FUNGAL DISEASES

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INTRODUCTION
• Fungi are unicellular or multi-cellular eukaryotic organisms that exist in all
environments worldwide. From fungi visible to the naked eye, such as
mushrooms, to microscopic yeasts and molds, they exist in a multitude of
forms.
• Like many microbes, there are helpful fungi and harmful fungi. When harmful
fungi invade the body, they can be difficult to kill, as they can survive in the
environment and re-infect the person trying to get better.
• In contrast to bacterial and viral diseases, invasive human fungal infections
are rarely communicable, and this has led to reduced interest by public health
authorities in surveillance

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INTRODUCTION
HOW FUNGI CAUSE DISEASES
• It is important to understand how fungi cause disease in order to know how
to prevent the development of infection and to control its source when
infection has already developed.
• Fungi reproduce by spreading microscopic spores. These spores are often
present in the air and soil, where they can be inhaled or come into contact
with the surfaces of the body, primarily the skin. Consequently, fungal
infections usually begin in the lungs or on the skin.
• Of the wide variety of spores that land on the skin or are inhaled into the
lungs, most types do not cause infection. A few types cause infection only in
people who have one of the following:
• A weakened immune system
• Foreign material, including medical devices (such as an artificial joint or heart
3
valve), in their body
INTRODUCTION
Fungal infections are either
• Opportunistic
• Primary
• Fungal infections can affect only one area of the body (localized) or many areas of the body
(systemic).

Opportunistic fungal infections

Opportunistic fungal infections take advantage of a weakened immune system.
• Aspergillosis , Candidiasis ,Mucormycosis
Opportunistic fungal infections can be very aggressive, spreading quickly to other organs and often
leading to death.

Primary fungal infections

Primary fungal infections can occur in people with a normal immune system, sometimes with serious
consequences. These infections usually occur after people inhale fungal spores, which can cause
pneumonia to develop in the lungs as the first sign of infection.eg.Histoplasmosis,Blastomycosis4
Fungal Nail Infections
Fungal nail infections are common infections of the fingernails or toenails that can cause the nail to
become discolored, thick, and more likely to crack and break. Infections are more common in toenails than
fingernails. The technical name for a fungal nail infection is onychomycosis.
Symptoms
• Discolored (yellow, brown, or white)
• Thick
• Fragile or cracked
Fungal nail infections can be caused by many different types of fungi(dermatophyte) (yeasts or molds) that
live in the environment. Small cracks in your nail or the surrounding skin can allow these germs to enter
your nail and cause an infection.
Anyone can get a fungal nail infection, People with the following conditions are more likely to have the
infection ;
• A nail injury or nail surgery
• Diabetes
• A weakened immune system 5
Prevention
• Keep your hands and feet clean and dry.
• Clip your fingernails and toenails short and keep them clean.
• Don’t walk barefoot in areas like locker rooms or public showers.
• Don’t share nail clippers with other people.

Diagnosis
• Fungal nail inspection
• Nail clipping for fungal culture

Treatment
• typically don’t go away without antifungal treatment
• In severe cases, a doctor might remove the nail completely

Complication
• Impaired or lost tactile function with fingernail involvement.
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• Difficulties walking, exercising, and fitting of shoes with toenail involvement.
IMAGE OF FUNGAL NAIL INFECTION

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RINGWORM
((DERMATOPHYTOSIS )

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RINGWORM (DERMATOPHYTOSIS)
Ringworm is a superficial fungal infection of the skin hair and nails on humans and
many animal species such as dogs, cats, goats and many more.

Causative Organism - Dermatophytes that typically belong to the genera

Tricophyton, Microsporum or Epidermophyton

Areas of the body that can be affected

• Feet
• Groin, inner thighs, or buttocks
• Scalp
• Beard
• Hands
• Toenails or fingernails
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•
MODE OF TRANSMISSION
• Touching a person who has ringworm.
• Using items such as clothes, towels, or hairbrushes that were used by someone with a
ringworm infection.

