Medical Mycology Outline

Medical Mycology Outline
1. 2. 3. 4. 5. Introduction, Actinomycetes Yeasts, Dermatophytes Filamentous Fungi, Dimorphic Fungi Dimorphic Fungi Opportunistic Fungi
www.freelivedoctor.com
INTRODUCTION
A. Classification
What is a Fungus ?
Eukaryotic a true nucleus Do not contain chlorophyll Have cell walls Produce filamentous structures Produce spores
Species of Fungi
100,000 200,000 species
About 300 pathogenic for man
Kingdom Fungi
Ascomycota Basidiomycota Zygomycota Mitosporic Fungi
(Fungi Imperfecti)
Eukaryocytes
KINGDOM
CHARACTERISTIC
EXAMPLE
Monera
Prokaryocyte
Bacteria Actinomyces Protozoa Fungi
Protista Fungi
Eukaryocyte Eukaryocyte * Eukaryocyte
Plants
Plants Moss
Arthropods Mammals Man
Animals
Eukaryocyte *
KINGDOM
CHARACTERISTIC
EXAMPLE
Monera
Prokaryocyte
Bacteria Actinomyces Protozoa Fungi Plants Moss
Protista Fungi Plants
Eukaryocyte Eukaryocyte * Eukaryocyte
Animals
Eukaryocyte *
Arthropods Mammals
Man
SIZE COMPARISON OF PATHOGENS

Cocci Bacilli Spirochetes Viruses Protozoa Nematodes Fungi 0.8 u 4-6 u 8 - 10 u 0.08 u 15 u 10 mm 10 15 u
Actinomyces (True Bacteria)

Tradition Clinical infection resembles mycoses Actinomyces grow on mycotic media Actinomyces grow slowly (24-48 h) Gross colonies resemble fungi
(rough,heaped, short aerial filaments)
Resemble mycelia microscopically, with branched mycelia in tissue and smears.

MYCOTIC DISEASES (Four Types)

1. Hypersensitivity
Allergy Production of toxin Pre-formed toxin
2. Mycotoxicosis 3. Mycetismus (mushroom poisoning) 4. Infection

Hypersensitivity
FARMERS LUNG Moldy hay MALT WORKERS DISEASE Moldy barley CHEESE WASHERS LUNG Moldy cheese WOOD TRIMMERS DISEASE Moldy wood
PATHOGENIC FUNGI
NORMAL HOST
Systemic pathogens - 25 species Cutaneous pathogens - 33 species Subcutaneous pathogens - 10 species
IMMUNOCOMPROMISED HOST
Opportunistic fungi - 300 species
PARASITIC STATE
1. Increased metabolic state 2. Modified metabolic pathways 3. Modified cell wall structure
Carbohydrate content Lipid structure RNA aggregates
PATHOGENICITY OF FUNGI
1. Thermotolerance
2. Ability to survive in tissue environment 3. Ability to withstand host defenses
REVIVED INTEREST IN MYCOLOGY
1. 2. 3. 4. 5. 6. 7.
Increased frequency of mycotic diseases Increased awareness by physicians Better trained laboratory personnel More invasive procedures used on patients Increased use of immunosuppressive drugs Increase in immunosuppressive disease Better laboratory diagnostic tools
B. MORPHOLOGY
MORPHOLGY
Yeasts Hyphae (filamentous fungi, mycelium)
Septate Coenocytic (non-septate)
Dimorphic
Yeast Mycelium
Dimorphic Fungi
Yeast Form
Parasitic form Tissue form Cultured at 37 C
Mycelial Form
Saprophytic form Cultured at 25 C
SPORES
SEXUAL ASEXUAL
Arthrospore Blastospore Chamydospore Conidia
Microconidia Macroconidia
C. EPIDEMIOLOGY
ECOLOGICAL ASSOCIATION
PATHOGEN HUMAN SOIL _________________________________________ Blastomyces dermatitidis 1898 1964 Cryptococcus neoformans 1894 1951 Coccidioides immitis 1900 1932 Histoplasma capsulatum 1934 1949
Mycotic Diseases Are NOT Contagious
ESTABLISHMENT OF INFECTION WITH A MYCOTIC AGENT DEPENDS ON
1. Inoculum size 2. Resistance of the host

THE CLINICIAN MUST DISTINGUISH BETWEEN: COLONIZATION FUNGEMIA
INFECTION
PORTAL OF ENTRY
RESPIRATORY TRACT
MOUTH EYE
SKIN
HAIR NAILS RESPIRATORY TRACT GASTROINTESTINAL TRACT URINARY TRACT
SKIN
UROGENITAL TRACT
ANUS
COLONIZATION
RESPIRATORY TRACT
MOUTH EYE
Multiplication of an organism at a given site without harm to the host

