MYCOLOGY

Medical Microbiology (Lecture)

BS Biology 4-5 | Dr. Diaz | 1st Sem 2023-2024

C. YEASTS VS. MOLDS

I. MYCOLOGY
● Yeasts
A. CHARACTERISTICS ○ Exists as unicellular and budding
○ Morphology:
● Eukaryotic ■ Unicellular
○ Ribosome - 80s ■ Round
■ Non Filamentous
Form Fungi Bacteria ○ Capable of forming Pseudohyphae
○ Colonies:
Cell type Eukaryotic Prokaryotic ■ Moist, creamy or buttery with an alcohol like
odor
Cell membrane Sterols present Sterols absent ○ Can be identified by Biochemical Test
(Ergosterols) (except in ○ Presence of:
Mycoplasma) ■ Blastospores
■ Chlamydospore
Cell wall Chitin present Peptidoglycan ➢ Also called as “Resting spore”
present ➢ In times of drought or low nutrients, fungi
can survive by using the chlamydospore.
● Mykes
○ Study of fungi
● Thallophytes Unique Structure Definition

● Nonmotile Pseudohyphae Seen in Candida albicans

● Rigid cell wall when grown at 20℃
○ Chitin
○ Sterol cell membrane Germ tube Seen in Candida albicans
● Heterotrophic & Non-photosynthetic or when grown at 37℃
Achlorophyllous
○ Not having any chlorophyll ● Molds
○ Unable to engage with photosynthesis ○ Consists of hyphal elements
● Mostly obligate or facultative aerobes ○ Morphology:
■ Multicellular
● Dimorphism ■ Filamentous
○ Fungi can exist either as yeast or molds ○ Capable of forming Hyphae
■ Depending on the temperature and the needs ○ Colonies:
of the environment ■ Dry with velvety surface
○ Can be identified by the appearance of spores
■ Yeast form and hypha
➢ Range of temperature is 35-37℃
➢ Resembles human body temp
■ Mold form
➢ Range of temperature is 25℃ II. FUNGAL STRUCTURES
➢ Resembles room temp
A. SPORES
○ Dimorphic Switching
● Can be formed through sexual process (via meiosis)
■ Switching from yeast form to mold form and
or asexual process (via mitosis)
vice versa
● Important feature for speciation of a certain fungal
organism
B. CELL WALL AND MEMBRANE
● Contains a phospholipid bilayer like bacteria ● Sexual spores
● Contains ergosterol instead of cholesterol ○ Ascospores: Phylum Ascomycota
○ Antifungal drugs targets this sterol to penetrate ○ Basidiospores: Phylum Basidiomycota
the cell wall and cell membrane ○ Zygospores: Order Mucorales
● Composed of mannoproteins, ɑ- and β-glucan, and
chitin ● Asexual spores
○ Differentiating factor: size or method of production
■ Via size differentiation:
➢ Microconidia: small spores
➢ Macroconidia: large or multicellular
■ Via method of production
➢ Chlamydoconidia
★ From terminal or intercalary
hyphae.
➢ Phialoconidia
★ From vase-shaped conidiogenous
cells called Phialides.
➢ Blastoconidia
★ From budding yeast
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 ➢ Arthroconidia
III. FUNGAL REPRODUCTION
★ From fragmentation of hyphal cells
➢ Sporangiospores
★ Characteristic asexual spores of the
order Mucorales.

B. SPORANGIUM
● Receptacle or enclosure where spores are being
formed
● For asexual spore reproduction.

C. STOLON
● An occasionally septate hyphae
● Connects sporangiophores together

D. HYPHAE
● Filamentous elements or tube-like elements in the
fungal structure that make up the body of the fungus.
● Usually consists of chitin and glucan.
● Can be seen in molds which can grow in cold
environments (in bread, utensils, pillows, etc.), and in ● Sexual Reproduction
yeasts. ○ It involves the vegetative form of fungi or the
● Structural unit of most fungi. mycelium
○ Involves fusion of two mycelia
● Septate Hyphae ■ Haploid to diploid to spore formation
○ Divisions are seen in the hyphal structures
(septated) ● Asexual Reproduction
○ Seen in molds ○ The mycelium will enter mitosis producing the
spores and the spores will undergo germination
● Ceonocytic Hyphae
○ Divisions are not seen in the hyphal structures
○ Non-septated
○ Seen in molds IV. LABORATORY DIAGNOSIS

