0109100930 - Mfm Ii - Opportunistic Fungal Infections (Alley)

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Candidiasis ranks where in occurrence of mycoses worldwide?

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#1

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Candida species most common for Candidiasis

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C. albicans
C. tropicalis
C. parapsilosis
C. glabrata

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Candidiasis morphological features

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Budding yeast, pseudohyphae, hyphae

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Candidiasis pathogenicity

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In immunocompromised patients, infection occurs by inhalation or GI persorption or any other route for candida to infect the blood stream. Commonly spread in hospitals among compromised pts.

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Morbidity of mucocutaneous candidiasis

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Accounts for most severe cases, self-limiting in health individuals. If immunocompromised, then can lead to poor oral intake -> malnutrition -> wasting -> death. Common in AIDs pts.

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Morbidity of disseminated candidiasis

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30 - 40% mortality, not common in AIDs pts.

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Candidiasis clinical presentations

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1) cutaneous and subcutaneous (vagina, oral, dermatits, penis);
2) systemic (esophogus, pulmonary, cardio, hepatospleno, arthritis, meninges, etc)
3) chronic mucocutaenous (genetic, impaired cellular immunity, effects skin and mucous membranes)

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Candidiasis Dx

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1) microscopy seen morphology
2) culture - CHROM agar
3) serology - Candida mannan assay

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Candidiasis Tx

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1) cutaneous/mucocutaneous - topical antifungal (ketoconazole, miconazole, nystatin)
2) systemic - amphotericin B
3) chronic mucocutaneous - Amphotericin B

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Cryptococcosis species

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C. neoformans
US and other temperate climates
Found in soil and aged pigeon droppings
C. gattii
Tropical and subtropical areas
Associated with eucalyptus trees

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Cryptococcosis Pathogenesis

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Inhaled yeast spores (from bird droppings) deposit into alveoli and are phagocytized by alveolar macrophage. Pathogen capsule causes immunosuppression.

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Cryptococcosis Clinical Presentation

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1) Pulmonary infection: prodrome, bilateral pneumonia, or asymptomatic
2) disseminated: C. gattii shows CNS cryptococcoma, nonspecific shows meningitis, skin lesions

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Cryptococcosis Dx

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Microscopy - encapsulated budding yeast
Serology - capsule antigen in CSF and serum by latex agglutination test

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Cryptococcosis Tx

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Long term treatment usually necessary Amphotericin B+flucytosine and for AIDs pts fluconazole prophylaxis for life

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Aspergillosis Tx

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1) ABPA - oral steroids
2) Aspergilloma - surgery, smphotericin B intracavity
3) CNPA - antifungal, surgical ressection
4) Invasive aspergillosis - surgical, antifungal (amphotericin B), filter air

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Aspergillosis Dx

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Microscopy - septate hyphae and conidia in sputum
Histo - septate hyphae that branches at acute angles
Culture - grows in absence of cycloheximide
Serology - Rapid dx of invasive (very important), assay for Asperigillus galactomannan Ag in serum

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Aspergillosis infection types

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ABPA - Allergic bronchopulmonary aspergillosis
CNPA - Chronic necrotizing pulmonary aspergillosis
Aspergilloma
Invasive aspergillosis

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Invasive aspergillosis clinical presentation

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Rapidly progressing, can be fatal, prodrome, disseminating even to CNS

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Aspergilloma clinical presentation

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fungus balls (mycetoma) in lung parenchyma

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CNPA clinical presentation

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immunosuppression, progressive cavity pulmonary infiltrate

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ABPA presentation

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hypersensitivity reaction to A. fumigatus in tracheobronchial tree. conjunction with asthma and cystic fibrosis

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Aspergillosis species

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Aspergillus fumigatus

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Aspergillosis pathogenicity

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saprobes that will infect immunosuppressed pts with inherent deficiency, lung disease

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Mucormycosis species

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Mucorales Rhizopus

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Mucormycosis pathogenicity

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air, water, soil inhalation of sporangiospores, but also ingestion and traumatic inoculation can occur. as spores grow, hyphae invade blood vessels -> infarction, necrosis, thrombosis.

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Mucormycosis morphology

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molds in environment, non-septate hyphae form with right angle branch in tissue

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Mucormycosis clinical presentation

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depends on route of infection can be cutaneous, pulmonary, GI, CNS
1) rhino cerebral causing orbital swelling and black pus discharge
2) opthalmoplegias, CN V and VII problems, loss of vision
3) reduced conscious state indicates brain involvement

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Mucormycosis Dx

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Histo - nonseptate right angle hyphae
Culture - cotton candy appearance (rhizoids) and sporangium

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Mucormycosis Tx

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Antifungal (Amphotericin B)
Surgery
High mortality rate

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Fungemia species

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Malassezia furfur
Trichosporon species

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Fungemia Trichosporon species

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Catheter-associated fungemia in neutropenic patients
Individuals with malignancies
Anti-fungal therapy usually inefficient
80% fatality rate

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Fungemia Malassezia furfur

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Malassezia furfur
Nosocomial infections directly related to the administration of IV lipid supplements through a central venous catheter
Infection subsides once lipid infusion stopped and lines removed