Systemic Mycoses (New)

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Systemic Mycoses

Fungi that cause systemic disease in humans (4)

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1) Histoplasma Capsulatum

2) Blastomyces Dermatitidis

3) Coccidioides immitis

4) Paracocidioidomycosis

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Systemic Mycoses

Characteristics of fungi that cause systemic fungal infections

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-Dimorphic= grow as mycelium w/ spores at 25C (room temp); grow as yeast at 37C (host's temp)
-endemic to specific geographic areas/countries/regions
-inhaled
-Lung= site of primary infection
-cause disease in the lungs, skin, bones & meninges
-asymptomatic, mild, severe or chronic lung infections
-lung granulomas, calcifications, and/or cavitations
-can disseminate through the blood to distant sites
-skin test like PPD
-no person-to-person transmission
-fungi w/ spores, NOT acid-fast bacteria

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Systemic Mycoses

Mechanism of Disease

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-spores are acquired by inhalation

-never transmitted from person to person

-following inhalation, there is local infection in the lung followed by bloodstream dissemination (LUNGS are affected in these diseases)

-COCCIDIODIN and HISTOPLASMIN are antibodies that are used to support a diagnosis--- when injected intradermally in a previously exposed person, they yield a delated type of hypersensitivity reaction which results in localized swelling w/i 24-48 hrs


-enter the lungs/alveoli as conidia (rather than as mycelia), b/c mycelia are too large to enter the alveoli and are phagocytoses

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Systemic Mycoses

Clinical Presentations (3)

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1) Assymptomatic- most cases are assymptomatic or mild respiratory cases

2) Pneumonia= mild pneumonia w/ cough, fever & mild chest X-ray infiltrates; GRANULOMAS W/ CALCIFICATIONS can form in the lungs

3) Disseminated= fungi are disseminated through the blood and reach the bone, skin, menginges and cause meningitis, organ lesions, etc.--- most commonly effects immunocompromised host

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Systemic Mycoses

The ______ form of systemic mycoses most commonly affects _______ patients.

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-disseminated
-immunocompromised

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Systemic Mycoses

Treatments

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-Acute Pulmonary Histoplasmosis & coccidioidomycosis---> NO TREATMENT (b/c infection is mild)

-Chronic or disseminated disease= ITRACONAZOLE or AMPHOTERICIN B

-all Blastomyces infections= aggressive AMPHOTERICIN B or INTRACONAZOLE

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Systemic Mycoses

Histoplasma capsulatum

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-NONencapsulated (despite its name)
-present in bird and bat droppings (chicken coops, caves. etc)

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Systemic Mycoses

Blastomyces Dermatitidis

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-isolated from soil and rotten wood

-rarest sytemic fungal infection

-rarely asymptomatic--- usually presents as chronic disseminated disease with weight loss, night sweats, lung involvement and skin ulcers

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Systemic Mycoses

Coccidioides immitis

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-causes mild pneumonia in normal people in the Southwestern US

-common opportunistic infection in AIDS patients from this area

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Systemic Mycoses

Types of blastomycoses (3)

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-1) acure or chronic Pulmonary Blastomycosis (chronic is most common)

-2) Primary Cutaneous Blastomycosis

-3) Disseminated Blastomycosis (cutaneous, osteoarticular, genitourinary, etc)

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Systemic Mycoses

______ is the only fungi that must be grown under extra precautions/rules.

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-Coccidioides immitis (a coccidioidmycosis)

-conidia can enter the host cells and reproduce (i.e., they are pathogenic) to form a ball of conidia called SPHEROLS

-the conidia are not heavy (very light), they can complete their work?

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Systemic Mycoses

Paracoccidioidomycosis

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-endemic to South America
-women are more predisposed to men for this disease (the fungi's flagella contains a protein that can bind to estrogen but not to testosterone
-mostly asymptomatic
-can cause lesions to mucosal surfaces, skin, pulmonary surfaces, etc;