Mycology

Dr. Ebtisam Al- Moayad

 Mycology
Mycology: is the study of fungi, yeast and mold.

General Characteristics of Fungi :

1- Fungi are eukaryotic organisms (contain a
nucleus with a nuclear membrane).
2- Fungi may be:
- Saprophytes (digest organic dead matter),
-Parasitic (obtain nutrients from tissues and
organism),
- Symbionts (beneficial relationship between a
fungus and another organism).
3- Morphology of fungi: Most of fungi are filamentous
and some are unicellular e.g. yeasts.
a. Filamentous (mold) fungi: Most fungi are
composed of microscopic filaments called hyphae,
which branch to form a network of hyphae (septate
or nonseptate), that called mycelium. They
reproduce by forming spores.
b. Yeast: It is single spheroid cells which
reproduce by budding.

c. Dimorphism (i.e. existing in two forms): Some

fungi are capable of alternating between a mycelial
growth form and a unicellular yeast phase. This
change in growth form is often in response to
some change in environmental conditions.
Morphology of fungi
 General Characteristics of Fungi
4- Fungal cell walls are composed largely of chitin, a
polymer of N-acetylglucosamine, rather than
peptidoglycan. Therefore, fungi are unaffected by
antibiotics (for example, penicillin) that inhibit
peptidoglycan synthesis.
-The fungal membrane contains ergosterol. These
chemical characteristics are useful in targeting
chemotherapeutic agents against fungal infections.
-For example, amphotericin B and nystatin bind to
ergosterol present in cell membranes of fungal
cells. Therefore, they form pores that disrupt
membrane function, resulting in cell death.
5- Fungi reproduce by forming spores
(sporulation). The spores are different in their
size, shape, color. These characteristics are
important in the identification.

6- All fungi are heterotrophs; they require some

organic carbon source for growth.

7- Fungi are obligate aerobes.

8- Fungi secrete degradative enzymes (for example,
cellulases, proteases, nucleases) into their
environment to obtain nutrients that enables fungi
to live saprophytically on organic waste.
 Importance of fungi
Beneficial Effects of Fungi :
1. Most of fungi play an important role in decomposition of
dead animal and plants.
- They are agents of biodegradation, fungi utilize dead
organic materials as sources of nutrients and are
responsible for the biodegradation of organic materials in
our environment.
- Fungi are very effective and efficient biodegraders because
of the wide range of extracellular enzymes they produce.
2. Biosynthetic factories. (e.g. can be used to produce drugs,
antibiotics, acids, mushrooms).
3. Some fungi are used in food industry (e.g. fermented
products,Saccharomyces species are used in bread-making
4.Beneficial in agriculture.
Mushrooms food

Poisonous mushrooms
Harmful Effects of Fungi:
1. Destruction of food, lumber, paper, and
cloth.
2. Animal and human diseases, including
allergies.
3. Toxins produced by poisonous mushrooms
and within food (e.g., grain, cheese, etc.).
4. Plant diseases.
Mold, Harmful Effects of
Fungi
 Classification of Fungi
Fungi are classified according to their
structure and method of reproduction.
The four main groups of fungi are:
Common molds (Zygomycota)

Sac fungi (Ascomycota)

Club fungi (Basidiomycota)

Imperfect fungi (Deuteromycota)

 The Common Molds
• Molds that grow on meat, cheese, and bread
are members of the phylum Zygomycota.
• Zygomycetes have life cycles that include a
zygospore.
– A zygospore is a resting spore that contains
zygotes formed during the sexual phase of the
mold's life cycle.
– Black bread mold,Rhizopus stolonifer , is a
zygomycete.
 Mycoses
Mycoses: mycoses are human fungal
diseases.

Classification of mycoses: Mycoses are

classified by the location on the body
where the infection occurs.
Cutaneous: They are called cutaneous
when limited to the epidermis.
Subcutaneous when the infection
penetrates beneath the skin.
Systemic when the infection is deep
within the body.
1- Cutaneous Mycoses
Also called dermatophytoses caused by
dermatophytes. Dermatophytes are fungi that
infect tissues containing plenty of keratin (skin,
hair, nails).

Pathology
A defining characteristic of the dermatophytes is
the ability to use keratin as a source of
nutrition. This ability allows them to infect
keratinized tissues and structures, such as
skin, hair, and nails.
1- Cutaneous Mycoses
Classification: Dermatophytes are classified in
three genera:
- Trichophyton
- Microsporum
- Epidermophyton

Morphology: The dermatophytes are

filamentous fungi.
 Pathogenesis and Clinical significance
• Dermatomycoses are infections that are
transmitted directly by human contact,
animal-human contact or indirectly on
inanimate objects (clothes, carpets,
moisture, and dust in showers, swimming
pools, wardrobes, gyms).

