Pathogenesis,pathology and diagnosis of Cryptococcosis,Histoplasmosis, Epizoo...Md Fayezur Rahaman
Pathogenesis,pathology and diagnosis of Cryptococcosis,Histoplasmosis, Epizootic lymphangitis in horses(Histoplasma farciminosum),Zygomycosis, Pythiosis and Rhinosporidiosis in man and animals.
All of the information are collected , it's not a research work but i think it will help the students to know about the basic information.
Superficial Mycoses Mycology - Tinea Versicolor / Tinea Nigra/Piedra
For Downloading PDF note
As the channel name suggests, our channel will be a perfect lounge for the malayali medicos..we wil be covering videos which will be like lecture classes related to the subjects biochemistry and microbiology in which we are specialised.. It will be a better learning experience for the students especially for those who are not able to understand and follow the normal classes in college..we assure the students that you will get a basic idea regarding the topic and extra reading can be done from the reference textbooks..
Qualification
AHLAD T O
Maneesha M Joseph
MSc MLT (Microbiology)
Assistant Professor
Baby memorial college of allied Health science
Kozhikode
Our Partner Channel
Health & Voyage channel link - https://youtu.be/nzKqRVjlwc0
#Superficial Mycoses Mycology microbiology
#Medical
#Microbiology
#Superficial Mycoses Mycology malayalam lecturer
#Mallu Medicos Lounge
##MalluMedicosLounge
#MLT
#Tinea Versicolor
#Tinea Nigra
#Piedra
Pathogenesis,pathology and diagnosis of Cryptococcosis,Histoplasmosis, Epizoo...Md Fayezur Rahaman
Pathogenesis,pathology and diagnosis of Cryptococcosis,Histoplasmosis, Epizootic lymphangitis in horses(Histoplasma farciminosum),Zygomycosis, Pythiosis and Rhinosporidiosis in man and animals.
All of the information are collected , it's not a research work but i think it will help the students to know about the basic information.
Superficial Mycoses Mycology - Tinea Versicolor / Tinea Nigra/Piedra
For Downloading PDF note
As the channel name suggests, our channel will be a perfect lounge for the malayali medicos..we wil be covering videos which will be like lecture classes related to the subjects biochemistry and microbiology in which we are specialised.. It will be a better learning experience for the students especially for those who are not able to understand and follow the normal classes in college..we assure the students that you will get a basic idea regarding the topic and extra reading can be done from the reference textbooks..
Qualification
AHLAD T O
Maneesha M Joseph
MSc MLT (Microbiology)
Assistant Professor
Baby memorial college of allied Health science
Kozhikode
Our Partner Channel
Health & Voyage channel link - https://youtu.be/nzKqRVjlwc0
#Superficial Mycoses Mycology microbiology
#Medical
#Microbiology
#Superficial Mycoses Mycology malayalam lecturer
#Mallu Medicos Lounge
##MalluMedicosLounge
#MLT
#Tinea Versicolor
#Tinea Nigra
#Piedra
Medically Important Histoplasma species .pptxNawangSherpa6
The Presentation here is about Medically important Histoplasma 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.
Most deep fungal infections have their primary foci in the lungs, therefore those presenting with distant organs or skin involvement should be managed aggressively as untreated or severe disease can lead to severe scarring, disfigurement and even death.
A TERM PAPER ON A TYPICAL MYCOSIS (HISTOPLASMOSIS) which include Introduction
Etiology
Symptomatology
Pathogenecity
Epidemiology
Diagnosis
Treatment and also the exisitence of the disease in three forms which are:
Acute or Primary Pulmonary Histoplasmosis
Chronic Pulmonary Histoplasmosis
Extra pulmonary-Dissemination Histoplasmosis
Fungal infection of the skin, most common on the exposed surfaces of the body, namely the face, arms and shoulders.
