Fungal Infections

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Dimorphism

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exists in both yeast and mold form

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Conidia

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axially produced spores

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Spores

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can be asexual or sexual

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Keratinocyte

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Main skin cell

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Stratum Corneum

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Top, most superficial layer of the skin. Made of dead cells.

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Epidermis

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Second most superficial layer. Waterproof barrier made of lipids.

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Dermis

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Third most superficial layer. Made of tough connective tissue, hair follicles and sweat glands.

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Subcutaneous

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Deepest layer of skin - made of fat and connective tissue.

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Superficial Fungal Infections

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Affect only the four layers of skin.

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Tinea (pityriasis) versacolor types

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M. (Malassezia) furfur

M. globosa

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Tinea (pityriasis) versacolor etiology

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commensal yeast that is dimorphic

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Tinea (pityriasis) versacolor pathology

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inflammatory response to fungal spores/hyphae in the stratum corneum.

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Tinea (pityriasis) versacolor clinical presentation

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Fine, scaly, branny plaques that are discoloured and pruritic - may develop into folliculitis and/or seborrheic dermatitis. Discoloured area is where the infection is replicated.

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Tinea (pityriasis) nigra

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like versacolor but darker colour, locate dmainly in areas with thicker skin like pads/soles of feet.

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Tinea (pityriasis) versacolor treatment

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Need an antifungal - antibiotics will exacerbate condition.

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Seborrheic Dermatitis location

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Trunk, Face, Upper proximal extremities

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Dermatophytosis

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Fungal infections affecting the epidermal/dermal layer. Can be in human, animals, environment - can cross contaminate

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Dermatophytes

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Causes dermatophytosis infections. Examples: Trichophyton, Epidermophyton, Microsporum.

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Dermatophytoses

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Environmental molds - NOT dimorphic! They begin as molds and stay that way. They love keratinized tissue - gives them nutrition.

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Tinea (ringworm)

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common name for dermatophytosis; not an actual worm, refers to the shape.

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Dermatophytosis Pathology

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affects epidermis/dermis: cycles of inflammation-desquamation. Spreads laterally because it can't move deeper.

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Dermatophytosis Clinical Presentation

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Scaly, itchy, circular lesions with red, vesiculated borders. Live fungi are on the outside ring with dead fungi in the center. May cause alopecia or onichomycosis (nails). Self-limiting and host's immune system will contain it to one area.

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Id reactions

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i.e. dermatophytid; allergic reaction to mold.

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Dermatophytosis Dx

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- Woods lamp UV light

- 10% KOH

- BEST: CULTURE w/ Sabourand's agar

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Dermatophytosis Treatment

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- antimycotics that act on ergosterol or glucan synthesis

- Griseofluvin (goes to keratinocytes in epidermis and stops it there)

- Nystatin

- Ketoconazol

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Dermatophytosis Transmission

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Intimate contact, cut/fissures

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Subcutaneous mycoses

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affect subcutaneous layer (can't cause any pathology in other layers), enter lymphatics and spread.

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Sporothrix schenkii- sporothricosis

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aka. Rose gardeners/thorn disease. Dimorphic mold. Exists in the environment as mold and then changes to a yeast!

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Sporothrix schenkii- sporothricosis Transmission

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Through small wounds/trauma/infected pus.

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Sporothrix schenkii- sporothricosis Pathogenesis

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granulomatous inflammation usually in the lymphatics. Inflammation that leads to papules then to ulcers then to NODULES under the skin. Nodules will be seen through skin in a straight line pattern.

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Sporothrix schenkii- sporothricosis Dx

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- morphology

- BEST: culture w/ Sabourand's agar

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Deep-seated Fungal Infections

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- deeper than the subcutaneous layer, may or may not be opportunistic, may be systemic (usually lungs).

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Candidia albicans

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- normal flora of skin, GI, GU

- yeast but turns into pathogenic mold (dimorphic)

- OPPORTUNISTIC

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Cutaneous candidiasis

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- skin infection of candidia albicans

- Intertrigo, Onchyomycosis, Paronychia

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Intertrigo

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- cutaneous candidiasis between skin fold in moist areas

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Onychomycosis

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- cutaneous candidiasis of the nails only

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Paronychia

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- cutaneous candidiasis of skin around nail bed

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Mucocutaneous candidiasis (mucosal)

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- white covering of mucous membrane

- Thrush (oral or vaginal)

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Vulvogenital candidiasis

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- i.e. yeast infection

- infection of mucus membrane of GU tract

- fatigue, fever, itchy

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Visceral candidia albicans

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- RARE

- invasive canditiasis (candidemia) in immunocompromised people

- when it enters blood stream and becomes SYSTEMIC (candidemia)

- predeposition: immunosurpressed, diabetes

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Culture

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best way to diagnose any infection!

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Aspergillus fumigatus

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- environmental mold (EVERYWHERE)

- NOT dimorphic, stays as mold

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Aspergillus fumigatus transmission

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via inhalation into the lungs

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Aspergillus fumigatus Dx

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biopsy, CULTURE from aspirates, can be seen on x-ray

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Allergic broncho-pulmonary aspergillosis

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accumulation of hyphae and mycelia in the lungs - forms a "fungus ball"

- invasive lung disease more common in immunocompromised people.

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Pneumocystitis jirovecii

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- newbie to the fungi class (last 5 years); previously known as protozoa

- no spores or mycelium

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Pneumocystitis pneumonia

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- aka PCP (P. carinii pneumonia)

- immunocompromised (common in AIDS pts)

- respiratory infection & serious pneumonia

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Non-opportunistic deep mycoses

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- lung infections, disseminated infections (rare)

- causes systemic infections in any person

- Most common = cryptococcosis - cryptococcus neoformans

- Others: Histplasmosis (Histoplasma capsulatum), Blastomycosis (Blastomyces dermatitidis), Coccidioidomycosis ( Coccidioides imitis - valley fever)

- Environmental molds, soil geographic limitations (i.e. valley fever - dry w/ low rainfall)

- DIMORPHIC MOLDS THAT BECOME PATHOGENIC YEASTS

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Non-opportunistic deep mycoses transmission

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inhalation of conidia, can't be transmitted person to person

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C. neoformans & C. gattii

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- most common non-opportunistic deep mycoses

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C. neoformans

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- ubiquitous - found everywhere

- can leave respiratory tract and cause infections elsewhere

- including Meningitis

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Non-opportunistic deep mycoses pathology

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- reticulo-endothelial cells (macrophages, etc.), pulmonary disease.

- self-limiting

- fatigue, cough, shortness of breath, fever, night sweats, headache, joint/muscle pain, rash, erythema nodosum (C. immitis caused, rare, spores enter via skin cuts)

- systemic: cryptococcal meningitis in immunocompromised pts

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Non-opportunistic deep mycoses Dx

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- culture

- microscopy (india ink highlights the capsule)

- CSF

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Polyenes

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- antifungals acting against ergosterol synthesis

- ex. Amphothericine B

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Enchinocandins

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- antifungals acting against glucan synthesis

- ex. capsofungin, mcafungin, anidulafungin