Systemic mycosis, Dimorphic fungus

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Systemic mycosis, Dimorphic fungus

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Systemic mycosis, Dimorphic fungus

  1. 1. SYSTEMIC MYCOSIS DIMORPHIC FUNGI BASICS DR.T.V.RAO MD2/10/2011 1Dr.T.V.Rao MD
  2. 2. SYSTEMIC MYCOSISDeep seated fungalinfectionsInhalation of air bornespores produced by casualmouldsPresent as saprophytes insoil and on plant materialThey are caused byDimorphic fungiOccurs mainly Americancontinent.2/10/2011 2Dr.T.V.Rao MD
  3. 3. IMPORTANT FUNGI IN SYSTEMIC MYCOSISCoccidioidomycosis.HistoplasmosisBlastomycosisParacoccidioidomycosis.Others can also manifest with systemicinfection ( Not Dimorphic ) Aspergillus,Candida,Cryptococcus spp2/10/2011 3Dr.T.V.Rao MD
  4. 4. HISTOPLASMOSIS AND COCCIDIOIDOMYCOSISHistoplasmosis and Coccidioidomycosisare similar fungal organisms that bothproduce a disease that resemblestuberculosis . Both are caused by fungithat grow as spore producing hyphae atenvironmental temperatures, but asyeasts (spherules or ellipses) at bodytemperature within the lungs.2/10/2011 4Dr.T.V.Rao MD
  5. 5. COCCIDIOIDOMYCOSISCoccidioidomycosis is initially, a respiratoryinfection, resulting from the inhalation ofconidia, that typically resolves rapidly leavingthe patient with a strong specific immunity tore-infection. However, in some individuals thedisease may progress to a chronic pulmonarycondition or to a systemic disease involvingthe meninges, bones, joints and subcutaneousand cutaneous tissues.2/10/2011 5Dr.T.V.Rao MD
  6. 6. COCCIDIOIDOMYCOSISDimorphic fungipresent in soilCoccidioides imitis,Prevalent in USA andMexicoDark skinned andAgricultural workers,2/10/2011 6Dr.T.V.Rao MD
  7. 7. COCCIDIOIDOMYCOSIS2/10/2011 7Dr.T.V.Rao MD
  8. 8. 2/10/2011 8Dr.T.V.Rao MD
  9. 9. CULTURINGIn culture / Soil as moldsBarrel shaped ArthoconidaDisperses through wind.In the lungs arthoconidabecomes spherules 30-60micronsContains end spores. 2/10/2011 9 Dr.T.V.Rao MD
  10. 10. PATHOGENESISC.imitis can be asymptomaticor self limited.Pulmonary involvement.Fatal illnessPulmonary 7-28 daysSkin rashesChronic cavitations,Pulmonary infectionLocal infection 102/10/2011Dr.T.V.Rao MD
  11. 11. 112/10/2011Dr.T.V.Rao MD
  12. 12. DEVASTATING LESIONS ARE PRODUCED 122/10/2011Dr.T.V.Rao MD
  13. 13. PATHOGENESIS ( CONT )Generalized infection inimmune suppressed.Organ transplant recipientsLymphoma patientsAIDSCNS Skin, Joints,Poor prognosis in immunesuppressed and Meningitispatients. 13 2/10/2011 Dr.T.V.Rao MD
  14. 14. LABORATORY DIAGNOSISMicroscopy Sputum Pus, Biopsy, Mature spherules,Grown in test tube slopes at 25 -30 c 3 weeksMorphology thick walled ArthoconidaFine Septate hyphae.Arthoconida are highly infectious.Skin test with Coccid odes 142/10/2011Dr.T.V.Rao MD
  15. 15. SEROLOGYPrecipitation test.Latexagglutination test.Complementfixation test. 152/10/2011Dr.T.V.Rao MD
  16. 16. TREATMENTI V AmphotericinBFluconazole,Itraconazole 162/10/2011Dr.T.V.Rao MD
  17. 17. HISTOPLASMOSISHistoplasmosis is an intracellular mycoticinfection of the reticuloendothelial systemcaused by the inhalation of conidia from thefungus Histoplasma capsulatum.Histoplasmosis has a world wide distribution,however, the Mississippi-Ohio River Valley inthe U.S.A. is recognized as a major endemicregion. Africa, Australia and parts of East Asia,in particular India and Malaysia are alsoendemic regions 172/10/2011Dr.T.V.Rao MD
  18. 18. HISTOPLASMOSISSoil – Enriched with Birddroppings and Batdroppings,Spread through inhalation ofsporesPrevalent in Eastern USA –95%Causative agentHistoplasma duboisii, 18 2/10/2011 Dr.T.V.Rao MD
  19. 19. 192/10/2011Dr.T.V.Rao MD
  20. 20. CLINICAL MANIFESTATIONS:Approximately 95% of cases ofHistoplasmosis are in apparent,subclinical or benign. Five percent ofthe cases have chronic progressivelung disease, chronic cutaneous orsystemic disease or an acutefulminating fatal systemic disease. Allstages of this disease may mimictuberculosis. 202/10/2011Dr.T.V.Rao MD
  21. 21. LUNG INVOLVEMENT A MAJOR MANIFESTATION IN HISTOPLASMOSIS 212/10/2011Dr.T.V.Rao MD
  22. 22. 222/10/2011Dr.T.V.Rao MD
