Fungi

• Mycology: the study of fungi

– Fungi are widespread in nature; ~200,000
species identified
– Most fungi involved in decomposition of
organic matter & play important role in
recycling organic compounds in nature
– Fungi are Eukaryotic organisms
• Unicellular morphology (=Yeast) or
Mulitcellular morphology (= Mold)
 Fungi
• Yeasts (Unicellular morphology)
– Single, oval or spherical fungal cell
– Reproduction: Asexual by budding
– Budding
• Division of nucleus
• Passage of one nucleus to a bud the “balloons” out from the mother
cell
• Formation of wall between the bud and mother cell
• Daughter cell = bud or blastospore
• Daughter cell initially smaller than mother cell; but, it will increase in
size & produce own buds
• Molds (Filamentous morphology)
– Multicellular – filamentous or tubular structures
– Reproduction: asexual or sexual (main discriminating feature)
 Fungi
• Growth of mold
– Germination of Condium (=asexual reproductive unit in fungi) –
send out a filament that grows by elongation @ its tip
– Hyphae – elongated filament; the basic structure of growing
molds
– Mycelium – multiple branches of hypae; mass of hypae
– Many nuclei located w/in each hypae
– Formation of Septae = “cross-walls” w/in hypae
– Conidia – terminal ends of hyphae; “seeds” for new colonies;
molds reproduce by developing conidia on the hyphae
• Sexual reproduction
– 2 reproductive bodies connect & haploid cells fuse to form
diploid cells (spores) – meiosis
– Resulting diploid cells become Spores = reproductive elements
formed from sexual reproduction
– Rare among the human fungal pathogens
 Fungi
• Dimorphic Fungi
– Dimorphism: the property of having 2 morphological
shapes; dimorphic fungi have capability of 2 distinct forms –
dependent on temperature
• Temperature Dependent
1. Yeast form: 37°C
2. Mold or mycelial form: 25°C
• General characteristics
– Cell wall: rigid & thick; NO PG
– 1° component is presence of sterol in cell wall
– No locomotion: non-motile
• Distinguishing Morphological Characteristics
– Size, presence of a capsule, cell wall thickness, spores or conidia
production
 Fungi
• Growth Conditions
– Molds: aerobic
– Yeasts: facultative anaerobes
– Acid pH (4.0 → 6.0)
– Selective Laboratory Media
• Sabouraud’s Dextrose Agar (SDA) – low pH
• Dermatophyte Test Media (DTM) – turns red in presence of all
dermatophytes
• Birdseed Agar – specific for ID of Cryptococcus neoformans ( agar
turns brown); all other Crytpococcus spp – turn it white
– Minimal Media
• Corn Meal Agar (ID of spore formation: production of terminal conidia)
– Slide cultures – undisturbed growth
– Colonial Morphology
• Molds – dry, cotton-like masses
• Yeast – moist, opaque, creamy colonies
 Mycoses (Fungal Diseases)
1. Superficial Mycoses
• “surface infection”
• Fungal diseases that grow on surface of skin & nails
1. Cutaneous Mycoses or Dermatomycoses
• Fungal infections of keratinous structures – outer layers of
skin, nails, in hair shafts
1. Subcutaneous Mycoses
• Infections that penetrate below the skin & involve the
subcutaneous CT and bone tissue
1. Systemic or Deep Mycoses
• Infections of internal organs – from disseminated disease
1. Opportunistic Mycoses
• Infections in compromised or immunosuppressed
 Dermatomycoses
• ONLY contagious fungal infection/disease in
humans; not associated w/ death, just
uncomfortable symptoms and characteristic
lesions
• Dermatophytes – fungi that invade keratinized
& cutaneous areas of the body
– Nails, hair and skin
• 3 Major Genera
– Microsporum
– Tichophyton = m/c dermatophyte fungus
– Epidermophyton
 Dermatomycoses
• Mode of Infection
– Hyphae grows into keratinized tissues of epidermis, into hair
shaft, or into finger/toe nail
– Growth outward from infection site in concentric circles
– Enzyme production – keratinase, elastase and collagenase
• Clinical Infections
1. Tinea capitis (ringworm of scalp) – Trichophyton &
Microsporum spp.