SIGNS AND SYMPTOMS

• Itchy skin
• Ring-shaped rash
• Red, scaly, cracked skin
• Hair loss

DIAGNOSIS AND TESTING FOR RINGWORM

• Examining the affected area and asking the patient about their medical history and symptoms.
• Scrapping skin samples to be examined under the microscope or sent to the laboratory for a
fungal culture. 10
PREVENTION
• Keep your skin clean and dry.
• Wear shoes that allow air to circulate freely around your feet.
• Don’t walk barefoot in areas like locker rooms or public showers.
• Clip your fingernails and toenails short and keep them clean.
• Change your socks and underwear at least once a day.

TREATMENT
The treatment for ringworm depends on its location on the body and how serious the
infection is.
Ringworm on the skin like athlete’s foot (tinea pedis) and jock itch (tinea cruris) can
usually be treated with non-prescription antifungal creams, lotions, or powders applied to
the skin for 2 to 4 weeks.

Ringworm on the scalp (tinea capitis) usually needs to be treated with prescription 11
antifungal medication taken by mouth for 1 to 3 months.
STATISTICS
• It’s estimated that up to 20% of people will have ringworm at some point in their lives.
Ringworm is very common. Anyone can get ringworm, but people who have weakened
immune systems may be especially at risk for infection and may have problems fighting off
a ringworm infection.

COMPLICATIONS
• Complications of Ringworm are very rare, although certain conditions may be
precipitated:
• Spread: Spreading of the lesions to other parts of the body is the most common
complication of ringworm.
• Bacterial Infection: Secondary infection of the lesions of Ringworm may result in painful
cysts or abscesses.
• Kerion: A condition occurring occasionally, ringworm of scalp may lead to severe painful
inflammation of scalp with pus formation and thick yellow crusts on the scalp. 12
IMAGE OF RINGWORM

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COCCIDIOIDOMYC
OSIS

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COCCIDIOIDOMYCOSIS
• Is a serious fungal disease of the lungs and other tissues, endemic in the warmer,
arid regions of America. Valley fever is an infection caused by the fungus
Coccidioides. The scientific name for Valley fever is “coccidioidomycosis,” and it’s
also sometimes called “San Joaquin Valley fever” or “desert rheumatism.” The
term “Valley fever” usually refers to Coccidioides infection in the lungs, but the
infection can spread to other parts of the body in severe cases (this is called
“disseminated coccidioidomycosis”).

TYPES OF COCCIDIOIDOMYCOSIS
• There are two types of coccidioidomycosis:
• acute
• chronic

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Acute
• Acute coccidioidomycosis is a mild form of the infection.
• Symptoms of the acute infection begin one to three weeks after inhaling the fungal spores and may
go unnoticed.

Chronic
• Chronic coccidioidomycosis is a long-term form of the illness.
• You can develop the chronic form months or years after contracting the acute form.
• In one form of the illness, lung abscesses (infections) can form. When the abscesses rupture, they
release pus into the space between the lungs and ribs.
• Scarring may occur as a result.

PATHOGENESIS
The pathogenesis of coccidioidomycosis can be described in following steps
• 1.Transmission
• 2. Dissemination
• 3. Seeding 16
17
INCUBATION PERIOD:
• The incubation period is 7–21 days. Most infections (60%) are asymptomatic. Symptomatic infection
ranges from primary pulmonary illness to severe disseminated disease.

MODE OF TRANSMISSION:
• Coccidioidomycosis is spread by inhaling infective fungal spores found in the soil, usually as dust. It does
not spread between people and/or animals. The disease cannot be spread from person to person.

SYMPTOMS AND SIGNS

Symptoms of Valley fever include:
• Fatigue (tiredness)
• Cough( sometimes producing phlegm/ mucus or blood)
• Fever
• Shortness of breath
• Headache
• Night sweats
• Muscle aches or joint pain
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• Rash on upper body or legs
COMPLICATIONS
• Severe pneumonia
• Lung abscess
• Lung scarring

PREVENTION
• Wearing of disposable Nose mask and wetting the soil before digging.

