MIC112
SYSTEMIC MYCOSES
Name: DE LOS SANTOS, FAITH JOY T.
Fungi MOT/Habitat
Blastomyces dermatitis • MOT: INHALATION of spores
from the air,
• Habitat: Central United States
(Mississippi and Ohio River
basins), Canada, Africa and India
Histoplasma capsulatum MOT: Inhalation of the microconidia
of Histoplasma capsulatum var.
capsulatum.
• Habitat: Worldwid, Highest
endemicity in the United States
occurs in the Ohio, Missouri, and
Mississippi river deltas
• Organism resides in soil with a
high nitrogen content, particularly • 2 to 3 µm × 4 to 5 µm
in areas heavily contaminated with • When smears are stained
bat and bird guano.
Paracoccidioides • Central and South America.
brasiliensis Geographic areas of highest
incidence are typically humid,
high-rainfall areas, with acidic soil
conditions.
Microscopic appearance
Yeast
! !
• 8-15um
• Double-contoured wall
• buds connected by broad
base
• spherical
! • Chronic pulmonary histoplasmosis in patients with
with Giemsa or Wright stain,
the yeast cells are commonly
seen within monocytes and
macrophages
! leathery, wrinkled to folded,
• 15 to 30 µm in diameter with
multipolar budding at the
periphery resembling a
mariner’s wheel.
• Daughter cells (2 to 5 µm)
connected by a narrow base
• “Mickey Mouse cap”
Section: 3MT01
Microscopic appearance Mold
• 2-10 um
• Conidia are borne on lateral
branches that are ovoid to
dumbell-shaped
! chronic obstructive pulmonary disease
• Microconidia can resemble
Chrysosporium spp.
• Macroconidia resemble
Sepedonium spp.
• White to brownish
• Pyriform microconidia
measuring 2 to 5 µm
! blastomycosis, Brazilian blastomycosis, Lutz-
• Flat colonies are glabrous to
occose to velvety, pink to
beige to brown with a
yellowish brown reverse
• small (2 to 10 µm in
diameter), one-celled conidia
Disease associated
• Primary infection: Flu-like symptoms
• Pulmonary disease with cough, weight loss, chest pain
and fever.
• Progressive pulmonary or invasive disease
• ulcerative lesions of the skin and bone
• Gilchrist disease, North American Blastomycosis,
Chicago disease.
• Host with intact immune defenses: infection is limited
and is usually asymptomatic, with the only sequelae
being areas of calcification in the lungs, liver, and
spleen.
• Heavy exposure: acute pulmonary disease
• Immunocompromised individuals: progressive and
potentially fatal disseminated disease.
• mediastinitis, pericarditis, and mucocutaneous lesions.
• H. capsulatum var. capsulatum: reticuloendothelial
cytomycosis, cave disease, spelunker’s disease, and
Darling disease.
• Pulmonary
• asymptomatic
• Ulcerative granulomatous lesions of the buccal, nasal,
and occasionally gastrointestinal mucosa.
• Paracoccidioidomycosis (South American
Splendore-Almeida disease, paracoccidioidal
granuloma)
Date:03142017
Laboratory Test
• Examination of tissue or purulent material in
cutaneous skin lesions
• 10% Potassium Hydroxide
• Calcofluor white
• Culture:
• At 22° C (white, tan, or brown and may be fluffy to
glabrous with raised areas-spicules seen in the centers
of the colonies)
• At 37° C (on suitable media it produces a
characteristic, broad-based, budding yeast cells.
• Confirmatory identification, typically by DNA probe:
mycelial phase of the systemic dimorphic fungi
• Skin testing
• Conversion of the mold form to the yeast form, using
brain-heart infusion (BHI) agar incubated at 37°C,
• Direct antigen detection and serologic procedures
• Enzyme immunoassay (EIA) methods
• Complement fixation, immunodiffusion, and latex
agglutination to detect circulating antibody
• Fluprescent Antibody microscopy to detect viable or
nonviable fungal elements in tissue sections
• Most useful serologic application combination of
complement fixation and immunodiffusion tests
• Direct microscopic examination of cutaneous and
mucosal lesions
• Growth on BHI blood agar at 37° C, the mycelial
phase rapidly converts to yeast phase.
 Coccidioides immitis MOT: Inhalation
C. immitis is usually found only in
the United States in the desert
Southwest, north- ern Mexico, and
Central America.
Semiarid regions— southwest
United States, Mexico, Central
and South America In soil
Penicillum marneffei • Endemic to Southeast Asia,
particularly the Guangxi Zhuang
Autonomous Region of the
People’s Republic of China. P.
marneffei has been associated with
the bamboo rat (Rhizomys
pruinosus) and the Vietnamese
bamboo rat (Rhizomys sinensis).
References:
Mahon, C. R., et al (2014). Diagnostic Microbiology (Fifth Edition), Elsevier, Missouri.
Tille, P.M., (2014), Bailey & Scott’s Diagnostic Microbiology (Thirteenth Edition), Elsevier, Missouri.
! • Alternating one-celled,
• nonbudding, thickwalled
spherule
• 20 to 200 µm
• Contains either granular
material or numerous small
(2 to 5 µm in diameter),
• nonbudding endospores
• Empty and collapsed “ghost”
spherules may also be
present
! !
• Resemble those of H.
capsulatum
• Oval to cylindric
• 3 to 6 µm long
• May have a cross wall.
• Pulmonary Infection • Direct smear examination of secretions
• Skin Infection • Direct antigen detection methods
• Osteomyelitis • Microscopic examination of the culture
• Meningitis
• Arthritis
• Disseminated Infection
!
“barrel-shaped” arthroconidia
with disjunctor cells
• Systemic infection in immunocompromised patients • Isolated from cutaneous lesions,
• Disseminated infections with multiple organ • Yeastlike cells can be detected in Wright-stained
involvement. smears from skin lesions or biopsy specimens
• Polymerase chain reaction tests
• Serologic (important in early diagnosis)
• Culture: Described as having
sparse green aerial and
reddish brown vegetative
hyphae and production of a
red diffusible pigment.
 MIC112
OPPORTUNISTIC MYCOSES
Name: DE LOS SANTOS, FAITH JOY T. Section: 3MT01 Date:03142017
Fungi MOT/Habitat Colonial Appearance Microscopic Appearance (Picture with Disease associated Laboratory Test
description)