UROGENITAL TRACT
SKIN
ANUS
INFECTION
RESPIRATORY TRACT
MOUTH EYE
Invasion and multiplication of organisms in body tissue resulting in local cellular injury.
UROGENITAL TRACT
SKIN
ANUS
GEOGRAPHIC DISTRIBUTION
The present ease and frequency of world-wide travel make it more likely that physicians in the United States will be confronted with a variety of unfamiliar mycoses acquired in distant parts of the country or of the world.
Endemic Mycoses
Those fungus infections with a limited geographic distribution. They are all caused by dimorphic fungi
D. DIAGNOSIS
Diagnosis 1. Wet Mount 2. Skin test 3. Serology 4. Fluorescent antibody 5. Biopsy and histopathology 6. Culture 7. DNA probes
DIRECT MICROSCOPIC OBSERVATION
10 % KOH Gentle Heat
KOH Wet Mount
SKIN TESTING
(DERMAL HYPERSENSTIVITY)
Use is limited to :
Determine cellular defense mechanisms Epidemiologic studies
FUNGI ARE POOR ANTIGENS
FUNGAL SEROLOGY ANTIBODIES

Latex Agglutination
Immunodiffusion Complement Fixation
IgM
IgG IgG
DIRECT FLUORESCENT ANTIBODY

CAN BE APPLIED TO
1. HISTOLOGIC SECTIONS 2. CULTURE

Viable organisms Non-viable organisms
INCUBATION TEMPERATURE
37 C - Body temperature 25 C - Room temperature
E. TREATMENT
THERAPY
Because they are eukaryotic, fungi are biochemically similar to the human host. Therefore it is difficult to develop chemotherapeutic agents that will destroy the invading fungus without harming the patient.
A BASIC TENET OF PATHOLGY :
A CAUSE OF IRREVERSIBLE CELL INJURY IS CELL MEMBRANE DAMAGE.
IN FUNGAL THERAPY
We attempt to induce cell injury by causing the cell membrane of the fungus to become permeable.
PRIMARY ANTI-FUNGAL AGENTS

1. Polyene derivatives
Amphotericin B Nystatin Ketoconazole Fluconazole Itraconazole Voriconazole Posaconazole
2. Azoles
AMPHOTERICIN B Mechanism of Action

Amphotericin B binds to sterols Ergosterol is a constituent of the fungal cell wall AMB has a greater avidity for ergosterol than for the cholesterol in the human cell wall Binding to the fungal cell wall alters the permeability and the intracellular contents leak
AMPHOTERICIN B Disadvantages
Intravenous administration Thrombophlebitis Nephrotoxic Fever Chills Anemia Long term administration
Azoles
There are a few rare serious side effects from Itraconazole and Fluconazole
PRIMARY ANTI-FUNGAL AGENTS

3. Griseofulvin 4. 5-fluorocytosine (5-FC) 5. Allylamines -Terbinafine (Lamasil) 6. Echinocandins - Caspofungin
Griseofulvin
A slow acting drug used for skin and nail infections. It accumulates in the stratum corneum and prevent hyphal penetration through these layers
5-fluorocytosine
(5-FC)
Interferes With RNA Synthesis
MECHANISMS OF ACTION
Polyenes
Azoles Griseofulvin
Ergosterol in cell membrane Interfere with ergosterol synthesis Forms a barrier to fungal growth
Inhibits RNA synthesis
5 - FC
F. Clinical Classification of Mycoses

Cutaneous Subcutaneous Systemic Opportunistic
Cutaneous Mycoses
Skin, hair and nails Rarely invade deeper tissue Dermatophytes
Subcutaneous Mycoses
Confined to subcutaneous tissue and rarely spread systemically. The causative agents are soil organisms introduced into the extremities by trauma
Systemic Mycoses
Involve skin and deep viscera May become widely disseminated Predilection for specific organs

Medical Mycology Outline

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Medical Mycology Outline

Uploaded by

Copyright:

Available Formats

Medical Mycology Outline

Bacteria Actinomyces Protozoa Fungi

Eukaryocyte Eukaryocyte * Eukaryocyte

Bacteria Actinomyces Protozoa Fungi Plants Moss

Protista Fungi Plants

Eukaryocyte Eukaryocyte * Eukaryocyte

SIZE COMPARISON OF PATHOGENS

Actinomyces (True Bacteria)

Resemble mycelia microscopically, with branched mycelia in tissue and smears.

MYCOTIC DISEASES (Four Types)

2. Mycotoxicosis 3. Mycetismus (mushroom poisoning) 4. Infection

REVIVED INTEREST IN MYCOLOGY

Mycotic Diseases Are NOT Contagious

ESTABLISHMENT OF INFECTION WITH A MYCOTIC AGENT DEPENDS ON

1. Inoculum size 2. Resistance of the host

THE CLINICIAN MUST DISTINGUISH BETWEEN: COLONIZATION FUNGEMIA

Multiplication of an organism at a given site without harm to the host

DIRECT MICROSCOPIC OBSERVATION

10 % KOH Gentle Heat

KOH Wet Mount

FUNGI ARE POOR ANTIGENS

FUNGAL SEROLOGY ANTIBODIES

DIRECT FLUORESCENT ANTIBODY

1. HISTOLOGIC SECTIONS 2. CULTURE

A BASIC TENET OF PATHOLGY :

A CAUSE OF IRREVERSIBLE CELL INJURY IS CELL MEMBRANE DAMAGE.

PRIMARY ANTI-FUNGAL AGENTS

AMPHOTERICIN B Mechanism of Action

PRIMARY ANTI-FUNGAL AGENTS

F. Clinical Classification of Mycoses

You might also like