Systemic mycoses

 Dimorphic
 Systemic
 Endemic
 All causes pulmonary infections
 Histoplasmosis
 Blastomycosis
 Coccidioidomycosis
 Paracoccidioidomycosis
 Penicilliosis marneffei
Histoplasmosis

 Causative agents –
 H.capsulatum var capsulatum
 H.capsulatum var duboisii
Morphology
 Both the varieties are thermally dimorphic ie as
mould in nature and in culture at 250C and as an
intracellular budding yeast in tissue and in culture at
370C
 MOULD –white or brown hyphal colonies;two types
of conidia –tuberculate macroconidia and small
oval microconidia
 YEAST-small oval budding yeast for capsulatum and
larger budding yeast for duboisii
 Yeast phase
 Pathogenesis
Geographical regions-
 Histoplasma cap var cap

the eastern half of US ,Latin America

 Histo cap var dub

Tropical areas of Africa

Source- soil containing bird feces
Mode of acquisition –inhalation
The microconidia which is inhaled is converted to the yeast phase within the
pulmonary macrophages (reticuloendothelial cells)
Clinical syndromes-
Var capsulatum

 Large majority of infections are asymptomatic

 In some acute pulmonary histoplasmosis- flulike illness
 In a few ,lymphadenopathy ,arthritis ,mediastinal fibrosis
 In a very few ,disseminated histoplasmosis –higher in children and
immunocompramised adults -weight loss, oral ulcers , hepatosplenomegaly,
anemia, fever
var duboisii-
-African histoplasmosis
-Pulmonary lesions are uncommon
-Lesions of skin and bone
-disseminated form only in the immunodeficient
marked by fever, lymphadenopathy, anemia
 Lab diagnosis
Specimens
Blood ,bone marrow, scrapings from lesions, urine,
BronchoAlveolarLavage, tissue, sputum
Microscopy-Giemsa, PAS demonstrates the yeast phase
Culture-on Sabouraud’s agar
-presence of tuberculate spores diagnostic
Serology-Ag AND antibody detection-CF,ID,EIA
 TREATMENT

Amphotericin B followed by oral itraconazole

Blastomycosis

 Causative agent –Blastomyces dermatitidis

 Dimorphic fungus
 Also called North American Blastomycosis
 Morphology
Exist as mould at 25oC and as yeast in tissue and in
culture at 37oC
MOULD –white to tan filamentous colonies with conidia
located on hyphal branches
YEAST-spherical and reproduce by the formation of
blastoconidia .The buds are single and attached to
the parent cell by broad bases
 Mycelial form
 Yeast phase
 Pathogenesis
 Geographic distribution-North America
(ohio and Mississippi river valleys ),Africa
 Source decaying organic matter
 Mode of acquisition –inhalation of conidia
 Clinical syndromes-
 pulmonary blastomycosis -asymptomatic or mild flu like
illness; Primary infection in the lung and may resemble
tuberculosis or histoplasmosis.
 From the lungs the fungus spreads and form multiple
abscesses in various parts of the body. The ulcerative
lesions are usually on the skin of the face or other exposed
parts
 Lab diagnosis
 Specimens –sputum,BAL,pus ,skin
scrapings ,tissue
 Microscopy –GMS,PAS,Giemsa –typical
broad based budding yeast forms
 Culture-Mycelial form has to be converted to
the yeast at 370C
 TREATMENT-
 Amphotericin B,ITRACONAZOLE
Coccidioidomycosis

 Causative agents-Coccidioides
immitis,C.posadasii
 Morphology –
MOULD –INITIALLY white to gray then
matures to brown or lavender;the vegetative
hyphae fragment into arthroconidia
YEAST-endosporulating spherule
 Mycelial form
 Yeast phase
 Pathogenesis –
 Geographical distribution-south western
US,northern mexico
 Source –soil,rodents
 Mode of acquisition-inhalation of
arthroconidia
 In most cases asymptomatic infection results
 Many persons develop influenza like fever
 Less than one percent develop ,chronic disseminated
disease(coccidiodal granuloma)
 Lab diagnosis-
 Specimens –sputum,BAL,tissue
 Microscopy –KOH ,H and E,GMS,PAS-
endosporulating spherules
 Culture –
 Serology –ID,LA,CF
 TREATMENT-
 Amphotericin B,ITRACONAZOLE
Paracoccidioidomycosis

 Causative agent-Paracoccidiodes
brasiliensis
 Also called South American blastomycosis
 MORPHOLOGY
 MOULD –white colonies,also brownish
colonies –septate hyphae with
chlamydoconidia
 YEAST-oval to round yeastlike cells, multiple
buds (blastoconidia )-mariners or pilot
wheel
 Mycelial phase
 Yeast phase
 Pathogenesis
 Geographical distribution –south America
 Source soil likely
 Mode of acquisition –inhalation or
inoculation
 Clinicalsyndromes-
 May be asymptomatic
 Pulmonary forms
o A chronic granulomatous disease of the skin,
mucosa, lymph nodes and internal organs
 Lab diagnosis-
 Specimens –sputum, BAL, Scrapings of
ulcer, pus, CSF, Tissue
 Microscopy –calcofluor fluorescence,H and
E,GMS-Charac. Multiple budding yeasts
 Culture
 Serology –ID ,CF
 TREATMENT-
 Itraconazole ,amphotericin B