The document discusses opportunistic fungal infections, focusing on Aspergillosis, Candidiasis, Cryptococcosis, and other mycoses. It provides details on:
- The causative fungi and their incidence in opportunistic infections
- Clinical manifestations of various fungal infections in different organ systems like the lungs and central nervous system
- Laboratory methods for diagnosing fungal infections through microscopy, culture, serology and molecular identification
- Specific details on presentations of Aspergillosis, Candidiasis and Cryptococcosis in the lungs, skin and brain
The document provides information on pulmonary aspergillosis, caused by inhalation of the Aspergillus fungus. It discusses the main disease entities: allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, invasive aspergillosis, and chronic necrotizing pulmonary aspergillosis. ABPA involves hypersensitivity reactions in asthma/CF patients. Aspergilloma forms fungal balls in pre-existing lung cavities. Invasive aspergillosis mainly affects immunocompromised individuals and can disseminate. Chronic forms progress over months-years in patients with underlying lung disease. Clinical features, diagnosis, treatment and prognosis are outlined
Aspergillosis is caused by the mold Aspergillus, which commonly grows on decaying plants. Inhalation of airborne spores can cause invasive or allergic diseases. Aspergillus fumigatus is the most common cause of acute pulmonary and allergic aspergillosis. Diagnosis involves identifying characteristic hyphae in specimens through microscopy or culturing, and detecting antigens or antibodies. Treatment depends on the specific type of aspergillosis and may involve antifungal drugs, surgery, or prevention with prophylaxis in high risk patients.
This document discusses Aspergillosis and different types of fungal infections caused by Aspergillus species, including invasive pulmonary aspergillosis, chronic pulmonary aspergillosis, fungal rhinosinusitis, sino-orbital-cerebral aspergillosis, and subacute invasive pulmonary aspergillosis. It covers the microbiology, epidemiology, clinical presentations, histopathology, diagnosis, and diagnostic tools for each type of infection.
This document provides an overview of pulmonary aspergillosis, caused by inhalation of the fungus Aspergillus. It discusses the main types including aspergilloma (fungal ball in a pre-existing lung cavity), allergic bronchopulmonary aspergillosis (ABPA, an immune response in people with asthma or cystic fibrosis), and invasive aspergillosis which occurs in immunocompromised people. The pathology, risk factors, clinical features, diagnosis and treatment are described for each type. ABPA is characterized by severe asthma attacks, mucus plugs and bronchial obstruction visible on chest imaging.
This document provides information on pulmonary aspergillosis caused by the fungus Aspergillus. It discusses the history and taxonomy of Aspergillus. There are four main clinical syndromes of pulmonary aspergillosis: invasive pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, chronic pulmonary aspergillosis, and Aspergillus tracheobronchitis. Invasive pulmonary aspergillosis is difficult to diagnose but the presence of septate hyphae in lung tissue along with a culture of Aspergillus is diagnostic. Voriconazole is now considered the primary treatment for invasive pulmonary aspergillosis.
Medically Important Aspergillus species.pptxNawangSherpa6
The Presentation here is about Medically important Aspergillus species. How does it infect the Human host? What are it's clinical manifestations and How can we diagnose for their infection and potential application for other studies.
This document provides information on the pulmonary manifestations of aspergillosis. It discusses the various types of aspergillosis including allergic, colonization, and invasive forms. Key points include:
- Aspergillus fumigatus is the most common pathogenic species. It produces gliotoxin which inhibits the immune response.
- Allergic forms include allergic bronchopulmonary aspergillosis (ABPA), bronchocentric granulomatosis, and extrinsic allergic alveolitis. Invasive forms include chronic necrotizing pulmonary aspergillosis.
- Diagnosis involves radiology, culture, serology and biopsy. Treatment depends on the specific
This document provides an overview of pulmonary aspergillosis. It discusses the different disease entities caused by Aspergillus including invasive aspergillosis, chronic necrotizing pneumonia, allergic bronchopulmonary aspergillosis, and aspergilloma. It covers the organism and ecology, epidemiology, pathophysiology, clinical features, diagnosis, treatment and prognosis of these pulmonary infections and diseases.
The document provides information on pulmonary aspergillosis, caused by inhalation of the Aspergillus fungus. It discusses the main disease entities: allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, invasive aspergillosis, and chronic necrotizing pulmonary aspergillosis. ABPA involves hypersensitivity reactions in asthma/CF patients. Aspergilloma forms fungal balls in pre-existing lung cavities. Invasive aspergillosis mainly affects immunocompromised individuals and can disseminate. Chronic forms progress over months-years in patients with underlying lung disease. Clinical features, diagnosis, treatment and prognosis are outlined
Aspergillosis is caused by the mold Aspergillus, which commonly grows on decaying plants. Inhalation of airborne spores can cause invasive or allergic diseases. Aspergillus fumigatus is the most common cause of acute pulmonary and allergic aspergillosis. Diagnosis involves identifying characteristic hyphae in specimens through microscopy or culturing, and detecting antigens or antibodies. Treatment depends on the specific type of aspergillosis and may involve antifungal drugs, surgery, or prevention with prophylaxis in high risk patients.
This document discusses Aspergillosis and different types of fungal infections caused by Aspergillus species, including invasive pulmonary aspergillosis, chronic pulmonary aspergillosis, fungal rhinosinusitis, sino-orbital-cerebral aspergillosis, and subacute invasive pulmonary aspergillosis. It covers the microbiology, epidemiology, clinical presentations, histopathology, diagnosis, and diagnostic tools for each type of infection.
This document provides an overview of pulmonary aspergillosis, caused by inhalation of the fungus Aspergillus. It discusses the main types including aspergilloma (fungal ball in a pre-existing lung cavity), allergic bronchopulmonary aspergillosis (ABPA, an immune response in people with asthma or cystic fibrosis), and invasive aspergillosis which occurs in immunocompromised people. The pathology, risk factors, clinical features, diagnosis and treatment are described for each type. ABPA is characterized by severe asthma attacks, mucus plugs and bronchial obstruction visible on chest imaging.
This document provides information on pulmonary aspergillosis caused by the fungus Aspergillus. It discusses the history and taxonomy of Aspergillus. There are four main clinical syndromes of pulmonary aspergillosis: invasive pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, chronic pulmonary aspergillosis, and Aspergillus tracheobronchitis. Invasive pulmonary aspergillosis is difficult to diagnose but the presence of septate hyphae in lung tissue along with a culture of Aspergillus is diagnostic. Voriconazole is now considered the primary treatment for invasive pulmonary aspergillosis.
Medically Important Aspergillus species.pptxNawangSherpa6
The Presentation here is about Medically important Aspergillus species. How does it infect the Human host? What are it's clinical manifestations and How can we diagnose for their infection and potential application for other studies.
This document provides information on the pulmonary manifestations of aspergillosis. It discusses the various types of aspergillosis including allergic, colonization, and invasive forms. Key points include:
- Aspergillus fumigatus is the most common pathogenic species. It produces gliotoxin which inhibits the immune response.
- Allergic forms include allergic bronchopulmonary aspergillosis (ABPA), bronchocentric granulomatosis, and extrinsic allergic alveolitis. Invasive forms include chronic necrotizing pulmonary aspergillosis.
- Diagnosis involves radiology, culture, serology and biopsy. Treatment depends on the specific
This document provides an overview of pulmonary aspergillosis. It discusses the different disease entities caused by Aspergillus including invasive aspergillosis, chronic necrotizing pneumonia, allergic bronchopulmonary aspergillosis, and aspergilloma. It covers the organism and ecology, epidemiology, pathophysiology, clinical features, diagnosis, treatment and prognosis of these pulmonary infections and diseases.
Infeksi Jamur pada Paru dapat disebabkan oleh berbagai jenis jamur, seperti Candida, Aspergillus, Cryptococcus, dan Pneumocystis. Candida albicans adalah penyebab utama kandidiasis paru yang menyebabkan gejala batuk berdahak, sesak napas, dan demam. Aspergillus dapat menyebabkan aspergilloma, ABPA, atau aspergilosis invasif yang ditandai dengan nodul paru dan bronkiektazis. Diagnosis didasarkan pada pemer
(1) Aspergillosis is caused by the fungus Aspergillus and can cause a spectrum of diseases in humans ranging from mild to severe and even fatal.
(2) The most common disease types are pulmonary aspergillosis (allergic, aspergilloma, invasive), disseminated disease affecting multiple organs, and sinus infections.
(3) Risk factors include immunosuppression, corticosteroid use, lung disease, and sinusitis. Diagnosis involves microscopy, culture, histology and serology of samples from infected sites.