• MANAGEMENT
• Rest
• Treatment includes taking an anti-fungal drug like fluconazole or itraconazole
• Surgery

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VAGINAL CANDIDIASIS
• Vaginal candidiasis is a fungal infection caused by a yeast called Candida. Candida normally
lives on the skin and inside the body, in places such as the mouth, throat and vagina, without
causing any problems.

• Causative agent: Candida albicans

Mode of transmission:
• Candida albicans is usually transmitted from mother to infant through childbirth and remains
as part of a normal humans microflora. Candida albicans infections very rarely spread through
sexual intercourse.

Signs and symptoms:

• pain during sexual intercourse.
• pain when urinating.
• vaginal itching.
• swelling around the vagina. 20
Complications:
• If left untreated it can lead to serious conditions, such as pelvic inflammatory disease. Pelvic
inflammatory disease increases a woman's risk of infertility, chronic pelvic pain and ectopic
pregnancy.

Prevention:
• Ways of preventing vaginal candidiasis are:
• wear loose-fitting, cotton underwear.
• only use antibiotics when necessary.
• avoid using menstrual products that are scented
• keep your vaginal area clean with warm water only.

Treatment:
• Vaginal candidiasis is usually treated with antifungal medicine. For most infections, the
treatment is an antifungal medicine applied inside the vagina or a single dose of fluconazole
taken by mouth. Other treatments may be needed for infections that are more severe, that
don't get better, or that keep coming back after getting better. These treatments include more
doses of fluconazole taken by mouth or other medicines applied inside the vagina. 21
PNEUMOCYSTIS PNEUMONIA

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Pneumocystis pneumonia (PCP)
• Pneumocystis pneumonia (PCP) is a disease that affect people who have a medical
condition that weakens their immune system, like HIV/AIDS, or take medicines (such as
corticosteroids) that lower the body’s ability to fight germs and sickness.

• Who get Pneumocystis pneumonia (PCP)

• PCP is extremely rare in healthy people,

• 20% of adults might carry this fungus at any given time, and the immune system
removes the fungus after several months.

• Most people who get PCP have weakened immune systems

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• About 30-40% of people who get PCP have HIV/AIDS.
• The other people who get PCP are usually taking medicine or have other medical
conditions, such as:
• Chronic lung diseases
• Cancer
• Inflammatory diseases or autoimmune diseases (for example, lupus or rheumatoid
arthritis)
• Solid organ or stem cell transplant

Causative Organism
• Pneumocystis pneumonia (PCP) is a serious infection caused by the fungus
Pneumocystis jirovecii.

• Mode of transmission
• PCP spreads from person to person through the air.
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Symptoms
The symptoms of PCP can develop over severaldays or weeks and include:

• Fever
• Cough
• Difficulty breathing
• Chest pain
• Chills
• Fatigue (tiredness)

Diagnosis and Testing

• PCP is diagnosed using a sample from a patient’s lungs. The sample is usually mucus that is either coughed up
by the patient (called sputum) or collected by a procedure called bronchoalveolar lavage.
• Sometimes, a small sample of lung tissue (a biopsy) is used to diagnose PCP. The patient’s sample is sent to a
laboratory, usually to be examined under a microscope.
• Polymerase chain reaction (PCR) can also be used to detect Pneumocystis DNA in different types of samples.
• A blood test to detect β-D-glucan (a part of the cell wall of many different types of fungi) can also help
diagnose PCP.
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• Treatment and Outcomes
• Without treatment, PCP can cause death. The most common form of treatment is
trimethoprim/sulfamethoxazole (TMP/SMX), also known as co-trimoxazole and by several different brand
names, including Bactrim, Septra, and Cotrim. This medicine is given by mouth or through a vein for 3
weeks.
• TMP/SMX can cause side effects such as rash and fever.