– Initial Sx: inflammation & itching of the scalp
– Mode of Infection: hypae spread into keratinized areas of scalp &
hair follicle → fungal growth weakens the hair → breakage @
shaft → ALOPECIA (hair loss): localized & spotty
– Associated mostly w/ children (high transmission)
 Dermatomycoses
• Clinical Infection
2. Tinea Barbae (ringworm of the beard)
– Infection site – bearded areas
– Superficial lesion – scaly
– Severe infection – development of deep pustules
– Result – permanent hair loss
2. Tinea pedis (ringworm of the foot, “Athlete’s Foot”) – m/c in
adolescents & adults
– Trichophyton rubrum, Trichophyton mentagrophytes,
Epidermophyton floccosum
– Sx’s – foot lesions
– Mode of infection – growth between toes of small fluid-filled
vesicles → vesicles rupture → development of shallow lesion that
itch; may become infected with bacterial (2° bacterial infection)
– Predisposing conditions – public showers, swimming pools,
failure to dry between toes.
 Dermatomycoses
• Clinical Infections
4. Tinea curis (ringworm of the groin, “Jock Itch”)
– E. floccosom & T. rubrum
– Sx’s – lesions in groin or perianal area → red, scaly, itchy and often dry
– Predisposing factors – moisture in the groin area; wet bathing suits,
athletic supporter, tight fitting pants/slacks and obesity
4. Tinea corporis (ringworm of the body)
– E. floccosum, spp. of Trichophyton & Microsporum
– Infection site – non-hairy areas of the body
– Sx’s – lesions are reddened, scaly, w/ papular eruptions
4. Tinea unguium (ringwom of nails - onychomycosis)
– T. rubrum
– Infection sites – fingernails and toenails
– Initial Sx’s – superficial white patches on nail beds: puffy & chalky
– Later Sx’s – thickening of the nail, accumulation of cheesy debris,
cracking and discoloration of the nail
 Dermatomycoses
• Diagnosis
– Clinical signs and symptoms
– Microscopic ID from tissue scraping samples: presence of hyphae
• Tissue scraping + 10% KOH (heated, then stain added) → presence of
septate hyphae visible under microscope
– Macroscopic ID
• Culture: Dermatophyt Test Media (DTM) – turns RED
• Culture: Sabouraud’s Dextrose Agar (SDA)
• Treatment
– Non-Rx: salves/ointments – for symptomatic relief
– Good hygiene
– Oral antibiotic therapy
– Topical antifungal agent
Note: re-infection may occur over & over => not good host immune
response
 Subcutaneous Mycoses
• Fungal source = normal inhabitants of soil or organic matter
• Introduction to host – wound or abrasions of skin
• Deeper infection – penetration to below skin
• Clinical Infections
1. Sporotrichosis (“Rose Gardner’s Disease”)
– Causative agent = Sporothrix schenckii
– Mode of infection – traumatic implantation of fungus into skin → painless
papule @ inoculation site → enlargement to form ulcerated lesion → then
possible spread to regional lymph nodes = Lymphocutaneous sporotrichosis
1. Lymphocutaneous Sporotrichosis
– Mode of infection – fungus form multiple nodules after being spread by
draining lymph node channels → nodules may ulcerate → untreated lesions
last for years
– Occupational Risk Groups = horticulturists, foresters, gardeners, farmers &
basket weavers
 Systemic Mycosis
• “True pathogens” – infect normal, healthy individuals
• “Opportunisitic pathogens” – infect debilitated +/or
immunocompromised individuals
• Mode of Infection – inhalation of spores → lower
respiratory tract → germinate into yeast → asymptomatic
or 1° pulmonary infection that parallels TB →
disseminated to other organs d/t compromised defense
mechanism
• NO person-to-person transmission; only airborne route to
humans from fungal spores
– Fungi growing in soil or on an. droppings produce conidia that be
aerosolized and carried by air-borne route to humans