This document provides information about community-acquired pneumonia (CAP). It discusses the epidemiology, risk factors, etiology, pathogenesis, clinical features, diagnosis, and management of CAP. CAP results in over 1 million hospitalizations and 55,000 deaths annually in the United States. The most common causes are Streptococcus pneumoniae, Haemophilus influenzae, and respiratory viruses like influenza. Clinical features may include fever, cough, shortness of breath, and findings on physical exam like crackles and decreased breath sounds.
1) The document discusses Allergic BronchoPulmonary Aspergillosis (ABPA), a condition caused by an allergic reaction to the fungus Aspergillus in the lungs. It covers the epidemiology, pathogenesis, clinical features, diagnostic criteria and management of ABPA.
2) Key points include that ABPA typically affects people with asthma or cystic fibrosis, and is diagnosed based on criteria including a history of asthma, pulmonary infiltrates on chest imaging, positive skin test to Aspergillus, and elevated IgE levels and precipitating antibodies.
3) Management involves use of corticosteroids to reduce inflammation during acute episodes.
Pneumocystis jirovecii is a fungus that causes pneumonia in immunocompromised patients. It is diagnosed through microscopic visualization of the organism in samples obtained through induced sputum or bronchoscopy with bronchoalveolar lavage. Real-time PCR assays have increased sensitivity over conventional staining but may produce false positives. Risk factors include HIV/AIDS with CD4 count <200 cells/uL, use of immunosuppressive drugs, hematologic malignancies, and organ transplantation. Presentation involves fever, cough, and dyspnea. Treatment involves trimethoprim-sulfamethoxazole.
This document provides information on approaching and evaluating patients with potential infectious diseases. It discusses taking an exposure and social history, performing a physical exam focusing on vital signs, lymph nodes, skin, and foreign bodies. Diagnostic testing options are outlined including lab tests, imaging, and pathogen-specific tests. Empirical antibiotic therapy is recommended for common infections like pneumonia based on presentation. Community-acquired pneumonia causes are discussed. Hospital-acquired pneumonia treatment typically involves antibiotics until culture results are available. Infective endocarditis typically involves bacterial vegetation on heart valves.
1. Aspergillosis is a group of diseases caused by the Aspergillus fungus. Some asthma patients are sensitized to the fungi Aspergillus.
2. Aspergillus fumigatus is one of the most common Aspergillus species that causes disease in immunocompromised individuals and people with leukemia. It is typically found in soil and decaying organic matter.
3. Aspergillosis is classified as invasive, chronic, or allergic depending on symptoms and disease progression. Invasive aspergillosis can disseminate and involve multiple organs while allergic aspergillosis includes conditions like allergic bronchopulmonary aspergillosis
Opportunistic Mycosis are: caused by fungi that cannot infect healthy humans but can
cause serious often fatal mycoses in people whose resistance has been lowered (immunocompromised patients).
Many fungi previously considered non- pathogenic are
now recognized as etiological agents of the
opportunistic fungal infections.
The laboratory must identify and report completely
the presence of all fungi recovered from
immunocompromised patient, since every organism is
a potential pathogen
The highly susceptible groups for opportunistic fungal
infection are
- AIDs patients,
-Leukemic patients,
-individuals on chemotherapy for treatment of cancer,
-alcoholics. The commonest causes of opportunistic mycosis are:
-Candidiasis
- Aspergillosis
- Zygomycosis
-Cryptococosis
-Pneumocystis carn
Candidiasis is a relatively common human infection that can
take form of;
superficial,
mucocutanous or
systemic disease.
Principally it is caused by the three species of the genus candida,
namely,
C.albicans,
C.tropicalis and
C.krusei
Superficial and mucocutaneous candidiasis
It is superficial infections of skin and mucous membranes
Through, oral and vaginal candidiasis
- Oesophageal candidiasis
-Skin lesions of folds, groin, axilla, and interdigital areas
- Napkin eruptions in infants
- Paranychial candidiaiasis
Invasive:
Candidemia: initial stage can be transient if phagocytic
system is intact.
Disseminated or hematogenous candidiasis if phagocytic
system is compromised.
Multi organs can be involved with infection: kidney,
prosthetic heart valves, brain, eye, meninges.
Mortality: 30-40%
Predisposing factors
Diabetes
Immunosupperession
T-cell immunodeficiency disorders
Acquired- immunodeficiency syndrome, (AIDS)
Leukaemias, Lymphomas
Steroid treatments
Broad spectrum antibiotics
Laboratory diagnosis
Superficial or mucocutaneous candidiasis is diagnosed by
finding the fungus in tissue scraping and culture
Systemic candidiasis is difficult to diagnose.
Definitive diagnosis is made by the histopathologic
demonstration of the invasion of tissue by the yeast.
Specimens from surface lesions, mouth, vaginal, sputum,
exudates etc are examined using different methods.
Direct examination
a) KOH
Exposed lesions can usually be easily diagnosed by
clinical appearance together with finding typical budding
yeast cells and pseudohyphae and /or true hyphea in lesion
scrapings treated with KOH.
b) Gram-stain
Gram stain smears show large gram-positive budding yeast cells
with pseudohyphea.
Germ tube test
Candida albicans can be presumptively identified based
on the production of a germ tube
Principle
When incubated with serum at 370C for 1 to 3 hours,
C.albicans will form a germ tube.
Procedure
1. Pipette 0.5 ml of serum into a test tube
2. Inoculate the tube with a small amount of the
organism to be
tested.
This document summarizes several unusual infectious diseases that can cause orthopaedic infections, including nontuberculous mycobacterial infections, brucellosis, typhoid fever, syphilis, viral and fungal osteitis/arthritis, actinomycosis, Lyme disease, coccidioidomycosis, blastomycosis, and histoplasmosis. For each infection, it describes the causative organism, modes of transmission, clinical manifestations, diagnostic approaches, and treatment recommendations.
This document provides an overview of aspergillosis, caused by pathogenic Aspergillus species. It discusses the most common disease manifestations by species and organ system. It also covers risk factors, pathogenesis, clinical features, diagnosis, and treatment approaches for various forms of aspergillosis, including invasive, chronic, allergic bronchopulmonary, and aspergilloma. The preferred and alternative antifungal therapies are outlined depending on the type of aspergillosis.
This document outlines an upcoming presentation on RNA viral infections by a group of physician assistant students. It provides an agenda that will cover 12 specific RNA viruses: mumps, Marburg, influenza, coronavirus, measles, Ebola, dengue fever, yellow fever, rubella, rabies, hepatitis C, and Lassa fever. For each virus, the presentation will describe the pathogenesis, clinical features, investigations, management, and preventions. It introduces RNA viruses and provides background information on viral structure and replication before delving into the individual viruses.
ASPERGILLOSIS, MUCORMYCOSIS AND HISTOPLASMOSIS.pptxMkindi Mkindi
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
A detailed discussion and description on fungal diseases and management. The focus is kept on those facts which frequently come across an intensivist but it is also important for the Internist.
This document discusses laryngeal infections. It begins by introducing laryngitis as an inflammation of the larynx that can be acute or chronic. Acute laryngitis is usually self-limited while chronic lasts over 3 weeks. Causes include vocal misuse, noxious agents, and viruses or bacteria. In children, important acute laryngeal infections are epiglottitis, croup, and bacterial laryngotracheobronchitis. Chronic laryngitis can be caused by repeated acute infections or long-term irritants like smoking. Diagnosis involves examination and investigations depend on the suspected infection. Management involves treating the underlying cause, antibiotics, corticosteroids, and occasionally intubation or tracheostomy
This document discusses different types of Aspergillus infections including allergic bronchopulmonary aspergillosis (ABPA), semi-invasive aspergillosis, and invasive pulmonary aspergillosis. ABPA is an allergic reaction seen in patients with asthma or cystic fibrosis and results in bronchial wall damage and bronchiectasis. Semi-invasive aspergillosis typically occurs in patients with mild immunosuppression and results in thick-walled cavities in the lungs. Invasive pulmonary aspergillosis is seen in severely immunocompromised patients like those with leukemia and causes multiple or single ill-defined lung opacities or consolidations.
This document discusses bovine respiratory disease (BRD) in calves, which is caused by various viruses and bacteria. It can cause pneumonia of varying severity. Common viral causes include respiratory syncytial virus, parainfluenza 3, and bovine viral diarrhea virus. Bacterial pathogens like Mannheimia haemolytica may cause secondary infections. Calves aged 2-5 months are most susceptible. Clinical signs include cough, nasal discharge, fever and respiratory distress. Diagnosis involves virus isolation, serology and histopathology. Treatment consists of antibiotics and supportive care. Vaccination helps control the spread of BRD.