Statistics
• The exact number of cases of PCP in most nations is difficult to determine because there is no national
surveillance for the diseasen in most countries

• Before the beginning of the HIV/AIDS epidemic in the 1980s, PCP was uncommon. In the late 1980s, an
estimated 75% of people living with AIDS developed PCP.
• Since then, PCP in people living with HIV/AIDS has decreased substantially due to anti-retroviral therapy
(ART) and preventive treatment with TMP/SMX.

• In a study of HIV-infected patients in the United States and Canada, PCP was the most common
opportunistic infection during 2008–2010.There were 10,590 estimated U.S. hospitalizations due to
Pneumocystis pneumonia in 2017. 26
MYCETOMA

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MYCETOMA (EUMYCETOMA AND ACTINOMYCETOMA)
• Mycetoma is a progressive chronic granulomatous infection of the skin and
subcutaneous tissue. The disease can occur due to true fungi, referred to as
eumycetoma, or by bacteria, referred to as actinomycetoma.
AFFECTED PEOPLE
• Mycetoma affects people of all ages and is more common in men. Many people
with mycetoma work in agricultural jobs, such as farmers and livestock herders.
This disease primarily affects poorer people in rural regions of Africa, Latin
America, and Asia that are located near the equator and have dry climates.
People affected by mycetoma often live-in remote areas where they have limited
access to healthcare and medications.
CAUSATIVE ORGANISM
• The most common causative agent of eumycetoma worldwide is Madurella
mycetomatis. Etiologic agents of eumycetoma can be classified based on the type
of grain produced. 28
SITE OF INFECTION
• Eumycetoma most characteristically occurs on the lower extremities and appears
as plaques with hard woody swelling, discharging sinuses, and characteristic
granular grains or microcolonies. Communicating sinuses and fistulae actively
drain purulent material and granules that vary in color from white to yellow to
black.
TREATMENT
• Treatment of eumycetoma remains challenging. There are no definitive treatment
protocol guidelines that have been established. Established treatment protocols
are largely based on published case reports and case series. Currently, treatment
includes a combination of antifungal therapies and surgical procedures.

• Various classes of antifungals have been used in the treatment of eumycetoma,

including azoles, amphotericin B, and terbinafine.
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• DIFFERENTIAL DIAGNOSIS
Lobomycosis - Chronic cutaneous fungal infection caused by Lacazia loboi,
endemic to Central and South America. Lesions begin as papules and progress to
keloid-like lesions that present as smooth nodules most commonly noted on
hands, ears, and ankles. Mycetoma presents with sinus or fistula formation with
the expulsion of granules.

DETERRENCE AND PATIENT EDUCATION

• Given the pathogenesis of this disease, wearing shoes might prevent injuries
that can lead to eumycetoma. Walking barefoot in highly endemic areas should
be avoided whenever possible. Shoes protect feet while walking or working in
areas that could lead to exposure to fungal elements present in water and soil.
Early detection and treatment before the eumycetoma spread deeper across
fascial planes can reduce disabilities from eumycetoma and improves outcomes.

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PIC OF MYCETOMA

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FOOTROT(TINEA PEDIS)
• Athlete’s foot also called tinea pedis is a contagious fungal infection that affects the skin on
the feet. It can also spread to the toenails and the hands. The fungal infection is prevalent in
athletes hence the name “athlete’s foot”.
• The fungus thrives in warm, moist environments. It’s commonly found in showers, on locker
room floors, and around swimming pools
CAUSATIVE AGENTS
• Trichophyton (T.) rubrum
• T. interdigitale, previously called T. mentagrophytes var. interdigitale
• Epidermophyton floccosum
RESERVOIR
• The reservoir for the causative agent is man
INCUBATION PERIOD
• The incubation period of Tinea Pedis is probably weeks, the exact period is unkown
MODE OF TRANSMISSION
• direct contact with an infected person 32
• PREDISPOSING FACTORS OF TINEA PEDIS
• visiting public places barefoot, especially locker rooms, showers, and
swimming pools
• sharing socks, shoes, or towels with an infected person
• wearing tight, closed-toe shoes
• keeping your feet wet for long periods of time
• having sweaty feet

SIGNS AND SYMPTOMS

• Itchy erosions and/or scales between the toes, especially between 4th and
5th toes
• Scale covering the sole and sides of the feet (hyperkeratotic/moccasin type,
usually caused by T. rubrum)
• Small to medium-sized blisters, usually affecting the inner aspect of the foot33
DIAGNOSIS
• A skin lesion potassium hydroxide examination

TREATMENT
• Athlete’s foot is mainly treated by topical antifungal medications such as
clotrimazole or miconazole
• Oral medications (antifungal) eg. fluconazol, itraconazole etc.