 Systemic Mycosis
• Clinical Diseases
1. Coccidioidomycosis
– Chronic, necrotizing mycotic infection of the lungs;
resembles TB pathologically
– Begins as a bronchopneumonia w/ its inflammatory
infiltrate
– Disseminated to many site in immunocompromised pt’s:
skin, bones, meninges, liver, spleen
– Causative agent: Coccidiodes immitis
• Dimorphic fungus that grows in soil of SW US
• Spore = Arthrospores – inhaled into alveoli and terminal
bronchi, where they enlarge into “spherules”
• Spherules fill w/ endospored, which are released to form more
spherules
• In Arizona – 50% chance (after 10 yrs) person w/ (+) serology
to this b/c of exposure, NOT necessarily the disease
 Systemic Mycosis
• Clinical Diseases
1. Coccidioidomycosis
– Epidemiology
 SW US, particularly San Joaquin and Sacramento Valley of California, areas
around Tucson and Phoenix in Arizona
 High incidence of infection & disease may follow dust storm
 Coccidioidomycosis = Valley Fever = San Joaquin Valley Fever = Desert
Rheumatism
– Pathogenesis
 Inhalation of arthroconidia leads to 1° infection
• Asymptomatic in 60% individuals
• 40%: self-limiting influenza-like illness – fever, malaise, cough, arthralgia,
HA
– Laboratory DX
1. Culture: specimen from sputum; exudate from cutaneous lesions; CSF, blood,
urine, tissue biopsies
2. Serology – IgM Ab detection w/ latex agglutination
3. Coccidioidin Skin Test (+)
4. Chest X-Ray analysis – hilar lymphadenopathy along w/ pulmonary
infiltrates, pneumonia, pleural effusions or nodules
 Systemic Mycosis
• Clinical Diseases
2. Histoplamosis
– m/c fungal disease in US
– Acute, necrotizing, caseous granuloma of the lungs
– Causative agent = Histoplasma capsulatum
 Dimorphic fungus found in nature
 Multiplies extensively in areas where bird feces accumulate
– Fungus grows in soil → formation of conidia → airborne →
inhalation into the lungs → germination into yeast-like cells →
engulfed by alveolar macrophages
– Infection – acute, but benign and self-limiting; or chronic,
progressive and fatal
 Usu. Self-limiting flu-like syndrome (fever, chills, myalgia, HA, non-
productive cough
– Dissemination = rare; but can occur – to reticuloendothelial
tissues (liver, spleen, BM lymph nodes)
 Systemic Mycosis
• Clinical Diseases
2. Hitoplasmosis
– Laboratory Dx
 Culture – specimens include sputum, urine, scrapings from
superficial lesions, BM aspirates
 Microscopic examination of fungus in macrophages
 Serology – Tests for Ab’s to Histoplasmin Ag or yeast cells
 Skin Test – Histoplasmin (+)
– Epidemiology
 most prevalent in Ohio & Mississippi River Valleys, including
Central and Eastern States
 KC = high risk area
 Reservoir = Soils laden w/ bird, chicken, or bat droppings = rich
sources of the fungus (natural habitat)
 Systemic Mycosis
• Clinical Diseases
3. Blastomycosis
– Chronic granulomatous and suppurative disease of the lungs,
resulting in small areas of consolidation
– Causative agent = Blastomyces dermatitidis
– Fungus produces microconidia in soil, which become airborne
and inhaled in lungs
 Germination into yeast cells
 Dissemination is rare, but can occur – skin, bone, GU tract
– M/c in South Central and South Eastern US
– M/c clinical presentation = pulmonary infiltrate w/ fever,
malaise, cough, myalgia, night sweats
 Opportunistic Mycoses
• Endogenous type infection – caused by
normal flora of respiratory tract, mouth,
intestinal tract and vagina
• Opportunistic Infection
– Overgrowth of normal flora → inflammation of
epithelial surfaces (m/c = oral cavity and
vagina) → dissemination to internal organs
 Opportunistic Mycoses
• Clinical Diseases
1. Cryptococcosis
– 1° disease of lungs w/ granulomas and consolidation
