Mycology
Opportunistic mycosis
Dr.Changkel Banak
Oppurtunistic mycosis
Ordinary fungi causing extraordinary
disease
Infections due to fungi of low
virulence in patients who are
immunologically compromised
Opportunistic fungi
1. Saprophytic - from the environment
e.g.,Cryptococcus sp. , Aspergillus,
Zycomycetes.
2. Endogenous – a commensal organism e.g.,
Candida sp.
Include many species from: A (Aspergillus)
To Z (Zygomyces)
Predisposing Factors: Providing a
Route/ Source
• Antibiotics
• Burns and other skin problems
• Catheter- related problems
• Devices (prosthetic)
• Effects on mucosal integrity
• Fungus isolated previously
Inducing Immunosuppression
• AIDS
• Bone marrow/ organ transplantation
• Cancer: Leukemia, lymphoma etc
• Drugs: Cytotoxic drugs,steroids etc
• Endocrine related: Diabetes
• Failure of organs: multi-organ
Candida albicans and
other Candida species
• Harmless inhabitants of the skin
and mucous membranes of all
humans
• Normal immune system keeps
candida on body surfaces
THE MOST IMPORTANT RISK
FACTORS
1. Neutropenia(less than 100 N/L)
2. Diabetes mellitus
3. AIDS
5. Myeloperoxidase defects
6. Broad-spectrum antibiotics
THE MOST IMPORTANT RISK FACTORS
7. Indwelling catethers
8. Major surgery
9. Organ transplantation
10. Neonates
11. Severity of any illness
12. Intravenous drug addicts
INVASIVE CANDIDIASIS
• If phagocytic system is
compromised, infection spreads
to many organs and causes focal
infection in these organs (kidney
,eye ,heart , liver , meninges)
• mortality of candidemia is 30-
40%
• Prophylactic antifungal drugs
during cytotoxic course of
therapy
DIAGNOSIS OF INVASIVE
CANDIDIASIS
• Gram stain and isolation from
blood, CSF , urine ,sputum or
peritoneal fluid
• Serology
• PCR (promising)
• isolation and/or pathology positive
of organ involved
EPIDEMIOLOGY
Although candidiasis is
endogenous in most cases,
cross infections are described,
especially in intensive care unit
patients.
• Account for 80% of nosocomial fungal
infections
• Account for 30% of deaths from
nosocomial infections
Cryptococcosis and Cryptococcus
neoformans
• Cryptococcus neoformans causes cryptococcosis.
• A widespread encapsulated yeast that inhabits soil
around pigeon roosts
• Common infection of AIDS, cancer or diabetes
patients
• Infection of lungs leads to cough, fever, and lung
nodules
• Dissemination to meninges and brain can cause
severe neurological disturbance and death.
12
Diagnosis
Microscopic
– India Ink for capsule stain (50-80% + CSF)
– Gram
– Silver stain
Culture
– Bird seed agar
– Routine blood culture
Serology
Aspergillosis: Diseases of the
Genus Aspergillus
• Very common airborne soil fungus
• 600 species, 8 involved in human disease; A. fumigatus
most commonly
• Serious opportunistic threat to AIDS, leukemia, and
transplant patients
• Infection usually occurs in lungs – spores germinate in
lungs and form fungal balls; can colonize sinuses, ear
canals, eyelids, and conjunctiva
• Invasive aspergillosis can produce necrotic pneumonia,
and infection of brain, heart, and other organs.
• Amphotericin B and nystatin
14
Zygomycosis
• Zygomycota are extremely abundant saprophytic fungi
found in soil, water, organic debris, and food.
• Genera most often involved are Rhizopus, Absidia, and
Mucor.
• Usually harmless air contaminants invade the membranes
of the nose, eyes, heart, and brain of people
(Rhinocerebral mucormycosis) with diabetes and
malnutrition, with severe consequences.
• main host defense is phagocytosis
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Diagnosis is made by direct smear
and by isolation of molds from
respiratory secretions or biopsy
specimens.
Treatment:
Control Diabetes ,surgery &
amphotericin B
Prognosis: very poor
Diagnosis of opportunistic infections
requires a
high index of suspicion
1. Atypical signs or symptom...M.furfur
2. Unusual organ affinity…liver candidiasis
3. Outside the endemic area
4. Unusual Histopathology…necrosis
5. Etiologic agent may be a “saprophyte”
6. Serological response may be suppressed
IMPROVING TREATMENT
1. New Drugs…Echinocandin
2. New therapeutic regimen
3. Aggressive therapy…prophylactic
4. Conjunctive therapy..Immunotherapy
5. IL, IFN,CSF