COMPLICATIONS
• Onychomycosis or tinea unquium (infection of the nails)
• Tinea cruris or ‘jock itch’ (infection of the groin area – genitals, buttocks
and inner thighs)

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PREVENTION
• Wash your feet with soap and water every day and dry them thoroughly,
especially between the toes.
• Wash socks, bedding and towels in water that’s 60°C or higher.
• Disinfect your shoes by using disinfectant wipes (like Clorox wipes) or sprays.
• Put antifungal powder on your feet every day.
• Don’t share socks, shoes, or towels with others.
• Wear sandals in public showers, around public swimming pools, and in other
public places.
• Air out your feet when you are at home by going barefoot.
• Wear shoes made of breathable materials.

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IMAGE OF FOOTROT

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ASPERGILLOSIS
Aspergillosus species are ubiquitous molds (throughout nature) found in the
soil, on plants and in decomposing organic materials. The most common
species causing Aspergillosis are Aspergillosis fumigatus and Aspergillosis
flavus. Risk infections include low CD4 count, exposure to broad spectrum
antibiotics.
Causative Agent
• Aspergillosus fumigatus

Incubation Period
• Between 12-16 days

Mode of Transmission
• Inhalation of Aspergillosus antifungal spores (i.e. dusty environment) can 37
Characteristics
• They have smooth surface.
• The color of the stripes is gray around the apex.
• They produce spores of between 200 and 400mm.

Clinical manifestation
• Fever, unresponsive to antibiotics
• Weight loss of 1-6 months duration
• Chest pain.
• Dyspnea (difficulty in breathing)

Diagnosis
• 1. Chest radiograph
• 2. Sputum culture 38
Prevention
• Wear a mask in dusty places.
• Avoid activities that involves close contact to soil or dust.
• Close your windows if there is construction work or digging outside.

Treatment
• Voriconazole

Complications
• Atelectasis (collapsed lungs)
• Asthma exacerbation (increased in severity)
• Steroid dependence.
• Hemoptysis (spitting up blood). 39
ASPERGILLOSIS

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HISTOPLASMOSIS
• Histoplasmosis is an infection caused by a fungus called Histoplasma. The fungus also lives in
the environment, particularly in soil that contains large amounts of bird or bat droppings. .
People can get histoplasmosis after breathing in the microscopic fungal spores from the air.
• Causative organism : Fungus Histoplasma capsulatum.
• Incubation period : 3-17 days

Mode of Transmission
• It is transmitted via the inhalation of fungal spores.

Signs and symptoms

• Fever
• Cough
• Chest pains
• Headache
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• Body aches
Complications
• Heart problem
• Meningitis
• Adrenal insufficiency

Preventions
• Wear safety mask in dusty places.
• Cleaning and remodeling old buildings.
• Avoid activities that involves close contacts to soil or dust.
• Exploring caves.

Treatment
• fluconazole (Diflucan).
• amphotericin B.