  23. 23. 232/10/2011Dr.T.V.Rao MD
  24. 24. CULTURINGGrows as mould at 25 – 30 cAnimal tissues as Yeast and 37cGrows in Blood agar, Enrichedmedium Sabouraud dextrose agarMould looks fluffy, wheat browncolored.Produce Unicellular, asexualsporesTuberculate Microcondia 8-14microns 242/10/2011Dr.T.V.Rao MD
  25. 25. PATHOLOGYActive influenza like illnessCalcified lesions in lungs,Lung cavities develop.Looks like TuberculosisWide spread infection in RESDisseminated infection in infants and old age.Aggregation in Neutropenia and Hematologicalmalignancies, 252/10/2011Dr.T.V.Rao MD
  26. 26. LABORATORY DIAGNOSISMicroscopic appreance insputum,pus,Giemsas stainingBlood cultures,Liver and lung biopsy,Culturing on Sabouraud agarat 37 and 25-30 c 1-2 weeksRecognize Macrocondia andMicro conidia 26 2/10/2011 Dr.T.V.Rao MD
  27. 27. LABORATORY DIAGNOSISCulture at 37 c showsyeast phaseMold form at 25-30 cSkin test HistoplasminSerology titers above 1in8 > 32CF test. RadioimmunoassayELISA 272/10/2011Dr.T.V.Rao MD
  28. 28. BLASTOMYCOSISBlastomycosis is a chronic granulomatous andsuppurative disease having a primarypulmonary stage that is frequently followed bydissemination to other body sites, chiefly theskin and bone. Although the disease was longthought to be restricted to the North Americancontinent, in recent years autochthonouscases have been diagnosed in Africa, Asia andEurope. 282/10/2011Dr.T.V.Rao MD
  29. 29. BLASTOMYCOSISPrevalent in USA andCanadaCaused by Blastomycosisdermatitidis,Inhalation of spores,Men between 30 to 50years are affected,Cool wet climatecondition 292/10/2011Dr.T.V.Rao MD
  30. 30. MORPHOLOGYBlastomycosis dermatitidis-Dimorphic fungusMould Septate mycelium 25 –30 cAsexual conidiaConidia are 2-10 microns /Dumbbell shapedYeast at 37 c with broad basedbuds 30 2/10/2011 Dr.T.V.Rao MD
  31. 31. 312/10/2011Dr.T.V.Rao MD
  32. 32. PATHOLOGYPulmonary formsDisseminated to otherorgans,X rays looks likeTuberculosis / CarcinomaCutaneous lesions occur80% patients withpulmonary infection 322/10/2011Dr.T.V.Rao MD
  33. 33. LABORATORY DIAGNOSISMicroscopy – pusScrapping from the lesions sputumThick walled yeast cells 8- 15 micronsBuds on broad base.PAS / Methenamine silver stain,Sabouraud dextrose agar – Blood agar,Retained for 6 weeksGrow in test tubes,ELISA test 332/10/2011Dr.T.V.Rao MD
  34. 34. TREATMENTI V AmphotericinBItraconazoleKetaconazole 342/10/2011Dr.T.V.Rao MD
  35. 35. PARACOCCIDIOIDOMYCOSISParacoccidioidomycosis is a chronicgranulomatous disease that characteristicallyproduces a primary pulmonary infection, oftenin apparent, and then disseminates to formulcerative granulomata of the buccal, nasal andoccasionally the gastrointestinal mucosa.. Theonly etiological agent, Paracoccidioidesbrasiliensis is geographically restricted toareas of South and Central America 352/10/2011Dr.T.V.Rao MD
  36. 36. PARCOCCODIOMYCOSISChronic granulomatus infectionParacoccodioides brasilensis,Lungs- Mucosa – Skin –Lymphatic vesselsEnter through the lungsSaprophytic in nature,Humid forests of South andCentralCommon in 20 – 40 years, 36 2/10/2011 Dr.T.V.Rao MD
  37. 37. MORPHOLOGYMycelium at 25 – 30 cYeast forms at 37 cConversion from mycelialforms to yeast.The yeast forms consists ofOval or globose cells 2- 30microns, in diameter, withsmall buds attached by anarrow neck encircling theparent cells. 37 2/10/2011 Dr.T.V.Rao MD
  38. 38. PATHOGENESISUlceration ,Granulomatousinfection of oral NasalMucosaLymphatic systemspleen, IntestinesLiver involvement 38 2/10/2011 Dr.T.V.Rao MD
  39. 39. 392/10/2011Dr.T.V.Rao MD
  40. 40. LABORATORY DIAGNOSISMicroscopy – Sputum , Pus,Biopsy of glaucomatous lesionsPresence of Numerous multipolar buddingcells is diagnosticStaining with PAS / Silver methenamineCultures kept for 6 weeks25 c moulds37 c yeastsSerology Precipitation tests, Complementfixation 402/10/2011Dr.T.V.Rao MD
  41. 41. TREATMENTAmphotericin BOral Ketaconazole,Itraconazole. 412/10/2011Dr.T.V.Rao MD
  42. 42. Created by Dr.T.V.Rao MD for “ e” learning resources for the Medical and Paramedical students in Developing world Email doctortvrao@gmail.com 422/10/2011Dr.T.V.Rao MD

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