PPT prepared by : DR.PRINCE C P Associate Professor &HOD Department of Microbiology, Mother Theresa Post Graduate & Research Institute of Health Sciences (Government of Puducherry Institution) According to tissue involved, MYCOSES are classified into: Superficial (Surface ) Cutaneous Subcutaneous Deep Cutaneous Systemic (Primary ) Systemic ( Opportunistic) Mycotic Poisoning most of the fungal infections are opportunistic in nature. candida albicans is the common Fungal pathogen.

1. FUNGAL INFECTIONS
(MYCOSES)
DR.PRINCE C P
Associate Professor &HOD
Department of Microbiology,
Mother Theresa Post Graduate & Research Institute of Health
Sciences
(Government of Puducherry Institution)

2. Classification of Mycoses
According to tissue involved,
MYCOSES are classified into:
 Superficial (Surface )
 Cutaneous
 Subcutaneous
 Deep Cutaneous
 Systemic (Primary )
 Systemic ( Opportunistic)
 Mycotic Poisoning

3. Classification of Mycoses

4. Surface Mycoses
Affect Stratum corneum/hair( dead layers
of Skin)
 1. PITYRIASIS VERSICOLOR
Agent : Malassezia furfur
 2. TINEA NIGRA
 Black or brownish macular lesions
especially of palms - Agent : Exophiala
werneckii
 3. PIEDRA - Hair – irregular nodules
along the hair shaft - Black piedra :
Piedraia hortae - White piedra :

5. CUTANEOUS MYCOSES
 1. DERMATOPHYTOSES - Infection
of keratinized structures like skin, hair,
nails by keratinophilic fungi called
Dermatophytes
 2. DERMATOMYCOSIS - Skin lesions
of Candida - Cutaneous
menifestations of systemic mycoses

6. DEEP MYCOSES /
SUBCUTANEOUS MYCOSES
 1. Mycotic Mycetoma
 2.
Chromomycosis(Chromoblastomycosi
s and Pheohyphomycosis)
 3. Rhinosporidiosis
 4. Subcutaneous phycomycosis or
Entomorphthoramycosis

7. SYSTEMIC MYCOSIS
(DIMORPHIC FUNGI)
 1. Blastomycosis - lungs -
Blastomyces dermatidis
 2. Paracoccidiodomycosis - Skin,
mucosa, lymph nodes, internal organs
- P.brasiliensis
 3. Coccidiodomycosis - Primary
pulmonary - Coccidiodes immitis
 4. Histoplasmosis - Intracellular
infection of reticuloendothelial system
- H.capsulatum

8. OPPORTUNISTIC
MYCOSES
 Fungi are part of normal commensal flora of body
 Occur in immunocompromised host
 1. Aspergillosis - A.fumigatus, A.niger, A.flavus -
ABPA, Aspergilloma, Invasive aspergillosis,
Superficial infections of eye (mycotic keratitis) &
ear (Otomycosis)
 2. Penicillosis – P.marneffei (HIV)
 3. Zygomycosis – Rhino-orbito-cerebral form,
Mucormycosis, Phycomycosis ……..
 4. Candidosis - Cutaneous, mucocutaneous,
systemic
 5. Cryptococcosis - C.neoformans - Pulmonary,
visceral, cutaneous, meningeal disease

9. MYCOTIC POISONING
 Mycetism – fungus is eaten itself -
Claviceps, Coprine, Inocybe poisoning
 Mycotoxicosis – ingestion of food
contaminated with mycotoxins -
Aflatoxins – Aspergillus spp.
(groundnuts, corn, peas) - Fumonism
– Fusarium (maize) - Ochratoxin –
Aspergillus spp. (cereals) - Penicillium
spp. (bread) - Ergot alkaloids – toxic
alkaloids - Claviceps (rye) - Fusarium -

10. Common fungal pathogens in
HIV
 Candida albicans
 Cryptococcus neoformans
 Coccidiodes immitis
 Blastomyces dermatidis
 Aspergillus fumigatus

12. Pityriasis (Tinea versicolor) :
 Caused by Malassezia furfur;elicits
mild, chronic scaling, mottling of skin;
also implicated in folliculitis, psoriasis,
and seborrheic dermatitis.
 Treated with daily applications of
selenium sulfide. Topical or oral azoles
are also effective.

