MEDICALLY IMPORTANT

FUNGI
DR. BREIDA BOYLE
EDITED BY
DR. EMMANUEL
MBAAWUAGA
Dept of Biological Sciences,
Benue State University
Makurdi, Nigeria
 INTRODUCTION
Fungi are a diverse group of sacrophytic and
parasitic eukaryotic organisms
Kingdom: Mycota
Of 100,000 fungal species only 100 have
pathogenic potential for humans, only a few
account for clinically important infections
Mycoses : Human Fungal Diseases
Fungal spores may be important as human
allergenic agents
Fungal Classification
 MYCOSES
CUTANEOUS: limited to the
dermis
SUBCUTANEOUS : when
infection penetrates
significantly beneath the skin
SYSTEMIC : when the
infection is deep within the
body or disseminated to
 PATHOGENIC FUNGI

TRUE OPPORTUNISTIC
PATHOGENS PATHOGENS
 TRUE PATHOGENS
Cutaneous infective agents Subcutaneous infective agents
Actinomadura madurae
Epidermophyton species Cladosporium
Microsporum species Madurella grisea
Trichophyton species Phialophora
Malassezia furfur Sporothrix schenckii

Systemic infective agents

Blastomyces dermatitidis
Coccidioides immitis
Histoplasma capsulatum
Paracoccidioides brasiliensis
OPPORTUNISTIC
PATHOGENS

Absidia corymbifera
Aspergillus fumigatus
Candida albicans
Crytococcus neoformans
Pneumocystis carinii
Rhizomucor pusillus
Rhizopus oryzae (R.arrhizus)
CLASSIFICATION OF FUNGI

Depends on :
Characteristic Structures
Habitats
Modes of Growth
Modes of Reproduction
 Cell Wall and Membrane
Composed mainly of chitin rather than
peptidoglycan (bacteria)-so unaffected by
antibiotics
Chitin: consists of a polymer of N-
acetylglucosamine
Fungal Membrane contains ergosterol rather
than cholesterol found in mammalian cells, use
in antifungal agents such as amphotericin which
binds to ergosterolpores that disrupts
membrane function cell death
 Cell Membrane

The imidazole antifungal

drugs
( clotrimazole, ketoconazole,
miconazole) and the triazole
antifungal agents (fluconazole
, itraconazole) interact with the
C-14 α-demethylase to block
 HABITAT
All fungi are heterotrophs ( they require some
form of organic carbon for growth)
They depend on transport of soluble nutrients
across their cell membrane
To do this they secrete degradative enzymes
( proteases etc) into their immediate
environment, therefore they live on dead
organic material
So Natural Habitat : is soil or water containing
decaying organic matter
 MODES OF FUNGAL
GROWTH

UNICELLULAR
FILAMENTOUS
YEASTS
MOLDS

However there are some dimorphic fungi ( they switch between these
Two forms depending on their environment)
Filamentous (mold-like) Fungi
Thallus (vegetitive body) –
mass of threads with
many branches
resembling cotton ball
Mass: mycelium
Threads: hyphae, tubular
cells that in some fungi are
divided into segments –
septate whereas in other
fungi the hyphae are
uninterrupted by
crosswalls-nonseptate
Grow by branching and tip
elongation
 YEAST like FUNGI
These fungi exist as
populations of single ,
unconnected , spheroid
cells, not unlike many
bacteria, although they are
sometimes 10 times larger
than a typical bacterial cell
Yeasts reproduce by
budding
Some fungal species
particularly those that
cause systemic infection
exist as dimorphic fungi
REPRODUCTION
 SPORULATION
The principal way in which fungi reproduce and
spread within the environment
Fungal spores are metabolically dormant,
protected cells, released by the mycelium in
enormous numbers
Borne by the air or water to new sites , where
they germinate and establish new colonies
Spores can be generate sexually or asexually
 ASEXUAL SPORULATION
(MITOSIS)

Colour of a particular fungus seen on bread, culture plate is due to the

Conidia, easly airborne and disseminated
 SEXUAL SPORULATION
meiosis

Relatively rare compared to asexual sporulation, and spore shape often

Used as a method of identification
 CUTANEOUS MYCOSES
-DERMATOPHYTOSES
EPIDEMIOLOGY
Three genera-Trichophyton, Epidermophyton,
Microsporum
Anthropophilic-reside on the human skin
Zoophilic-reside on the skin of domestic and
farm animals
Geophilic-reside in the soil
Transmission from humans or animals is by
infected skin scales
 PATHOLOGY
Dermatophytes use keratin as
a source of nutrition
Therefore they infect skin,
hair, nails
All 3 organisms infect attack
skin, Microsporum does not
infect nails and
Epidermophyton does not
 CLINICAL SIGNIFICANCE

