Module 6 July 2016

6.5 Mycology
Lecturer: Nico Fabian
Pharmaceutical Microbiology o As hypha
o sporangia
MYCOLOGY o fruiting body

I. Introduction
A. Definition of Terms C. Revived Interest in Mycology
- Mycelium: mass or mat of hyphae; vegetative part - ↑frequency of mycolic diseases
- Sporangiophore: stalk - ↑awareness of physician
- Sporangium: sac - ↑trained personnel and laboratory facilities
- Sporangiospore: laman ng sac - ↑immunocompromised patients
- Aspergillus: conidiophore & conidia - ↑in immunosuppressive agent (steroids)
- Germ tube: initial hyphal outgrowth
- Pseudohyphae: chain of successivelybudding yeast cells D. Innate Immunity to Fungi
- Rhizoid: root-like branched hyphae - Skin: FA, pH, epithelial turnover
- normal flora
B. Biology of Fungi - ciliary movements
- Generally eukaryotic, unicellular or filamentous
- Sterol: ergosterol E. Mycotic diseases
- Major Classes Factors to consider
- Px w/ diseases or immunocompromised state
Taxonomic classification Clinical classification - Drugs & catheterization
Zygomycetes Aseptate Yeast Mold Dimorphic - Hypersensitivity rxns
fungi
Ascomycetes Sac fungi
Unicellular Filamentous mold↔yeast o Farmer’s lung: Moldy Hay
Budding Hyphae Mold: 25°C,
Basidiomycetes Mushroom o Malt worker’s lung: Moldy barley
Blastophores or Mycelium (group natural reservoir
Deuteromycete Imperfect
Pseudohyphae (chain of hyphae)  SDA o Cheese washer’s lung: moldy cheese
fungi o Wood Trimmer’s lung: Moldy wood
of blastophores) Yeast: 37°C, brain-
Encapsulated heart infusion
agar
Mycetismus
Eg. Histoplasma, - mushroom poisoning due to preformed toxins
capsulatum
Mycotoxicosis
- Features - fungal toxin eg. aflatoxin (peanuts)
o obligate aerobes
o facultative anaerobes Human fungal infection
o not all are obligatory anaerobe 1. Superficial/ cutaneous
o all fungi require a performed source of carbon - Bun/ringworm
- Natural habitat - oral thrush: C. albicans
o most are in environment: except Candida albicans (part of normal - pityriasis versicolor/ tinea versicolor/ tinea flava
flora) - nail infection
- Reproduction by spores 2. Subcutaneous
- After traumatic implantation
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Module 6.5 Mycology
- risk factor: walking barefoot *kerion: w/ hair loss & erythematous scalp
- eg. chromomycosis *favs: a) crust  honeycomb appearance;
- sporotrichosis b) scutula
- mycetoma T. unguium Nail; more difficult to tx
T. cruris Genital or groin area
 *false mycetoma is for Actinomyces (sand in feet)
aka Hadhad/ jock itch
T. pedis Feet; aka Alipunga/ athlete’s foot

