This document discusses various opportunistic mycoses including Candida species, Cryptococcus neoformans, and Aspergillus. It provides details on the morphology, pathogenicity, clinical presentation, diagnosis, and treatment of candidiasis and cryptococcosis. Key points include that Candida is a dimorphic yeast that can cause superficial or systemic infections depending on host immunity. Common species include C. albicans. Cryptococcus neoformans is an encapsulated yeast that can cause pulmonary or disseminated disease, especially in immunocompromised hosts such as those with HIV/AIDS. Diagnosis involves microscopy, culture, and antigen detection of Candida and Cryptococcus from clinical samples. Treatment involves antifungal

1. MYCOSIS
OPPORTUNISTIC

2. MYCOSIS
• Superficial
• Cutaneous
• Sub-cutaneous
• Systemic
• Opportunistic:

3. COMMON OPPORTUNISTIC MYCOSIS
ENDOGENOUS
• CANDIDA
• PNEUMOCYSTITIS CARRINI
EXOGENOUS
• ASPERGILLUS
• CRYPTOCOCCUS
• Zygomycetes MUCOR

4. CANDIDIASIS
Also, Monoliasis
• Skin
• Mucosa
• Internal organs
• IMMUNITY: integrity of skin, mm
normal bacterial flora
• DEFENSE: Phagocytosis mainly polymorphs
less in macrophages
T cells: CD4

5. NORMAL FLORA
• Mouth
• GIT
• Vagina
• Skin: 20% individuals carry as flora
• Colonization: increases with age, hospitalization, drugs AB
& birth control pills, pregnancy
• Immunity: T lymphocytes
• Disease: Neutropenia, Myeloper-oxidase deficien
• DM, HIV/AIDS. SCID

6. Candida types
• C albicans
• C tropicalis
• C parapsilosis
• C glabrata
• C gullermondii
• C dubliniensis
• Azole-resistant species: C krusei, C lusitaniae

7. MORPHOLOGY
DIMORPHIC
1.Oval, spherical budding yeast; 3-6um
2.Pseudo-hyphae; buds grow; fail to detach
Chains of elongated cells; pinched at septations
between cells
3.Occasional true, septate hyphae
• MEDIA: Sabouraud’s Glucose Agar
• Nutritionally deficient media
• In vivo: all 3 forms seen as mixture

8. SUPERFICIAL CANDIDIASIS
• CUTANEOUS
• MUCOSAL
• Increase number
• Damage to skin, mucosa
• Local invasion; by yeast, pseudo-hyphae
• Inflammatory reaction
• Pyogenic abscess to chronic granulomas
• Abundant yeasts & pseudo-hyphae

9. ORAL THRUSH

10. PATHOGENESIS
• Mucosal infection: Thrush
• discrete superficial pseudomembranous white patches of yeast, epithelial
cells, pseudo-hyphae patchy to confluent
• ORAL: Tongue, lips, gums, palate: infants, old, AIDS, steroids,AB, immune
deficency
• VAGINAL:
• common
• Vulvo-vaginitis; irritation, pruritis, white discharge, white lesions & soreness
• Pregnancy, AB alter flora, acidity, secretions

11. Cutaneouscandidiasis

12. INTER-DIGITAL CANDIDIASIS

13. AXILLARY CANDIDIASIS

14. Cutaneous: red, moist, vesicles
• Weakened skin:
• Trauma, burns, maceration
• Moist, warm skin: axillae, groin, inter-gluteal, infra
mammary folds
• Common in obese, diabetics
• Inter-digital of fingers/toes; water immersion washer-
men, veges/fish handlers, masons
Nails: Onychomycosis; painful, erythematous swelling of
nail-fold

15. ORAL THRUSH: ONYCHOMYCOSIS

16. CHRONIC MUCO-CUTANEOUS
• Early childhood
• Cellular immuno-deficiency
• Endocrinopathies
• Superficial disfiguring infections of all areas of
skin/ mucosa

17. Post therapy
• Post operative immuno-suppression
• Instrumentation: I/V catheters
• urinary catheters
• Drugs: anti- biotics{ broad-spectrum}
• cytotoxic
• cortico-steroids
• Cross-infections in ICUs

18. SYSTEMIC CANDIDOSIS
• More yeast in Mouth &GIT
• Predisposed individuals
1. anti-biotic, steroid therapy
2. immuno-suppressed
3. organ transplant recipients
4.age: infancy, old, pregnancy, AB therapy
5. bed-ridden with trauma occluding lesions
• Immuno-suppression
• DM, DEFICIENCY; IRON, ZINC

19. CLINICAL FORMS
INVASIVE:
• Candidemia: initial stage. Transient if phagocytic
system intact
• Disseminated, hematogenous candidiasis
If phagocytic system compromised
• Multi organs involved with infection: kidney,
prosthetic heart valves, brain, eye, meninges
• Mortality: 30-40%