DERMATOPHYTOSES
Characterized by
itching,scaling skin patches
that can become inflamed and
weeping
Infection in different sites may
be due to different organisms
 Tinea pedis(Athlete`s foot)
Common organisms are
Trichophyton rubrum ,
Trichophyton
mentagrophytes and
Epidermophyton
floccosum.
Initially between the toes
spreads to nails, yellow
and brittle
Secondary bacterial
infection
Id Reaction
Tinea corporis( Ringworm)
Epidermophyton
floccosum, Trichophyton,
Microsporum
Advancing annular rings
with scaly center
Periphery of ring area of
active fungal growth,
usually inflammed and
vesiculated
Non-Hairy areas of trunks
mostly
Tinea capitis( scalp ringworm)
Trichophyton and
Microsporum
Depends on area
Small scaling patches
to involvement of
entire hair with
hairloss
Microsporum infects
hair shafts , Wood`s
lamp
 TINEA CRURIS/UNGUIUM
Epidermophyton ,
Trichophyton rubrum,
simliar to ringworm but
thighs and genitalia
Trichophyton rubrum, nails
thickened discoloured and
brittle
Treatment for months until
all of the infected nail
grows out and is trimmed
off
 Treatment
Samples to be sent for fungal staining and
culture
Infected skin may be treated with topical
application of antifungal agents miconazole and
clotrimazole
Refractory lesions oral griseofulvin and
itraconazole, terbinafine
Infections of hair and nails usually require
systemic ( oral) therapy
 SUBCUTANEOUS
MYCOSES( dermis, subc
tissues and Bone)
Causative organisms reside in the soil and in
decaying or live vegetation
Almost always acquired through traumatic
lacerations or puncture wounds
Common among those who work with soil and
vegetation and have little protective clothing
Not usually transmitted humans to humans
Usually confined to tropics and subtropics with
exception of Sporotrichosis in USA
 Sporotrichosis
Sporothrix schenckii-dimorphic fungus
Granauloma ulcer at a puncture skin usually a
thorn prick and may produce secondary lesions
along draining lymphatics
In most disease is self-limiting may exist in
chronic form
Treatment oral itraconazole
Chromomycosis : Phialophora or Cladosporium
 Mycetoma
Madurella grisea, Actinomadura
madura
Localized abscess usually on
the feet, that discharge pus
serum and blood
Has coloured grains( compact
hyphae) black, white, red or
yellow depending on organism
 Eastern US

Males
Diagram of Systemis mycoses(dimorphic, yeast in infective tissue)
 Clinical significance

Simliar to Tb in that
asymtomatic primary infection
is seen whereas chronic
pulmonary or disseminated
infection rare
In the immunocompetent
usually mild and self limiting
 Blastomycosis
Blastomyces dermatitidis
Most in arid areas of North US, tropical and subtropical Africa, India and
far East.
In the soil forms arthrospores
Spores airborne , germinate in the lungs and produce sphercules filled
with many endospores- new spherule
Can cause chronic lung disease resembling pulmonary tuberculosis.
Disseminated affect CNS, urogenital system, bone.
Cutaneous infection can lead to ulceration or warty granuloma
B.dermatitidis is dimorphic fungus with a yeast form in tissues.
DX: Yeast can be detected in pus, sputum and other specimen in
lactophenol cotton blue preparation.
Yeast are large, round, thick wall 5 – 15 um in diameter.
Cells show single budding.
 Histoplasmosis
Histoplasma capsulatum
Complete species names (H.capsulatum var capsulatum and H.capsulatum
var duboisii)
In the soil conidia, germinate lungs into yeast-like cells
Becomes engulfed by macrophages
Benign self-limiting or chronic, progressive , fatal
Disseminated disease only fungus intracellular RES parasitism
Area Ohio and Mississippi River area
DX: Sputum, pus, bone marrow aspirates, blood. Yeast cells found in
endothelial and mononuclear cells in giemsa preparation.
Culture: Mycelial growth with warty conidia at room temperature. Small
microconidia and large, round, spiny macroconidia are produced
At 37oC it induces the yeast phase.
Infants and AIDS patients are at risk,
Treatment: Amphotericin or Itraconazole
OPPORTUNISTIC
PATHOGENS

Absidia corymbifera
Aspergillus fumigatus
Candida albicans
Crytococcus neoformans
Pneumocystis carinii
Rhizomucor pusillus
Rhizopus oryzae (R.arrhizus)
OPPORTUNISTIC MYCOSES