13. Pityriasis (Tinea versicolor)

14. Tinea nigra
(or Tinea nigra palmaris)
 Caused by the dematiaceous fungus
Hortaea (Exophiala)werneckii.
 The lesions appear as a dark (brown
to black) discoloration, often on the
palm.
 Tinea nigra will respond to treatment
with keratolytic solutions, salicylic
acid, or azole antifungal drugs

15. Tinea nigra

16. Piedra
 • White piedra – caused by
Trichosporon beigelii; whitish or
colored masses develop scalp, pubic,
or axillary hair
 Black piedra – caused by Piedraia
hortae; darkbrown to black gritty
nodules, mainly on scalp hairs

17. Piedra

18. Dermatophytosis
 Infections strictly confined to
keratinized epidermis (skin, hair, nails)
are called dermatophytosis
(ringworm and tinea)
 40 species in the genera
Trichophyton, Microsporum,
Epidermophyton
 Closely related and morphologically
similar Causative agent of ring worm
varies case to case

19. Dermatophytosis
 Natural reservoirs- humans, animals,
and soil (Anthropophilic, Zoophilic and
Geophilic) respectively.
 Infection facilitated by moisture, warmth,
specific skin chemistry, composition of
sebum and perspiration, youth, heavy
exposure, and genetic predisposition.
 Long infection period followed by
localized inflammation and allergic
reactions to fungal proteins

21. T.pedis( Athlet’s foot)

22. T.unguium

23. T.cruris

25. T.corporis

26. T.barbae

27. T.capitis

29. Treatment of dermatophytes
 Therapy consists of thorough removal
of infected and dead epithelial
structures and application of a topical
antifungal chemical or antibiotic.
 Treatment of dermatophytes includes
topical antifungal agents – tolnaftate,
miconazole applied for several weeks

30. Subcutaneous Mycoses
 Sporotrichosis
 Chromoblastomycosis
 Mycetoma

31. Sporotrichosis
(rose-gardener’s disease)
 Caused by Sporothrix schenckii
 Very common saprobe fungus that
decomposes plant matter in soil
 Infects appendages and lungs
 The initial lesion is usually located on
the extremities but can be found
anywhere.
 followed by secondary spread with
involvement of the draining lymphatics
and lymph nodes

32. Sporotrichosis
 Lymphocutaneous variety occurs
when disseminated infection spreads
to nearby lymph nodes usually in
debilitated patients.
 The treatment of choice is oral
itraconazole or another azole.
 For systemic disease, amphotericin B
is given

33. Sporotrichosis

34. Sporotrichosis

35. Chromoblastomycosis
 Caused by soil saprobes with
darkpigmented mycelia and spores
 (Fonsecaea pedrosoi, Phialophora
verrucosa, Cladosporium carrionii)
 The fungi are introduced into the skin
by trauma.
 The primary lesion becomes
verrucous and wart-like with extension
along the draining lymphatics.

36. Chromoblastomycosis

37. Chromoblastomycosis
 Surgical excision with wide margins is
the therapy of choice for small lesions.
 Chemotherapy with flucytosine or
itraconazole may be efficacious for
larger lesions.

38. Mycetoma
 Madura foot
 Eumycetoma is a mycetoma caused
by a fungus accidentally implanted
into the skin
 Caused by Pseudallescheria or
Madurella
 Particularly prevalent in India, Africa,
and Latin America
 Progressive, tumorlike disease of the
hand or foot due to chronic fungal

39. MYCOTIC MYCETOMA
 Gill (1842)-Madura foot from Madurai in
South India.
 Three types
 1.Eumycetoma =caused by fungi eg –
Scedosporidium, Madurella
mycetomatis, Acremonium, Exophiala,
Aspergillus,--- -
 2.Actinomycetoma=caused by
filamentous bacteria eg
Actinomadura,Nocardia,-- -
 3.Botryomycosis=Staphylococcus aureus
(grains of various colors-
white,yellow,red,brown,black)

40. Mycetoma
 Draining sinuses, swelling, and
granules in the lesions
 The management of eumycetoma is
difficult, involving surgical debridement
or excision and chemotherapy

41. Mycetoma

42. Mycetoma

43. Opportunistic Mycoses
Most important fungal pathogens:
 Candida
 Aspergillus
 Cryptococcus
 Pneumocystis
 Rhizopus
 Mucor
 Absidia

44. Candidiasis
 Candida albicans, C.parapsilosis,
C.glabrata, C.tropicalis,
C.guilliermondii, and C.dubliniensis.
 Widespread yeast
 They are members of the normal flora
of the skin, mucous membranes, and
gastrointestinal tract.

45. Candida
 Budding cells of varying size that may
form both elongate pseudohyphae and
true hyphae
 Forms off-white, pasty colony with a
yeasty odor
 Infections can be short-lived,
superficial skin irritations to
overwhelming, fatal systemic diseases

46. Candida albicans
 Normal flora of oral cavity, genitalia,
large intestine or skin of humans
 Account for 80% of nosocomial fungal
infections

47. Candida – Gram’s staining

48. Candida albicans

49. Candida –Morphological
forms

51. Thrush:
occurs as a thick,white, adherent growth
on the mucous membranes of mouth and
throat

52. Vulvovaginal yeast infection:
painful inflammatory condition of the
female genital region that causes
ulceration and whitish discharge

53. Cutaneous candidiasis:
occurs in chronically moist areas of skin
and in burn patients

54. Systemic Candidiasis
 Candidemia can be caused by
indwelling catheters, surgery,
intravenous drug abuse, aspiration, or
damage to the skin or gastrointestinal
tract.
 Occult lesions anywhere, especially
the kidney, skin (maculonodular
lesions), eye, heart, and meninges.

