SOME DISEASES CAUSED BY FILAMENTOUS FUNGI
• Chromoblastomycosis
• Mycetoma
• Mucormycosis ****
• Aspergillosis ****
www.freelivedoctorcom
CHROMOBLASTOMYCOSIS
A chronic localized infection of the subcutaneous tissue caused by several species of dematiaceous fungi
www.freelivedoctorcom
Chromoblastomycosis
Fonsecaea pedrosoi
Cladosporium carrionii
Phialophora verrucosa
www.freelivedoctorcom
Ecological AssociationChromoblastomycosis
• Soil
• Decaying vegetation
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
Sclerotic Bodies
A fungus form resulting from host defenses
www.freelivedoctorcom
SCLEROTIC BODIESwww.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
Chromoblastomycosis
Melanin may be a virulence factor
www.freelivedoctorcom
Geographic distribution
World-wide
(usually warmer climates)
www.freelivedoctorcom
CLINICAL SPECIMENS
• PUS
• BIOPSY MATERIAL
www.freelivedoctorcom
TREATMENT
• EXCISION
• TERBINEFINE
• ITRACONAZOLE
• POSACONAZOLE
www.freelivedoctorcom
No Serological Tests Available
www.freelivedoctorcom
www.freelivedoctorcom
Mycetoma
• Tumefaction
• Granules
• Draining sinus tracts
• Muscle invasion
• Bone invasion
www.freelivedoctorcom
www.freelivedoctorcom
Mycetoma agents
• Madurella mycetomatis
• Phialophora jeanselmei
• Pseudallescheria boydii
www.freelivedoctorcom
GEOGRAPHIC DISTRIBUTION
WARM CLIMATES
(SE United States, South America, Africa)
www.freelivedoctorcom
ECOLOGICAL ASSOCIATION
SOIL
www.freelivedoctorcom
Clinical SpecimensMycetoma
• Pus
• Tissue
www.freelivedoctorcom
IDENTIFICATION
• Colonial morphology
• Conidia formation
• Granules– Color– Size shape– Texture
• Biochemical reactions
www.freelivedoctorcom
De
DEMATIACEOUS HYPHAEwww.freelivedoctorcom
Serological TestPseudalescheria
Immunodiffusion
www.freelivedoctorcom
Therapy
Terbinefine
Itraconazole
Posaconazole
www.freelivedoctorcom
Mucormycosis
An acute infection characterized by inflammation and vascular invasion and thrombosis.
www.freelivedoctorcom
Portal of entry
• Inhalation
• Ingestion
• Surface contamination (burns)
www.freelivedoctorcom
Mucormycosis
*Rhizopus species
Mucor species
Absidia species.
www.freelivedoctorcom
GEOGRAPHIC DISTRIBUTION
WORLDWIDE
www.freelivedoctorcom
ECOLOGICAL NICHE
UBIQUITOUS
• FOOD
• SOIL
• ORGANIC DEBRIS
www.freelivedoctorcom
UNCONTROLLED DIABETIC
Rapidly fatal
www.freelivedoctorcom
MUCORMYCOSIS
CLINICAL SIGNS
Ketoacidosis
Nasal stuffiness
Proptosis
Eschar
www.freelivedoctorcom
CHARACTERISITICS OF MUCOR INFECTION
• AFFINITY FOR ARTERIAL INVASION
• NASAL OR SINUS INFECTIONS
• DIRECT EXTENSION TO THE BRAIN THROUGH CRIBIFORM PLATE
• RAPIDLY FATAL
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
WIDE, NON-SEPTATE, RIBBON-LIKEwww.freelivedoctorcom
www.freelivedoctorcom
TREATMENT
MUCORMYCOSIS
• Control diabetes (or other underlying condition)
• Biopsy
• Culture
