Opportunistic Mycoses

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Opportunistic Mycoses

______ is the most common cause of mycoses.

Back 1

Candida

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Opportunistic Mycoses

_______ is the 2nd most common cause of mycoses.

Back 2

Aspirgillosis

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Opportunistic Mycoses

True Pathogens

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-Dimorphic

-endemic to specific regions (require specific pH and temperature conditions for growth)

-affect both normal healthy people AND immunocompromised people

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Opportunistic Mycoses

Opportunistic Pathogens

Back 4

-not dimorphic

-found all over the world

-only affect immunocompromised people

Front 5

Opportunistic Mycoses

Examples of Opportunistic Mycoses and the Pathogenic Fungi that Cause Them

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-Aspergillosis (caused by: Aspergillus sp)
-Candidiosis (" " Candida sp.)
-Cryptococcosis (" " Cryptococcus neoformans)
-Murcomycosis= HIGHLY FATAL in large % of cases= (" " Mucor Rhizopus)
-Phycomycosis & Zygomycosis--- caused by fungi w/o septae
-Fusarymycosis= typically affects plants, b/ can affect humans too (" " Fusarium)
-Penecilliosis (" " Penicillium)
-Saccharomyetis= baker's yeast (can infect compromised host)

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Opportunistic Mycoses

Factors that predispose individuals to opportunistic mycoses (4)

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-1) Medical procedures (surgery, catheterization, implants, etc)

-2) Medical Therapies (immunosuppressive therapies, cancer therapies, radiotherapies, etc)

-3) Pre-existing conditions (AIDS, leukemia, lymphoma, diabetes, etc)

-4) Lifestyle Factors (poor diet, poor hygeine, IV drug use)

Front 7

Opportunistic Mycoses

Malassezia (a group of opportunistic mycoses)

Back 7

-superficial opportunistic mycoses

Front 8

Opportunistic Mycoses

Zygomycetes (a group of opportunistic mycoses)

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-opportunistic mycoses that have neither septae or a cell wall

-EX) Rhizopus & Mucor

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Opportunistic Mycoses

Hyaline Moulds

Back 9

-dematacious: brown, black

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Opportunistic Mycoses

"Other" Hyaline Moulds

Back 10

-not of the normal colour

-transparent

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Opportunistic Mycoses

Aspergillus

Back 11

-2nd most common cause of mycoses (after Candida)

-spores are found in the soil

Front 12

Opportunistic Mycoses

Why should hospital patients breath air that is purified with a HEPA-filter?

Back 12

-because opportunistic mycoses can be transmitted through the air

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Opportunistic Mycoses

Diseases caused by Aspergillus (4)

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1) Allergic Aspergillosis= many people are allergic to aspergillus and to candida

2) Aspergilloma= fungus ball in the lung (looks like a cancer; appears in lungs that have cavities, which may be b/c of previous diseases or immunocompromised hosts)

3) Aspergillosis of the lung (inflammation of the lung)--- Actue Invasive Aspergillosis & Chronic Necrotixing Aspergillosis (worse)

4) Invasive Aspergillosis (mainly affects/colonizes SINUES & LUNGS)=
-infection of paranasal sinuses
-CNS aspergillosis
-ocular aspergillosis
-endocarditis & myocarditis
-osteomyelitis
-cutaneous

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Opportunistic Mycoses

Epidemiology of Aspergillosis:

1) Method of transmission

2) Incidence of Infection

3) Mortality in Infected Patients

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1) Airborne transmission

2) 4%-38% (incidence of infection)

3) 85% (mortality in infected patients)--- mortality is less in people who are infected at fewer sites

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Opportunistic Mycoses

________ is a good treatment for Aspergillosis

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-Amphotericin B (can be combined w/ antifungal agents such as 5-fluorocytosine; liposomal treatment is also used)

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Opportunistic Mycoses

Penicilliosis (esp. Peneceilliosis Marneffei)

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-found in bamboo rats

-clinical manifestations:
1) papules on skin
2) esophageal lesions
3) lesions on eyes

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Opportunistic Mycoses

Mucromycosis

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-causal fungi: RHIZOPUS & MUCOR (other fungi include: Absidia & Cumminghamella)

-zygomycetes (= don't have septum)

-high % of death (b/c these fungi multiply v. fast <2-3 days> and quickly affect several places in the body: head, neck, arteries, veins, and cause INFARCTION and CVA in the brain b/c they grow v. quickly and can obstruct arteries)

-diagnosis is mostly post-mortem (b/c of rapid progression of disease)

-DIABETES patients are esp. susceptible

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Opportunistic Mycoses

Why are Diabetes patients especially susceptible to mucromycoses?

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-b/c these patients have acidosis, which is one of the triggers for these fungi to grow

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Opportunistic Mycoses

Forms of Mucromycoses (4)

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-RHINOCEREBRAL= most common, most difficult to treat= facial/eye pain, involvement of nerves, muscles, vessels
-Complications= cavernous sinus & internal carotid artery thrombosis
-Mostly Affects: Diabetics w/ ketoacidosis

2) Pulmonary Mucromycoses= nonspecific symptoms (fever, cough, dyspnea)
-Who is Affected: Neutropenic patients

3) Gastrointestinal Mucromycoses= affects stomach, ileum, colon (appears similar to intra-abdominal abscesses)
-Who is Affected: Pt's w/ severe malnutrition

-4) Cutaneous Mucromycoses= necrotic lesions progress from epidermis to dermis to muscle

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Opportunistic Mycoses

Pre-disposing factors for opportunistic fungal infections

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-1) Underyling Conditions (leukemia, lymphoma, bone marrow transplant, organ transplant, AIDS, primary immune disorders, GI disease, diabetes, severe burns, premature birth, IV drug abuse)

-2) Immune Defect (Granulocytopenia, T-cell-mediated immunity= T-Cell immunity is v. important in fungal infections)

-3) Iatrogenic Factors (chemotherapy, immunosuppressive drugs, broad-spectrum antibiotics, breaks in skin or mucosa, catheters, dialysis, prolonged hopitalization, antifungal prophylaxis)
-in transplant pt's, only CORNEA transplant pt's don't take immunosuppressive drugs

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Opportunistic Mycoses

________ (type of medical procedure) can cause both Mycromycosis and Aspergillosis

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-bone marrow transplants

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Opportunistic Mycoses

Pneumocystis carinii (PCP/PJP)

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-always affects LUNGS

-used to be the #1 cause of death in AIDS patients

-affects IMMUNOSUPPRESSED populations

-Clinical Manifestations= cough, dyspnea, fever, hypoxemia, & bilateral interstitial infiltrates

-Diagnostic Methods= sputum induction, bronchoalveolar lavage

-Treatment/Prophoylaxis= TRIMETHOPRIM-SULFAMETHOXAZOLE= 1st choice of treatment (Adjunctive corticosteroid therapy improves survival in moderate to severe cases)

-Complications= pneumothorax, respiratory failure

-declining mortality rates (in developed world) due to use of prophylactics (hard disease to treat)

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Opportunistic Mycoses

Types of PCP/PJP (3)

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-1) Superficial PCP/PJP (Type of infection= Direct Contact; Microorganism type= Parazitic)

-2) Subcutaneous PCP/PJP (Type of infection= Direct Contact <almost>; Microorganism type= Saprophyte)

-3) Systemic Deep-Mycosis PCP/PJP (Type of infection= inhalation, skin <trauma>; Microorganism type= Saprophyte <almost always from soil>)

-Saphorytic Diseases= most dangerous diseases
-Parazitic Diseases= less dangerous