Diagnosis
• Blood test or urine test
• CT scan of your chest 42
IMAGE OF HISTOPLASMOSIS

43
FUNGAL EYE INFECTION

FUNGAL EYE INFECTION

Eye infections are infections of the eye that can be caused by many different
organisms, including bacteria, viruses, amoeba, and fungi.
Types
Fungal infections can affect different parts of the eye and they are;
•Keratitis: This is an infection of the clear, front layer of the eye (the cornea).
• Endophthalmitis: This is an infection of the inside of the eye (the vitreous
and/or aqueous humor).
There are two types of endophthalmitis: exogenous and endogenous.
• Exogenous fungal endophthalmitis occurs after fungal spores enter the eye
from an external source.
• Endogenous endophthalmitis occurs when a bloodstream infection (for
example, candidemia) spreads to one or both eyes. 44
• Types of Fungi that cause eye infections
Different types of fungi can cause eye infections but the common types include:
• Fusarium – a fungus that lives in the environment, especially in soil and on
plants
• Aspergillum – a common fungus that lives in indoor and outdoor environments
• Candida – a type of yeast that normally lives on human skin and on the
protective lining inside the body called the mucous membrane.
• Causative Organism
• Eye infections can be caused by many different organisms, including bacteria,
viruses, amoeba, and fungi.
Reservoir
• Man

Incubation Period
• 4-10 days 45
Mode of Transmission
There are many through which one can get a fungal eye infection. Some of which are through;
• Eye injury .
• Eye surgery
• Invasive eye procedures
• Fungal bloodstream Infection .

Signs and Symptoms

• Eye pain
• Redness if the eyes
• Blurred vision
• Sensitivity to light
• Excessive tearing
• Eye discharge

Complication
• Fungal eye infections are very rare but if not treated, they can become serious and result in permanent vision
loss or blindness. 46
Prevention of Fungal Eye Infection
• Keep your hands clean especially before putting on contacts, applying eye drops, or
otherwise touching your eyes.
• Avoid touching eyes excessively
• Keep your glasses and their cases clean
• Maintain excellent contact lens hygiene

Management
• Fungal eye infections can be managed through;
• Antifungal eye drops
• Antifungal medications given as pills or intravenously
• Antifungal medications injected directly into the eyes
• Eye surgery
47
Keratitis Endophthalmitis

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SPOROTRICHOSIS
• Sporotrichosis also known as Gardener’s disease is a chronic infection which is characterised
by often ulcerating in the skin, subcutaneous tissue and nearby lymph nodes.
Causative Organism
• Sporotrichosis is caused by fungus called Sporothrix .
• The fungus can be found in soil and on plants.

Incubation Period
• Has an incubation period of several days to 3 months.

Mode of transmission
• People get sporotrichosis by coming in contact with the fungal spores in the environment.

• Usually, when someone touches contaminated plant matter, the fungus enters the skin
through a small cut or scrape and cause infection. Breathing in the fungus can also cause
49
pulmonary infection.
Signs and Symptoms
• Often start off several weeks of exposure. This include small bump that can be red, pink or purple on the
site of exposure. Others include cough, Shortness of breath and chest pain.

Complications
• Arthritis
• Pneumonia
• Brain infection (meningitis)
• Bone infection

Prevention
• By wearing protective clothing such as gloves or long sleeves when touching plant matter that can cause
cuts or scrapes.

Management
• By giving antifungal medications such Itraconazole to people infected with with the fungus.
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• Also giving supersaturated iodide for skin sporotrichosis.
Image of
Sporotrichosis

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CRYPTOCOCCUS NEOFORMANS

• Cryptococcus neoformans is an encapsulated yeast and an obligate aerobe that

can live in both plants and animals(environment).
• Infection with the fungus is called cryptococcosis. Cryptococcosis usually affects
the lungs or the central nervous system, but it can also affect other parts of the
body. Brain infections due to the fungus Cryptococcus are called cryptococcal
meningitis.

Mode of transmission of cryptococcosis

• C. neoformans infections(cryptococcosis) are not contagious. Humans can get
the infection after inhaling the microscopic fungus from the environment. The
infection may also be spread to humans through contact with pigeon droppings
or unwashed raw fruit.

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• Mode of transmission of cryptococcosis

53
• Symptoms of cryptococcosis
The symptoms of the infection depend on the parts of the body that are affected.

