Você está na página 1de 23

Systemic Mycoses

 General futures
 Inherently virulent
 Geographic distribution varies
 Cause disease in healthy humans
 Dimorphic fungi
 Infection originated in the lung
 A symptomatic
CONT.

 No evidence of transmission among humans or


animals
 FUNGI CAUSE TRUE SYSTEMIC (ENDEMIC)
MYCOSES
1. Coccidioidomycosis
2. Histoplasmosis
3. Blastomycosis
4. Paracoccidioidomycosis
Histoplasmosis

 Etiologic agent
 Histoplasma capsulatum
 Mycology
 Dimorphic fungi
 Mycelium at 25Ć with tuberculate conidia
 Yeast found in histocytes at tissue (37Ć)
 Epidemiology and ecology

 Temperate
 Tropical and subtropical area
 Soil contaminated with bats, chicken dropping
 African varieties called H. caps var duboisii
 Pathogenesis
 Inhalation of microconidia / primary cutaneous inoculation
 Conversion to budding yeast cells
 Phagocytosis by alveolar macrophages
 Restriction of growth or dissemination to RES by
bloodstream
 Suppression of cell-mediated immunity
Clinical diseases

 In normal host
 Mild-flu-like illness with normal exposure
 Acute pulmonary disease with heavy exposure
 Opportunistic infection
 Disseminated Histoplasmosis
 Patients with an immune-defect
 Chronic pulmonary in patient with structural defect
Laboratory diagnosis

 Samples
 Sputum, tissue, bone marrow, CSF, blood
 Direct examination
 Giemsa / Wright
 Intra- and extracellular yeast cells
 Culture
 Mould at 25°C
 Conversion to yeast on an enriched medium at
37°C
Diagnosis-II

 Serology
 Complement fixation...
 Skin test
 (Histoplasmin antigen): Limited
diagnostic value
AFRICAN HISTOPLASMOSIS

 Aetiology
 Histoplasma capsulatum var. duboisii
 Differentiation from classical histoplasmosis
 Larger, thick-walled yeast cells
 Pronounced giant cell formation in infected tissue
 Diminished pulmonary involvement
 Greater frequency of skin and bone lesions
Treatment

 Amphotericin B (drug of choice)


 Itraconazole
 Surgical resection of pulmonary
lesions
Blastomycosis

 Etiologic agent
 Blastomyces dermatitidis
 Mycology
 Mycelial at 25Ć with pyriform microconidia
 Yeast with bud attached by broad base 37Ć
 Epidemiology and Ecology
 North America, parts of Africa
 Veterinary problem
 Similar disease in dogs
Clinical diseases

 Primary infection
 ASYMPTOMATIC INF.
 PULMONARY INF.
 CHRONIC CUTANEOUS INF
 Subcutaneous nodule, ulceration
 DISSEMINATED INF.
 Skin, bone, GUT, CNS, spleen
 PRIMARY CUTANEOUS INF.
Laboratory Diagnosis

 Diagnosis-I
 Samples
 Sputum, tissue
1. Direct micr.ic exam
 KOH, H&E
 Yeast cells; bud is attached to the parent cell by a broad
base
2. Culture
 Mould at 25°C
 Conversion to yeast on an enriched medium at 37°C
Diagnosis-II

3. Serology
 Immuno diffusion test
 ELISA
 to detect antibodies to exoantigen A
4. Skin test
 Blastomycin antigen
 Limited/no diagnostic value
Treatment

 Amphotericin B
 Itraconazole
 Fluconazole
 Corrective surgery
American Coccidiodes

Paracoccidioidomycosis
 Etiologic agent
 Paracoccidiodes brasiliensis
 Mycology
 Mycelial at 25Ć with no typical sporulation
 Yeast with several buds at 37Ć (pilot’s wheel)
 Epidemiology and Ecology

 Central and south America


 More incidence in males
 Rarely isolated from soil
 Clinical findings
 ASYMPTOMATIC INF.
 LATENT FORM (duration variable)
 SYMPTOMATIC INF
 Ulcerative lesion of buccal, nasal GT
 Nodular lesions in lungs
 Dissemination to other organs (rare)
Laboratory diagnosis

 Diagnosis-I
 Samples
 Sputum, tissue
1. Direct micr.ic exam.
 KOH, H&E or silver stain
 multiply budding yeasts; the buds are attached to
the parent cell by a narrow base
2. Culture
 Mould at 25°C
 Conversion to yeast on an enriched medium at 37°C
Diagnosis-II

3. Serology
 Immunodiffusion
 Complement fixation
 Treatment
 Amphotericin B
 Ketaconazole
 Itraconazole
 Sulphonamides
Coccidioidomycosis

 Etiologic agent
 Coccidiodes immitis
 Mycology
 Mycelial at 25Ć fragmented to arthroconidia
 Spherules at 37 Ć
Epidemiology and ecology
 Restricted to north, central, south, America
 Disease also occur in animal
 Fungi isolated from soil in endemic area
 Clinical finding
 PRIMARY INF
 60% are asymptomatic
 Cough, fever and chest pain
 Nodular lesions in lungs
 Epidemiologic history is important
 SECONDARY (DISSEMINATED) INF. (1%)
 Chronic / fulminant
 Infection of lungs, meninges, bones and skin
Laboratory Diagnosis

 Diagnosis-I
 Samples
 Sputum, tissue
1. Direct examination
 (KOH; H&E) Spherule
2. Culture
 SDA Mould colonies at 25 °C
 Spherule production in vitro by incubation in
an enriched medium at 40°C, 20% CO2
Diagnosis-II

3. Serology
 Tube precipitin (IgM) test
 Complement fixation
Skin test
 coccidioidin and spherulin antigens
 Negative result may rule out the
diagnosis
Treatment

 Symptomatic treatment only (primary


infection)
 Amphotericin B
 Itraconazole
 Fluconazole (particularly for
meningitis)