Systemic Mycoses A.
Blastomycosis
infections that affect internal organs or deep tissue of the body
the lung is the initial site of infection,
most lung infections are asymptomatic and self-limited
infected persons do not communicate these diseases to others
caused by inhalation of thermally dimorphic fungus which exist in
two phases of growth:
1. Yeast phase, parasitic, invasive or tissue form takes
place at 35-37C
2. Mycelial phase, mold or saprobic form takes place
at room temperature (25-30C) I. Characteristics:
Summary
Agent Infection Dissemination Drug of
choice
Blastomyces Blastomycosis Skin and bone Amphotericin
dermatitidis Later nervous B
system and visceral Itraconazole
organs
Coccidioides Coccidioidomycosis Skin, bones, joints, Amphotericin
immitis subcutaneous B
tissues, and visceral
organs
Paracoccidioid Paracoccidioidomyco Oro-nasal mucosa Amphotericin II. Causative agent:
es brasiliensis sis latter spleen, liver, B + sulfas or Blastomyces dermatitidis
intestine and skin azoles
Histoplasma Histoplasmosis Acute pneumonia Amphotericin B. dermatitidis is a dimorphic
capsulatum (cave disease) B fungus that exists as a mold in soil
and as a yeast in tissue.
Chronic pneumonia
The yeast is round with a doubly
(smoker) refractive wall and a single broad-
Disseminated based bud
(immunocompromis
ed)
Primary cutaneous
(lab accidents)
a. Specimen
III. Epidemiology Sputum for pulmonary form
Mississippi River Valley Basin is the major endemic area & some Skin scrapings from periphery of cutaneous lesions
cases in North Africa Biopsy material
Organism grows in moist soil
b. Direct Microscopy:
- 10% KOH, PAS, Silver or Gram stain
IV. Transmission
Inhalation of the conidia causes human infection
c. Culture:
V. Pathogenesis & Clinical findings - SDA + BHIA at 37C
- At room temp on Sab, Mycosel, Mycobiotic agar
Infection occurs mainly via the respiratory tract. colonies are fluffy, white to brownish-white fungus
Asymptomatic or mild cases are rarely recognized. which produces pyriform spores after 2 weeks of
Dissemination may result in ulcerated granulomas of skin, bone, or incubation
other sites. - Hyphae at room temperature that are incubated on
BHI at 37C; after 2 weeks, yeast cells are formed
VI. Clinical Forms: - Spores are the infectious form
1. Pulmonary
Fungus enters the human body via the lungs
Infected individual initially has mild respiratory symptoms such as
fever, cough and hoarseness
Infection progresses after a few months and patient then has
productive cough, fever and eventually weight loss
Radiographically, the disease looks like tuberculosis, carcinoma or
other chronic respiratory problems
2. Systemic
An extension of the pulmonary form
The most common sites of involvement are liver and spleen
Granulomatous lesions are present and abscesses often occur
3. Cutaneous
Presence of cutaneous lesions indicate systemic mycoses
Lesions develop slowly and after months or years cover large areas of
the skin, several inches in diameter.
Lesions appear crusty, elevated 1-3 mm and have well-defined margin
which contain small microabscesses
VII. Laboratory diagnosis
VIII. Treatment:
Itraconazole is the drug of choice for most patients
Amphotericin B should be used to treat severe disease.
Surgical excision may be helpful.
There are no means of prevention.
