PATHOGENIC

FUNGI
Group 21
Members of group:
oArinda Rifana Nabillah 1718011057
oC Byli Pandu Eka Putra 1758011010
oDaniel Christianto 1718011109
oElmarossa Dinda 1758011034
oFeby Aulia Hasanah 1718011007
oJesica Natalia 1718011018
oJihan Azita Maharani 1718011137
oMuhammad Panji Marga 1758011015
oZhovarina Isniarta 1758011044
 Medical mycology
• field of medicine concerned with
the diagnosis, managements and
prevention of mycoses
 MYCOSES
• Diseases caused by fungi

• Mode of infection:
– Inhalation
– Trauma
– Ingestion
– Rarely from person to person

• Most mycoses are not contagious

 Clinical Manifestations
of Mycoses
• Fungal infections (most common)

• Toxicoses (poisoning)

• Allergies (hypersensitivity
reactions)
 Mycoses are also among
the most difficult diseases
to heal.
 Because…
• Fungi possess the biochemical ability
to resist the oxidative damage
perpetuated by T cells during cell-
mediated immune response

• Fungi are eukaryotic and thus

biochemically similar to human cells,
which means most fungicides are toxic
to human tissues
 The alternative..
• Azole drugs
– which only inhibit the fungi
(fungistatic) rather than kill it

– less toxic to humans

– e.g. ketoconazole, itraconazole and

fluconazole
 Categories of Fungal
Agents

• True fungal pathogens

• Opportunistic fungi
 True pathogens
• Have the ability to actively attack
and invade tissues

• Can infect any host, regardless of

its immune status
 Opportunistic Fungi
• Lack genes for proteins that aid in
colonizing the body

• Do not cause disease in healthy

individuals

• Can infect only susceptible individuals,

those whose body’s defenses are low
The only fungi known to cause disease
in humans:

• Blastomyces dermatiditis
• Coccidiodes immitis
• Histoplasma capsulatum
• Paracoccidiodes brasiliensis

The remaining fungi that cause disease are

considered opportunistic fungi.
SYSTEMIC MYCOSIS
caused by TRUE PATHOGENS
 SYSTEMIC
MYCOSES
• those fungal infections that spread
throughout the body

• result of infections by one of the four

pathogenic, dimorphic fungi of the division
Ascomycota.

• Ascomycota: Blastomyces, Coccidioides,

Histoplasma, and Paracocidioides
BLASTOMYCOSIS

• Pathogen: Blastomyces dermatitidis

• B. dermatitidis normally grows in soil

rich in organic material, such as
decaying vegetation and animal wastes,
where cool, damp conditions favor
growth and sporulation.
BLASTOMYCOSIS

• Mode of infection: Inhalation of dust

disturbed from the environmental
sources carries fungal spores and
pieces of hyphae into the lungs.
BLASTOMYCOSIS

• Pulmonary Blastomycosis – the most

common manifestation of Blastomyces
infection in humans.

• Initial pulmonary lesions are asymptomatic.

• If symptoms do develop, they are vague

and include cough, fever, malaise, and
weight loss.
BLASTOMYCOSIS

• Cutaneous blastomycosis – consists

of generally painless lesions on the
face and upper body.

• Can be raised and wartlike, craterlike

due to the death of tissue.
BLASTOMYCOSIS

• Treatment – amphotericin for 10

weeks.

• Osteoarticular blastomycosis – a
condition where fungus spreads to the
spine, pelvis, cranium, ribs, long bones,
or subcutaneous tissues surrounding
joints.
•Patients with Cutaneous blastomycosis -
• painless lesions on the face and upper body.
COCCIDIOIDOMYCOSIS

Pathogen: Coccidioides immitis

• Can be recovered from desert soil,

rodent burrows, archaeological
remains, and mines.
• Once inhaled in dust, anthrospores
become trapped in the alveolar
spaces of the lungs.
COCCIDIOIDOMYCOSIS

Pathogen: Coccidioides immitis

COCCIDIOIDOMYCOSIS

• Major manifestation - pulmonary

• Invasion of the CNS may result in

meningitis, headache, nausea, and
emotional disturbance

• Amphotericin B – the drug of

choice
HISTOPLASMOSI
S
• Pathogen: Histoplasma capsulatum
• Two strains recognized:
a. strain capsulatum - intracellular
parasite, first attacks alveolar
macrophages in lungs
b. strain duboisii - limited to Africa.
• most common fungal pathogen
affecting humans.
 HISTOPLASMOSI
S
TREATMENT:
• Amphotericin B - prescribed when
symptoms do not resolve.

• Ketoconazole – used to treat mild

infections.

