SYSTEMIC MYCOSIS

DIMORPHIC FUNGI
BASICS
DR.T.V.RAO MD

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Dr.T.V.Rao MD
 SYSTEMIC MYCOSIS
Deep seated fungal
infections
Inhalation of air borne
spores produced by casual
moulds
Present as saprophytes in
soil and on plant material
They are caused by
Dimorphic fungi
Occurs mainly American
continent.

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Dr.T.V.Rao MD
 IMPORTANT FUNGI IN SYSTEMIC
MYCOSIS
Coccidioidomycosis.
Histoplasmosis
Blastomycosis
Paracoccidioidomycosis.
Others can also manifest with systemic
infection ( Not Dimorphic )
Aspergillus,Candida,Cryptococcus spp
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 HISTOPLASMOSIS AND
COCCIDIOIDOMYCOSIS
Histoplasmosis and Coccidioidomycosis
are similar fungal organisms that both
produce a disease that resembles
tuberculosis . Both are caused by fungi
that grow as spore producing hyphae at
environmental temperatures, but as
yeasts (spherules or ellipses) at body
temperature within the lungs.

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Dr.T.V.Rao MD
 COCCIDIOIDOMYCOSIS
Coccidioidomycosis is initially, a respiratory
infection, resulting from the inhalation of
conidia, that typically resolves rapidly leaving
the patient with a strong specific immunity to
re-infection. However, in some individuals the
disease may progress to a chronic pulmonary
condition or to a systemic disease involving
the meninges, bones, joints and subcutaneous
and cutaneous tissues.

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Dr.T.V.Rao MD
 COCCIDIOIDOMYCOSIS
Dimorphic fungi
present in soil
Coccidioides imitis,
Prevalent in USA and
Mexico
Dark skinned and
Agricultural workers,
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 COCCIDIOIDOMYCOSIS

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 CULTURING
In culture / Soil as molds
Barrel shaped Arthoconida
Disperses through wind.
In the lungs arthoconida
becomes spherules 30-60
microns
Contains end spores.

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 PATHOGENESIS
C.imitis can be asymptomatic
or self limited.
Pulmonary involvement.
Fatal illness
Pulmonary 7-28 days
Skin rashes
Chronic cavitation's,
Pulmonary infection
Local infection

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 DEVASTATING LESIONS ARE
PRODUCED

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 PATHOGENESIS ( CONT )
Generalized infection in
immune suppressed.
Organ transplant recipients
Lymphoma patients
AIDS
CNS Skin, Joints,
Poor prognosis in immune
suppressed and Meningitis
patients.

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 LABORATORY DIAGNOSIS
Microscopy
Sputum Pus, Biopsy,
Mature spherules,
Grown in test tube slopes at 25 -30 c 3 weeks
Morphology
thick walled Arthoconida
Fine Septate hyphae.
Arthoconida are highly infectious.
Skin test with Coccid odes

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 SEROLOGY
Precipitation test.
Latex
agglutination test.
Complement
fixation test.

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 TREATMENT
I V Amphotericin
B
Fluconazole,
Itraconazole

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 HISTOPLASMOSIS

Histoplasmosis is an intracellular mycotic

infection of the reticuloendothelial system
caused by the inhalation of conidia from the
fungus Histoplasma capsulatum.
Histoplasmosis has a world wide distribution,
however, the Mississippi-Ohio River Valley in
the U.S.A. is recognized as a major endemic
region. Africa, Australia and parts of East Asia,
in particular India and Malaysia are also
endemic regions

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 HISTOPLASMOSIS
Soil – Enriched with Bird
droppings and Bat
droppings,
Spread through inhalation of
spores
Prevalent in Eastern USA –
95%
Causative agent
Histoplasma duboisii,

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 CLINICAL MANIFESTATIONS:

Approximately 95% of cases of

Histoplasmosis are in apparent,
subclinical or benign. Five percent of
the cases have chronic progressive
lung disease, chronic cutaneous or
systemic disease or an acute
fulminating fatal systemic disease. All
stages of this disease may mimic
tuberculosis.