A. SPECIMEN COLLECTION AND HANDLING

● Pseudohyphae
○ “Not hyphae”
● BSC II
○ Ellipsoid in shape that can be described as that
buds off a true hypha.
● 10% KOH
○ Seen in many yeast species.
○ KOH dissolves any tissue cells.
○ Makes the highly refractory fungal cells more
● Hyaline Hyphae
visible.
○ Nonpigmented or lightly pigmented hyphae.
■ Dissolve keratin to easily visualize fungal
elements.
● Dematiaceous (Phaeoid) Hyphae
○ Initial examination of keratinized tissues.
○ Darkly pigmented due to the presence of
melanin in the cell wall.
○ Preparation:
■ Add a small amount of specimen to one gram
of KOH (press cover slip)
■ Warm the slide to hasten clearing
➢ Hair samples can be examined if
infection is endothrix or ectothrix.

B. STAINING

● India Ink
E. SPORES
○ Also known as Nigrosin
● Conidiospores ○ Used “negative staining”
○ The head is the conidiospore ■ Highlight the heavily thickened capsule of
○ The stalk is the conidiophore Cryptococcus neoformans.
○ One conidiospore is capable of producing one ○ Used for capsule demonstration.
mycelium
● Gomorimethenamine silver (GMS)
● Blastospores ○ Stains fungal cell wall black
○ Also called new yeast bud ○ Used to stain Pneumocystis carinii
○ Spores attached to pseudohyphae
● Mucicarmine stain
● Chlamydospore (Resting spore) ○ Stains fungal capsule red
○ In times of drought or low nutrients, the fungi ○ Used to stain Cryptococcus neoformans
can survive using the chlamydospore

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● Giemsa or Wright Stain
Hyphae (nonseptate) Mucormycosis (species of
○ Best for filamentous fungi and yeasts
Rhizopus, Lichtheimia,
○ Recommended stain for Histoplasma
Cunninghamella, etc.)
■ Found in blood and bone marrow
Hyphae (septate); brownish Phaeohyphomycosis
● Calcofluor White
cell walls (species of Bipolaris,
○ Stains fungal cell wall and makes it fluorescent
Cladosporium, Curvularia,
○ Binds to the components of cell wall specifically
Exserohilum, etc.)
the chitin and cellulose
○ Upon using wood’s lamp, it will fluoresce
Yeasts and pseudohyphae Candidiasis (species of
○ Best in detecting viable fungal elements
Candida)

C. AGAR Yeasts and Hyphae in skin Pityriasis versicolor

scrapings
● Sabouraud’s Dextrose Agar (SDA)
○ Fungal infections need requests for culture to Spherules Coccidioidomycosis
determine the specific fungi that cause the
disease. Sclerotic cell (brownish cell Chromoblastomycosis
○ The standard culture for isolation of fungal agents. walls)
○ Different fungi appear differently in SDA.
Sulfur granules Mycetoma
○ Candida albicans
■ Pasty opaque, slightly dome, smooth and Arthroconidia in hair Dermatophytosis
cream or white colonies
○ Aspergillus flavus Conidia in pulmonary cavity Hyalohyphomycosis
■ Yellow green powdery on front and pale (species of Aspergillus,
yellowish on reverse (plate flipped on the Fusarium, etc.)
other side)
○ Aspergillus fumigatus Cysts (asci) in pulmonary Pneumocystis jirovecii
■ Bluish green powdery colonies on front and specimens
pale yellow on the reverse

● Inhibitory Mold Agar (IMA)

○ Used to enhance the recovery of fungi from V. FUNGAL PATHOGENESIS
clinical experiments