Viral laryngitis is the most common cause of laryngeal infection and presents with symptoms like dysphonia, odynophagia, and laryngeal trauma from phonation and coughing. Bacterial laryngitis can also occur from pathogens like Streptococcus and Staphylococcus and may result in supraglottitis or epiglottitis. Fungal, mycobacterial, and other infections like leprosy and syphilis can also infect the larynx, especially in immunocompromised patients. Autoimmune conditions such as Wegener's granulomatosis, rheumatoid arthritis, relapsing polychondritis, and pemphigus/pemphigoid can cause
Pneumonia is inflammation of the lung parenchyma that can be caused by infectious or non-infectious etiologies. Streptococcus pneumoniae is the most common cause of bacterial pneumonia in children aged 3 weeks to 4 years. Pneumonia is the leading infectious cause of death in children under 5 years globally. Clinical manifestations include cough, increased respiratory rate, grunting, and fever. Chest x-ray and laboratory tests are used for diagnosis. Management involves oxygen therapy, fluid therapy, antibiotics, and admission is indicated for young infants or those with respiratory distress. Prevention includes vaccines for pathogens like Streptococcus pneumoniae, influenza, and RSV.
Paracoccidioidomycosis is a fungal infection caused by Paracoccidioides species. It primarily involves the lungs and can disseminate to other organs. The disease ranges from asymptomatic to acute or chronic forms. Diagnosis involves microscopic examination of clinical samples to identify the characteristic yeast forms and culture growth at 37°C. Treatment requires long-term antifungal therapy for 6-12 months.
This document introduces permutation methods for statistical testing. It begins with background on permutation principles and explains that most biostatistics texts only cover rank-based permutation methods but this text will cover both rank-based and non-rank-based methods. It then reviews key mathematical concepts of permutations and combinations that are important for understanding permutation methods. It provides examples of calculating permutations and combinations. Finally, it states that several permutation-based tests will be presented, with the first using original observations and the second using ranks to test different statistical concepts like correlation in a distribution-free manner.
Infeksi Jamur pada Paru dapat disebabkan oleh berbagai jenis jamur, seperti Candida, Aspergillus, Cryptococcus, dan Pneumocystis. Candida albicans adalah penyebab utama kandidiasis paru yang menyebabkan gejala batuk berdahak, sesak napas, dan demam. Aspergillus dapat menyebabkan aspergilloma, ABPA, atau aspergilosis invasif yang ditandai dengan nodul paru dan bronkiektazis. Diagnosis didasarkan pada pemer
(1) Aspergillosis is caused by the fungus Aspergillus and can cause a spectrum of diseases in humans ranging from mild to severe and even fatal.
(2) The most common disease types are pulmonary aspergillosis (allergic, aspergilloma, invasive), disseminated disease affecting multiple organs, and sinus infections.
(3) Risk factors include immunosuppression, corticosteroid use, lung disease, and sinusitis. Diagnosis involves microscopy, culture, histology and serology of samples from infected sites.
This document provides information about community-acquired pneumonia (CAP). It discusses the epidemiology, risk factors, etiology, pathogenesis, clinical features, diagnosis, and management of CAP. CAP results in over 1 million hospitalizations and 55,000 deaths annually in the United States. The most common causes are Streptococcus pneumoniae, Haemophilus influenzae, and respiratory viruses like influenza. Clinical features may include fever, cough, shortness of breath, and findings on physical exam like crackles and decreased breath sounds.
1) The document discusses Allergic BronchoPulmonary Aspergillosis (ABPA), a condition caused by an allergic reaction to the fungus Aspergillus in the lungs. It covers the epidemiology, pathogenesis, clinical features, diagnostic criteria and management of ABPA.
2) Key points include that ABPA typically affects people with asthma or cystic fibrosis, and is diagnosed based on criteria including a history of asthma, pulmonary infiltrates on chest imaging, positive skin test to Aspergillus, and elevated IgE levels and precipitating antibodies.
3) Management involves use of corticosteroids to reduce inflammation during acute episodes.
Pneumocystis jirovecii is a fungus that causes pneumonia in immunocompromised patients. It is diagnosed through microscopic visualization of the organism in samples obtained through induced sputum or bronchoscopy with bronchoalveolar lavage. Real-time PCR assays have increased sensitivity over conventional staining but may produce false positives. Risk factors include HIV/AIDS with CD4 count <200 cells/uL, use of immunosuppressive drugs, hematologic malignancies, and organ transplantation. Presentation involves fever, cough, and dyspnea. Treatment involves trimethoprim-sulfamethoxazole.
This document provides information on approaching and evaluating patients with potential infectious diseases. It discusses taking an exposure and social history, performing a physical exam focusing on vital signs, lymph nodes, skin, and foreign bodies. Diagnostic testing options are outlined including lab tests, imaging, and pathogen-specific tests. Empirical antibiotic therapy is recommended for common infections like pneumonia based on presentation. Community-acquired pneumonia causes are discussed. Hospital-acquired pneumonia treatment typically involves antibiotics until culture results are available. Infective endocarditis typically involves bacterial vegetation on heart valves.
1. Aspergillosis is a group of diseases caused by the Aspergillus fungus. Some asthma patients are sensitized to the fungi Aspergillus.
2. Aspergillus fumigatus is one of the most common Aspergillus species that causes disease in immunocompromised individuals and people with leukemia. It is typically found in soil and decaying organic matter.
3. Aspergillosis is classified as invasive, chronic, or allergic depending on symptoms and disease progression. Invasive aspergillosis can disseminate and involve multiple organs while allergic aspergillosis includes conditions like allergic bronchopulmonary aspergillosis
Opportunistic Mycosis are: caused by fungi that cannot infect healthy humans but can
cause serious often fatal mycoses in people whose resistance has been lowered (immunocompromised patients).
Many fungi previously considered non- pathogenic are
now recognized as etiological agents of the
opportunistic fungal infections.
The laboratory must identify and report completely
the presence of all fungi recovered from
immunocompromised patient, since every organism is
a potential pathogen
The highly susceptible groups for opportunistic fungal
infection are
- AIDs patients,
-Leukemic patients,
-individuals on chemotherapy for treatment of cancer,
-alcoholics. The commonest causes of opportunistic mycosis are:
-Candidiasis
- Aspergillosis
- Zygomycosis
-Cryptococosis
-Pneumocystis carn
Candidiasis is a relatively common human infection that can
take form of;
superficial,
mucocutanous or
systemic disease.
Principally it is caused by the three species of the genus candida,
namely,
C.albicans,
C.tropicalis and
C.krusei
Superficial and mucocutaneous candidiasis
It is superficial infections of skin and mucous membranes
Through, oral and vaginal candidiasis
- Oesophageal candidiasis
-Skin lesions of folds, groin, axilla, and interdigital areas
- Napkin eruptions in infants
- Paranychial candidiaiasis
Invasive:
Candidemia: initial stage can be transient if phagocytic
system is intact.
Disseminated or hematogenous candidiasis if phagocytic
system is compromised.
Multi organs can be involved with infection: kidney,
prosthetic heart valves, brain, eye, meninges.
Mortality: 30-40%
Predisposing factors
Diabetes
Immunosupperession
T-cell immunodeficiency disorders
Acquired- immunodeficiency syndrome, (AIDS)
Leukaemias, Lymphomas
Steroid treatments
Broad spectrum antibiotics
Laboratory diagnosis
Superficial or mucocutaneous candidiasis is diagnosed by
finding the fungus in tissue scraping and culture
Systemic candidiasis is difficult to diagnose.
Definitive diagnosis is made by the histopathologic
demonstration of the invasion of tissue by the yeast.
Specimens from surface lesions, mouth, vaginal, sputum,
exudates etc are examined using different methods.
Direct examination
a) KOH
Exposed lesions can usually be easily diagnosed by
clinical appearance together with finding typical budding
yeast cells and pseudohyphae and /or true hyphea in lesion
scrapings treated with KOH.
b) Gram-stain
Gram stain smears show large gram-positive budding yeast cells
with pseudohyphea.
Germ tube test
Candida albicans can be presumptively identified based
on the production of a germ tube
Principle
When incubated with serum at 370C for 1 to 3 hours,
C.albicans will form a germ tube.
Procedure
1. Pipette 0.5 ml of serum into a test tube
2. Inoculate the tube with a small amount of the
organism to be
tested.