22. DIAGNOSIS
SAMPLES:
1. Swabs & scrapings from superficial
Skin/ mucosa lesions
2. blood,
3. CSF or peritoneal fluid
4. Tissue biopsies of organs
5. Urine
6. Exudate/materials from catheters

23. MICROSCOPY
1. Gram Stain:
Centrifuged deposit, tissue biopsies
2.KOH Mount: skin & nail
3. Calcofluor stain

24. CULTURE & ID of C albicans
• Grow at 370 C or room temperature
• Colonies: soft, cream-colour & yeasty odor
• Sub-merged growth: pseudo-hyphae
Germ-tube test:
• incubate in serum for 90 minute at 370 C
• True hyphae; germ tube formed
Nutritionally deficient media: large,spherical
chlamydiospores

25. Yeast/pseudohyphae/hyphae

26. C albicans: Yeast; germ tube

27. Candida; yeast;psedohyphae

28. CHLAMYDIOSPORES C albicans corn-meal
agar

29. GRAM STAIN; CANDIDA YEAST

31. interpretation
• Sterile sites:
Positive cultures significant
• Urine: quantitative weigh out sample integrity
Foleys catheter: false positive
• Blood: transient candidaemia
systemic candidiasis
contaminated i/v catheters
• Sputum? No value ; oral flora
• Skin: culture confirmatory

32. C albicans
• 2 sero-types by use of anti-sera
• A & B
• Anti bodies: life long exposure; so +
• Ag detection: cell wall mannan by latex, EIA
• Beta glucan in cell wall is promising
• Immunity:
Muco-cutaneous: CD4 cells
Systemic: Neutrophils

33. TREATMENT
Thrush & muco-cutaneous:
• Topical nystatin
• Oral ketoconazole
• Fluconazole
SYSTEMIC:
Amphotericin B
Oral fluconazole
Prevention: remove moisture, drugs,
Chronic muco-cutaneous: oral ketoconazole; lifelong

34. CRYPTOCOCCUS NEOFORMANS
• C neoformans: pigeon droppings; enrich & resevoir;
birds not effected
• C gatti: tropical trees
• Basidiomycetous yeasts with Large capsules
• Cryptococcosis
• Inhalation of spores, yeast
• Lungs---CNS cause meningo-encephlitis
• Skin, eyes, prostate

35. Susceptibility to C neoformans
• HIV/AIDS
• Hematogeous malignancies
• Immunosuppressive conditions
C gattii: affects normal host

36. MORPHOLOGY
• Microscopy: sperical budding yeast; 5-10um
diameter
• Surrounded by thick non staining capsule
• CULTURE:
• White mucoid colonies in 2-3 days
• UREASE: in all species
• Pathogenic: grow at 370C
• produce laccase; a phenol oxidase

37. VIRULENCE
• CAPSULE
• LACCASE: ake melanin from phenols substrate
Capsular Serotypes: 5
• C neoformans: A-D & AD
• C gattii: B &C
• Capsule: soluble in body fluids
• Detect: latex agglutination with coated AB
• EIA

38. PATHOGENESIS
• Inhalation of yeast cells:
dry, minimum capsule, aerosolized
Primary pulmonary infection:
Asymptomatic
Influenza-like
Resolve spontaneously
Immuno-compromized: multiply, disseminate to
CNS…..meningo-encephlitis, skin, adrenals, Bone,prostate

40. CLINICAL FINDINGS
• Chronic meningitis
• D/D : Brain tumor,
• brain abscess,
• degenerative CNS disease
• mycobacterial meningitis
• fungal meningitis
CSF: Increased pressure, proteins cells
Glucose; normal or low

41. COURSE
• Fluctuant
• Fatal: untreated
• AIDS: 5-8% cases have cryptococcal infection
• NO transmission to contacts
• Inflammatory response: minimal…
granulomatous

42. DIAGNOSIS
• SPECIMEN:
• Csf: centrifuge
• Tissue
• Exudate
• Sputum
• Blood
• Urine
• Cutaneous scrapings

43. MICROSCOPY
• WET MOUNT:
• Direct
• India ink: to delineate capsule
• CULTURE:
• Grow in most media at 37 0 C
• Do not use cyclohexamide
• Urease positive
• Diphenolic substrate: melanin in cell wall ; brown

44. CULTURE C neoformans

49. • capsular Ag detected: CSF & serum
• Latex agglutination:
• 90% positive in meningitis
• Especially high titres in AIDS.
• Other conditions titres drop with T/M

50. TREATMENT
Combination therapy: curative
• Amphotericin B
• Flucytosine
• AIDS:
Relapse on withdrawl of Amphotericin
Flucanazole: suppresses: excellent penetration of CNS
HAART: better prognosis; less cryptococcosis incident