Medical Mycology

Introduction to Basics
Dr.T.V.Rao MD

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Dr.T.V.Rao MD

Introduction
Mykes (Greek word) : Mushroom Fungi are eukaryotic protista; differ from bacteria and other prokaryotes.
1. Cell walls containing chitin (rigidity & support), mannan & other polysaccharides 2. Cytoplasmic membrane contains ergosterols 3. Possess true nuclei with nuclear membrane & paired chromosomes. 4. Divide asexually, sexually or by both 5. Unicellular or multicellular
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Characteristics of Fungus
Diverse group of chemo heterotrophs
> 90,000 known species

Saprophytes
Digest dead organic matter

Parasites
Obtain nutrients from tissues of organisms

Molds & mushrooms are multicellular Yeasts are unicellular

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Fungus Everywhere

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How the fungus are nourished

All are chemo heterotrophs Absorption of nutrients: powerful Exoenzyme Grow at lower pH-5 than bacteria Grow in high salt and sugar Metabolize complex CH2O like lignin in wood-wood rot
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Mycology
Present as saprophytes in soil, decaying plants ,nature. Eukaryotes Known before bacteria Botanists Developing Nations changing trends USA More serious and even fatal diseases,
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FUNGI (Mycology)
Diverse group of heterotrophs.
Many are ecologically important saprophytes (consume dead and decaying matter) Others are parasites.

Most are multicellular, but yeasts are unicellular.

Most are aerobes or facultative anaerobes.

Cell walls are made up of chitin (polysaccharide).

Over 100,000 fungal species identified. Only about 100 are human or animal pathogens.
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 Yeasts and molds have different structural and reproductive characteristics

Yeast are unicellular, nucleated rounded fungi while molds are multicellular, filamentous fungi Yeast reproduce by a process called budding while molds produce spores to reproduce Some yeast are opportunistic pathogens in that they cause disease in immuno-compromised individuals Yeast are used in the preparation in the variety of foods
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Understanding the Structure of Fungi

Predisposing factors
Use of Antibiotics, Use of steroids,
Immunosuppressive

conditions
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 Mycosis- fungal infection

Fungal Diseases

< 100 cause human disease Not highly contagious Humans acquire from nature

Groups based on degree on tissue involvement and mode of entry Cutaneous mycoses-dermatophytes
Epidermis, hair & nails Contagious-direct or indirect contact Secrete keratinase that degrades keratin
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Fungal Morphology
Hyphae (threads) making up a mycelium

Yeasts

Many pathogenic fungi are dimorphic, forming hyphae at ambient temperatures but yeasts at body temperature.

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Structure of Fungi
Vegetative structures involved in catabolism and growth Thallus- in molds and fleshy fungi
Tubular filaments of cells-hyphae Septate hyphae - cross walls that divide them into unicellular units
Pores to allow cytoplasm & nuclei to pass

Coenocytic hyphae- no septa, continuous cells with many nuclei

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Basic structure of Fungus

Cell wall is rigid Contains Chitin,Mannan, Polysaccharides, Cytoplasm contains Sterols. Contains True Nuclei, Paired chromosome. Divide Sexually, Asexually or by Both Can have specialized cells
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Characteristics of fungi
A. eukaryotic, non- vascular organisms B. reproduce by means of spores, usually wind-disseminated C. both sexual (meiotic) and asexual (mitotic) spores may be produced, depending on the species and conditions D. typically not motile, although a few (e.g. Chytrids) have a motile phase. E. like plants, fungi have an alternation of generations
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Understanding the Terms in Mycology

Simplest Unicellular, Budding yeasts, Tubular elongations Thread like structures called as Hyphae Tangled mass is called as Mycelium Molding produces filamentous fungi. Septate Aseptate Grown up Aerial Mycelium Grows into media Vegetative mycelium
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Understanding the Structure of Fungus

Simplest fungus :- Unicellular budding yeast Hypha :- Elongation of apical cell produces a tubular, thread like structure called hypha
Mycelium :- Tangled mass of hyphae is called mycelium. Fungi producing mycelia are called molds or filamentous fungi. Hyphae may be septate or non-septate
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CLASSIFICATION Depending on cell morphology

1. Yeasts 2. Yeast like fungi 3. Molds 4. Dimorphic fungi
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Yeasts
Unicellular fungi which reproduce by budding On culture produce smooth, creamy colonies e. g Cryptococcus neoformans (capsulated yeast)
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Yeast like fungi

Grow partly as yeasts and partly as elongated cells resembling hyphae which are called pseudo hyphae. e.g. Candida albicans

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Molds/ Filamentous fungi

Form true mycelia & reproduce by formation of different types of spores. Vegetative/ aerial hyphae e.g. Rhizopus, Mucor

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4. Dimorphic fungi
Occur in 2 forms
Molds (Filaments) 25C (soil) Yeasts 37C (in host tissue)

Most fungi causing systemic infections are dimorphic:

Histoplasma capsulatum Blastomyces dermatidis Paracoccidioides brasiliensis Coccidioides immitis Penicillium marneffei Sporothrix schenkii
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Reproduction in fungi
Sexual - formation of Zygospore, ascospores
or basidiospores