This document summarizes several unusual infectious diseases that can cause orthopaedic infections, including nontuberculous mycobacterial infections, brucellosis, typhoid fever, syphilis, viral and fungal osteitis/arthritis, actinomycosis, Lyme disease, coccidioidomycosis, blastomycosis, and histoplasmosis. For each infection, it describes the causative organism, modes of transmission, clinical manifestations, diagnostic approaches, and treatment recommendations.
This document provides an overview of aspergillosis, caused by pathogenic Aspergillus species. It discusses the most common disease manifestations by species and organ system. It also covers risk factors, pathogenesis, clinical features, diagnosis, and treatment approaches for various forms of aspergillosis, including invasive, chronic, allergic bronchopulmonary, and aspergilloma. The preferred and alternative antifungal therapies are outlined depending on the type of aspergillosis.
This document outlines an upcoming presentation on RNA viral infections by a group of physician assistant students. It provides an agenda that will cover 12 specific RNA viruses: mumps, Marburg, influenza, coronavirus, measles, Ebola, dengue fever, yellow fever, rubella, rabies, hepatitis C, and Lassa fever. For each virus, the presentation will describe the pathogenesis, clinical features, investigations, management, and preventions. It introduces RNA viruses and provides background information on viral structure and replication before delving into the individual viruses.
ASPERGILLOSIS, MUCORMYCOSIS AND HISTOPLASMOSIS.pptxMkindi Mkindi
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
A detailed discussion and description on fungal diseases and management. The focus is kept on those facts which frequently come across an intensivist but it is also important for the Internist.
This document discusses laryngeal infections. It begins by introducing laryngitis as an inflammation of the larynx that can be acute or chronic. Acute laryngitis is usually self-limited while chronic lasts over 3 weeks. Causes include vocal misuse, noxious agents, and viruses or bacteria. In children, important acute laryngeal infections are epiglottitis, croup, and bacterial laryngotracheobronchitis. Chronic laryngitis can be caused by repeated acute infections or long-term irritants like smoking. Diagnosis involves examination and investigations depend on the suspected infection. Management involves treating the underlying cause, antibiotics, corticosteroids, and occasionally intubation or tracheostomy
This document discusses different types of Aspergillus infections including allergic bronchopulmonary aspergillosis (ABPA), semi-invasive aspergillosis, and invasive pulmonary aspergillosis. ABPA is an allergic reaction seen in patients with asthma or cystic fibrosis and results in bronchial wall damage and bronchiectasis. Semi-invasive aspergillosis typically occurs in patients with mild immunosuppression and results in thick-walled cavities in the lungs. Invasive pulmonary aspergillosis is seen in severely immunocompromised patients like those with leukemia and causes multiple or single ill-defined lung opacities or consolidations.
This document discusses bovine respiratory disease (BRD) in calves, which is caused by various viruses and bacteria. It can cause pneumonia of varying severity. Common viral causes include respiratory syncytial virus, parainfluenza 3, and bovine viral diarrhea virus. Bacterial pathogens like Mannheimia haemolytica may cause secondary infections. Calves aged 2-5 months are most susceptible. Clinical signs include cough, nasal discharge, fever and respiratory distress. Diagnosis involves virus isolation, serology and histopathology. Treatment consists of antibiotics and supportive care. Vaccination helps control the spread of BRD.
Viral laryngitis is the most common cause of laryngeal infection and presents with symptoms like dysphonia, odynophagia, and laryngeal trauma from phonation and coughing. Bacterial laryngitis can also occur from pathogens like Streptococcus and Staphylococcus and may result in supraglottitis or epiglottitis. Fungal, mycobacterial, and other infections like leprosy and syphilis can also infect the larynx, especially in immunocompromised patients. Autoimmune conditions such as Wegener's granulomatosis, rheumatoid arthritis, relapsing polychondritis, and pemphigus/pemphigoid can cause
Pneumonia is inflammation of the lung parenchyma that can be caused by infectious or non-infectious etiologies. Streptococcus pneumoniae is the most common cause of bacterial pneumonia in children aged 3 weeks to 4 years. Pneumonia is the leading infectious cause of death in children under 5 years globally. Clinical manifestations include cough, increased respiratory rate, grunting, and fever. Chest x-ray and laboratory tests are used for diagnosis. Management involves oxygen therapy, fluid therapy, antibiotics, and admission is indicated for young infants or those with respiratory distress. Prevention includes vaccines for pathogens like Streptococcus pneumoniae, influenza, and RSV.
Similar to Opportunistic fungal infection.pptx (20)
Paracoccidioidomycosis is a fungal infection caused by Paracoccidioides species. It primarily involves the lungs and can disseminate to other organs. The disease ranges from asymptomatic to acute or chronic forms. Diagnosis involves microscopic examination of clinical samples to identify the characteristic yeast forms and culture growth at 37°C. Treatment requires long-term antifungal therapy for 6-12 months.
This document introduces permutation methods for statistical testing. It begins with background on permutation principles and explains that most biostatistics texts only cover rank-based permutation methods but this text will cover both rank-based and non-rank-based methods. It then reviews key mathematical concepts of permutations and combinations that are important for understanding permutation methods. It provides examples of calculating permutations and combinations. Finally, it states that several permutation-based tests will be presented, with the first using original observations and the second using ranks to test different statistical concepts like correlation in a distribution-free manner.
Lecture-8 (Demographic Studies and Health Services Statistics).ppthabtamu biazin
This document provides an overview of key concepts in demography and health services statistics. It discusses the study of demography, including the static and dynamic aspects of populations. It also describes sources of demographic data like censuses, vital registration, and surveys. Other topics covered include demographic transition, population pyramids, vital rates like fertility and mortality rates, and population projections methods.
The chi-square test is a non-parametric method used to analyze categorical data to evaluate hypotheses about populations. It can be used for goodness of fit, independence, and homogeneity. The chi-square test involves calculating expected frequencies, verifying assumptions, selecting a significance level, computing the chi-square statistic and comparing it to a critical value to determine whether to reject or fail to reject the null hypothesis.
The document discusses t-tests and one-way ANOVA statistical tests. It provides details on how to conduct one-sample t-tests, paired t-tests, two independent sample t-tests, and one-way ANOVA. It includes the assumptions, test statistics, and procedures for each test. An example is also provided to demonstrate a one-way ANOVA comparing red blood cell folate levels between three patient groups receiving different nitrous oxide treatments.
The document provides an overview of survival analysis. It defines survival analysis as a branch of statistics that focuses on time-to-event data and their analysis. It discusses censored and truncated data, the life table method, the Kaplan-Meier estimator for estimating survival functions when there is censoring, and the Cox regression model for assessing relationships between covariates and survival times. The key aspects of survival analysis are estimating the probability of surviving past a certain time point and comparing survival distributions between groups while accounting for censored observations.
This document provides an overview of logistic regression. It begins by explaining that linear regression is not appropriate when the dependent variable is dichotomous. Logistic regression uses an S-shaped logistic function to model the probabilities of different outcomes. The logistic function transforms the non-linear probabilities into linear-looking data that can be modeled using linear regression. Examples are provided to demonstrate how logistic regression can be used to predict the probability of coronary heart disease based on age and to analyze the relationship between patient satisfaction and residence.
Linear regression was used to analyze the relationship between daily food intake (independent variable) and weight gain (dependent variable) in a sample of 20 children. The regression equation obtained was: Weight gained = 0.16 + 0.643(food weight). This indicates that for each additional 1kg of daily food intake, a child's weight increases by 0.643kg on average. The coefficient of determination (R2) was 0.81, meaning 81% of the variation in children's weight gain was explained by differences in daily food intake.
Lecture-3 Probability and probability distribution.ppthabtamu biazin
This document provides an overview of key concepts in probability and probability distributions that will be covered in the chapter. The objectives are to understand probability, the difference between probability and probability distributions, conditional probability, and different types of distributions for categorical and continuous variables. Specific distributions discussed include the normal, student t, and chi-square distributions. Examples are provided on probability, conditional probability, counting rules for permutations and combinations, sampling with and without replacement, and the binomial distribution.
1) The document discusses descriptive statistics and methods for summarizing categorical and numerical data through tables, graphs, and numerical measures.
2) Descriptive statistics are used to describe and characterize data through methods like frequency tables, measures of central tendency, and measures of variability.
3) Various graphs like bar charts, pie charts, histograms and frequency polygons are demonstrated to visually depict distributions of categorical and numerical variables.
