3. • Fungi are eukaryotic organisms, do not
contain chlorophyll, have cell walls,
filamentous structures, and produce
spores.
• Grow as saprophytes and decompose
dead organic matter. Between 100,000 to
200,000 species depending on how they
are classified.
• About 300 species are presently known to
be pathogenic for man.
4. Features Fungi Bacteria
Nucleus eukaryotic prokaryotic
Cell membrane Sterols present absent
Cytoplasm Mitochondria
and ER present
Absent
Cell wall
content
Chitin Peptidoglycan
Spores Sexual asexual Endospores
5. 2 types
1. Yeasts 2.
Molds.
1. Yeasts grow as single cells , reproduce by
budding.
2. Molds grow by filamentous hyphae, and form a
mat ( mycelium). Form septate and aseptate
hyphae.
6.
7.
8.
9.
10. Several medically imp. Fungi are thermally
Diamorphic.
i.e, different structures at different temperatures.
Molds in environment at ambient temperatures and
as yeasts at body temperature.
11.
12.
13.
14.
15.
16.
17.
18.
19. There are four types of Mycotic
diseases:
1. Hypersensitivity - allergic reaction to molds
and spores.
2. Mycotoxicoses - poisoning of man and animals
by feeds and food products contaminated by
fungi producing toxins from the grain substrate.
3. Mycetismus- ingestion of preformed toxin
(mushroom poisoning).
4. Infections.
In this lecture , we shall be concerned only with
the last type.
20. • The establishment of a mycotic infection
depends on size of inoculum on the resistance
of the host.
• Severity of infection depend mostly on
immunologic status of host.
• Thus, the demonstration of fungi, for example, in
blood drawn from an intravenous catheter can
correspond to colonization of the catheter, to
transient fungemia (i.e., dissemination of fungi
through the blood stream), or to a true infection.
21. • Most mycotic agents are soil
saprophytes and are generally not
communicable from person-to-person
(occasional exceptions: Candida and
some dermatophytes).
• Outbreaks of disease may occur, but
these are due to a common
environmental exposure, not
communicability.
22. . CLINICAL CLASSIFICATION OF
THE MYCOSES
a.Superficial mycoses
b. Subcutaneous mycoses
c. Systemic mycoses
d. Opportunistic mycoses
23. a. Superficial mycoses
(or cutaneous mycoses) are
fungal diseases that are
confined to the outer layers of
the skin, nail, or hair,
(keratinized layers) rarely
invading the deeper tissue or
viscera. The fungi involved are
called dermatophytes
24. b. Subcutaneous mycoses are
confined to the subcutaneous tissue
rarely spread systemically.
Form deep, ulcerated skin lesions or
fungating masses, most commonly
involving the lower extremities.
Causative organisms are soil
saprophytes which are introduced
through trauma to the feet or legs.
25. c. Systemic mycoses may
involve deep viscera and
become widely disseminated.
Each fungus type has its own
predilection for various organs.
26. d. Opportunistic mycoses
are infections due to fungi
with low inherent virulence.
The etiologic agents are
organisms which are
common in all
environments.
27. YEASTS
• Yeasts are single-celled budding
organisms.
• They do not produce mycelia.
• Colonies visible on the plates in 24-48
hours. Their soft, moist colonies resemble
bacterial cultures rather than molds.
• Many species of yeasts which can be
pathogenic for humans.
• Two most significant species: Candida
albicans and Cryptococcus neoformans
28. SUPERFICIAL MYCOSES
• The superficial (cutaneous) mycoses
are usually confined to the outer layers
of skin, hair, and nails, and do not
invade living tissues.
• The fungi are called dermatophytes.
• Tinea means "ringworm" or "moth-like".
Dermatologists use the term to refer to a
variety of lesions of the skin or scalp.
29. CLINICAL MANIFESTATIONS
ETIOLOGIC AGENTS
• 1. Trichophyton These infect skin, hair and
nails.
• 2. Microsporum may infect skin and hair,
rarely nails. easily identified on the scalp
because infected hairs fluoresce a bright
green color when illuminated with a UV-
emitting Wood's light.
• 3. Epidermophyton floccosum. These
infect skin and nails and rarely hair
30. Trychophyton rubrum, right and left great toe.
Tinea unguium.
Tinea unguium (onychomycosis) - nails. Clipped
and used for culture
31. Tinea versicolor on chest.
Characterized by a blotchy discoloration of
skin which may itch. Caused by
Malassezia furfur
32. • Tinea capitis - head. Frequently found in
children.
• Tinea cruris - "jock itch". Infection of the
groin, perineum or perianal area.