– Rapidly spreads to the meninges and brain, causing
meningoencephalitis
– Etiological agent = Cryptococcus neoformans
 Only systemic fungus that is NOT dimorphic
 Only true yeast unicellular pathogen of humans
– Epidemiology
 Occurs worldwide in nature; found in very large #’s in dry pigeon feces
 Usually associated w/ immunosuppression – AIDS, malignancy
 2nd m/c fungal dis in AIDS pts (after candidiasis)
 Reservoir = decomposing plant materials (soil) w/ high N content from pigeon
feces
– Pathogenesis
 Inhalation of yeast cells (encapsulated, dry, easily aerosolized)
 Influenza-like illness follows
 Immunosupressed: yeast cells multiply and disseminated to CNS
• YEAST CELLS FOUND W/IN CSF
 Opportunistic Mycoses
• Clinical Diseases
1. Cryptococcus
– S/sx’s: MAJOR clinical manifestation = chronic meningitis w/ spontaneous
remissions and exacerbations
– Pt presentation
 HA
 Stiff neck
 Disorientation
 Lesions in skin, lungs
– Laboratory Dx
 CSF pressure and protein [ ] ↑
 WBC count ↑
 Glucose [ ] normal or low
– Diagnosis
 Specimens from CSF, sputum, blood, urine, exudates
 Culture
 Serology
 Opportunistic Mycoses
• Clinical Diseases
2. Candidiasis (candidiosis)
– Causative agent = Candida albicans
 Normal flora of skin, vagina, and intestines
 Considered a yeast, but is Dimorphic (forms a true mycelium)
– Cutaneous Infections
 arise d/t host’s condition – diabetes, immunological
deficiencies, exposure of skin to moist environment
 Mode of infection
1. Adherence to epithelial surfaces
2. Fungal proliferation
3. Invasion of epithelial tissue
 Opportunistic Mycoses
• Cutaneous Infection w/ C. ablicans
1. Thrush or Oral Candidiasis = Most Common Candidiasis
– Symptomatic appearance: white, adherent patches
(pseudomembranes) attach to epithelial membranes of tongue,
gums, cheeks, or throat – FUNGAL MAT formation
– Pseudomembrane composition = yeast, hyphae, epithelial debris
– Increased susceptibility: Newborns
– Transmission: Vertical - Mother→Child
1. Vaginal Candidiasis = m/c form of vaginal infection
– Sx’s: yellow to white milky discharge, inflammation, painful
ulcerations & itching
– Candidal overgrowth – related to increased glucose content of
vaginal secretions
– Assoc’d w/ - diabetic ♀, pregnant ♀, broad spectrum antibiotic tx
 Opportunistic Mycoses
• Cutaneous Infection w/ C. ablicans
3. Esophageal Candidiasis
– Complication of AIDS patients
– Sx’s: painful bleeding, ulcerations, nausea,
vomiting
3. General Candidiasis Infections
– Infections of epidermal tissue – folds of skin on
obese people (usual sites =upper legs,
underarms); tissue that remains wet
(dishwashers); skin covered by wet diapers
(diaper rash)
 Opportunistic Mycoses
• Disseminated infection w/ C. albicans
– Cutaneous infection → mutisystem disease
– Iatrogenic – use of catheters of prosthetic devices
• Diagnosis
– Clinical symptoms
– Microscopic examination
– Macroscopic examination – culture
• SDA (white- to cream-colored colny, pasty w/ a yeasty odor
• Corn Meal Agar – visualization of spores
• Treatment: Antifungals
 Opportunistic Mycoses
• Clinical Diseases
3. Asperigellosis
– Causative agent = Aspergillus fumigatus
– Acute, invasive infection of lung – dissemination to brain, GIT,
other organs
– Non-invasive lung infection gives rise to aspergilloma (Fungal
Ball) – a mass of hyphal tissue that can form in lung cavities
produced by other diseases, like TB
3. Pneumocystis Pneumonia
– Causative agent = Pneumocystis jiroveci
Pneumocystis carnii
– Acute interstitial pneumonia w/ plasma cell infiltrates
– As disease progresses, pt. experiences weakness, dyspnea, and
tachypnea leading to cyanosis; Death can result from
asphixiation
– m/c cause of DEATH in AIDS pts from Pneumocystis carinii
pnuemonia