SYSTEMIC MYCOSES

Five fungi

Histoplasma capsulatum Blastomyces dermatitidis Paracoccidioides brasiliensis Coccidioides immitis Cryptococcus neoformans

Primary focus of infection lungs, Each organism exhibits its own characteristic pattern of secondary organ involvement Only 5 % of the infected individual will have clinical diseases.

Dimorphic fungi

Coccidoides immitis
Histoplasma capsulatum

Monomorphic fungi

Cryptococcus neoformans

Blastomyces dermatitidis

Paracoccidioides brasiliensis

Histoplasmosis

Histoplasma capsulatum : intracellular parasite Primarily disease of reticuloendothelial system Worldwide distribution (USA) Reservoirs :soil with high nitrogen conc. - bird droppings Mode of infection: Inhalation of spores/ hyphal fragments Other names: Reticuloendothelial cytomycosis & Darlings / cave / spelunkers disease Clinical syndrome: Acute / chronic pulmonary & Disseminated Histoplasmosis

Lab diagnosis

Specimens: Sputum, BM aspirates, Scrapings / Biopsy & Blood smear Direct Examination: Giemsa, PAS etc Fungal culture: SDA & BHI agar M to Y : Kelleys medium Histoplasmin skin tests Immunodiagnosis: LAT,CFT & Exoantigen test HPE:H&E and GMS stain

Mycelia at 25 c Tuberculate Macroconidia (8 - 14um)

BYC at 37 c & in tissues (2 x 4 um ) Single narrow neck buds Found predominately in histiocytes

Blastomycosis

Blastomyces dermatitidis Distribution: Central &Western America and eastern canada Reservoirs: soil that contain organic debris Natural disease exist in dogs & horse Infection acquired by inhalation of conidia from soil Other names: Gilchrist/ Chicago disease Clinical disease involves lung, cutaneous / mucosal (oral, GIT) & bones No calcification during resolution

Lab diagnosis

Specimens: Pus, Scraping from skin lesions & Sputum Direct Examination: KOH, Giemsa etc Double walled yeast cells with single broad base buds {8 - 10 um } Culture: SDA,BHI up to 6 weeks Serology : unreliable Exoantigen test DNA probes

Paracoccidioidomycosis

Paracoccidioides brasiliensis Distribution : humid forests of South & central America Infection by inhalation of spores M>F { less estradiol} IP:10-20 years Other names: SA blastomycosis Clinical disease involves lungs, LN, Skin & mucosa( ulcerative / granulomatous lesions)

Lab diagnosis

Specimens: Pus, scrapings Direct examination:KOH Yeast cells with multipolar buds [Ship wheels pattern] Culture: SDA, BHI & GYE to demonstrate Chlamydospores Skin test: limited value Serology :Exoantigen test, CFT [98%]

Coccidioidomycosis

Coccidioides immitis Distribution:North,Central & South America Reservoir: Desert soil Infection by inhalation of arthrospores Other names: Valley fever, Desert rheumatism & New world disease Clinical disease involves Pulmonary disease(60%) & meningitis(<1%) and skin and soft tissue infections

Lab diagnosis

Specimens: Sputum, Scrapings, CSF Direct examination: Spherules [10 - 60 um] with endospores [2 - 5 um] Culture: SDA in test tube for 3 weeks at 37 C / 25 C Mycelial form Skin test: life long immunity Serology: LAT/CFT HPE:H&E /GMS Nucleic acid Probes: For species identification

Treatment

Amphotericin B Azole derivatives