MICROBIOLOGY VI

MLS 306
AARON SIAW KWAKYE

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 OPPORTUNISTIC MYCOSES
CONTENT
• DESCRIPTION
• CANDIDIASIS
• ASPERGILLOSIS
• CRYPTOCOCCOSIS

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 DESCRIPTION

• Opportunistic mycoses are infections attributable to fungi that are normally

found as human commensals or in the environment

• The most common opportunistic fungal pathogens are the yeasts Candida spp.
and C. neoformans, the mold Aspergillus spp., and P. jirovecii.

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 CANDIDIASIS

• Most common human Candida are Candida albicans, Candida glabrata,

Candida parapsilosis, and Candida tropicalis - Ascomycota

• Carried harmlessly on the skin, in the mouth, vagina and gastro-intestinal tract

• Cause cutaneous infections at many sites on the body, especially those that are
moist, such as folds of flesh and armpits

• Infection of the mouth and vagina is commonly called thrush due to formed
white yeast plaques 4
 CANDIDIASIS

Forms of Candida clinical

manifestation
• Oropharyngeal candidiasis (thrush)

• Lesions can occur anywhere on the

oral mucosa (hard and soft palates,
gums), the tongue, or extending
back into the posterior pharynx
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 CANDIDIASIS

Forms of Candida clinical manifestation

• Vulvo-Vaginal Candidiasis (VVC) or vaginal thrush

• The infection can have an important physical and psychologic impact on

women, affecting relationships with their partners

• VVC is caused by C. albicans in approximately 73%, with C. glabrata

around 20%

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 CANDIDIASIS

Forms of candida clinical

manifestation

• Candidal Intertrigo

• Infection of the skinfolds caused by

Candida spp. is called intertrigo

• It usually affects the skin of the

groin and under the breast and 7

armpits
 CANDIDIASIS

Forms of Candida clinical

manifestation
• Interdigital Candidiasis

• The lesions are very similar to those of

intertrigo. The typical location is the
interdigital spaces of the hands

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 CANDIDIASIS

Forms of candida clinical erythematous, swollen plaque.

manifestation
• Common in persons who are in
• Paronychia or Candidal Onychia. frequent contact with water

• This is involvement of the skin

around the nail. The presentation is
usually very painful with an

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 CANDIDIASIS

• Candidiasis of the nail (onychomycosis)

• Common in patients with mucocutaneous candidiasis or persons who are in

frequent contact with water

• Diagnosis of Candida infections is made by direct microscopy which shows

pseudohyphae and yeast forms

• Azoles are the first line of therapy for Candida infections

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 CANDIDIASIS

Host factors
1. Vaginal colonization with Candida is more frequent in diabetic women
2. Symptomatic VVC is frequently observed during or after use of systemic antibiotics
3. Significantly higher in HIV-positive women
4. During pregnancy the clinical attack rate is maximally increased in the third trimester,
but symptomatic recurrences are more common throughout pregnancy
• High levels of reproductive hormones raise the glycogen content in the vaginal
environment 11
 CANDIDIASIS

• Penile colonization with Candida is present in approximately 20% of male

partners of women with RVVC

• Most patients with symptomatic VVC may be readily diagnosed on the basis of
vaginal pH estimation and microscopic examination of vaginal secretions

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 ASPERGILLOSIS

• Covers a broad spectrum of diseases caused by species of Aspergillus - most

common being Aspergillus fumigatus - Ascomycota

• They produce large quantities of small (2–4 μm), airborne conidiospores, to

which we are all exposed, yet mostly do not succumb to disease

• Commonly called farmer’s lung

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 ASPERGILLOSIS

Three main types of disease caused by Aspergillus species:

1. Allergic Bronchopulmonary Aspergillosis
• Hypersensitive reaction to spore and hyphal surface antigens, leading to asthmatic reactions, and is
particularly common in asthma and cystic fibrosis patients

2. Pulmonary Aspergilloma
• Formed balls of hyphae plus host cells, tissue debris, and other substances in cavities within the lungs

3. Invasive Aspergillosis
• From the primary focus, Aspergillus invades blood vessels and is transported to other organs, 14

particularly the brain

 ASPERGILLOSIS

• Sputum, other respiratory tract specimens, and lung biopsy tissue provide good
specimens

• Direct examination of sputum with KOH or calcofluor white or in histologic

sections

• Aspergilloma is treated with itraconazole or amphotericin B and surgery

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 CRYPTOCOCCOSIS

• Cryptococcus neoformans and Cryptococcus gattii are environmental,

basidiomycetous yeasts which cause cryptococcosis

• More than 90% of these infections are caused by C. neoformans.

• Cryptococcus neoformans is worldwide in distribution

• C. neoformans occurs in immunocompetent persons but more often in patients

with HIV/AIDS, hematogenous malignancies, and other immunosuppressive
conditions 16
 CRYPTOCOCCOSIS

Pathogenesis

• Infection is initiated by inhalation of the yeast cells

• The primary pulmonary infection may be asymptomatic

• In patients who are compromised, the yeasts may multiply and disseminate to
other parts of the body but preferentially to the central nervous system, causing
cryptococcal meningoencephalitis
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 CRYPTOCOCCOSIS

Clinical features

• Major clinical manifestation is chronic meningitis

• Patients may complain of headache, neck stiffness, and disorientation

• The course of cryptococcal meningitis may fluctuate over long periods, but
untreated cases are ultimately fatal

• The infection is not transmitted from person to person

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 CRYPTOCOCCOSIS

Lab diagnosis

• Specimens include cerebrospinal fluid (CSF), tissue, exudates, sputum, blood,

cutaneous scrapings, and urine.

• Cultures can be identified by growth at 37°C and detection of urease

• Serological tests are useful

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 CRYPTOCOCCOSIS

Lab diagnosis
• For direct microscopy, specimens are often examined in wet mounts, both directly and
after mixing with India ink, which delineates the capsule

Combination therapy of amphotericin B and flucytosine is standard treatment 20