Lungs of normal person and a patient with histoplasmosis

PARACOCCIDIOIDOMYCOSI
S
• Pathogen: Paracoccidioides brasiliensis

• chronic granulomatous disease that

characteristically produces a primary
pulmonary infection, and then
disseminates to form ulcerative
granulomata of the buccal, nasal and
occasionally the gastrointestinal
mucosa.
Steering wheel apperance
Paracoccidiomycosis patients –
ulcerative granulomata of
the buccal, nasal mucosa…
PARACOCCIDIOIDOMYCOSI
S

• Treatment - Amphotericin B or
Ketoconazole
Systemic Mycoses Caused by
Opportunistic Fungi

• Opportunistic mycoses do not typically affect

health humans.

• One of the more significant causes of human

disease and death and appear only when
their hosts are weakened.

• considered “classical” opportunists because

they are routinely encountered.
• 5 genera of opportunistic fungi that cause
systemic mycoses:
– Aspergillus
– Candida
– Cryptococcus
– Pneumocystis
– and Mucor
ASPERGILLOS
IS
• a term for several diseases caused
by the inhalation of spores of fungi
• causes allergies and a growing
problem for AIDS patients.
• Pathogens: Aspergillus fumigatus
Aspergillus niger
and Aspergillus flavus
ASPERGILLOS
IS
• 3 clinical manifestations:

-Hypertensitivity aspergillosis-
manifests as asthma

-Noninvasive aspergillomas- ball-

like masses of fungal hyphae
ASPERGILLOS
IS

- Acute invasive pulmonary

aspergillosis- more serious. Signs
and symptoms, which include fever,
cough, and pain, may present as mild
pneumonia.
Aspergillus growing inside
the lungs of a bird
ASPERGILLOS
IS
• TREATMENT of hypersensitivity -
either the use of various allergy
medications or desensitization to the
allergen.

• Invasive disease – treated by surgical

removal of aspergillomas and
surrounding tissue, plus high-dose,
intravenous administration of
amphotericin B.
CANDIDIASIS
• Pathogen: Candida albicans.

• Common members of the microbiota of

the skin and mucous membranes .
CANDIDIASIS
 TREATMENT – Nystatin for oral
candidiasis in infants.

 Amphotericin B-treatment for invasive

candidiasis.
CRYPTOCOCCOSIS

• Pathogen: Cryptococcus neoformans

• Human infections result from the inhalation of

spores and/or dried yeast forms made
airborne.
• Cryptococcal meningitis – most common
clinical form of cryptococcal infection, follows
dissemination of the fungus to the CNS.
CRYPTOCOCCOSIS

• Pathogen: Cryptococcus neoformans

CRYPTOCOCCOSIS

• Treatment – Amphotericin B and 5-

fluorocytosine administered together
for 6-10 weeks
PNEUMOCYSTIS PNEUMONIA

 Transmission occurs through inhalation

of droplet nuclei containing fungus.

 Treatment- antiprotozoan drugs

trimethoprim and sulfanilamide.
ZYGOMYCOSES
• are opportunistic fungal infections caused by
various genera of fungi, Mucor, Rhizopus,
and Absisia.
• Commonly seen in patients with uncontrolled
diabetes, people who inject illegal drugs, in
some cancer patients, and in some patients
receiving antimicrobial agents.
• Infections generally develop in the face and
head are.
ZYGOMYCOSES
 Conditions which resulted from the
dissemination of the infections
throughout the body in severely
immunocompromised individuals:
a. Rhinocerebral zygomycosis
b. Pulmonary zygomycosis
c. Gastrointestinal zygomycosis
d. Cutaneous zygomycosis
Rhinocerebral zygomycosis
ZYGOMYCOSES
• TREATMENT- physical removal of infected
tissues and management of predisposing
factors.

• Drug of choice- Amphotericin B

administered intravenously for 8-10
weeks.
Superficial, Cutaneous,
and Subcutaneous
Mycoses
caused by OPPORTUNISTIC FUNGI
 Superficial Mycoses
• Usually acquired by direct contact with
the fungus and are the most common
infections.

• Confined at the outer, dead layers of

the skin, nails, or hair, all of which are
composed of dead cells filled with a
protein called keratin.
Superficial Mycoses

 Piedra- a superficial infection that

forms nodules on hair shafts
- infections are normally
associated with the scalp, but faial and
pubic hairs can also be infected
-transmission is via shared hair
brushes and combs, and several
members of a family are typically
infected at the same time
Superficial Mycoses

 Black piedra- caused by Piedra Hortae

- characterized as hard,
black nodules encircling the hair shafts

 White piedra- caused by Trichosporon

beigelii
- characterized as soft, gray
to white nodules on the hair shafts
Black piedra
Dermatophytoses

 Infections caused by dermatophytes.

 Fungal infection of nails and skin.

