Microbiology: Fungus Subcutaneous Mycoses And Opportunistic Yeasts

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cause: Chromoblastomycosis

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Cladophialophora, Fonsecaea and Phialophora

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epidemiology: Chromoblastomycosis

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Americas, Africa, Japan in plant and soil

traumatic implantation of fomites into skin

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pathogenesis: Chromoblastomycosis

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mycelial invasion of subcutaneous tissues of skin results in suppurdative exudate

lesions consist of sclerotic cells surrounded by neutrophils, lymphocytes and plasma cells

dense collagenous encapsulation of connective tissue forms around fungi producing psuedoepitheliomous hyperplasia and granulomas

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Sx: Chromoblastomycosis

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Verrucous dermatitis begins as papules pustules and nodules

Cladosporiosis- single or multiple lesions in brain

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Dx: Chromoblastomycosis

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KOH and Pas reveal sclerotic bodies with branching septate brown hyphae

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Tx: Chromoblastomycosis

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Itraconazole

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Cause: Subcutaenous zygomycosis

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basidiobolus ranarum and delacroixia coronatus

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epidemiology: subcutaneous zygomycosis

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basidiobolus ranarum causes basidiobolomycosis and found in Africa and Asia in soil, decaying vegetation and reptile dung

delacroixia coronatus causes conidiobolomycosis and found in Central America, Africa and India

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pathogenesis: subcutaneous zygomycosis

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hyphae invade buttox

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sx: subcutaneous zygomycosis

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basidiobolomycosis -> nodules in lymph -> elephantiasis

hyperpigmented skin

conidiobolomycosis - nasal polyps

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dx: subcutaneous zygomycosis

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hyphae with swollen ends if Basidiobolus ranarum

hyphae with terminal conidia if Delacroixia coronatus

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tx: subcutaneous zygomycosis

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ketoconazole

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cause: phaeohyphomycosis

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alternaria, cladophialophora and exophialia

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pathogenesis: phaeohyphomycosis

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multiple granulomatous abscesses

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sx: phaeohyphomycosis

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phaeohyphomycosis- cracked fissured skin

phaeohyphomycosis cysts- asymptomatic, solitary, well-encapsulated nodules

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Dx: phaeohyphomycosis

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branching septate brown hyphae

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tx: phaeohyphomycosis

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miconazole

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cause: pseudallescheriasis

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pseudallescheria and madurella

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pathogenesis: pseudallescheriasis

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evade defenses by depositing extracellular melanin

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sx: pseudallescheriasis

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eumycetomas- painless tumor like swellings

pulmonary pseudallescheriasis- bronchial pneumonia

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dx: pseudallescheriasis

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black grains, broad hyphae

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tx: pseudallescheriasis

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ketoconazole

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cause: lobomycosis

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lacazia loboi

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epidemiology: lobomycosis

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South and Central America and Florida

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pathogenesis: lobomycosis

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release toxic compounds cause inflammatory rxn

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sx: lobomycosis

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painless plaques and keloids, spread to form tumor like areas of infection

squamous cell carcinomas

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dx: lobomycosis

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globose to lemon shaped budding yeast joined by short tubes

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tx: lobomycosis

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surgical excision

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epidemiology: Rhinosporidiosis

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inhalation or contact with stagnant fresh water

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pathogenesis: Rhinosporidiosis

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micro-abscess or polyp

lesion contain globular sporangia filled with endospores

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sx: Rhinosporidiosis

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nasal: polyp,
ocular: stalked growths in conjunctiva,
cutaneous: wart like lesions,
systemic: polyp growths throughout

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dx: Rhinosporidiosis

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thick walled spherules with endospores inside

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tx: Rhinosporidiosis

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amphotericin B

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cause: Sporotrichosis

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Sporotrichosis schenckii (dimorphic)

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pathogenesis: Sporotrichosis

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lesions in lymphatics

circumbscrimed microabscesses

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sx: Sporotrichosis

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lymocutaneous- painless lesions away from primary lesion

fixed cutaneous- single ulcers at site of inoculation

mucocutaneous- mucous membrane

pulmonary

extracutaneous disseminated- cutaenous lesions in eye, bones, periosteum, synovium, meningitis

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dx: Sporotrichosis

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chlamydospores in asteroid bodies and cigar shaped budding yeast

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tx: Sporotrichosis

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Itraconazole

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Cause: Candidiasis

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candida albicans

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epidemiology: Candidiasis

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nosocomially

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pathogenesis: Candidiasis

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gelatinous types of lesions develop-> large emboli in brain, spleen and kidneys

granulomas

allergic rxns possible

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sx: Candidiasis

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mucocutaneous: (thrush)- glossitis, stomatitis (raised patches on tongue), cheilitis (lips), perleche, vaginitis, balanitis (penile infection), gastroenteritis, bronchitis

cutaneous- paronychia
diaper rash,

systemic candidiasis, heart murmur, endocarditis and meningitis can be induced by physician actions iatrogenically

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dx: Candidiasis

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oval to globose budding yeasts or pseudohyphae

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tx: Candidiasis

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fluconazole or amphotericin B

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Cause: Rhodotorulosis

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Candida, Rhodotorulosis, Saccharomyces and Schizosaccharomyces

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epidemiology: Rhodotorulosis

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airborne contaminants
normal flora

transmission: person to person, contaminated needles, catheters or dialysis equipment

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pathogenesis: Rhodotorulosis

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yeasts are seeded into blood and result in fungemia

fungal peritonitis occurs in patients on continuous ambulatory peritoneal dialysis

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sx: Rhodotorulosis

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shock and fatal infections

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dx: Rhodotorulosis

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spherical to elongate budding, non-encapsulated yeast like cells

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tx: Rhodotorulosis

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removal of source of contamination

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cause: Pneumocystosis

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Pneumocystosis jiroveci

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epidemiology: Pneumocystosis

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rodents
inhalation of airborne particles

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Pathogenesis: Pneumocystosis

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yeasts multiply in lung tissue and evoke mononuclear cell infiltrate

formation of cystlike granulomas

Ventilation perfusion reduced- consolidation of lungs

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Protective immunity besides all tenia

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Opportunistic:
Pneumocystosis
Cryptococcus

Systemic fungal infections:
Coccidioidiomycosis
Histoplasmosis

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Sx: Pneumocystosis

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interstitial plasma cell pneumonia

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Dx: Pneumocystosis

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thick-walled crescent shaped cysts with many internal bodies

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Tx: Pneumocystosis

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Cortimoxazole

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Cause: Cryptococcosis

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Cryptococcus neoformans and gattii
in pigeon dung

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epidemiology: Cryptococcosis

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pigeon dung

flowering eucalyptus trees (gatti)

transmission by inhalation

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Pathogenesis: Cryptococcosis

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capsular polysaccharides inhibit development of CMI deplete complement

slow resolution

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sx: Cryptococcosis

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CNS involvement (meningoencephalitis)

pulmonary cases

Cutaneous cryptococcosis: papules
Mucocutaneous: swollen nodes
Disseminated disease: meningitis and lesions in heart
Osseus cryptococcosis- swelling and pain in bones

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Dx: Cryptococcosis

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globose yeast cells with thick polysaccharide capsules (nigrosin stain) forming halos

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tx: Cryptococcosis

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fluconazole