Fungi constitute an important group of eukaryotic organisms including yeasts and molds. Anti-fungal drugs target differences between fungal and human cells, such as fungal cell walls and sterol composition. Major classes of anti-fungals include polyenes such as amphotericin B, azoles, and allylamines. Amphotericin B binds to ergosterol in fungal cell membranes, forming pores that disrupt membrane function. It has broad antifungal activity but can cause renal toxicity. Newer lipid formulations reduce this toxicity. Nystatin is a polyene used topically due to toxicity concerns. Griseofulvin and flucytosine inhibit fung
The document discusses immunology and immunopathology of human parasitic infections. It covers:
1) Microparasites multiply within host cells and pose an immediate threat, while macroparasites (helminths) do not multiply within the host and do not present an immediate threat.
2) Infections by protozoa and helminths are long-lasting and can induce immunopathological changes over years that are more dangerous than the initial infection.
3) During any infection, dying or killed parasites can deposit molecules on host cells and elicit autoimmune responses, contributing to pathology.
5,6,7. Protein detection Western_blotting DNA sequencing.ppthabtamu biazin
1. The document describes the process of isolating and detecting proteins from various samples through cell lysis, SDS-PAGE gel electrophoresis, and western blotting. Key steps include lysing cells with detergents and inhibitors, boiling samples with loading buffer, running proteins on a gel, transferring proteins to a membrane, and detecting proteins with antibodies and chemiluminescent reagents.
2. Common components of lysis buffers and SDS loading buffers are described, as well as tips for pouring gels and troubleshooting western blots. The process allows estimation of protein molecular weights and analysis of post-translational modifications.
3. Proper controls and testing antibody specificity are emphasized for accurate analysis of western blot results.
6. aa sequencing site directed application of biotechnology.ppthabtamu biazin
Protein sequencing involves an eight step strategy to determine the amino acid sequence of a protein. The steps include separating polypeptide chains, reducing disulfide bonds, determining amino acid composition, identifying terminal residues, cleaving chains into fragments, sequencing the fragments, reconstructing the sequence from overlapping fragments, and determining disulfide bond positions. Frederick Sanger developed the first method for protein sequencing by determining the structure of insulin in 1953. Advances now allow sequencing entire proteins or genomes using techniques like mass spectrometry and determining gene sequences.
Genetic engineering involves purposefully manipulating genetic material to alter organism characteristics. There are five techniques: genetic fusion, protoplast fusion, gene amplification, recombinant DNA technology, and hybridoma creation. Genetic engineering tools include specialized enzymes, gel electrophoresis, DNA sequencing machines, RNA primers, and gene probes. The Human Genome Project, completed in 2003, mapped the human genome consisting of 20,000 to 25,000 protein-coding genes. 'Omics' fields like genomics, proteomics, and metabolomics emerged from studying entire genomes and cellular components.
The document provides an overview of real-time PCR (polymerase chain reaction). It discusses extracting RNA from tissue, converting the RNA to cDNA using reverse transcriptase, performing real-time PCR, and analyzing the results. Several key steps are described, including the importance of RNA quality, using appropriate reverse transcriptase primers and PCR primers, including necessary controls, and selecting appropriate reference standards for normalization.
2. Prokaryotic and Eukaryotic cell structure.pptxhabtamu biazin
Prokaryotic cells, which include bacteria, lack membrane-bound organelles and have no nucleus. They contain a single, circular chromosome. Eukaryotic cells have a membrane-enclosed nucleus and organelles. Prokaryotes reproduce through binary fission, while eukaryotes use mitosis or meiosis. Both prokaryotic and eukaryotic cells are surrounded by a plasma membrane and contain DNA.
This document outlines the fundamentals of microbiology, including the historical development and significance of studying microbes. It discusses key topics like the structure of prokaryotic and eukaryotic cells, bacterial taxonomy, and bacterial genetics. The objectives are to understand the historical background of microbiology, classify medically significant bacteria, describe bacterial metabolism and growth, and explain methods of disinfection.
Mycobacterium is a genus of bacteria that includes the species that cause tuberculosis (TB) and leprosy. It contains obligate parasites like Mycobacterium tuberculosis and M. leprae, which cause diseases, as well as opportunistic pathogens like non-tuberculous mycobacteria. Mycobacterium species are acid-fast bacilli with a cell wall rich in lipids, making them resistant to disinfectants and host immune responses. They can survive outside of hosts for weeks. M. tuberculosis was discovered in 1882 and is the main cause of TB, appearing as thin rods in tissue.
Staphylococcus aureus is a common cause of skin and soft tissue infections that produces several virulence factors like coagulase and toxins. It is carried in the nasopharynx and skin of healthy individuals. Streptococcus pyogenes causes a variety of infections from minor skin infections to severe invasive diseases like necrotizing fasciitis. It produces extracellular enzymes and toxins that damage tissues. Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea, while Neisseria meningitidis can cause a severe blood infection and meningitis. Both Neisseria species possess pili and capsules important for virulence.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
3. Opportunistic Systemic Mycoses
• These are fungal infections of the body which occur almost exclusively in
debilitated patients whose normal defence mechanisms are impaired.
• The organisms involved are cosmopolitan fungi which have a very low inherent
virulence.
• The increased incidence of these infections and the diversity of fungi causing
them, has paralleled the emergence of AIDS, more aggressive cancer and post-
transplantation chemotherapy and the use of antibiotics, cytotoxins,
immunosuppressives, corticosteroids and other macro disruptive procedures that
result in lowered resistance of the host.
4. Opportunistic Systemic Mycoses
Disease Causative organisms Incidence
Aspergillosis
Aspergillus fumigatus complex, A. flavus, complex, A.
terreus complex etc.
Common
Candidiasis
Candida, Debaryomyces, Kluyveromyces, Meyerozyma,
Pichia, etc.
Common
Cryptococcosis Cryptococcus spp. especially C. neoformans and C. gattii. Uncommon
Hyalohyphomycosis
Penicillium, Paecilomyces, Beauveria,
Fusarium, Scopulariopsis etc.
Rare
Phaeohyphomycosis Cladophialophora, Exophiala, Bipolaris, Exserohilum etc. Uncommon
Scedosporiosis
(Pseudallescheriasis)
Scedosporium and Lomentospora. Rare
Zygomycosis
(Mucormycosis)
Rhizopus, Mucor, Rhizomucor, Lichtheimia etc. Rare
5. Opportunistic Systemic Mycoses
• Aspergillosis is a spectrum of diseases of humans and animals caused by members
of the genus Aspergillus.
• These include
• 1. mycotoxicosis due to ingestion of contaminated foods;
• 2. allergy and sequelae to the presence of conidia or transient growth of the
organism in body orifices;
• 3. colonization without extension in preformed cavities and debilitated tissues;
6. Opportunistic Systemic Mycoses
• 4. invasive, inflammatory, granulomatous, narcotizing disease of lungs, and
other organs; and rarely
• 5. systemic and fatal disseminated disease.
• The type of disease and severity depends upon the physiologic state of the host and the
species of Aspergillus involved.
• The etiological agents are cosmopolitan and include Aspergillus fumigatus complex, A.
flavus complex, A. niger complex, A. nidulans and A. terreus complex.
7. Clinical manifestations…
• Pulmonary aspergillosis: including allergic, aspergilloma and invasive aspergillosis.
• The clinical manifestations of pulmonary aspergillosis are many, ranging from harmless
saprophytic colonization to acute invasive disease.
• Allergic aspergillosis is a continuum of clinical entities ranging from extrinsic asthma to extrinsic
allergic alveolitis to allergic bronchopulmonary aspergillosis (hypersensitivity pneumonitis) caused by
the inhalation of Aspergillus conidia.
• Features include asthma, intermittent or persistent pulmonary infiltrates, peripheral eosinophilia,
positive skin test to Aspergillus antigenic extracts, positive immunodiffusion precipitin tests for
antibody to Aspergillus, elevated total IgE, and elevated specific IgE against Aspergillus.
8. Clinical manifestations…
• Plug expectoration and a history of chronic bronchitis are also common.
• Symptoms may be mild and without sequelae, but recurrent episodes frequently progress
to bronchiectasis and fibrosis.
• Non-invasive aspergillosis or aspergilloma (fungus ball), is caused by the saprophytic
colonization of pre-formed cavities, usually secondary to tuberculosis or sarcoidosis.
• Features often include hemoptysis with blood stained sputum, positive immunodiffusion
precipitin tests for antibody to Aspergillus, and elevated specific IgE against Aspergillus.
• However, many cases are asymptomatic and are usually found by routine chest x-ray.
