – bone – systemic – Pulmonary and CNS infections are rare but reported
  35. 35. Starts as one ulcerative lesion and then chains Up the lymphatics – can involve lymph nodes and bone
  36. 36. Sporothrix schenckii • Dimorphic fungus • MOLD PHASE – 30*˚C growth in 3 -5 days – Turns brown to black over time – Septate hyphae with conidia in daisy wheel pattern • YEAST PHASE – At 37˚C small oval yeast cells, elongated 2 – 5 µM, described as cigar bodies
  37. 37. Sporothrix schenckii • Histology – – Pyogenic – to – granulomatous inflammation – Hard to find yeast in human tissue – Asteroid body known as Splendore-Hoeppli phenomenon can be seen – also seen in: • • • • Zygomycetes (mucorales) Aspergillus Blastomycosis Candida
  38. 38. Sporothrix schenckii Daisy like spore arrangement
  39. 39. THANKS FOR LISTENING AND GODBLESS!

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