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 LUNG INVOLVEMENT A MAJOR
MANIFESTATION IN HISTOPLASMOSIS

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 CULTURING
Grows as mould at 25 – 30 c
Animal tissues as Yeast and 37
c
Grows in Blood agar, Enriched
medium
Sabouraud dextrose agar
Mould looks fluffy, wheat brown
colored.
Produce Unicellular, asexual
spores
Tuberculate Microcondia 8-14
microns

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 PATHOLOGY
Active influenza like illness
Calcified lesions in lungs,
Lung cavities develop.
Looks like Tuberculosis
Wide spread infection in RES
Disseminated infection in infants and old age.
Aggregation in Neutropenia and Hematological
malignancies,

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 LABORATORY DIAGNOSIS
Microscopic appreance in
sputum,pus,
Giemsas staining
Blood cultures,
Liver and lung biopsy,
Culturing on Sabouraud agar
at 37 and 25-30 c 1-2 weeks
Recognize Macrocondia and
Micro conidia

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 LABORATORY DIAGNOSIS
Culture at 37 c shows
yeast phase
Mold form at 25-30 c
Skin test Histoplasmin
Serology titers above 1in
8 > 32
CF test. Radio
immunoassay
ELISA

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 BLASTOMYCOSIS

Blastomycosis is a chronic granulomatous and

suppurative disease having a primary
pulmonary stage that is frequently followed by
dissemination to other body sites, chiefly the
skin and bone. Although the disease was long
thought to be restricted to the North American
continent, in recent years autochthonous
cases have been diagnosed in Africa, Asia and
Europe.

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 BLASTOMYCOSIS
Prevalent in USA and
Canada
Caused by Blastomycosis
dermatitidis,
Inhalation of spores,
Men between 30 to 50
years are affected,
Cool wet climate
condition

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 MORPHOLOGY
Blastomycosis dermatitidis-
Dimorphic fungus
Mould Septate mycelium 25 –
30 c
Asexual conidia
Conidia are 2-10 microns /
Dumbbell shaped
Yeast at 37 c with broad based
buds

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 PATHOLOGY
Pulmonary forms
Disseminated to other
organs,
X rays looks like
Tuberculosis / Carcinoma
Cutaneous lesions occur
80% patients with
pulmonary infection

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 LABORATORY DIAGNOSIS
Microscopy – pus
Scrapping from the lesions sputum
Thick walled yeast cells 8- 15 microns
Buds on broad base.
PAS / Methenamine silver stain,
Sabouraud dextrose agar – Blood agar,
Retained for 6 weeks
Grow in test tubes,
ELISA test

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 TREATMENT
I V Amphotericin
B
Itraconazole
Ketaconazole

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 PARACOCCIDIOIDOMYCOSIS

Paracoccidioidomycosis is a chronic
granulomatous disease that characteristically
produces a primary pulmonary infection, often
in apparent, and then disseminates to form
ulcerative granulomata of the buccal, nasal and
occasionally the gastrointestinal mucosa.. The
only etiological agent, Paracoccidioides
brasiliensis is geographically restricted to
areas of South and Central America

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 PARCOCCODIOMYCOSIS
Chronic granulomatus infection
Paracoccodioides brasilensis,
Lungs- Mucosa – Skin –
Lymphatic vessels
Enter through the lungs
Saprophytic in nature,
Humid forests of South and
Central
Common in 20 – 40 years,

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 MORPHOLOGY
Mycelium at 25 – 30 c
Yeast forms at 37 c
Conversion from mycelial
forms to yeast.
The yeast forms consists of
Oval or globose cells 2- 30
microns, in diameter, with
small buds attached by a
narrow neck encircling the
parent cells.

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 PATHOGENESIS
Ulceration ,
Granulomatous
infection of oral Nasal
Mucosa
Lymphatic system
spleen, Intestines
Liver involvement

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 LABORATORY DIAGNOSIS
Microscopy – Sputum , Pus,
Biopsy of glaucomatous lesions
Presence of Numerous multipolar budding
cells is diagnostic
Staining with PAS / Silver methenamine
Cultures kept for 6 weeks
25 c moulds
37 c yeasts
Serology Precipitation tests, Complement
fixation

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 TREATMENT
Amphotericin B
Oral Ketaconazole,
Itraconazole.

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Email
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