● Two types of host response

D. OTHER TESTS
○ Granulomatous
○ Pyogenic
● Serological Testing
○ Helpful among immunocompetent ● Some can be detected by using skin tests for delayed
○ Positive antibody test hypersensitivity reaction
■ May confirm the diagnosis ● Reduced cell-mediated immunity predisposes to
○ Negative antibody test disseminated disease
■ May exclude the diagnosis
● Mycotoxins
● Molecular Methods ○ Exotoxins produced by fungi
○ PCR ■ Aflatoxins
○ MALDI-TOF-MS ➢ Produced by Aspergillus flavus
■ Matrix-assisted laser desorption ■ Ergot alkaloids
ionization-time of flight mass spectrometry ➢ Produced by Claviceps purpurea
■ For rapid diagnosis of fungal organisms ➢ Causes ergotism
➢ St. Anthony's Fire or Holy Fire
E. KEY FUNGAL STRUCTURES OBSERVED ★ Immediately feel burning sensation
that will result to gangrene
Predominant Morphology formation in the limbs
★ Caused by ingestion of rye bread
Yeasts (single or multiple Blastomycosis, Erysipelas
buds) Histoplasmosis, ■ Psychotropics
Paracoccidioidomycosis, ➢ Amanitin and Phylloidin
Penicilliosis,
Sporotrichosis A. OVERVIEW OF FUNGAL DISEASES

Yeasts with capsules Cryptococcosis ● Fungal Allergies

Hyphae (septate) Hyalohyphomycosis
(species of Aspergillus,
Fusarium, Geotrichum,
Trichosporon, et al.)
Hyphae (septate in skin or Dermatophytosis
nail specimens)
○ Sick building syndrome
■ From molds
○ Farmer’s lung
■ From thermophilic actinomycetes
○ Allergic bronchopulmonary aspergillosis
■ Aspergillus fumigatus IgE-mediated
hypersensitivity
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● Mycotoxicoses ○ Unable to grow in 37℃ or in the presence of
○ May result from ingestion of fungal-contaminated serum, hence, no deep infections
food ○ Caused by a group of at least 40 related fungi
belonging to the following genera:
○ Aflatoxin
■ Aspergillus flavus
■ May cause liver cancer
Genera Skin Hair Nails
○ Amanitin & Phylloidin
■ Amanita mushroom
Trichophyton X X X
■ Causes liver necrosis
➢ Dose-related disease called mycetismus
Microsporum X X No
infection
● Fungal Infections (Mycoses)
○ Range from superficial to overwhelming systemic
Epidermophyton X No X
infections that are rapidly fatal in the compromised
infection
host
○ Increasing in prevalence because of increased
use of antibiotics, corticosteroids, and cytotoxic
drugs ● Pathogenesis
○ Chronic infections often locate in the warm, humid
● All fungal diseases are not infective to other areas of body
organisms except for cutaneous mycoses. ○ Forms ringworms
○ Humans are dead-end hosts. ■ Raised circular lesions
● Infective vs Infectious ○ May also cause hypersensitivity causes
○ Infective refers to communicable diseases dermatophytid reactions
○ Infectious is the nature of the disease which is ■ Inflammatory reaction to dermatophytosis at
microbial in origin. a cutaneous site distant from the primary
infection

