CRYPTOCOCCOSISPARACOCCIDIOIDOMYCOSISCOCCIDIOIDOMYCOSIS

CRYPTOCOCCOSIS

• It is also known as TORULOSIS• Sub acute or chronic infection • Caused by :- Cryptococcus

neoformans• HABITAT: soil saprophyte and

particularly abundant in feces of pegeons

MORPHOLOGY

• Round or ovoid budding cell• 4 – 20 µm in diameter• Prominent polysaccharide capsule

PATHOGENICITY

• Source – dust containing basidiospores• Route: mostly by inhalation and some

times through skin or mucosa• Most infections are asymptomatic• Can produce disease in animals

[mastitis in cattle]

Pulmonary cryptococcosis

• It may lead to mild pneumonitis- No calcification occur- Dissemination of infection may

lead to : visceral , cutaneous and meningeal diseases

LABORATORY DIAGNOSIS

Direct microscopy: • Specimens –serum, CSF and other

body fluid • indian ink or 10%nigrosin with formalin

wet mount shows round budding yeast cells with distinct halo

• A wide refractile gelatinous capsule surrounds the organism

diagram

CULTURE

• Grows readyly on Sabouraud’s Dextrose Agar.

• smooth, mucoid , cream coloured colonies are formed

SEROLOGY

• There are 4 serological types of Capsular polysaccharide – A, B, C, & D.

• Demonstration of Capsular antigen by precipitation is valuable in diagnosing some cases of Cryptococcal meningitis when the CSF is negative by smear or culture

TREATMENT

• Amphotericin B• 5 –fluorocytosine• Clotrimazole• miconazole

EPIDEMIOLOGY

• World wide in distribution• Known as European blastomycosis• It is Only deep mycosis common in

our country

COCCIDIOIDOMYCOSIS

• Caused by Coccidioides immitis• Infection is usually self limited• The disease is endemic in the dry

and arid regions of Southwestern USA, where the fungus is present in soil and rodents.

MORPHOLOGY• It is a dimorphic fungus

at 37°C – Yeast form 25°C – Mould form

PATHOGENECITY

• Source: Dust containing Arthrospores

• Route: Inhalation• After inhalation, these spores

become spherical and enlarged forming SPHERULES.

SPHERULES

• 15-75µm in diameter• Thick, double layered refractile

wall is present• Filled with endospores• Spherules are the diagnostic

features of C. immitis.

Possible sites of infection CNS & Bone

Contd..

• In 60% of cases, the infection is assymptomatic

• This leads to immunization and is demonstrated by “positive” skin test with COCCIDIOIDIN

• The other 40% develops self limited influenza like illness with Fever, Malaise, Cough, Arthralgia and Headache. This condition is known as VALLEY FEVER or DESERT RHEUMATISM.

DIAGNOSIS

• Specimens: Sputum Exudate from cutaneous lesions Spinal fluid Blood and Urine

Microscopy

• Specimen stained with KOH or Calcoflour white stain

• Shows Spherules and endospores

Culture• Culturing on SDA

incubated at 37°Cand at room temp.shows Mycelialform.

• The colonies arewhite to tan cottonycolonies.

Serology

• With in 2-4 weeks after infection IgM Ab – Latex Agglutination

IgG Ab – CFT or ID

Skin test

• After 24-48 of cutaneous injection with 0.1ml of standard dilute solution containing Coccidioidin Ag there is a formation of induration >5mm diameter.

• It is known as Positive skin test

Treatment

• Amphotericin B• Itraconazole• Fluconazole

PARACOCCIDIOIDO MYCOSIS

• It is a chronic granulomatous disease of skin, mucous membranes, lymphnodes and internal organs like spleen, liver..

• Caused by Paracoccidioides brasiliensis

• South American Blastomycosis

Morphology

• Dimorphic fungi• Mycelial form produces

Chlamydiospores and Conidia

Pathogenesis & Clinical findings• Source: Dust containing

chlamydiospores and conidia• Route: Inhalation• Chronic, progressive pulmonary

diseases occurs.• Dissemination to other organs like skin,

mucocutaneous tissue, spleen, liver, lymphnodes etc..

Contd..

• Many patients present with painful sores involving the oral mucosa.

• The yeasts are generally observed in Giant cells or directly in exudate from mucocutaneous lesions.

DIAGNOSIS

• Microscopy• Culture• Serology• Skin test

Treatment

• Itraconazole• Ketoconazole• Amphotericin - B