9. Acute invasive pulmonary aspergillosis.
• Predisposing factors include prolonged neutropenia, especially in leukemia
patients or in bone marrow transplant recipients, corticosteroid therapy,
cytotoxic chemotherapy and to a lesser extent patients with AIDS or chronic
granulomatous disease.
• Clinical symptoms may mimic acute bacterial pneumonia and include fever,
cough, pleuritic pain, with hemorrhagic infarction or a narcotizing
bronchopneumonia.
• The typical patient is granulocytopenia and receiving broad-spectrum antibiotics
for unexplained fever.
• Radiological features may be non-specific and tests for serum antibody precipitins
are also usually negative.
• Clinical recognition is essential as this is the most common form of aspergillosis in
the immunosuppressed patient.
10. • Chronic narcotising aspergillosis is an indolent, slowly progressive,
"semi-invasive" form of infection seen in mildly immunosuppressed
patients, especially those with a previous history of lung disease.
• Diabetes mellitus, sarcoidosis and treatment with low-dose
glucocorticoids may be other predisposing factors.
• Common symptoms include fever, cough and sputum production;
positive serum antibody precipitins may also be detected.
12. Disseminated aspergillosis:
• Hematogenous dissemination to other visceral organs may occur, especially in patients
with severe immunosuppression or intravenous drug addiction.
• Abscesses may occur in the brain (cerebral aspergillosis), kidney (renal aspergillosis),
heart, (endocarditis, myocarditis), bone (osteomyelitis), and gastrointestinal tract.
• Ocular lesions (mycotic keratitis, endophthalmitis and orbital aspergilloma) may also
occur, either as a result of dissemination or following local trauma or surgery.
• Aspergillosis of the paranasal sinuses:
• Two types of paranasal sinus aspergillosis are generally recognised. (1) A non-invasive
"aspergilloma" form, primarily seen in non-immunosuppressed individuals. Predisposing factors
include a history of chronic sinusitis and poorly draining sinuses with excessive mucus. (2) An
invasive form, usually seen in the immunosuppressed patient. This form has a similar clinical
setting to that seen in rhinocerebral zygomycosis; and symptoms include fever, rhinitis and signs of
invasion into the orbit.
• .
13. Cutaneous aspergillosis:
• Cutaneous aspergillosis is a rare manifestation that is usually a result of
dissemination from primary pulmonary infection in the immunosuppressed
patient.
• However, cases of primary cutaneous aspergillosis also occur, usually as a result
of trauma or colonisation.
• Lesions manifest as erythematous papules or macules with progressive central
necrosis
14. Laboratory diagnosis:
• Clinical material:
• Sputum, bronchial washings and tracheal aspirates from patients with pulmonary
disease and tissue biopsies from patients with disseminated disease.
• Direct microscopy:
a) Sputum, washings and aspirates make wet mounts in either 10% KOH & Parker
ink or Calcofluor and/or Gram stained smears;
b) Tissue sections should be stained with H&E, GMS and PAS digest.
• Note: Aspergillus hyphae may be missed in H&E stained sections.
• Examine specimens for dichotomously branched, septate hyphae.
17. Laboratory diagnosis…
• Interpretation:
• The presence of hyaline, branching septate hyphae, consistent with Aspergillus
in any specimen, from a patient with supporting clinical symptoms should be
considered significant.
• Biopsy and evidence of tissue invasion is of particular importance.
• Remember direct microscopy or histopathology does not offer a specific
identification of the causative agent.
18. Laboratory diagnosis…
• Culture:
• Clinical specimens should be inoculated onto primary isolation media, like Sabouraud's dextrose agar.
• Colonies are fast growing and may be white, yellow, yellow-brown, brown to black or green in colour.
• Interpretation:
• Aspergillus species are well recognized as common environmental airborne contaminants,
• Therefore, a positive culture from a non-sterile specimen, such as sputum, is not proof of infection.
• The detection of Aspergillus (especially A. fumigatus and A. flavus) in sputum cultures, from patients with
appropriate predisposing conditions, is likely to be of diagnostic importance and empiric antifungal therapy
should be considered.
• Unfortunately, patients with invasive pulmonary aspergillosis, often have negative sputum cultures making a
lung biopsy a prerequisite for a definitive diagnosis.
20. Laboratory diagnosis…
• Serology:
• Immunodiffusion tests for the detection of antibodies to Aspergillus species have proven to be of value in the diagnosis of
allergic, aspergilloma, and invasive aspergillosis.
• However, they should never be used alone, and must be correlated with other clinical and diagnostic data.
• Several antigen tests for the detection of Aspergillus from blood, urine and CFS are now available.
• The (1→3)- β-D- glucan test detects a wide variety of fungal pathogens including Aspergillus, Candida, Fusarium,
Trichosporon and several commercial kits (FungiTec G, Fungitell) are available.
• However the most widely used system is the Aspergillus galactomannan ELISA test (Platelia® Aspergillus ELISA kit).
• The Aspergillus galactomannan (GM) test has a reported specificity of 89-93%; sensitivity of 61-71%; NPV of 95-98%;
PPV of 26-53% (Meta-analysis 27 studies Pfeiffer et al. CID 2006).
• However as galactomannan is rapidly eliminated from blood - serial screening twice weekly for optimal diagnosis is
recommended.
22. Laboratory diagnosis…
• Identification:
• Aspergillus colonies are usually fast growing, white, yellow, yellow-brown, brown to black or
shades of green, and they mostly consist of a dense felt of erect conidiophores.
• Conidiophores terminate in a vesicle covered with either a single palisade-like layer of
phialides (uniseriate) or a layer of subtending cells (metulae) which bear small whorls of
phialides (the so-called biseriate structure).
• The vesicle, phialides, metulae (if present) and conidia form the conidial head. Conidia are
one-celled, smooth- or rough-walled, hyaline or pigmented and are basocatenate, forming long
dry chains which may be divergent (radiate) or aggregated in compact columns (columnar).
• Some species may produce Hülle cells or sclerotia.
24. Candidiasis
• Candidiasis is a primary or secondary mycotic infection caused by members of the genus Candida and other
related genera.
• The clinical manifestations may be acute, subacute or chronic to episodic.
• Involvement may be localized to the mouth, throat, skin, scalp, vagina, fingers, nails, bronchi, lungs, or the
gastrointestinal tract, or become systemic as in septicemia, endocarditis and meningitis.
• In healthy individuals, Candida infections are usually due to impaired epithelial barrier functions and occur in
all age groups, but are most common in the newborn and the elderly.
• They usually remain superficial and respond readily to treatment.
• Systemic candidiasis is usually seen in patients with cell-mediated immune deficiency, and those receiving
aggressive cancer treatment, immunosuppression, or transplantation therapy.
25. Cryptococcosis
• a chronic, subacute to acute pulmonary, systemic or meningitic disease,
• initiated by the inhalation of infectious propagules (basidiospores and/or desiccated
yeast cells) from the environment.
• Primary pulmonary infections have no diagnostic symptoms and are usually subclinical.
• On dissemination, the fungus usually shows a predilection for the central nervous system,
• However , skin, bones and other visceral organs may also become involved.
26. Cryptococcosis …
• Cryptococcus neoformans and C. gattii are the principle pathogenic species.
• Naganishia albida (formerly Cryptococcus albidus) and Patiliotrema laurentii
(formely Cryptococcus laurentii) have on occasion also been implicated in human
infection.
27. Clinical manifestations:
• Cryptococcus is an encapsulated basidiomycete yeast-like fungus with a predilection for the
respiratory and nervous system of humans and animals.
• Two species, C. neoformans and C. gattii are distinguishable biochemically and by molecular
techniques.
• In humans, C. neoformans affects immunocompromised hosts predominantly and is the
commonest cause of fungal meningitis;
• worldwide, 7-10% of patients with AIDS are affected.
• AIDS associated cryptococcosis accounts for 50% of all cryptococcal infections reported annually
and usually occurs in HIV patients when their CD4 lymphocyte count is below 200/mm3.
28. Clinical manifestations…
• Meningitis is the predominant clinical presentation with fever and headache as the most common
symptoms.
• Secondary cutaneous infections occur in up to 15% of patients with disseminated cryptococcosis
and often indicate a poor prognosis.
• Lesions usually begin as small papules that subsequently ulcerate, but may also present as
abscesses, erythematous nodules, or cellulitis.
• This variety is found worldwide.
• In contrast, the distribution of cryptococcosis due to Cryptococcus gattii is geographically
restricted, non-immunocompromised hosts are usually affected, large mass lesions in lung and/or
brain (cryptococcomas) are characteristic and morbidity from neurological disease is high.