• Dermatomycoses are characterized by

itching, scaling skin patches that can
become inflamed and weeping.
 Clinical significance of Cutaneous
Mycoses
Different species can cause the same clinical
picture. Frequent dermatomycoses include:
• Tinea pedis (athlete’s foot):T. rubrum, T.
mentagrophytes, and Epidermophyton
floccosum. The infected tissue is initially
between the toes, but can spread to the
nails, which become yellow and brittle.
• Tinea corporis (ringworm):Microsporum canis
and Trichophyton mentagrophytes. Lesions appear
as advancing annular rings with scaly centers.

• Tinea capitis (scalp

ringworm):
T. tonsurans and M. canis.
Disease ranges from small,
scaling patches, to
involvement of the entire
scalp with extensive hair loss.
• Tinea cruris: T. rubrum and E. floccosum .
Disease are similar to ringworm, except that
lesions occur in the moist groin area, where
they can spread from the upper thighs to the
genitals.

• Tinea unguium: T. rubrum, T. mentagrophytes,

and E. floccosum.
The nails are thickened,
discolored, and brittle.
 Diagnosis
Diagnosis: Material suitable for diagnostic analysis
include skin and nail scrapings and infected hair. The
fungi are observed under the microscope in a KOH
preparation. Identification is based on the
morphology of the hyphae as well as on the
macroconidia and microconidia in the fungal cultures.
Therapy. Dermatomycoses can be treated with locally
applied antifungal agents such as miconazole or
clotrimazole.
In cases of massive infections of the hair, and above
all of the nails, the oral allylamine terbinafine or
azoles can be used.
Azoles: These agents disrupt ergosterol biosynthesis.
Allylamines: Inhibition of ergosterol biosynthesis.
 Epidemiology and prevention
• Dermatophytes occur naturally all over the
world.
• Prophylactic measures for all
dermatomycoses consist in avoiding direct
contact with the pathogen.
• Regular disinfection of showers and
wardrobes can contribute to prevention of
athlete’s foot, a very frequent infection.
 2- Subcutaneous Mycoses
Subcutaneous mycoses are fungal infections of the dermis,
subcutaneous tissue, and bone. Fungi that cause
subcutaneous mycoses grow in the soil and on dying plants.
They penetrate through skin injuries into the subcutaneous
connective tissue, where they cause local, chronic,
granulomatous infections.
Clinical Significance
Sporotrichosis is caused bySporothrix schenckii , a dimorphic
fungus that grows as yeast cells in host tissues.
Sporotrichosis is characterized by an ulcerous primary
lesion, usually on an extremity, and multiple nodules and
abscesses along the lymphatic vessels.
In most patients, the disease
is self-limiting, but may
persist in a chronic form.
Oral itraconazole is the drug
of choice.
 3. Systemic Mycoses
• The organisms responsible for systemic mycoses
fall into two general categories:
1) Those that infect normal healthy individuals.
2) Those that primarily infect immunocompromised
individuals.
• These infections occur in defined geographic areas
where fungal pathogens are found in the soil and
can be aerosolized.
• The fungi causing these diseases are uniformly
dimorphic, exhibiting the yeast form in infected
tissue, and the mycelial form in culture or in their
natural environment.
 3. Systemic Mycoses
Epidemiology and pathology
• Entry into the host is by inhalation of airborne
spores, which germinate in the lungs. From the
lungs, dissemination can occur to any organ
of the body where the fungi can invade and
destroy tissue.
Clinical significance
Most cases of coccidioidomycosis,
histoplasmosis, and paracoccidioidomycosis
in otherwise healthy patients present only mild
symptoms and are self-limiting. In
immunosuppressed patients, however, the
same infections can be life-threatening.
Clinical significance of Systemic Mycoses
 Treatment of systemic mycoses
• Systemic mycoses are usually treated with
amphotericin B, sometimes in combination
with flucytosine.
• Ketoconazole, fluconazole, and itraconazole
are also used, depending on the stage and
site of the disease.
 4. Opportunistic Mycoses
• Opportunistic mycoses infect
immunocompromised individuals, and are
rare in healthy individuals.
• The use of immunosuppressive drugs for:
 organ transplantation,
 widespread use of chemotherapy in cancer
treatment,
 and the high frequency of immunodeficient
individuals caused by the AIDS
have resulted in increasing the spectrum of
opportunistic fungal pathogens.
 Example of opportunistic mycoses:
• Candidiasis (candidosis): is caused by the
yeastCandida albicans , and otherCandida
species, which are normal body flora found
in the skin, mouth, vagina, and intestines.
• Infections occur when competing bacterial
flora are eliminated, for example, by
antibacterial antibiotics, allowing the yeast
to overgrow.
 Candidiasis
• Candida infections have various
manifestations depending on the site. For
example, oral candidiasis (thrush) presents as
raised, white plaques on the oral mucosa,
tongue, or gums.
• Most HIV-positive individuals eventually
develop oral candidiasis, which often spreads
to the esophagus.

