Opportunistic Mycoses &

Miscellaneous mycoses

OBJECTIVES

• To describe the etiology, morphology, pathogenesis, clinical spectrum of opportunistic mycoses

• To elaborate the laboratory diagnosis and treatment of Opportunistic mycoses.

Introduction

• Opportunistic Mycoses – Fngal infections in Immuno-compromised or Immuno-suppressed individuals

• HIV/AIDS, Diabetes, Patients with Malignancy, Pts. Taking cancer chemotherapy, Prolonged corticosteroid therapy, Infants & young Children, Elderly age, Tuberculosis & Pregnancy

ASPERGILLOSIS

1. Allergic Broncho Pulmonary Aspergillosis – Type I Hypersensitivity reactions (Asthma, Type III (extrinsic alveolitis)

2. Aspergilloma3. Invasive Aspergillosis4. Superficial infections like otomycosis &

Mycotic keratitis or Oculomycosis

ASPERGILLOSIS

1. Aspergillus fumigatus2. Aspergillus niger3. Aspergillous flavus4. Aspergillus terreus

ASPERGILLOSIS

• Laboratory diagnosis: • Microscopy: LPCB stain: Septate hyaline

hyphae is suggestive of Aspergillus infection• Culture: Velvetty or powdery colonies1. Aspergillus fumigatus - Green2. Aspergillus niger - Black3. Aspergillous flavus - Yellow4. Aspergillus terreus - Brown

Aspergillus niger

Aspergillus flavus

Aspergillus fumigatus

PENICILLOSIS

CANDIDOSIS

• CANDIDIASIS• MONILIASIS• Candida albicans, C. dubliniensis• Candida non-albicans • Candida tropicalis, C. glabrata, C. krusei, • C. pseudotropicalis, C. gueillermondii

CANDIDOSIS

• KOH mount: Potassium hydroxide

Candida albicans

Candida albicans

Candida albicans• Reynold – Braude phenomenon – Lady Hand

mirror appearance (Germ tube test positive)

Candida albicans• Corn meal agar – Chlamyospores positive

CRYPTOCOCCOSIS

• TORULOSIS• Cryptococcus neoformans var. neoformans• Cryptococcus laurentii• Cryptococcus albidus• Rapid urease positive

CRYPTOCOCCOSIS Gram stain Negative stain Spherical Gram Positive Clear halo seen (capsule)

CRYPTOCOCCOSISCulture on SDA

ZYGOMYCOSIS

• MUCORMYCOSIS • PHYCOMYCOSIS• Rhino orbito cerebral

Mucormycosis• Diabetes mellitus• H & E Stain

ZYGOMYCOSIS - RHIZOPUS

Rhizopus

ZYGOMYCOSIS - MUCOR

PNEUMOCYSTIS JIROVECII

• Trophozoite – 1-5 µm• Pre-cyst – 5-8 µm• Cyst - >8 µm• Cannot be cultured in SDA• Can be cultured in Complex media• Modified Gomori’s Methanamine Silver stain • Cotrimoxazole (Trimethoprim - Sulfamethoxazole)

PNEUMOCYSTIS JIROVECII

MISCELLANEOUS TOPICS

• OTOMYCOSIS• OCULOMYCOSIS• MYCOTIC POISONINGa. MYCETISMb. MYCOTOXICOSIS• WOOD’s LAMP FLUORESCENCE

OTOMYCOSIS

OCULOMYCOSIS

MYCOTIC POISONING

a. MYCETISMPsilocybe spp.,Produces d-Lysergic Acid & Psilocybinb. MYCOTOXICOSISAspergillus spp., Claviceps purpura

MYCOTIC POISONING

MYCETISM

MYCOTOXINS

• Aspergillus spp., - Aflatoxin• Amanita phalloides – Phallotoxin• Fusarium spp., - Fumonisin• Aspergillus spp., in cereals • Penicllium spp., in Bread• Fusarium graminareum – Zearalenone• Claviceps purpura – Ergotism – ergot alkaloid

Ochratoxin

MYCOTOXICOSIS

WOOD’s LAMP FLUORESCENCE

WOOD’s LAMP FLUORESCENCE

Summary & Take home message

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