CRYPTOCOCCOSIS PARACOCCIDIOIDOMYCOSIS COCCIDIOIDOMYCOSIS

1
CRYPTOCOCCOSISPARACOCCIDIOIDOMYCOSISCOCCIDIOIDOM
YCOSIS
2
CRYPTOCOCCOSIS

• It is also known as TORULOSIS
• Sub acute or chronic infection
• Caused by - Cryptococcus neoformans
• HABITAT soil saprophyte and particularly
  abundant in feces of pegeons

3
MORPHOLOGY

• Round or ovoid budding cell
• 4 20 µm in diameter
• Prominent polysaccharide capsule

4
PATHOGENICITY

• Source dust containing basidiospores
• Route mostly by inhalation and some times
  through skin or mucosa
• Most infections are asymptomatic
• Can produce disease in animals mastitis in
  cattle

5
Pulmonary cryptococcosis

• It may lead to mild pneumonitis
• No calcification occur
• Dissemination of infection may lead to
  visceral , cutaneous and meningeal diseases

6
(No Transcript)
7
(No Transcript)
8
LABORATORY DIAGNOSIS

• Direct microscopy
• Specimens serum, CSF and other body fluid
• indian ink or 10nigrosin with formalin wet mount
  shows round budding yeast cells with distinct
  halo
• A wide refractile gelatinous capsule surrounds
  the organism

9
diagram
10
CULTURE

• Grows readyly on Sabourauds Dextrose Agar.
• smooth, mucoid , cream coloured colonies are
  formed

11
SEROLOGY

• There are 4 serological types of Capsular
  polysaccharide A, B, C, D.
• Demonstration of Capsular antigen by
  precipitation is valuable in diagnosing some
  cases of Cryptococcal meningitis when the CSF is
  negative by smear or culture

12
TREATMENT

• Amphotericin B
• 5 fluorocytosine
• Clotrimazole
• miconazole

13
EPIDEMIOLOGY

• World wide in distribution
• Known as European blastomycosis
• It is Only deep mycosis common in our country

14
COCCIDIOIDOMYCOSIS

• Caused by Coccidioides immitis
• Infection is usually self limited
• The disease is endemic in the dry and arid
  regions of Southwestern USA, where the fungus is
  present in soil and rodents.

15
(No Transcript)
16
MORPHOLOGY

• It is a dimorphic fungus at 37C Yeast
  form 25C Mould form

17
PATHOGENECITY

• Source Dust containing Arthrospores
• Route Inhalation
• After inhalation, these spores become spherical
  and enlarged forming SPHERULES.

18
SPHERULES

• 15-75µm in diameter
• Thick, double layered refractile wall is present
• Filled with endospores
• Spherules are the diagnostic features of C.
  immitis.

19

• Possible sites of infection CNS
  Bone

20
Contd..

• In 60 of cases, the infection is assymptomatic
• This leads to immunization and is demonstrated by
  positive skin test with COCCIDIOIDIN
• The other 40 develops self limited influenza
  like illness with Fever, Malaise, Cough,
  Arthralgia and Headache. This condition is known
  as VALLEY FEVER or DESERT RHEUMATISM.

21
DIAGNOSIS

• Specimens Sputum Exudate from cutaneous
  lesions Spinal fluid Blood and
  Urine

22
Microscopy

• Specimen stained with KOH or Calcoflour white
  stain
• Shows Spherules and endospores

23
(No Transcript)
24
Culture

• Culturing on SDAincubated at 37Cand at room
  temp.shows Mycelialform.
• The colonies arewhite to tan cottonycolonies.

25
Serology

• With in 2-4 weeks after infection IgM
  Ab Latex Agglutination
• IgG Ab CFT or ID

26
Skin test

• After 24-48 of cutaneous injection with 0.1ml of
  standard dilute solution containing Coccidioidin
  Ag there is a formation of induration gt5mm
  diameter.
• It is known as Positive skin test

27
Treatment

• Amphotericin B
• Itraconazole
• Fluconazole

28
PARACOCCIDIOIDO
MYCOSIS

• It is a chronic granulomatous disease of skin,
  mucous membranes, lymphnodes and internal organs
  like spleen, liver..
• Caused by Paracoccidioides brasiliensis
• South American Blastomycosis

29
Morphology

• Dimorphic fungi
• Mycelial form produces Chlamydiospores and Conidia

30
Pathogenesis Clinical findings

• Source Dust containing chlamydiospores and
  conidia
• Route Inhalation
• Chronic, progressive pulmonary diseases occurs.
• Dissemination to other organs like skin,
  mucocutaneous tissue, spleen, liver, lymphnodes
  etc..

31
Contd..

• Many patients present with painful sores
  involving the oral mucosa.
• The yeasts are generally observed in Giant cells
  or directly in exudate from mucocutaneous lesions.

32
DIAGNOSIS

• Microscopy
• Culture
• Serology
• Skin test

33
(No Transcript)
34
Treatment

• Itraconazole
• Ketoconazole
• Amphotericin - B