Absidia • ubiquitous in nature • Rapidly growing • Disseminated disease from a

• can be isolated from soils and
decaying vegetation
• White to a grayish-brown cutaneous site with pulmonary,
• Woolly texture gastrointestinal, and cerebral
involvement
• Congenital heart disease
• Fungal pneumonitis

!
• Aseptate hyphae (rare septa)
• 6 – 15 µm in diameter.

Mucor • Commonly isolated from the • Growing rapid and form cottony • Rhinocerebral Infection Calcofluor white
environment worldwide • Dirty white colonies that become • Pulmonary Infection Potassium hydroxide preparation.
mousy brown to gray with age. • Gastrointestinal Infection Nucleic Acid Amplification
• Mycotic Keratitis Cultivation
• Intraocular Infection
• External Otomycosis
• Orbital Cellulitis
• Disseminated Infection
!
• Sporangiophores arise alone or in
groups from the aerial hyphae
• Sporangia are about 20 – 90 µm in
diameter are spherical to pyriform in
shape..

Rhizopus • worldwide distribution, this isolate is • Fluffy • Rhinocerebral infection, pulmonary

easily recovered from the environment • White to gray or brown hyphal growth infection, mycotic keratitis, intraocular
in decaying vegetation. • Ressembles cotton candy and that infection, orbital cellulitis, external
diffusely covers the surface of the agar otomycosis, disseminated infection
within 24 to 96 hours