Asexual reproduction budding or

fission Asexual spores are formed on or in specialized structures. Vary in size, shape & colour but these characteristics are constant for a particular species.
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Reproduction in fungi Micro conidia Small, single celled Macro conidia Large, single
or many celled
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Systematic classification
Based on sexual spore formation: 4 classes
1. Zygomycetes 2. Ascomycetes sexually 3. Basidiomycetes
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reproduce

4. Deuteromycetes (fungi imperfectii)

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Zygomycetes
Lower fungi Broad, nonseptate hyphae Asexual spores Sporangiospores: present within a swollen sac- like structure called

Sporangium
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Zygomycetes
Sexual spores Zygospore: a resting, thick walled cell in between hyphae e.g. Rhizopus, Mucor
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Ascomycetes
Includes both yeasts & filamentous fungi Narrow, septate hyphae

Asexual spores are called conidia borne on conidiophore

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Ascomycetes
Sexual spores called ascospores are present within a sac like structure called Ascus. Several asci may be seen within a fruiting body as seen in Penicillium, Aspergillus Each ascus has 4 to 8 ascospores.
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Basidiomycetes
Sexual fusion results in the formation of a club shaped organ called base or basidium which bear spores called basidiospores

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Deuteromycetes or Fungi imperfectii

Group of fungi whose sexual phases are not identified. Grow as molds as well as yeasts. Asexual stage conidia e.g. Candida, Cryptococcus
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Vegetative Structures of Fungi

Arthrospores
formed by segmentation & condensation of hyphae

Chlamydospores
thick walled resting spores e.g. C.albicans
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Asexual Spores
Produced by aerial hyphae: adapted for dispersal Progeny genetically identical to parent Several types Conidiospores- not enclosed in a sac
produced in a chain at end of a conidiophore Several types

Sporangiospores
Within a sac, sporangium End of sporangiophore

Sexual Spores
Three phases of development
Plasmogamy-haploid nucleus of a donor cell (+) penetrates the cytoplasm of a recipient cell (-) Karyogamy- the 2 nuclei fuse to form a diploid nucleus Meiosis-diploid nucleus gives rise to haploid nuclei Sexual spores, some + , some -,some recombinants Sexual spores used to classify fungi into divisions

Fungal Infections/ Mycoses

Superficial mycoses:
2 types: surface and cutaneous mycoses Skin, hair & nails. Mild but chronic disease

Deep mycoses:

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2 types: subcutaneous & systemic mycoses Caused by soil saprophytes Infection is accidental Range from a symptomatic infection to fatal disease
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Superficial: Surface mycoses Live exclusively on dead surfaces of

skin and its appendages No contact with living tissue, hence no inflammatory response
1. Tinea versicolor 2. Tinea nigra 3. Piedra
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Superficial: Cutaneous mycoses

Cornified layer of skin & its appendages Contact with living tissue, hence inflammatory & allergic responses seen
1. Dermatophytes skin, hair & nails 2. 3 genera - Trichophyton Microsporum Epidermophyton
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CHARACTERISTICS OF FUNGI (Continued)

Dimorphic Fungi
Can exist as both multicellular fungi (molds) and yeasts. Many pathogenic species.
Mold form produces aerial and vegetative hyphae. Yeast form reproduces by budding.

Dimorphism in pathogenic fungi typically depends on temperature:

At 37oC: Yeast form.

At 25oC: Mold form.

Dimorphism in nonpathogenic fungi may depend on other factors: Carbon dioxide concentration.
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Mycoses
Superficial Cutaneous Subcutaneous

Systemic
Opportunistic
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Deep mycoses
Subcutaneous mycoses

1. Mycotic Mycetoma 2. Chromoblastomyc oses 3. Sporotrichosis 4. Rhinosporidiosis

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Systemic mycoses 1. Cryptococcoses 2. Blastomycosis 3. Coccidioidomyc oses 4. Histoplasmoses

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 Caused by candida sps, forms a bridge between superficial & deep mycoses as it can cause cutaneous as well as systemic infections Can also cause opportunistc

Candidiasis

infections
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Opportunistic infections
Pts with debilitating disease, altered physiological state Mainly caused by fungi which are common lab contaminant on culture media
Aspergillus Pencillium Mucor Rhizopus

Produce serious & fatal infections

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Useful Properties of Fungi

Source of food e.g. mushrooms

Antibiotic production e.g. Penicillin from Penicillium notatum

Fermentation - Production of alcohol, bread, cheese e.g. Sacchromyces spps

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Useful Properties of Fungi

Ergot from Claviceps purpurea, used to induce uterine contractions

Vaccines for Hepatitis B Sacchromyces cerevisiae

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Diagnosis/Treatment
Grown in medium that selects for fungal growth
Grow at 25 C and 37 C

KOH preparations of skin biopsies

Dissolves keratin in skin scrapings or biopsies Leaves only fungal cells

Therapy- amphotericin B or ketoconazole

Toxic to humans

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 Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World Email doctortvrao@gmail.com

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