29. Pulmonary cryptococcosis:
• Asymptomatic carriage of Cryptococcus has been reported from the respiratory tract, especially
sputum and from skin in healthy people as a result of normal environmental exposure.
• In addition, patients with chronic lung disease, such as bronchitis and bronchiectasis, may also
have asymptomatic colonization, with Cryptococcus being isolated from their sputum over many
years.
• Subclinical cryptococcosis may result of environmental exposure, normal individuals may
experience a self-limiting pneumonia with accompanying sensitization.
• Most primary infections of this type have no diagnostic symptoms and are usually discovered only
by routine chest x-ray. When present, symptoms include cough, low-grade fever and pleuritic pain.
30. Pulmonary cryptococcosis:
• Invasive pulmonary cryptococcosis may occur
• in some patients when primary infections may not readily resolve in some patients,
• leading to a more chronic pneumonia progressing slowly over several years.
• Patients may become pyrexic and have an accompanying cough, however
many pulmonary lesions are often asymptomatic, especially when chronic
granulomas are formed.
• Chronic pulmonary cryptococcosis also increases the risk of dissemination
to the central nervous system.
32. Central nervous system
• Dissemination to the brain and meninges is the most common clinical manifestation of cryptococcosis and includes
meningitis, meningoencephalitis or expanding cryptococcoma.
• Meningitis is the most common clinical form, accounting for up to 85% of the total number of cases, however the clinical
signs are rarely dramatic.
• Symptoms usually develop slowly over several months, and initially include headache, followed by drowsiness, dizziness,
irritability, confusion, nausea, vomiting, neck stiffness and focal neurological defects, such as ataxia.
• Diminishing visual acuity and coma may also occur in later stages of the infection.
• Acute onset cases may also occur, especially in patients with widespread disease, and these patients may deteriorate rapidly
and die in a matter of weeks.
• Meningoencephalitis due to invasion of the cerebral cortex, brain stem and cerebellum is an uncommon, rapid fulminate
infection, often leading to coma and death within a short time.
• Symptoms include slow response to treatment and signs of cerebral edema or hydrocephalitis, especially papilledema.
34. Cutaneous cryptococcosis:
• Primary cutaneous cryptococcosis in the form of ulcerated lesions or cellulitis
occasionally occurs, especially in immunosuppressed patients.
• These lesions may resolve spontaneously or with systemic antifungal treatment.
• However, all patients with skin lesions should be monitored carefully for possible
dissemination to the central nervous system.
• Secondary cutaneous infections occur in up to 15% of patients with disseminated
cryptococcosis and often indicate a poor prognosis.
• Lesions usually begin as small papules that subsequently ulcerate, but may also
present as abscesses, erythematous nodules, or cellulitis.
35.
36. • Cryptococcosis of bone:
• Osseous cryptococcosis occurs in up to 10% of disseminated cases and may involve bony
prominences, cranial bones and vertebrae.
• The lesions are lytic without periosteal reaction and symptoms of dull pain on movement are
reported.
• Occasional cases of arthritis have also been reported, mostly involving the knee joint.
• Ocular cryptococcosis:
• Ocular manifestations of cryptococcosis most commonly include papilledema and optic
atrophy, due to raised intracranial pressure. Other ocular signs of cryptococcosis are
uncommon and usually occur as a result of dissemination.
• Other forms of cryptococcosis:
• Cryptococcus neoformans is often isolated from urine of patients with disseminated infection.
• Occasionally, signs of pyelonephritis or prostatitis may be observed.
• Other rare forms of cryptococcosis include adrenal cortical lesions, endocarditis, hepatitis,
sinusitis, and localized oesophageal lesions.
37. • Laboratory diagnosis:
• Clinical material:
• Cerebrospinal fluid (CSF), biopsy tissue, sputum, bronchial washings, pus, blood and urine.
• Direct microscopy:
• (a) For exudates and body fluids make a thin wet film under a coverslip using India ink to demonstrate
encapsulated yeast cells. Sputum and pus may need to be digested with 10% KOH prior to India ink staining.
(b) For tissue sections use PAS digest, GMS and H&E, mucicarmine stain is also useful to demonstrate the
polysaccharide capsule. Examine for globose to ovoid, budding yeast cells surrounded by wide gelatinous
capsules. Note, non-encapsulated variants, although rare, may also occur.
• Interpretation:
• The demonstration of encapsulated yeast cells in CSF, biopsy tissue, blood or urine should be considered
significant, even in the absence of clinical symptoms. Positive sputum specimens should be considered
potentially significant, even though Cryptococcus may also occur in respiratory secretions as a saprophyte.
Basically, all patients with a positive microscopy for cryptococci, from any site should be investigated for
disseminated disease, especially by culture and antigen detection.
38.
39.
40.
41. • Culture:
• Inoculate specimens onto primary isolation media, like Sabouraud's dextrose
agar. Look for translucent, smooth gelatinous colonies, later becoming very
mucoid and cream in color.
• Interpretation:
• The isolation of C. neoformans or C. gattii from any site should be considered
significant and patients without clinical symptoms should be thoroughly
investigated for disseminated disease. Positive culture of CSF is definitive.
However, positive culture of respiratory secretions, especially in patients without
clinical symptoms, needs to be interpreted with some caution, until additional
supporting evidence is available. Isolation of Naganishia albida (Cryptococcus
albidus) or Papiliotrema laurentii (Cryptococcus laurentii), should also be
interpreted with caution as these species are infrequent pathogens and once
again, additional supporting clinical and microscopic evidence is necessary.
42. • Identification:
• The genus Cryptococcus is characterized by globose to elongate yeast-like cells or
blastoconidia that reproduce by multilateral budding. Pseudohyphae are absent
or rudimentary. On solid media the cultures are generally mucoid or slimy in
appearance. Red, orange or yellow carotenoid pigments may be produced, but
young colonies of most species are usually non-pigmented, and are cream in
color. Most strains have encapsulated cells with the extent of capsule formation
depending on the medium. Under certain conditions of growth the capsule may
contain starch-like compounds which are released into the medium by many
strains. Within the genus Cryptococcus, fermentation of sugars is negative,
assimilation of nitrate is variable and assimilation of inositol is positive. The genus
Cryptococcus is similar to the genus Rhodotorula. The distinctive difference
between the two is the assimilation of inositol, which is positive in Cryptococcus.
• Causative agents: Cryptococcus neoformans and Cryptococcus gattii.
43.
44. • Serology:
• It should be noted that the detection of cryptococcal capsular
polysaccharide antigen in spinal fluid is now the method of choice for
diagnosing patients with cryptococcal meningitis. In AIDS patients,
cryptococcal antigen can be detected in the serum in nearly 100% of
cases. However, in non-AIDS patients antigen detection in serum is
less sensitive with only about 60% of patients with cryptococcosis
reported as being positive. Note, serum specimens should be
pretreated with pronase to enhance detection of antigen and avoid
false negative results.
45.
46. Hyalohyphomycosis
• A mycotic infection of man or animals caused by a number of hyaline (non-dematiaceous) hyphomycetes where the tissue morphology of the causative organism is mycelial. This separates it from phaeohyphomycosis
where the causative agents are brown-pigmented fungi. Hyalohyphomycosis is a general term used to group together infections caused by unusual hyaline fungal pathogens that are not agents of otherwise-named
infections; such as Aspergillosis. Etiological agents include species of Penicillium, Paecilomyces, Acremonium, Beauveria, Fusarium and Scopulariopsis.
• Clinical manifestations:
• The clinical manifestations of hyalohyphomycosis are many ranging from harmless saprophytic colonization to acute invasive disease. Predisposing factors include prolonged neutropenia, especially in leukemia
patients or in bone marrow transplant recipients, corticosteroid therapy, cytotoxic chemotherapy and to a lesser extent patients with AIDS. The typical patient is granulocytopenic and receiving broad-spectrum
antibiotics for unexplained fever.
• Laboratory diagnosis:
• Clinical material:
• Skin and nail scrapings; urine, sputum and bronchial washings; cerebrospinal fluid, pleural fluid and blood; tissue biopsies from various visceral organs and indwelling catheter tips.
• Direct microscopy:
• (a) Skin and nail scrapings, sputum, washings and aspirates should be examined using 10% KOH and Parker ink or calcofluor white mounts; (b) Exudates and body fluids should be centrifuged and the sediment
examined using either 10% KOH and Parker ink or calcofluor white mounts, (c) Tissue sections should be stained using PAS digest, Grocott's methenamine silver (GMS) or Gram stains. Note hyphal elements are often
difficult to detect in H&E stained sections.