Most common fungal diseases ; Ringworm. A common fungal skin infection that often looks like a circular rash.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. SUMMARY OF DEEP MYCOSES
DISEASES AND SAPROPHYTIC PHASE PARASITIC PHASE
ETIOLOGIC AGENT
Blastomycosis budding yeast with
septate mycelium; conidia are
Blastomyces dermatitidis broad base bud
pyriform, globose or double
colonies are white or beige,
fluffly or glaborous
Histoplasmosis septate mycelia microconidia; small single budded
Histoplasma capsulatum tuberculate macroconidia yeast
colonies are white and buff
Coccidioidomycosis septate mycelium fragment to spherule (10-20 u) with
Coccidiodes arthroconidia; colonies are endospores
immitis buff or white and moth
Paracoccidiodomycosis similar to B. dermatitidis large multiple budding
Paracoccidioides yeast
Wednesday, January 11, 2012
3. CHARACTERISTICS TO REMEMBER
Monomorphic Dimorphic
No change in form/state Change in form in
in response to stimulus response to stimulus like
like temperature. temperature. Example
Example, yeast at 25° C yeast at 37° C and
and 37° C mycelium at 25° C
Examples: Mycelium = Examples: Histoplasma capsulatum;
Blastomyces dermatitidis;
Aspergillus species; Yeast
Paracoccidiodes brasiliensis;
= Cryptococcus species Coccidiodes immitis
Wednesday, January 11, 2012
4. FACTORS AFFECTING DIMORPHISM
Temperature
Oxidation-reduction potential
Availability of sulfhydril groups
CO2 tension
Wednesday, January 11, 2012
5. Histoplasma capsulatum
Dimorphic
Mycelial phase: 25° C
Macroconidia
(8-14μm)
Microconidia
(2-4μm)
Wednesday, January 11, 2012
6. Histoplasma capsulatum
At 37°C or at body
temperature =
budding yeast 2-3 x
3-4 μm
Found predominantly
in histiocytes
Wednesday, January 11, 2012
7. LIFE CYCLE
soil with high nitrogen content, associated with the
guano of bats and starlings
rotting guano mixed with soil & feathers of the birds
open environment, soil is nitrogen rich with a rainfall
of 35-50 inches and 67-87% relative humidity
caves, the main habitat of bats, which are the
reservoir of Histoplasma capsulatum
Wednesday, January 11, 2012
9. CLASSIFICATION OF
HISTOPLASMOSIS
TYPE OF SPECIFIC
COMMENTS
INFECTION DISORDER
• Asymptomatic or
• Occurs with
mild like flu
normal exposure
illness
• Acute pulmonary • Occurs with
Normal Hosts
histoplasmosis heavy exposure
• Pericarditis,
• Rare
mediastinal
complications
fibrosis
Wednesday, January 11, 2012
10. CLASSIFICATION OF
HISTOPLASMOSIS
TYPE OF SPECIFIC
COMMENTS
INFECTION DISORDER
• Occurs in
• Disseminated individuals who
histoplasmosis have an immune
Opportunistic defect
Infection • Occurs in
• Chronic
individuals who
pulmonary
have a structural
histoplasmosis
defect
Wednesday, January 11, 2012
11. CLASSIFICATION OF
HISTOPLASMOSIS
TYPE OF SPECIFIC
COMMENTS
INFECTION DISORDER
• Occurs in
• Disseminated individuals who
histoplasmosis have an immune
Opportunistic defect
Infection • Occurs in
• Chronic
individuals who
pulmonary
have a structural
histoplasmosis
defect
Wednesday, January 11, 2012
12. CLINICAL FORMS & SYMPTOMS
TYPE OF INFECTION SPECIFIC DISORDER
• Asymptomatic or flu-like syndrome
Primary acute • Chest pain, shortness of breath and hoarseness
• Radiologically, discrete lung lesion may or may not develop
• Large pulmonary lesions develop
Chronic cavitary • lesions may exist in a relative quiescent state
• Often mistaken for tuberculosis
• Only small percentage progress into this clinical forms
• Disease of reticuloendothelial system in which organs infection may
Severe disseminated develop
• In massive dissemination, it could be fatal
Wednesday, January 11, 2012
14. LABORATORY DIAGNOSIS
Direct Examination:
KOH; Wright/Giemsa
Culture: SDA; Smith and
Goodman (for
contaminated specimen);
Yeast Extract = place the
CM in a plastic bag
Wednesday, January 11, 2012
15. LABORATORY DIAGNOSIS
Skin test with
histoplasmin Ag
CF test
Immunodiffusion
test
Wednesday, January 11, 2012
16. TREATMENT & PREVENTION
Amphotericin B for
disseminated infection
Itraconazole for
immunocompromised
patients
Cleaning of bat
droppings
Wednesday, January 11, 2012
18. Blastomyces dermatitidis
MYCELIAL FORM
The mycelial phase at 25° C showed typical
pyriform microconidia , which are about 2-4
microns in diameter.