• Surgery (Debridement)
• Amphotericin B
www.freelivedoctorcom
SEROLOGIC TEST
IMMUNODIFFUSION
www.freelivedoctorcom
ASPERGILLOSIS
A variety of diseases:
pulmonary, external ears, eyes, meninges, sinuses or blood stream
www.freelivedoctorcom
CLINICAL TYPES OF PULMONARY DISEASE
1. ALLERGIC
2. FUNGUS BALL
3. INVASIVE
www.freelivedoctorcom
Difficult to diagnose
1. Clinical symptoms are not specific
2. Radiography not specific (except fungus ball)
3. Blood cultures seldom positive
4. Serology seldom positive (early)
5. Need invasive procedures for early detection
www.freelivedoctorcom
COMMON PATHOGENIC SPECIES
• A. FUMIGATUS
• A. NIGER
• A. FLAVUS
www.freelivedoctorcom
GEOGRAPHIC DISTRIBUTION
WORLD-WIDE
www.freelivedoctorcom
ECOLOGICAL ASSOCIATION
UBIQUITOUS
• SOIL
• DECAYING VEGETATION
• FOOD
• MEDICATION
• AIR VENTS
• DISINFECTANTSwww.freelivedoctorcom
Culture
• More than 900 species• Slow growing• Various gross colors• Spores
– Size– Shape– Texture– color
www.freelivedoctorcom
www.freelivedoctorcom
HISTOPATHOLOGY
• DICHOTOMOUS BRANCHING
• WIDE, SEPTATE HYPHAE
www.freelivedoctorcom
www.freelivedoctorcom
DICHOTOMOUS BRANCHING
www.freelivedoctorcom
Aspergilloma
Cavity wall
www.freelivedoctorcom
www.freelivedoctorcom
SEROLOGIC TESTS
1. IMMUNODIFFUSION
(antibody)
2. EIA - GALACTOMANNAN
(antigen)
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
DRUG OF CHOICE
VORICONAZOLE
AMPHOTERICIN B
www.freelivedoctorcom
DIMORPHIC FUNGI(Endemic Mycoses)
COMMON CHARACTERISTICS
• LIMITED GEOGRAPHIC AREA
• SPECIFIC ECOLOGICAL NICHE
• SYSTEMIC INFECTIONS
• MORPHOLOGICALLY DISTINCT
www.freelivedoctorcom
BLASTOMYCOSIS
Blastomyces dermatitidis
www.freelivedoctorcom
BLASTOMYCOSIS
A CHRONIC SUPPURATIVE AND GRANULOMATOUS DISEASE OF ANY TISSUE WITH A PREDILECTION FOR LUNGS, SKIN, PROSTATE AND BONE.
www.freelivedoctorcom
PORTAL OF ENTRY
INHALATION
INOCULATION
(rare)
www.freelivedoctorcom
CLINICAL FORMS
1. SYSTEMIC
USUALLY PULMONARY
2. CUTANEOUS
PRIMARY
SECONDARY
www.freelivedoctorcom
www.freelivedoctorcom
Pulmonary Symptoms
• Anorexia
• Weight loss
• Cough
• Hemoptysis
• Night sweats
www.freelivedoctorcom
www.freelivedoctorcom
CLINICAL SPECIMENS
• SKIN SCRAPINGS
• SPUTUM
• PUS
• BIOPSY MATERIAL
• URINE
• BRONCHIAL WASHINGSwww.freelivedoctorcom
ECOLOGICAL ASSOCIATION
ORGANIC DEBRIS
(SOIL, ROTTED WOOD, DECAYED VEGETATION)
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
Virulence Factor
BAD1
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
Identification
• 1. Microscopic observation
• 2. Conversion
• 3. DNA Probe
www.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom
Wet Mount
www.freelivedoctorcom
SEROLOGIC TEST
• IMMUNODIFFUSION
• COMPLEMENT FIXATION
• EIA
www.freelivedoctorcom
DRUGS OF CHOICE
•ITRACONAZOLE
•AMPHOTERICIN B
•VORICONAZOLEwww.freelivedoctorcom
www.freelivedoctorcom
www.freelivedoctorcom