• Tinea barbae - ringworm of the bearded
areas of the face and neck.
• Tinea pedis - "athlete's foot". Infection of
toe webs and soles of feet.
33. THE ID REACTION
•Patients infected with a dermatophyte
may show a lesion, on the hands, from
which no fungi can be recovered .
• These lesions, which often occur on
the dominant hand (i.e. right-handed or
left-handed), are secondary to
immunological sensitization to a primary
lesion.
•Secondary lesions will not respond to
topical treatment but will resolve if the
primary infection is successfully
treated.
34. Subcutaneous Mycosis
1. Sporothrix schenckii:
Diamorphic , occupational disease typically
itroduced in gardners by a thorn, , causes
pustule and spread by lymphatics.
2. Chromomycosis: soil fungi , introduced by
trauma , typically in legs or during war injuries.
3. Mycetoma: enters through wounds on hand
and feet and produce abscesses with draining
sinuses.
46. CRYPTOCOCCOSIS
(Cryptococcus neoformans)
• Meningitis or pulmonary disease.
• Portal of entry is the respiratory system.
• Infection subacute or chronic.. symptoms begin with
vision problems and headache, then progress to
delirium, nuchal rigidity leading to coma and death .
• CSF is examined for chemistry (elevated protein and
decreased glucose), cells (usually monocytes), and
evidence of the organism.
• Visual demonstration of the organism (India Ink
preparation) The India Ink test, which demonstrates
the capsule of this yeast
48. Black grain mycetoma: subcutaneous
nodule due to Madurella Mycetomatis,
magnified x 100
49. A. CANDIDIASIS (Candida albicans)
• Candidiasis. Candida albicans ,
endogenous organism. found in 40-80%
of normal human beings.
• Present in the mouth, gut, and vagina,
• Commensal or a pathogenic organism.
• Usually alteration in cellular immunity,
normal flora or normal physiology.
Although most frequently infects the skin
and mucosae, Candida can cause
pneumonia, septicemia or endocarditis in
the immuno-compromised patient
50. Gram-stain of vaginal smear showing
Candida albicans epithelial cells and many
gram-negative rods. (1,000X oil)
55. • Aspergillus species are highly
aerobic and are found in almost
all oxygen-rich environments,
where they commonly grow as
molds on the surface of a
substrate, as a result of the high
oxygen tension.
56. The most common causing
pathogenic species
• The most common pathogenic species are
• Aspergillus fumigatus : causing allergic
disease
• Aspergillus flavus.,produces aflatoxin which
is both a toxin and a carcinogen, and which can
potentially contaminate foods such as nuts.
• Other species are important as agricultural
pathogens.
Aspergillus spp. cause disease on many grain
crops, especially maize, and synthesize
mycotoxins including aflatoxin.
57. • Aspergillosis
• Pulmonary aspergillosis.
• Aspergillosis is the group of diseases caused
by Aspergillus. The most common subtype
among paranasal sinus infections associated
with aspergillosis is Aspergillus fumigatus.
• symptoms: include fever, cough, chest pain
or breathlessness, Usually, only patients with
already weakened immune systems or who
suffer other lung conditions are susceptible.
58. Major forms of disease
• Allergic bronchopulmonary aspergillosis or
ABPA, which affects patients with respiratory
diseases like asthma, cystic fibrosis, and
sinusitis).
• Acute invasive aspergillosis, a form that grows
into surrounding tissue, more common in those
with weakened immune systems such as AIDS or
chemotherapy patients.
• Disseminated invasive aspergillosis, an
infection spread widely through the body.
• Aspergilloma, a "fungus ball" that can form
within cavities such as the lung
61. DIAGNOSIS
1. Skin scrapings suspected to contain
dermatophytes or pus from a lesion can be
mounted in KOH on a slide and examined
directly under the microscope.
2. Skin testing (dermal hypersensitivity).
3. Serology may be helpful when it is applied
to a specific fungal disease.
4. Direct fluorescent microscopy may be used
for identification.
5. Biopsy and histopathology.
6. Culture: Sabouraud dextrose agar.
62.
63.
64.
65. TREATMENT
The primary antifungal agents are:
1. Amphotericin B. drug of choice for most
systemic fungal infection, administered I.V.
(patient usually needs to be hospitalized), often for
2-3 months. The drug is rather toxic; thrombo-
phlebitis, nephrotoxicity, fever, chills and anemia
frequently occur during administration
2. Azoles: ketoconazole, fluconazole, oral.
3. Griseofulvin: slow-acting drug which is
used for severe skin and nail infections,
oral.
4. 5-fluorocytosine:inhibits RNA synthesis,
oral.