!
• Large, ribbonlike (10-30 µm), twisted
• Aseptate hyphae may be present; septa
occasionally may be seen
• Sporangium on sporangiophore
• unbranched sporangiophores
• Umbrella-like
Aspergillus • MOT: Inhalation of fungal conidia.
• Second most isolated fungus after
Candida spp. Aspergillus fumigatus is
the species most commonly isolated
• A. fumigatus was linked to at least one
case following the use of injectable
steroids.
• Most cases in this multistate out-
break were caused by Exserohilum
rostratum, a common mold found in
soil and on plants.
Culvularia • Inhalation of Conidia
• Decaying vegetation
Fusarium • Temperate and tropical regions of the
world
Geotrichum • Soil
• Water,
• Plants
• black to white and include yellow, • Neutropenia • wet mounts
brown, green, gray, pink, beige, and • disease in bone marrow transplant • Gram stain
tan recipients in addition to other cancer • lankophor or Calcofluor mixed with
• Granular texture and transplantation patients 10%–20% potassium hydroxide
• Most known pathogens in this group • pneumonia-like symptoms (KOH)
form green- to tan-colored colonies. • Aspergillosis • Aspergillus precipitin tests
• Multiorgan system involvement,
including the brain, liver, heart, and
! bone.
• Uniseriate species-phialides attach • Allergic reactions
directly to the vesicle at the end of the • Fungus balls in the lungs (agricultural
conidiophore workers who routinely are in contact
• Biseriate species-possess a supporting with fungal conidia)
structure called a metula.
• Rapidly growing phaeoid colony • Allergic reaction • IgE Antibody Test
• Dirty gray to Black • Hay Fever
!
• Cresent-Shaped sonidia
• 3-5 cells of unequal size
• Enlarged central cell
• Sparse to abundant cottony mycelium • mycotic keratitis
with colony colour • high fever
• Pale violet, dark violet to peach-violet. • disseminated skin lesions
• fungemia. usarium spp. are easily
recovered in blood culture system
• Panama Disease of Banana
!
• Abundant macroconidia with fewer
microconidia are produced on
vegetative hyphae
• Banana- or canoe-shaped
• Macroconidia typically are
multicelled.
• white to cream, yeastlike, • pulmonary disease in • Sputum Examination
immunocompromised patients • Lesion Scrapings
• Selective Isolation Method
!
• abundant arthroconidia formed from
the vegetative hypha that occurs singly
or may be branched
 MIC112
OPPORTUNISTIC MYCOSES
Name: DE LOS SANTOS, FAITH JOY T. Section: 3MT01 Date:03142017
Fungi MOT/Habitat Colonial Appearance Microscopic Appearance (Picture with Disease Associated Laboratory Test
description)

Cryptococcus neoformans
• Mot: Inhalation
• Immunocompromised Patients
Suffering From Infection Die Each
Year, With An Estimated 500,000 In
Africa Alone.
• Pasty, smooth to mucoid
• cream coloured colonies on Sabouraud
dextrose agar
! •
• Exhibit Great Variation In Size
• Usually Spherical But May Be
Football Shaped;
• Buds Single Or Multiple And
“Pinched Off”; Capsule May
• Pseudohyphal Forms With Or Without
A Capsule May Be Seen In Exudates
Of Cerebrospinal Fluid
• Pulmonary Infection, • Microscopic examination
• Meningitis • Rapid urease test
• Osteomyelitis • Failure to utilize an inorganic nitrate
• Fungemia substrate
• Disseminated Infection • Substrate utilization patterns
• Endocarditis • Pigment production on niger seed
• Skin Infection (thistle or birdseed) agar
• Mycotic Keratitis • Diagnosis is typically made by
Orbital Cellulitis identifying the encapsulated yeast in
• Endophthalmic Infection the spinal fluid using India ink
• serological techniques for the
detection of the cryptococcal
polysaccharide capsule
glucuronoxylamannan (GXM) may be
completed using latex agglutination or
enzyme-linked immunosorbent assay
(ELISA)

Candida spp. • Direct invasion/ dissemination • Smooth, Glabrous • Candidiasis (oroesophageal • production of germ
C. albicans • C. albicans-most commonly isolated • Creamy White candidiasis, intertriginous candidiasis) • tubes or chlamydoconidia
C. glabrata yeast • Paronychia-infection of the tissues • CHROMagar Candida
C.tropicalis • Caused by endogenous yeasts or may surrounding the nails, and • Urease Test
be acquired in the hospital onychomycosis is an infection of the
nail and nail bed
• Thrush-infection of the mucous
membranes in the mouth
! • Paronychia, onychomycosis, perlèche
• Budding yeast cells (blastoconidia) respiratory infections, vulvovaginitis,
• 2 to 4 µm in diameter thrush, pulmonary infection, eye
• pseudohyphae infection, endocarditis, meningitis,
• regular points of constriction, fungemia or candidemia, or
resembling links of sausage. disseminated infection

References:
Mahon, C. R., et al (2014). Diagnostic Microbiology (Fifth Edition), Elsevier, Missouri.
Tille, P.M., (2014), Bailey & Scott’s Diagnostic Microbiology (Thirteenth Edition), Elsevier, Missouri.