Systemic infections
*scabies/ galis aso
1. Dimorphic fungal infection
- endemic fungal infection’
Selected dermatophytes
- x predisposing condition
-
- Histoplasma, Blastomyces, Coccidioides, Paracoccidioides (HBCP)
Epidermophyton Trichophyton spp
2. Opportunistic: w/ predisposing condition
E. - Tinea corporis, T. Tinea pedis
floccosum unguium mentagrophyte (athlete’s foot)
F. Diagnosis
T. rubrum Tinea pedis, corporis
- Determination of fungal elements using KOH, stains such as
o Grocott-Gomori’s methenamine silver (GMS) stain Microsporum spp T. schoenleinii Tinea favus
o Periodic acid-Schiff (PAS) stain M. canis - Zoophilic T. tonsurans Tinea capitis
- Ab detection by serology - Tinea capitis, corporis T. verrucosum Tinea capitis,
- Culture meium: Sabouraud dextrose agar corporis, unguium
o Stain: lactophenol cotton blue M. gypsum - Geophilic T. concentricum Tinea imbricate
- Tinea barbae (balbas) (known in Badjao as
Toquelao): concentric
or tattoo-like
II. Dermatophytes
- molds w/c affect dead cornified integuments & produce keratinase
III. Superficial fungal infections (cutaneous)
Acute Chronic
Zoophilic & Geophilic Anthropophilic Pityriasis versicolor Tinea nigra Black piedra White piedra
aka An-an Etiology: Etiology: Etiology:
Usually limited Other areas
Etiology: Malassezia furfur Hortae (Exophiala) Piedraia hortae Trichosporon
Good prognosis Bad prognosis Formerly: pityrosporum werneckii - firmly - loosely
Rare recurrene Frequent recurrence ovale - Black colonies attached to attached to
- Areas of the hair the hair
hypopigmentation - scalp hair - genital hair,
Ringworm/ tinea/ buni - Very fine scaling axillary hair
- sharply demarcated
- easily ID infected vs non-infected
Tinea corporis Trunk
IV. Subcutaneous Fungal Infection
T. manuum Hand
A. Sporotrichosis
T. faciei Face
T. capitis Scalp
- Etiology: Sporothrix schenkii
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- thermally dimorphic fungi - South Am. Blastomycosis
- common among horticulturist and gardener - Paracoccidioides brasiliensis
- lymphocutaneous involvement - (+) Mariner’s wheel 
- Culture: 3. Coccidioidomycosis
 SDA: molds daisy like microconidia - San Joaquin Valley Fever, desert fever
 Brain-Heart Infusion Agar: yeast  cigarette butt - Coccidioides immitis
appearance - (+) spherules
- Clinical form:
 1° pulmonary coccidioidomycosis: erythema
B. Chromomycosis & phaeohypomycosis nodosum
- Dematiaceous fungi  Benign
-  Disseminated
Chromomycosis Phaeohypomycosis - *review: Rift Valley fever (phlebovirus)
- Yeast cells in tissues - Hyphae in tissues 4. HIstoplasmosis
- Verrucous cauliflower (molds) Histoplas capsulatum: misnomer since x encapsulated
lesions & sclerotic - Pigmented septate - Trans: feces of certain birds, bats
bodies/ copper pennies - Granulomatous rxn - Clinical forms
- Causative agent:  1° acute
Fonsecaea pedrosoi  chronic cavitary
 severe, disseminated (reticuloendothelial
C. Mycetoma system)
- Eumycetoma, true mycetoma, Madura foot, maduromycosis - African histoplasmosis
- Most common: Pseudallescheria boydii  H. capsulatum var duboisii
- True mycetoma (fungi) vs false mycetoma (actinomycetes)  Less pulmonary, more cutaneous involvement
- *review: mycetismus (mushroom poisoning) vs mycotoxicosis B. Opportunistic
(aflatoxin) 1. Candidiasis
- aka. Moniliasis, thrush
D. Rhinosporidiosis - Candida albicans (part of normal flora)
- Rhinosporidium seeberi - Most common opportunistic mycosis
- polypoid masses: polyps-like - Salient features
 mimic dermatophytosis (dry lesions)
 Candidiasis (moist environment)
- Clinical Forms
V. Systemic Fungal infections  oral thrush
A. Dimorphic fungal infection  nail infection
1. Blastomycosis  mycotic vulvovaginitis
- aka. Gilchrist’s disease, North American Blastomycosis  cutaneous candidiasis
- Etiology: Blastomyces dermatitidis  systemic candidiasis
- Trans: spores (infectious form), x person to person - Dx: germ tube test
- Clinical forms: pulmonary, systemic, cutaneous 2. Cryptococcosis
2. Paracoccidioidomycosis - European blastomycosis
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- Cryptococcus neoformans 2. Itraconazole
 Only pathogenic Cryptococcus - DOC: indolent, nonmeningeal infections
 Monomorphic yeast - PO, IV
- Epidemeology - Capsule: w/ food
 Before: Eucalyptus tree - Sol’n: w/ fasting state
 Now: Globally distributed, pigeon dropping - AE: HTN, rhabdomyolysis
- Dx: india ink staining 3. Fluconazole
3. Aspergillosis - DOC: coccidioidal meningitis (disseminated form) &
- Aspergillus fumigatus, A. flavus, A. niger invasive aspergillosis
 Mnomorphic mold - PO, IV
- Clinical forms - Abs. w/ or w/o food
 Allergic - AE: SJS
 Extrapulmonary
 invasive or systemic 4. Voriconazole
- Pathology: granuloma formation & necrosis - Oral BA: nearly 100%
4. Mucomycosis - 1°: invasive aspergillosis
- aka. Zygomycosis - AE: transient visual changes
- Etiologic agenta: Rhizopus, Mucor 5. Posaconazole
- Clinical form: Rhinocerebral & mucormycosis - Newest triazole
- Broadest spectrum azole

Imidazoles Triazoles
VI. Antifungals
Less specific More specific
A. Amphotericin B
More toxic Less toxic
- queen of all antifungals, broad spectrum
Ketocon- Flucon-
- amphoteric (acid/ base)
Micon- Posacon-
o vs amphiphatic ~ polar/non
Cotrim- Itracon-
- DOC: life threatening fungal infection
Voricon-
- MOA: Bind to ergosterol  ↑ membrane permeability
- Pkin
o IV, x oral D. Caspofungin
o Liposomal form (lipid delivery system) - MOA: inh 1,3-β-glucan
- Tox: nephrotoxicity - IV only
B. Flucytosin - salvage therapy for invasive aspergillosis
- Narrowest spectrum, not for monotherapy E. Griseofulvin
- Antimetabolite - MOA: inh mitosis by binding to microtubule-associated proteins
- MOA: inh DNA synthesis - Uses: ringworm
C. Azoles - Pkin: ↑ abs w/ fatty food
- MOA: inh 14-α-sterol demethylase  ↑methylated groups F. Terbinafine
1. Ketoconazole - Allylamine
- 1st oral azole - MOA: inh squalene epoxidase
- Less specific for fungal P450 - Uses: onchomycosis

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