 Infections were previously called

ringworms because they resemble a worm
lying below the surface of the skin.
Dermatophytoses

 Result from the fungi that use keratin

as a nutrient source and thus colonize
only dead layers of the skin, nails, and
hair.
 No living tissues are infected.
 Caused by various Epidermophyton,
Microsporum, Trichophyton species.
Types of Diseases Caused by
Dermatophytes

 Tinea infections (ringworm)

 Athlete’s foot (Tinea Pedis)
 jock itch (Tinea cruris)
 yeast infections of the mouth and
vagina
often caused by Candida species.
Tinea corporis
Treatment

 can be treated effectively with topical

antifungal agents
 terbinafine
 griseofulvin
 MALASSEZIA INFECTIONS

• Malassezia furfur is a fungus that infects the

skin. Clinical manifestations include pityriasis,
in which fungal growth disrupts melanin
production to produce discolored patches, and
the most common manifestation of M. furfur
infection- dandruff.
 MALASSEZIA INFECTIONS

• Folliculitis- caused by M. furfur

involves infection of the hair follicles on the
back, chest, and upper arm, producing
follicular papules or pustules
 MALASSEZIA INFECTIONS

• Treatment
- solutions of antifungal imidazoles, such as
ketoconazole shampoos.
- topical applications of zinc pyrithione
- selenium sulfide lotions
- propylene glycol
Cutaneous and Subcutaneous
Mycoses
• Infection requires traumatic introduction of
fungal elements beneath the outer, dead
layers of skin.
 CHROMOBLASTOMYCOSIS

 Chromoblastomycosis- small, itchy but

painless, scaly lesions on the skin surface
resulting from fungal growth in subcutaneous
tissues near the site of inoculation.
PHAEOHYPHOMYCOSIS

Paranasal sinus phaeophomycosis –

involves colonization of the nasal
passages and sinuses; it occurs in
allergy sufferers and AIDS patients
 Cerebral phaeophomycosis – caused
by Cladophiolophora bantiana
has a preference for neural cells and
actively invades the brain
 Patients with
chromoblastomycosis
Treatment

 Phaeohyphomycosis can be treated

with intraconazole, but the disease is
permanently destructive to tissues

 Chromoblastomycosis requires surgical

removal of infected and surrounding
tissues followed by antifungal therapy.
MYCETOMAS

 tumorlike infections of the skin, fascia

(lining of muscles), and bones of the
hands of feet caused by mycelial fungi

 This fungi live in soil and are introduced

into humans via the prick wounds and
scrapes caused by twigs, thorns, or
leaves contaminated with fungi.
Treatment

 Surgical removal of the mycetoma

 Anti fungal therapy with ketoconazole
SPOROTRICHOSIS

 Pathogen: Sporothrix schenckii

 Also called “rose-gardener’s disease”, a

subcutaneous infection limited to the
arms and legs.
Treatment

 Topical applications of saturated

potassium iodide for several months
 Itraconazole
 Terbinafine
 It can be prevented by wearing of
gloves, long clothing and shoes to
prevent inoculation.
 Clinical Manifestations
of Mycoses
• Fungal infections (most common)

• Toxicoses (poisoning)

• Allergies (hypersensitivity
reactions)
 Toxicosis
• Mycotoxicosis – caused by eating
food contaminated with fungal
toxins only

• Mycetismus - poisoning caused

by eating the fungus
 Mycotoxicosis
• Mycotoxins – chemicals produced
by fungi during metabolism, that
are poisonous to humans

• Aflatoxins – are the most well-

known mycotoxins, produced by
certain species of Aspergillus
 Mycetismus
• Amanita phalloides
– “death cap mushroom”
– Produces the deadliest mushroom
toxin
 Allergies to Fungi
• Allergens – spores or other fungal
elements that cause type I
hypersensitivities, or more rarely,
type III
 CATEGORIES OF FUNGAL AGENTS

True Fungal Pathogens Opportunistic Fungi

Systemic Mycoses Systemic Superficial Cutaneous and

Mycoses Mycoses Subcutaneous

Aspergillus Dermatophytes Chromoblasto-

Blastomyces
mycosis
Candida Malassezia Phaehypho-
Coccidioides
mycosis
Cryptococcus
Histoplasma mycelial fungi
Pneumocystis
Sporothrix
Paracoccidioides Mucor
 References
• Goe F Brooks dkk. 2004. Mikrobiologi Kedokteran
Jawetz, Melnick & Adleberg’s Medical Microbiology Edisi
23. The McGraw-Hill Companies, Inc.
• Staf Pengajar FK UI. 1993. Buku Ajar Mikrobiologi
Kedokteran, Edisi Revisi. Jakarta: FK UI.
• Eliott, Tom, dkk. 2009. Mikrobiologi Kedokteran dan
Infeksi. Jaka
• Dwidjoseputro. 2010. Dasar-Dasar Mikrobiologi. Jakarta:
Penerbit Djembatan.
• Irianto, K. 2007. Mikrobiologi Umum. Bandung: CV
Yrama Widya.
THANK YOU