In the lungs:
• Cough
• Shortness of breath
• Chest pain
• Fever

In the brain (cryptococcal meningitis):

• Headache
• Neck pain
• Nausea and vomiting
• Sensitivity to light
• Confusion or changes in behaviour 54
Statistics of cryptococcosis
C. neoformans infections(cryptococcosis) are rare in people who are healthy; most cases occur in
people who have weakened immune systems.

Complications of cryptococcosis
• repeat cryptococcal infections
• seizures
• Severe pneumonia
• brain damage

Treatment of cryptococcosis
• fluconazole.
• amphotericine
• flucytosine

Management of cryptococcosis
• The best way to prevent cryptococcosis is to not inhale the fungus. This is difficult to do if you live
55
in areas where the fungus resides, although some researchers say that some masks may help
MUCORMYCOSIS
• Previously called zygomycosis is also known as black fungus.
• It’s a rare fungal infection caused by a group of molds called mucormycetes. These molds
live throughout the environment.
• It’s not contagious and thus cannot spread from person to person.

• Causative agents that can cause mucormycosis.

• Rhizopus species, mucor species, rhizormucor species, syncephalastrum species,
Cunninghamella bertholletiae, apophysomyces species and lichtheimia species.

• Types of mucormycosis and their transmission mode.

• Rhino cerebral mucormycosis( brain and sinuses)
• Pulmonary mucormycosis ( lung)
• Gastrointestinal mucormycosis
• Cutaneous mucormycosis ( skin) 56
• Signs and symptoms of mucormycosis.
Rhinocerebral
• One sided facial swelling
• Headache
• Nasal congestion
• Black lesions on nasal bridge
• Fever

Cutaneous
• Blisters
• Infected area turns black
• Pain, warmth
• Excessive redness
• Swelling around the wound.

Disseminated
• Occurs in people who are already sick from other medical conditions. It can be difficult to know 57
Treatment of mucormycosis.
• It’s a serious infection and needs to be treated with prescription antifungal
medicines through a vein or by mouth but some antifungal drugs do not work
against fungi that cause mucormycosis. Often requires surgery to cut away the
infected tissue.
Prevention.
• Avoid areas with lots of dust like construction or excavation sites or wear an N95
respirator.
• Avoid direct contact with water damaged building and flood water after natural
disasters.
• Avoid activities that requires close contact to soil or dust.
• If you have high risk of developing it, your healthcare provider may prescribe
medications to prevent mucormycosis.

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IMAGE OF MUCORMYCOSIS

59
BLASTOCYTOSIS
• Blastomycosis is an infectious disease caused by fungus called Blastomyces
• The fungus is endemic primarily in Eastern north America.
• Less commonly occur in the Africa,north and central America .

CAUSATIVE AGENT
• -Blastomyces dermatitiditis.
PATHOGENESIS
• -Infections occurs mainly through the respiratory tract by inhaling the conidia of
blastomyces dermatitiditis.
• -The conidia then moves to the lungs (alveoli precisely) where they multiply and
may desseminate through blood stream and lymphatics to the other
organs ,including the skin,bone,genitourinary tract,and brain.
• -The incubation period is 30 to 100 days,although infection can be asymptomatic.
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TREATMENT
• Itraconazole is the drug of choice 200mg for most patients.
• Amphotericin B should be used to treat severe disease.
• Surgical excision may be helpful .

MANAGEMENT
• Patients with subclinical disease(presence of serologic or other markers without symptoms)can be
observed and do not require antifungal treatment.mild to moderate diseases should be treated in
all patients.All immunocompromised patients and patients with progressive pulmonary disease or
extrapulmonary disease require treatment.
• Pregnant women should receive the lipid formulation of amphotericin B;azoles should be avoided
because of possible teratohenicity.Voriconazole may have role in the treatment of CNS
blastomycosis,but the lipid formulation of amphotericin B remains first line.

PREVENTION
• There is no vaccine to prevent blastomycosis,and it may not be possible to completely avoid being
exposed to the fungus that causes blastomycosis in areas where it is common in the
environment.people who have weakened immune system may want to consider avoiding activities 61