Those that affect the

immunocompromised but are
rare in normal individual
Organ transplantation, post
chemotherapy for cancer,
immunodeficient due to Aids
and congenital
 CANDIDIASIS(Moniliasis)
Candida albicans and other candida species which are normal flora in the
mouth, skin , vagina and intestines
C.albicans is dimorphic
May occur as a results of overgrowth as suppression of bacteria by
antibiotics
Manifestations depend on the site e.g. oral candidiasis and vaginal
candidiasis and disseminated candidiasis in cancer patients, post GI surgery
and AB`s, systemic corticosteroids
Candida vaginitis is common during pregnancy. Oral candidiasis and thrush
(infection of the oesophagus) are common in those with HIV.
DX: Candidia yeast cells can be detected in unstained wet preparation or
Gram stained preparations of skin, urine, vaginal discharge or ther exudates
C. albicans grow on Sabourad dextrose agar (SDA) or routinely use media
like nutrient agar.
 CRYTOCOCCOSIS
Crytococcus neoformans, found worldwide
Especially found in soil containing bird(esp.
pigeons) droppings
Characteristic thick capsule that surrounds
budding yeast cell –seen Indian Ink
Most common form is mild subclinical lung
infection
In the immunocompromised often disseminates
to the brain , meningitis often fatal
However half those with crytococcal meningitis
have no obvious immune deficiency
 ASPERGILLOSIS
Several species of genus Aspergillus, mostly
Aspergillus fumigatus
Worldwide distribution, ubiquitous
Filamentous molds, produce large numbers of
conidiospores
Reside in soil, decomposing organic matter and
dust, associated outbreks with construction
work
Disease presentation depends on immunologic
status of patient
 ASPERGILLOSIS
Acute Aspergillus infections
Most severe and often fatal
form of aspergillosis is acute
invasive infection of the
lungdissemination to brain
etc
Less severe form gives rise to
a fungus ball( aspergilloma) ,
 Allergic Aspergillosis

Relatively rare, can arise from

inhalation of spores, without
sussequent extensive spore
germination hyphal invasion
The allergic reaction results in
bronchial constriction
Diagnosis by
 MUCORMYCOSIS
Most often caused by Rhizopus oryzae and less
often by other members of the Mucorales such
as Absidia corymbifera, Rhizopus pus
Ubiquitous in nature, spores found in great
abdunance on rotting fruit and old bread
Usually restricted to those with underlying
conditions such as burns, leukaemia or
diabetus mellitus
The most common form of the disease can be
fatal within a week-Rhino cerebral
Mucormycosis
 PCP
Various cellular forms encysted group of
dormant cells and vegetitive form –trophozoite
Ubiquitous
Activation of preexisting dormant cells in the
lungs in immunodeficient persons
The encysted forms induce an inflammination of
the alveoli-exudate which blocks gas exchange
Diagnosis by microscopic examination , by
silver stain or fluorescence of bronchial
washings or biopsy
 LABORATORY
IDENTIFICATION
Standard media –Sabouraud`s agar, potato
dextrose agar, low ph 5.0 , inhibits bacterial
growth but allows fungal colonies to form
Cultures can be started from spores or hyphae
fragments
Specimens: blood, pus, CSF, sputum, tissue
biopsies, skin scrapings , nail clippings
Identification by the morphology of conidia
structures and carbonhydrate assimiliation tests
 LABORATORY DIAGNOSIS
OF FUNGAL INFECTION
Specimens
Depends on site of infection
Systemic: -Blood culture( really only useful for
yeast-low sensitivity) or
- antigen testing e.g.crytococcal
and
histoplamsosis antigen
Pneumonia: Bronchoscopy washings or
brushings for staining and fungal culture or
bronchial biopsy
 LABORATORY DIAGNOSIS
OF FUNGAL INFECTIONS
Meningitis: Cerebrospinal
fluid for methylene blue
staining and indian ink and
crytococcal antigen and fungal
culture
If Skin infection require skin
scrapings
 LABORATORY DIAGNOSIS
FUNGAL INFECTIONS
Types of tests carried out
Fungal Staining – methylene blue staining or
wet prep using KOH to dissolve tissue material
Fungal culture on media that encourages fungal
growth e.g. PDA
Antigen Testing i.e. to test for antigen present in
the wall of fungus e.g crytococcal antigen,
galactomannan used in serum and CSF
samples
PCR not used on a routine basis on samples
Laboratory Identification