oral candidiasis
 Candidiasis
• The plaques can become confluent and ulcerated and
spread to the throat.
• Most HIV-positive individuals eventually develop oral
candidiasis, which often spreads to the esophagus. The
latter condition is considered an indicator of full-blown
AIDS.
• Vaginal candidiasis presents as itching and burning pain
of the vagina, accompanied by a thick or thin white
discharge.
• Systemic candidiasis is a potentially life-threatening
infection that occurs in debilitated individuals, cancer
patients (with neutropenia secondary to chemotherapy),
individuals on systemic corticosteroids, and patients
treated with broad-spectrum antibiotics.
• Systemic candidiasis may involve the gastrointestinal
tract, kidneys, liver, and spleen.
Treatment of Candidiasis
• Both oral and vaginal infections are treated
topically with nystatin or clotrimazole.
• Oral systemic antifungal agents such as
ketoconazole, fluconazole, and itraconazole
are preferred for ease of administration and
increased efficacy.
• Amphotericin B by itself or in combination
with flucytosine is used in systemic disease.
 Laboratory diagnosis of fungi
The collection of specimens depended on the location of
fungal infection:
For the diagnosis of cutaneous infection, scraping from the
skin, nails and hair is required.
Dermatophytes are a group of three types of fungi that
commonly causes skin disease in animals and human.
• Trichophyton (microconidia).
• Epidermophyton (short macroconidia).
• Microsporum (spindle macroconidia).

Collection of samples:
• Cleanse the affected area with 70% ethanol.
• Collect the samples from skin by scrapping with blade, from
nail by clipping, from hair by trimming.
• Put the samples on a clean paper.
• Deliver the samples to the mycology laboratory with
patient’s name, number, source of sample, and date of
collection.
 Laboratory diagnosis of fungi
The collection of specimens depended on the
location of fungal infection:

• Subcutaneous infection: pus or biopsy.

• Systemic infection: sputum, pus, spinal fluid,
tissue biopsy samples and blood.
 Laboratory diagnosis of fungi
1- Microscopic examination.
a. KOH preparation:
- KOH is used for the materials from skin, nails and hair.
- KOH digest the keratin surrounding the fungi so the
hyphae and spores can be seen. Specimen is placed
on a slide in a drop of 10%-20% KOH for 10-20 mins,
covered with a coverslip, and examined
microscopically.
b. Gram stain: is used for the diagnosis of yeasts
(Candida). Candida appears as a gram-positive oval,
budding cells.
c. Methylene blue, lactophenol Blue: is used to stain the
hyphae and spores of filamentous fungi.
 Laboratory diagnosis of fungi
2-Culturing. This is possible on universal and selective
mediums. Sabouraud dextrose agar can contain selective
agents (e.g., chloramphenicol and cycloheximide), this
medium has an acid pH of 5.6.
Filamentous fungi: most of fungi are cultured on Sabouraud
dextrose agar. The incubation period of 2 weeks is sufficient,
whereas for dermatophytes, a 4-week incubation period is
necessary.
• Yeasts: are cultured on sabouraud agar, Nutrient agar and C.
albicans can be grown on the usual culture mediums. After
48 hours of incubation on agar mediums, round, whitish,
somewhat rough-surfaced colonies form. blood agar.

• Biochemical tests are used for identification.

 Laboratory diagnosis of fungi
3- Serology. By the identification of antibodies
to special fungal antigens in patient’s serum.
4- Antigen detection. By finding of specific
antigens in the diagnostic material by direct
means using known antibodies, possible in
some fungal infections
5- Nucleic acid detection. Combined with
amplification, such tests are useful for rapid
detection of mycotic diseases in
immunocompromised patients.
 Treatment of fungi
- A limited number of anti-infective agents are
available for specific treatment of fungal
infections:
Polyenes: These agents bind to membrane
sterols and destroy the membrane structure,
e.g. Amphotericin B.
Azoles: These agents disrupt ergosterol
biosynthesis, e.g. Ketoconazole.
- Removal of infected skin, followed by topical
application of antifungal antibiotics.