YEAST FORM
At 37° C and at body temperature, this
organism is a yeast 8-15 microns in diameter.
Buds are produced singly and are attached to
parent cell by broad base.
Wednesday, January 11, 2012
19. LIFE CYCLE
The mode of transmission: inhalation of the
spores or the microconidia
Natural habitat: remains an enigma
Favors environment with high nitrogen
content, acid pH, abundant moisture, and
perhaps enriched with animal excreta
Wednesday, January 11, 2012
21. BLASTOMYCOSIS
Chicago Disease = Gilchrist’s disease = North American Blastomycosis
Wednesday, January 11, 2012
22. CLINICAL FORMS SYMPTOMS
Pulmonary • Fever, cough and hoarseness
• Productive cough, fever and weight loss
after several months
• Radiographically resembles tuberculosis
Systemic • Extension of pulmonary form
• Common sites of involvement are liver
and spleen
• Granulomatous lesions are present
Cutaneous • Indicates systemic disease
• May result from direct inoculation from
the soil
Wednesday, January 11, 2012
23. TESTS IMPORTANT FEATURES
1. Direct Microscopic 20% KOH
• specimen is sputum for pulmonary form
and skin for cutaneous form
• Biopsy material can also be used
• Look for the presence of broad based
buds
2. Culture Saborauds, Mycosel or Mycobiotic Agar
• Fluffy, whitish brown fungus with pyriform
spores
• Culture is not routinely done
3. Skin Test Blastomycin
• Has a tendency of high cross reactivity
• Little diagnostic value
Wednesday, January 11, 2012
25. TREATMENT & PREVENTION
Amphotericin B has been used but with erratic
results
2-hydroxystilbamidine
Ketoconazole, less nephrotoxicity
Prevent fomite inhalation in endemic
area
Wednesday, January 11, 2012
26. Coccidioides immitis
Amphotericin B has been used but with erratic results
Asexual phase: Coccidiodes immitis
Sexual phase: not known
MYCELIAL STAGE (25°C)
septate hyphae mature in a manner such that alternate cells
develop into arthroconidia being separated by vacuolized cells
arthroconidia separate readily and have a “barrel” shape
appearance
Wednesday, January 11, 2012
28. Coccidioides immitis
YEAST FORM
In tissue and at body temperature:
Develops into spherules (sporangia;
10-60μm) filled with endospores (2-5μm)
Wednesday, January 11, 2012
30. COCCIDIOMYCOSIS
Posada’s Disease = San Joaquin Valley Fever = Desert Rheumatism
TREATMENT & PREVENTION
Generally difficult to manage
regardless of drug use
Amphotericin B is the drug of choice
Itraconazole and fluconazole have
been tried with little success
Prevent spores inhalation
Wednesday, January 11, 2012
31. CLINICAL FORMS SYMPTOMS
Primary Pulmonary • Occurs 7-28 days after inhalation of
single spore
• Positive skin test
• Flu-like fever, malaise and cough
• 10% develop erythrema nodosum or
erythrema multiforme
Benign Form • Precipitin and complement fixation titers
appear
• Development of well defined lung
cavitation
• Exist for years and could be unnoticed
Disseminated Form • 1 in 500 patients progressed into this
state
• Fungi spreads into various organs
• Prognosis is grave
Wednesday, January 11, 2012
32. TESTS IMPORTANT FEATURES
1. Direct Microscopic 10-20% KOH
• sputum, tissue or skin are used as specimen
• look for the presence of spherules
2. Culture Saboraud’s medium with or without antibiotics
• room temperature, white fluffy fungus
• arthrospores are dangerous to work with
• Never try the organism in the petri dish but always
on the bottle or test tube
• Examine on the 3rd or 4th day, but must kill
organisms with formalin before attempting to
make an LPCB mount
• Can prepare exoantigen
3. Others Skin test
• conversion back to skin test positive (anergy) is an
