Subcutaneous Fungal Infections

2009 Mark Tuttle

Name Diagnosis/Labs Symptoms Pathogenesis Treatment
Mycetoma Madura foot
- Granules of mycelium
- Can also see filamentous bacteria
(actinomycetes) but distinuis! based
on t!e "idt! of t!e filaments
- #us filled sinuses in foot
- $ee black rain
- Caused by many
species
Chromomycosis Chromoblastomycosis% &ound' sclerotic
bodies
(aturally bro"n in )*+
mount
- C!ronic infection of
melani,ed cells
Phaeohyphomycosis% +y-!ae
(aturally bro"n in )*+ mount
Sporotrichosis
.s also a true -at!oen
- Sporothrix schenckii
- &ose-t!orn/&ose-ardner 0isease
- 0imor-!ic (determined by tem-erature)
12C 3 ciar-s!a-ed yeast4 25C 3 mold
6ab
- Conidia/conidio-!ores at 25C culture
!C (in vitro) "#C (in vivo)
Conidia Cigar-shaped yeast
- $ee cutaneous lesions
usually at t!e site of
inoculation/lym-!atics
- 7-idemics in Gold mines (8ia
"ood structure) and forestry
"orkers (inoculated 8ia -ine
needles)
6ym-!ocutaneous
- $kin trauma' often 8ia
t!orns' s-linters
- Neutrophil immunity
im-ortant
$ystemic (&are'
immunosu--ress9d)
- .n!aled' s-read to :oints'
bones' brain
- $trains "it! !i!er
tem-erature t!res!old
s-read better
C!ronic (&are'
immunosu--ress9d)
6ym-!ocutaneous
- $aturated ).
orally
Triggers $%I in
neutrophils 8ia
myelo-ero;idase
- <,oles
$ystemic
- <m-!otericin =
- <,oles
- &I doesn't (or)

True Pathogenic Fungal Infections * +LL +,- DIM%,P$IC
2009 Mark Tuttle
Name Diagnosis/Labs Symptoms ,egion Treatment
Histoplasm
a
capsulatum
0arlin9s
$a-robic -!ase #arasitic -!ase
Tuberculate hyphae =uddin yeast
- .n!aled s-ores ..intraphagocytic yeast
- T=-like lesions in luns %
calcifi9d
- 0issemination% ro"s
- $een in
Mid(est
and South
- 6atin
- +/oles /+mphoterici
n 0
*nly really needed in
immunocom-romised
0iseases
- Macroconidia and microconidia
Micro are "orse because t!ey et dee-er in
lun
6abs
- <9s' but some react "it! Coccoides <9s
(>est)
- ?rine <9s in se8ere disseminated infection
- =io-sy for !isto-at!oloy and culture
any"!ere
- Mediastinitis ro"s o8er time
- Mucocutaneous1 Mouth lesion
- #ericarditis
- Gro"s in soil and ot!er t!ins contaminated
"it! 0at/0ird guano@ =irds don9t actually
carry it because t!eir body tem- is too !i!@
=ats do@
- A0-AB days before immune system controls
=?T' inflammatory sym-toms not seen for 2
"k
- Infection should confer immunity
=ut massi8e subseCuent inoculation could
cause sym-tomatic inflammation
<merica'
<sia'
7uro-e'
<frica
- &esistance stronly
de-endent on T2cell
mediated immunity
- T+A res-onse leads to
macro-!ae killin
8ia .D(-E
0T+ skin test F is
ood -ronosis
(GT-cells)
- T+2 res-onse (<b) is
!i! in uncontrolled
infection
CD <bs (.G) G
means -roressi8e
infection
Coccidoide
s immitis
California
Halley De8er
$a-robic -!ase #arasitic -!ase
+rthroconidia
(T!allic)
Spherules (/endo's
3Not a yeast4
- .nfection s!ould confer immunity
- >orse in males
- Pregnant (omen more susceptible as
pregnancy progresses Spherules gro(
faster (/-stradiol
- .n!aled art!ros-ores thick-"alled
spherules disseminate (only endos-ores
are 8ulnerable)
- Goes to many sites' includin s)in I CNS
- C($ infections are lifelon if
immunosu--ress9d
- .nfection from aerosoli,ed dirt
- T!e most 8irulent funal -at!oen
- AJ of -eo-le are sym-tomatic and need
medical care
- Coin lesion in lung * 00; "it! cancer
- $ypersensiti5ity reactions (6ike id K
rin"orm)
7ryt!ema multiforme (skin)
7ryt!ema nodosum (skin)
- Desert soil
in $> ?$<'
Me;ico'
reion of
Central/$out
! <merica
Blastomyce
s
dermatidis
(ort!
<merican
=lastomycosi
s
$a-robic -!ase #arasitic -!ase
Conidophore
(=lastic)
=uddin yeast
- *ften see a broad based yeast but not
al"ays
- .n!aled s-ores yeast disseminate
- Chronic6 (ill )ill if not treated
- #ulmonary disease may be se8ere or 8ery
mild
- 0isseminated to skin6 bone6 prostate
- Can sometimes find yeast in -rostatic
secretions
- .n soil and oranic debris
- %hio2
Mississippi
ri5er 5alley
- +/oles /+mphoterici
n 0
Paracoccoi
des
brasiliensis
$out!
<merican
=lastomycosi
s
$a-robic -!ase #arasitic -!ase
Conidia Multipolar budding
yeast
- .n!aled s-ores Multipolar yeast
disseminate
- C!ronic sinle or multi-le oran
in8ol8ement
- 6uns' mout!' nose' lym-! nodes
- South
+merica
- <,oles/<m-!otericin
= L