55. Diagnosis and Treatment
 Presumptive diagnosis made if budding
yeast cells and pseudohyphae are found;
germ tube
 Growth on selective, differential media
differentiates Candida species
 Topical antifungals such as Nystatin for
superficial infections, amphotericin B and
fluconazole for systemics
 The most important preventive measure
is to avoid disturbing the normal balance
of microbiota and intact host defenses

56. Cryptococcosis
 Caused by Cryptococcus neoformans
 A widespread encapsulated yeast that
inhabits soil around pigeon roosts
 Common infection of AIDS, cancer or
diabetes patients

57. Cryptococcus neoformans

58. Cryptococcosis
 Infection of lungs leads to cough,
fever, and lung nodules
 Dissemination to meninges and brain
can cause severe neurological
disturbance and death.
 They infect many other organs (eg,
skin, eyes, prostate).

59. Cryptococcosis

60. Diagnosis &Treatment
 Microscopic examination of CSF
mounted in Indian ink reveals
encapsulated yeast cells.
 Culture at 37°C produce whitish
mucoid colonies within 2–3 days.
 Detection of Ag and Ab is also
effective.
 Treatment: Systemic infection
requires amphotericin B and
fluconazole

61. Aspergillosis
 Very common airborne soil fungus
 600 species, 8 involved in human
disease; A.fumigatus most common
 Others A flavus, A niger, A terreus,
and A lentulus
 The species are identified according to
differences in the size, shape, texture,
and color of the conidia.

62. Aspergillus

63. Aspergillosis

64. Clinical Findings
 A. Allergic Forms
 Uncommon Bronchial allergic reaction
seen in atopic individuals mainly due to
IgE antibodies to the surface antigens of
Aspergillus conidia which elicits an
immediate asthmatic reaction upon
subsequent exposure.
 B.Allergic bronchopulmonary
aspergillosis
 occur when the conidia germinate and
hyphae colonize the bronchial tree
without invading the lung parenchyma

65.  Aspergilloma (fungus ball) Occurs
when inhaled conidia enter an existing
cavity. (eg, tuberculosis, sarcoidosis,
emphysema)
 Often asymptomatic but Chronic
cough, dyspnea, malaise, weight loss
and haemoptysis may occur.
 Localized, noninvasive infections may
involve the nasal sinuses, the ear
canal, the cornea, or the nails.

66. Aspergilloma (fungus ball)

67.  C. Invasive Aspergillosis
 From the lungs, the disease may spread
to the gastrointestinal tract, kidney, liver,
brain, or other organs, producing
abscesses and necrotic lesions.
 Hyphae invade the lumens and walls of
blood vessels, causing thrombosis,
infarction, and necrosis.
 Symptoms include fever, cough,
dyspnea, and hemoptysis.

68. Diagnosis:
 Sputum samples show hyaline and
septate hyphae under microscope
 The ID test for precipitins to A
fumigatus is positive in over 80% of
patients with aspergilloma or allergic
forms

70. Treatment:
 Allergic aspergillosis does not require
treatment, but when treatment is
indicated, prednisolone is drug of
choice.
 Aspergilloma is treated with
Itraconazole or Amphotericin B and
surgery.
 Invasive aspergillosis requires rapid
administration of amphotericin B or
voriconazole,

71. Zygomycosis
 Zygomycota are extremely abundant
saprophytic fungi found in soil, water,
organic debris, and food.
 Genera most often involved are
Rhizopus, Absidia, Mucor, Lichtheimia
& Cunninghamella
 Produce abundant cottony colonies
 Diagnosis based on the sporangial
structures

72. Rhizopus

73. Zygomycosis

74. Zygomycosis
 Usually harmless air contaminants
invade the membranes of the nose,
eyes, heart, and brain of people with
diabetes and malnutrition, leukemias,
lymphoma, corticosteroid treatment,
severe burns and
immunodeficiencient.
 Clinical form is rhinocerebral
mucormycosis, and Thoracic
mucormycosis
 Surgical debridement and
amphotericin B,

75. Zygomycosis

76. Zygomycosis

77. Rhinosporidiosis
 a chronic infectious disease of the
upper respiratory tract characterized
by the formation of polypoid masses
and caused by the fungus
Rhinosporidium seeberi.
 Rhinosporidiosis is endemic in India,
Sri Lanka, and Brazil

79. Lab diagnosis of Fungal
infections
 Direct microscopic examination :-Wet mounts-
KOH ,LPCB, Calcoflour white, India ink,
 Stains- Grams, PAS, Giemsa
 Fluorescent antibody stain
 Culture – Sabouraud’s dextrose agar medium
 Serology - Antibody detection , Antigen
detection
 Latest techniques -Some of the latest
techniques employed in the detection of Fungi,
including FISH-fluorescence in situ
hybridization, DNA array technology, multiplex
tandem PCR, real-time PCR, PCR-ELISA,
RAPD, and loop-mediated isothermal

80. Thank you
Pencillium