indication of grave prognosis
Wednesday, January 11, 2012
34. Paracoccidioimycosis brasiliensis
Dimorphic
Mycelial stage (25°C): no
typical sporulation
Yeast stage (37°C): with
several budding cells
attached to the parent cell,
some in a “mariner’s
wheel” arrangement
about 2-30μm
Wednesday, January 11, 2012
35. LIFE CYCLE
Transmitted by inhalation of
the spores
Restricted to South and Central
America
Isolated in acidic soil and its
growth requires increased
humidity
natural habitat remains to be
elucidated
Wednesday, January 11, 2012
37. PARACOCCIDIODOMYCOSIS
South American Blastomycosis = Lutz-
Splendore-Almeida’s Disease
A chronic granulomatous disease of skin,
mucous membranes, lymph nodes and internal
organs
Central and South America more specifically in
Brazil
Wednesday, January 11, 2012
38. PARACOCCIDIODOMYCOSIS
Females are as susceptible to infections as males,
but the incidence of clinical disease in males is
nine times higher
Primary pulmonary disease is often inapparent
Disseminated disease often causes ulcerative
lesions of the buccal, nasal and occasionally
gastrointestinal mucosa.
Wednesday, January 11, 2012
39. TESTS IMPORTANT FEATURES
1. Direct Microscopic 10-20% KOH
• 1-2 drops are used
• demonstration of multiple budding yeast
2. Culture Saboraud’s
• At room temperature it grows a non
spore forming septate fungus
Brain Heart Infusion at 35° C
• It produces yeast that is seen in tissue
3. Others • Paracoccidioidin skin test
• Complement fixation test
• Immunodiffusion test
Dr. Supachai Basit
Wednesday, January 11, 2012
40. TREATMENT & PREVENTION
Amphotericin B
Itraconazole
Long term therapy is required
Prevent inhalation of dust in endemic
area
Wednesday, January 11, 2012
41. Cryptococcus neoformans
Monomorphic:
always in yeast form
whether at 25° or at
37° C.
Unique feature: acidic
mucopolysaccharide
capsule
Wednesday, January 11, 2012
42. LIFE CYCLE
The etiologic agent of cryptococcosis has been
recovered in large numbers from the excreta
debris of pigeon roosts, thus it appears to survive
well in a dessicated, alkaline, nitrogen-rich and
hypertonic environment
There is a close relationship to the habitats of
pigeon, but the organism does not infect the bird
Wednesday, January 11, 2012
44. CRYPTOCOCCOSIS
Busse-Buschke’s Disease, Torulosis, European
Blastomycosis
The disease is worldwide in distribution.
This yeast has been repeatedly isolated from sites
inhabited by pigeons, particularly their roosts and
droppings.
Pigeons are not naturally infected.
Wednesday, January 11, 2012
45. CRYPTOCOCCOSIS
Primary pulmonary cryptococcosis is usually
inapparent but may be chronic, subacute or acute.
The clinical entity is most often seen in
cryptococcal meningitis.
Osseous and cutaneous disease can be present
without apparent neurologic involvement.
Wednesday, January 11, 2012
48. TESTS IMPORTANT FEATURES
1. Direct Microscopic India Ink Stain
• Cerebrospinal fluid (CSF) is used as
specimen
• The organisms appear as yeast about
8-12 microns in diameter, which are
usually surrounded by clear capsules
2. Culture Saboraud’s medium with or without
antibiotics
• either at room temperature or at 35° C,
the colonies develop after 1-3 weeks
incubation as shiny, slimy, light tan
yeast colonies
3. Others Latex Agglutination Test
Urease Test Positive
Dr. Supachai Basit
Wednesday, January 11, 2012
50. TREATMENT & PREVENTION
Amphotericin B in combination with
5-fluorocytosine have been successful
Fluconazole is as effective too
Clean pigeon droppings
Avoid visiting caves without protective
gears
Wednesday, January 11, 2012