VI. FUNGAL DISEASES

FORMS OF DERMATOPHYTOSIS BASED ON
LOCATION ON THE BODY

Dermatophytosis Features

Tinea pedis Involves the feet

(Athlete’s foot)
Most prevalent of all
dermatophyses

Tinea unguium Involves the nails

(Onychomycosis)
Most difficult to treat

Requires months of oral

azole or terbinafine as well
as surgical removal of nail

Tinea corporis Involves the body

Tinea cruris Involves the groin area

(Jock itch)
A. CUTANEOUS MYCOSES
Tinea manus Involves the hands
● Involves the skin, hair, and nails.
● This is the only classification of mycoses that is Tinea capitis Involves the scalp
infective to other organisms.
● This group is the most prevalent mycoses in the Ectothrix - formation of
world. dense sheaths of spores
● Source / Habitat: around the hair (Microsporum
○ Usually resides in soil or on vegetation. sp.)
● Transmission
○ Agents may enter the subcutaneous tissue via Endothrix - formation of
traumatic inoculation. spores within the hair shaft
○ You will observe in the patient granulomatous in (T. tonsurans, T. violaceum)
nature and (+) positive with lymphatic spread.
Tinea barbae Involves the areas with facial
● Dermatophytes hair
○ Dermatophytoses (Ring Worms)
○ Secrete the enzyme keratinase
■ Digests keratin
➢ Infect only superficial keratinized
structure)
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 ■ (+) yellow fluorescence on Wood’s lamp
CLINICAL FEATURES OF DERMATOPHYTE INFECTIONS
➢ Certain species of Microsporum will
fluoresce under ultraviolet light
Skin Location Clinical Fungi most
disease of features frequently
● Treatment
lesions responsible
○ Local antifungal creams (e.g. topical imidazole)
○ Oral Griseofulvin
Tinea Non-hairy, Circular Trichophyton
■ For tinea unguium and tinea capitis
corporis smooth patches with rubrum
○ Oral terbinafine
(ringworm) skin advancing red,
○ Keep skin dry
vesiculated Epidermophyton
border, and floccosum
● Cutaneous fungi (detailed)
central scaling.
○ Trichophyton (genus)
■ 2 to 3 weeks to grow in culture
Pruritic
■ Microconidia
➢ The characteristics structures of the
Tinea pedis Interdigita Acute: itching, T. rubrum,
genus Trichophyton
l spaces red vesicular.
■ Macroconidia
on feet of E.
➢ Smooth, thin-walled septate
persons Chronic: floccosum,
➢ Composed of 0 to 10 septa
wearing itching,
➢ Pencilshaped
shoes scaling, Trichophyton
➢ The colonies are loose aerial mycelium
fissures mentagrophytes
scereting pigments in variety of
Tinea cruris Groin Erythematous T. rubrum,
○ Trichophyton rubrum
scaling lesion
■ Colonies on front:
in E.
➢ Flat to slightly raised, white to cream,
intertriginous floccosum,
suede-like
area.
■ Colonies on reverse
Trichophyton
➢ Pinkish red
Pruritic mentagrophytes
➢ Downy type
Tinea Beard Edematous, T. rubrum, ★ Yellow-brown to wine-red on
barbae hair erythematous reverse
lesion Trichophyton
mentagrophytes,

Trichophyton
verrucosum

Tinea Scalp Circular bald Trichophyton

capitis hair. patches with mentagrophytes,
Endothrix: short hair
fungus stubs or Microsporum
inside hair broken hair canis,
haft. within hair ■ Numerous clavate to pyriform microconidia
Ectothrix: follicles. Trichophyton formed evenly on hyphae
fungus on tonsurans ➢ Resembling “birds on a wire”
the Kerion rare.
surface of
hair Microsporum
infected hairs
fluoresce.

Tinea Nail Nails No fungi present

unguium thickened or in lesion.
crumbling
distally, May become
discolored; secondarily
lusterless. infected with
bacteria
Usually
associated ■ Moderate numbers of smooth thin-walled
with tinea multiseptate, pencil-shaped macroconidia
pedis ■ Present strains of downy type
➢ Few microconidia and no macroconidia
● Diagnosis
○ 10% KOH ○ Trichophyton tonsurans
■ Septate hyphae ■ Major causative agent of tinea capitis
■ Colonies
○ Sabouraud dextrose agar (SDA) ➢ Suede-like to powdery
■ Hyphae and conidia ➢ Flat with a raised center or folded
➢ Often with radial grooves
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 ○ Others:
■ Malassezia furfur
■ Cladosporium werneckii
■ Trichosporon beigelii

B. SUBCUTANEOUS MYCOSES

● Sporthrix shenckii
○ Causes Sporotrichosis
○ Dimorphic fungus that lives on vegetation
○ Occurs most often in gardeners, especially those
who prune roses
■ Color varies from buff to yellow (sulfureum
form) to dark brown ○ Histopathology
■ The reverse varies from yellow-brown to ■ (+) cigar shaped yeasts, asteroid bodies
red-brown to mahogany
■ Numerous microconidia along the hyphae or ○ Transmission
on a short conidious spores ■ Via thorn prick
■ Varies in size and shape from long clavate to
broad pyriform, at right angles to the hyphae ○ Treatment
(match stick shape) ■ Itraconazole, potassium iodide for cutaneous
➢ May enlarge into balloon forms form
■ Occasional smooth thin-walled clavate ■ Amphotericin B for systemic disease
microconidia in some culture
● Other Subcutaneous Mycoses
○ Chromoblastomycosis (CMB)
■ Agent
➢ Phialophora verrucosa
➢ Fonsecaea pedrosoi
➢ Fonsecaea compacta
➢ Rhinocaldiella aquaspera
➢ Cladosporum carrionii