• Interpretation: The presence of hyaline, branching septate hyphae, similar to Aspergillus in any specimen, from a patient with supporting clinical symptoms should be considered significant. Biopsy and evidence of
tissue invasion is of particular importance. Remember direct microscopy or histopathology does not offer a specific identification of the causative agent.
47. • Culture:
• Clinical specimens should be inoculated onto primary isolation media, like
Sabouraud's dextrose agar.
• Interpretation:
• The hyaline hyphomycetes involved are well recognized as common
environmental airborne contaminants, therefore a positive culture from a
non-sterile specimen, such as sputum or skin, needs to be supported by
direct microscopic evidence in order to be considered significant. A
supporting clinical history in patients with appropriate predisposing
conditions, is also helpful. Culture identification is the only reliable means
of distinguishing these fungi.
48. Culture of Chrysosporium [left] and Fusarium [right] showing
typical colony colour for a hyaline hyphomycete ie any colour
except brown, olivaceous black or black.
49. • Serology:
• There are currently no commercially available serological procedures for the
diagnosis of any of the infections classified under the term hyalohyphomycosis.
• Identification:
• Culture characteristics and microscopic morphology are important, especially
conidial morphology, the arrangement of conidia on the conidiogenous cell and
the morphology of the conidiogenous cell.
• Causative agents:
• Acremonium sp., Beauveria sp., Fusarium sp., Paecilomyces sp., Penicillium sp.,
Scopulariopsis sp. etc.
50. Phaeohyphomycosis
• A mycotic infection of humans and lower animals caused by a number
of dematiaceous (brown-pigmented) fungi where the tissue
morphology of the causative organism is mycelial. This separates it
from other clinical types of disease involving brown-pigmented fungi
where the tissue morphology of the organism is a grain (mycotic
mycetoma) or sclerotic body (chromoblastomycosis). The etiological
agents include various dematiaceous hyphomycetes especially
species of Exophiala, Phialophora, Bipolaris, Exserohilum,
Cladophialophora, Verruconis, Aureobasidium, Cladosporium,
Curvularia and Alternaria. Ajello (1986) listed 71 species from 39
genera as causative agents of phaeohyphomycosis.
51. Scedosporosis (Pseudallesheriasis)
• Scedosporium and Lomentospora infection
• A spectrum of disease similar in terms of variety and severity to those caused by Aspergillus. The vast majority of infections are
mycetomas, the remainder include infections of the eye, ear, central nervous system, internal organs and more commonly the
lungs. Infections result from either inhalation of air-borne conidia or by the traumatic implantation of fungal elements due to a
penetrating injury. The etiological agents are Scedosporium apiospermum,Scedosporium aurantiacum, Scedosporium boydii and
Lomentospora prolificans.
• Clinical manifestations:
• Scedosporium apiospermum, Scedosporium boydii and Scedosporium aurantiacum infections:
• Non-invasive colonization of the external ear and pulmonary colonization in patients with poorly draining bronchi or paranasal
sinuses and "fungus ball" formation in pre-formed cavities are similar to those seen in Aspergillus.
• Invasive infections in normal patients are usually caused by traumatic implantation. Mycetoma, where the fungus exists in tissue
as resistant microcolonies or grains is the most common infection in the normal patient. This is followed by penetrating joint
injuries, especially to the knee, resulting in arthritis and osteomyelitis. Other manifestations include mycotic keratitis and non-
mycetoma like cutaneous and subcutaneous infections.
• Invasive infections have also been reported in patients receiving treatment with corticosteroids and immunosuppressive therapy
for organ transplantation, leukemia, lymphoma, systemic lupus erythematous or Crohn's disease. Infections include invasive
sinusitis, pneumonia, arthritis with osteomyelitis, cutaneous and subcutaneous granulomata, meningitis, brain abscesses,
endophthalmitis, and disseminated systemic disease.
52. • Lomentospora prolificans infections:
• The spectrum of clinical manifestations are similar to that described above
for Scedosporium. Disseminated disease has been reported in
immunosuppressed patients especially those with prolonged neutropenia
and post-transplantation therapy. Colonization of the external ear,
paranasal sinuses and lung, including "fungus ball" have been reported.
Cases of onychomycosis and mycotic keratitis have also been documented.
However, localized invasive infections, especially septic arthritis and
osteomyelitis following penetrating injuries to joints, are now an emerging
clinical problem, accounting for 80% of the reported cases. Culture
identification is important, because this fungus is often resistant to
antifungal therapy and treatment may require surgical intervention.
53. Laboratory diagnosis:
• Clinical material:
• Sputum, bronchial washings and tracheal aspirates from patients with pulmonary disease and tissue biopsies from patients with subcutaneous and disseminated disease.
• Direct microscopy:
• (a) Sputum, washings and aspirates make wet mounts in either 10% KOH & Parker ink or Calcofluor and/or Gram stained smears; (b) Tissue sections should be stained with H&E,
GMS and PAS digest. Note hyphal elements of Scedosporium species and Lomentospora prolificans are indistinguishable from those of Aspergillus hyphae and may be missed in
H&E stained sections. Examine specimens for branched, septate hyphae.
• Interpretation:
• The presence of branching septate hyphae in any specimen, from a patient with supporting clinical symptoms should be considered significant. Biopsy and evidence of tissue
invasion is of particular importance. Remember culture is necessary for a specific identification of the causative agent.
• Culture:
• Colonies are fast growing and are greyish-white, to olive-grey to black with a suede-like to downy surface texture.
• Interpretation:
• S. apiospermum, S. boydii, S. aurantiacum and L. prolificans are common soil fungi, therefore a positive culture from a non-sterile specimen, such as sputum or skin, needs to be
supported by direct microscopic evidence in order to be considered significant. A positive culture from a biopsy or aspirated material from a sterile site should be considered
significant. Culture identification is the only reliable means of distinguishing these fungi from Aspergillus species.
54. • Serology:
• As in cases of aspergillosis immunodiffusion tests have become valuable in the
diagnosis of pseudallescheriasis. However, at present reagents are not
commercially available and antigenic extracts have to be made in the laboratory.
• Identification:
• Culture characteristics and microscopic morphology are important, especially
conidial morphology, the arrangement of conidia on the conidiogenous cell and
the morphology of the conidiogenous cell, in this case an annellide.
• Causative agents:
• Scedosporium apiospermum, Scedosporiun aurantiacum, Scedosporium boydii,
Lomentospora prolificans.
55. Zygomycosis(Mucormycosis)
• The term zygomycosis describes in the broadest sense any infection
due to a member of the Zygomycetes. These are primitive, fast
growing, terrestrial, largely saprophytic fungi with a cosmopolitan
distribution. To date, some 665 species have been described although
infections in humans and animals are generally rare. Medically
important genera causing systemic zygomycosis (Mucormycosis)
Rhizopus, Lichtheimia, Rhizomucor, Mucor, Cunninghamella,
Saksenaea, Apophysomyces, Cokeromyces and Mortierella.
57. • Histopathology: Haematoxylin and eosin (H&E) stained section of tissue
showing broad septate hyphae surrounded by an eosinophilic sheath
(Splendore-Hoeppli phenomenon) typical of Entomophthoromycosis. Note
there are two major histological differences between subcutaneous
zygomycosis caused by Basidiobolus and Conidiobolus
(Entomophthoromycosis) and zygomycosis caused by members of the
Mucorales (mucormycosis). Firstly, in Entomophthoromycosis the hyphae
are surrounded by an eosinophilic sheath and there is a lack of vascular
invasion, which is so characteristic of infections caused by the Mucorales.
Secondly, the hyphal elements of Mucorales are sparsely septate in tissue,
whereas frequent septation is seen in tissue hyphae of Basidiobolus or
Conidiobolus.
58.
59. • Culture: Basidiobolus ranarum on Sabouraud's dextrose agar after 17
days incubation at 26C showing a flat, yellowish-grey, glabrous,
radially folded colony covered by a fine, powdery, white surface
mycelium.
• Note the satellite colonies formed by germinating conidia ejected
from the primary colony.
60.
61. • Microscopy: Microscopic morphology of Basidiobolus ranarum showing globose, one-
celled conidia that are forcibly discharged from a sporophore.
• The sporophore has a distinct swollen area just below the spore that actively participates
in the discharge of the spore.
• Comments: Basidiobolus ranarum is commonly present in decaying fruit and vegetable
matter, and as a commensal in the intestinal tract of frogs, toads and lizards. It has been
reported from tropical regions of Africa and Asia including India, Indonesia and Australia.