OPPORTUNISTIC MYCOSES
General charateristic
• agents are ubiquitous in the environment or part of
normal flora
• mostly monomorphic fungi
• patients are usually the immunocompromised
Candida albicans and other Candida
spp.(C.tropicalis, C. parapsilosis, C. glabrata)
• Epidemiology
• agent of Candidiasis (Moniliasis, mycotic vulvovaginitis, thrush,
candidosis, Candida endocarditis)
• most frequently encountered opportunistic fungal infections
• Candida albicans is the most significant isolate from the genus
• may be part of the normal flora
CI
• Cutaneous and Mucosal Candidiasis
• risk factors include AIDS, pregnancy, diabetes, young or old age, birth
control pills, and trauma (burns, maceration of skin)
• examples:
• a. oral thrush
• b. onychomycosisc
• c.intertrigenous infection (moist , warm parts of the body)
• d. interdigital infections
• e. vulvovaginitis
• Systemic Candidiasis
• usually introduced via indwelling catheters, surgery, IV
drug abuse, damage to skin or GI tract
• associated with chronic administration of
immunosuppressive drugs
• Chronic Mucocutaneous Candidiasis
• chronic superficial disfiguring infections of any or all areas
of skin or mucosa
• onset is usually in early childhood
Laboratory Diagnosis
• Specimen collection
• swabs and scrapings from superficial lesions
• blood, spinal fluid, tissue biopsies, urine, exudates
• material from removed IV catheters
• Direct Microscopic Examination
• examined in gram-stained smears for pseudohyphae and
budding cells
• skin or nail scrapings are first put in 10%KOH
Culture
• incubated at 37°C
• yeast colonies produce pseudohyphae
• Candida albicans is germ tube test (+) and produce chlamydospores in
cornmeal agar
• urease negative
• may be identified using CHROMagar, a differential medium
• may be identified using carbohydrate assimilation tests
• API 20C AUX- gold standard
• Uni-Yeast-Tek
• Yeast Biochemical Card (Vitek)
• MicroScan Yeast Identification Panel
• RapidID Yeast Plus System
Aspergillus spp
(A. fumigatus, A. flavus, A. niger, A. terreus)
• Epidemiology
• agent of Aspergillosis
• found worldwide
• normal saprophyte in soil
• may produce a carcinogenic hepatotoxin known as
aflatoxin
CI
• Allergic Forms -
• a. allergic bronchopulmonary aspergillosis
• b. extrinsic allergic alveolitis
• Aspergilloma(pulmonary "fungus ball") - inhaled conidia enter an
existing cavity
• rarely become invasive
• Extrapulmonary Colonization
• Invasive Aspergillosis
• Others: external otomycosis, mycotic keratitis, onychomycosis
lab diag
• Specimen
• sputum and other respiratory specimens are most common
• blood samples are rarely positive
• Direct microscope
• hyphae are hyaline and septate
• Culture
• incubated at room temperature
• species are identified according to the morphology of their conidial structures