■ Features
➢ Sclerotic cell walls
➢ Cauliflower-like lesions

○ Trichophyton interdigitale ○ Mycetoma

■ Anthropomorphic species ■ Agent
■ Cause of tinea pedis ➢ Pseudallescheria boydii
■ Colonies ➢ Madurella mycetomatis
➢ Flat white to cream color ➢ Madurella grisea
➢ Powdery to suede-like surface. ➢ Exophiala jeanselmei
■ Reverse is yellowish and pinkish brown, ➢ Acremonium falciforme
becoming red-brown with age
■ Features
➢ Sulfur granules from interconnecting
draining sinuses

○ Phaeohyphomycosis
■ Agent
➢ Phialophora richardsiae
➢ Exophiala jeanselmei
➢ Bipolaris spicifera
➢ Wangiella dermatitidis
➢ Exserohilum rostratum
➢ Alternaria
■ Sub-spherical to pyriform microconidia, ➢ Curvularia
occasional spiral hyphae and spherical
chlamydoconidia ■ Features
■ Occasional slender, clavate, smooth walled ➢ Darkly pigmented septate hyphae in
multiseptate macroconidia tissue

C. ENDEMIC/SYSTEMIC MYCOSES

● Mode of Transmission
○ Inhalation of infective stage of fungi.

● Disease: Pneumonia
● Endemic in certain geographic regions

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 ○ Usually present as asymptomatic among ➢ Fluconazole
immunocompetent individuals.
○ There will be a widespread systemic presentation ○ Coccidioides immitis
in the immuno-compromised population. ■ Epidemiology
➢ Southwestern US
● Caused by a Dimorphic Fungi ➢ California
○ Caused by thermally dimorphic fungi
geographically restricted to specific areas of ■ Transmission
endemicity ➢ Inhalation of spores from soil, rodents

● General pathogenesis ■ Diagnostic feature

○ Inactivation of inhaled spores via alveolar ➢ Presence of spherules (filled with
macrophages endospores)
■ Initiation of antibody and cell-mediated
immunity ■ Clinical features
➢ Valley fever / San Joaquin Valley fever /
● Clinical presentation Desert rheumatism
○ Most infections are asymptomatic or mild and ★ Self-limited, influenza-like illness,
resolve without treatment malaise, cough, arthralgia
○ A small but significant number develop pulmonary
disease (pulmonary form) and may disseminate to ■ Remarks
other organs (disseminated form) ➢ Filipinos are most susceptible

● Examples: ■ Treatment
➢ Amphotericin B
○ Histoplasma capsulatum ➢ Itraconazole
■ Epidemiology ➢ Fluconazole
➢ Global distribution
➢ Mississippi ○ Paracoccidioides brasiliensis
➢ Ohio River valleys ■ Epidemiology
➢ Latin America
■ Transmission
➢ Inhalation of spores from avian and bat ■ Transmission
habitats (guano) ➢ Inhalation of spores
➢ Alkaline soil ➢ Unknown (soil)

■ Diagnostic feature ■ Diagnostic feature

➢ Presence of macrophage filled with ➢ With large, multiply budding yeasts
Histoplasma oval yeasts ★ Mariner’s wheel or captain’s wheel

■ Clinical features ■ Clinical features

➢ Pancytopenia, oral ulceration, ➢ South American blastomycosis or
splenomegaly Brazilian blastomycosis
➢ Erythema nodosum ★ Ulcerated granulomas, lytic bone
lesions
■ Treatment
➢ Amphotericin B ■ Treatment
➢ Itraconazole, ➢ Amphotericin B
➢ Fluconazole ➢ Itraconazole
➢ Fluconazole
○ Blastomyces dermatitidis
■ Epidemiology
Summary of Endemic Mycoses
➢ Eastern and Central US
➢ Great Lakes
Mycosis Etiology Tissue Form
■ Transmission Histoplasmosis Histoplasma Oval yeasts, 2 x 4 µm,
➢ Inhalation of spores capsulatum intracellular in
➢ Unknown (riverbanks) macrophages

■ Diagnostic feature Coccidioido- Coccidioides Spherules, 10 – 80 µm,

➢ With broad-based budding yeasts mycosis posadasii containing endospores, 2 –
4 µm
■ Clinical features Coccidioides
➢ Ulcerated granulomas immitis
➢ Lytic bone lesions
Blastomycosis Blastomyces Thick-walled yeasts with
dermatitidis broad-based, usually
■ Remarks single, buds, 8 – 15 µm
➢ Mimicker of squamous cell carcinoma
Paracoccidioido Paracoccidioides Large, multiply budding
■ Treatment -mycosis brasilensis yeasts, 15 – 30 µm
➢ Amphotericin B
➢ Itraconazole

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 D. OPPORTUNISTIC MYCOSES ➢ Fungal culture

● Will appear on those patients who have low immune ■ Treatment

system or immunocompromised ➢ Amphotericin B
○ Elders ➢ Flucytosine
○ Those who are infected with human ➢ Chemoprophylaxis: Fluconazole
immunodeficiency virus (HIV)
○ Pneumocystis jirovecii
● They are ubiquitous fungi. ■ Characteristics
○ To which, healthy people are exposed but usually ➢ Indeterminate organism
they are resistant.
■ Diagnosis
● In general, to say that you are prone to having ➢ Cannot be cultured
opportunistic mycoses, you need to request a CD4 ➢ Diagnosed by staining BAL washings
Count. with the following stains:
○ CD4 Count of less than 200 cells/uL = increases ★ Methenamine silver stain – (+)
the susceptibility to opportunistic fungi. disc-shaped yeast with cysts and
trophozoites
● Examples ★ Quantitative PCR may be useful in
distinguishing between colonization
○ Candida albicans and active infection
■ Characteristics
➢ Member of the normal flora of URT, GIT, ■ Pathogenesis
and female GUT ➢ Transmission occurs by inhalation of
cysts
■ Diagnostic features ➢ Cysts in alveoli induce an inflammatory
➢ With pseudohyphae (at room response consisting plasma cells
temperature) ★ Frothy exudate that blocks oxygen
➢ With germ tubes (at body temperature) exchange

■ Spectrum of Disease ■ Spectrum of Disease

➢ Immunocompetent ➢ Pneumonia usually occurs when CD4
★ Oral thrush count <400
★ Vulvovaginitis → curd-like ➢ Most common AIDS-defining illness
discharge
★ Intertrigo ■ Gold Standard Imaging
★ Skin infections → satellite lesions ➢ CT SCAN
★ Onychomycosis ★ Diffuse interstitial pneumonia with
ground glass infiltrates bilaterally in
➢ Immunocompromised 100% mortality if untreated
★ Esophagitis
★ Subcutaneous nodules ■ Treatment and Prevention
★ Right-sided endocarditis ➢ Prophylaxis
★ When CD4 count is less than 200
○ Cryptococcus neoformans ★ TMP-SMX or Aerosolized
■ Characteristics pentamidine
➢ Oval yeast with narrow based bud ➢ Drug of choice
surrounded by a wide polysaccharide ★ TMP-SMX
capsule ★ Pentamidine isethionate
➢ India ink preparation
➢ Positive latex agglutination test (CALAS) ○ Aspergillus fumigatus
■ Characteristics
■ Transmission ➢ Exist only as molds
➢ Grows abundantly in soil containing bird ➢ Septate hyphae that form V-shaped
(especially pigeon) droppings (dichotomous) branches at acute angles
➢ Transmission by inhalation of airborne
yeast cells ■ Transmission
➢ Widely distributed in nature
■ Spectrum of Disease ➢ Inhalation of airborne conidia
➢ Asymptomatic lung infection
➢ Meningitis, encephalitis ■ Pathogenesis
★ Most common cause of ➢ Infections
meningoencephalitis in HIV patients ★ Wounds, burns, the cornea,
external ear, sinuses
■ Diagnosis ➢ Aspergilloma (fungus ball) in lung
➢ India ink (clear halo) cavities
➢ Mucicarmine (red inner capsule) ➢ Allergic bronchopulmonary
➢ Cryptococcal Antigen Latex aspergillosis (ABPA)
Agglutination System (CALAS) of the ★ Asthmatic symptoms with
CSF expectoration of brownish bronchial
★ Detects polysaccharide capsular plugs
antigen and is more specific. ★ Most common etiologic agent

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 Radiologic Description Diagnosis Flucytosine Blocks nucleic acid synthesis by
Feature inhibiting DNA and RNA polymerases

Monod sign Gas surrounding Aspergilloma Griseofulvin Interferes with microtubule function
the aspergilloma in dermatophytes and may also
inhibit the synthesis and
Air crescent Presence of Invasive polymerization of nucleic acids
sign crescent-shaped aspergilloma
space between
mass and lung Bronchogenic E. SUPERFICIAL MYCOSES
cavity carcinoma
● Diseases affecting the outermost layer of the skin
(stratum corneum), or rowing along hair shafts
■ Diagnosis
➢ Allergic bronchopulmonary aspergillosis ● Pityriasis versicolor (tinea versicolor or An-an)
★ High level of IgE (IgE level > 1000 ○ Most common, causes patches of hypo-orhyper
IU/dL) pigmentation of the neck, shoulders, chest and
★ Sputum culture back.
★ Wheezing patient and chest X-ray ○ Malassezia furfur
with fleeting infiltrates ■ May cause fungemia in premature infants on
★ Increased level of eosinophils IV lipid supplements because it is lipophilic
★ Skin test: immediate ➢ There is a degradation of lipids that
hypersensitivity reaction leads to the production of acids and
eventual destruction of melanocytes that
■ Treatment can be found in the skin.
➢ Drug of choice ★ Hypopigmented macules/patches in
★ Amphotericin B dark skin
★ Hyperpigmented macules/patches
➢ Allergic bronchopulmonary aspergillosis in fair skin
★ Corticosteroids ➢ Associated with seborrheic dermatitis
➢ Aspergilloma
★ Removal via thoracic surgery ■ Diagnostic Features
➢ Invasive aspergillosis ➢ “Spaghetti and meatballs” appearance.
★ Voriconazole ➢ Sometimes called “bacon and eggs”
appearance in 10% KOH preparation.
○ Rhizopus oryzae and Mucor spp. ➢ Coppery-orange under Wood’s lamp
■ Mucormycosis
➢ Saprophytic molds with nonseptate
hyphae and branches ranches at right
angles (90 Degrees) Other Superficial Mycoses
➢ Can present as rhino-orbital-cerebral
infection with eschar formation Mycosis Agent Feature
★ Especially among patient with
diabetic ketoacidosis, burns, Tinea nigra Hortaea Dark (brown to
leukemia werneckii black) discoloration
of the palm/soles
○ Others (Exophiala
■ Pneumocystis pneumonia werneckii) Caused by a
■ Penicilliosis dematiaceous fungi

Black Piedra Piedraia hortae Small, firm/hard

Common Drug of Choice for Fungal Infection black nodules on
hair shaft
Drugs Mechanism of Action
White Piedra Trichosporon Soft, beige/white
Polyenes Binds to ergosterol in fungal cell nodules on the
Amphotericin B membranes, forming leaky pores distal ends of hair
shafts
Azoles Inhibit fungal P450-dependent
Ketoconazole enzymes (lanosterol
Fluconazole 14-a-demethylase) blocking
Itraconazole ergosterol synthesis
Posaconazole
Voriconazole Resistance can occur with long-term
use

Terbinafine Inhibits epoxidation of squalene

Echincandins Inhibit B-glucan synthase

Caspofungin decreasing fungal cell wall synthesis
Micafungin
Anidulafungin

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