Objectives for Introduction to Medical Mycology

State the general characteristics of a fungus (what differentiates a fungus from a

plant or a bacteria or a eukaryote?)

Eukaryotic:
o

Nucleus surrounded by nuclear membrane

True nucleus sets apart from bacteria

Mitochondria

Do not have chlorophyll

o

Sets apart from plants

Obtain nutrients from environment

Cell wall made of chitin

Most are obligate aerobes

Tolerate wide pH range

Require water
o

Moist environment needed to survive

250,000 know species

Approximately 150 species cause disease

Define yeasts

Single cell

Similar microscopic & macroscopic appearance: smooth & oval

Reproduce by budding meaning asexual reproduction

Inhabit GI & UG tracts

ID- microscopic, growth at 37 C, germ tube test, carbohydrate

assimilation, fermentation, urease test, & phenol oxidase

Define mold

Multicellular

Morphologically diverse

Mycelia made of microscopic tube like structures called hyphae

o

Septae: amount of divisions that occur between cells

Frequent

Sparse (very rarely)

Use mycelia, hyphae, and septae to identify organism visually

Describe the two types of mycelia

Aerial: above ground

Vegetative: below the ground

State the four most common hyphae morphologies

Antler

Racquet

Spiral

Rhizoid

Define hyaline

Light pigmentation- almost clear upon wet mount microscopic examination

Define phaeoid

Dark pigmentation- pale brown to dark brown to black

o

Only on wet mount- no stain involved

Due to presence of melanin in cell wall

Define dimorphism (take on yeast or mold form)

Thermally dimorphic

Exist in two forms based on temperature

o

Mold phase & yeast or spherule phase

Yeast in vivo or if grown at 37 C + 5% CO2

Mold phase at room temp

Define polymorphism (take on mold or yeast form)

Exists in both mold & yeast forms at the same time despite growth conditions

Few organisms have an initial yeast phase that changes to a mold phase later
in life

Compare and contrast dimorphism and polymorphism

Asexual reproduction:

Fruiting structures called condidophore produce condida

Condida- contain all of the genetic material necessary to produce a

new fungal colony

Sexual reproduction:

Fungi that reproduce sexually are called teleomorphs

o

Sexual reproduction takes place when two hyphae & two compatible
nuclei join & then undergo meiosis

Discuss how morphology plays an important role in the identification of fungal

infections

Define the term mycoses

Disease caused by fungi

o

Superficial: grow on top of skin

Superficial infections are on top of skin so doesnt really reach

the immune system

Therefore no symptoms

Infection causes issues with physical appearance

Patchy skin

Damaged hair & flaky skin

Appearance of organism on skin

M.furfur (example she wants us to know)

Cutaneous: deeper in skin

Cutaneous infections involve the epidermal layer of the skin &

sometimes the hair follicles

Keritinophilic organisms grow on hair, nails & skin

Cause inflammation

Most live freely in environment

Subcutaneous

Systemic

Opportunistic

Yeast

State the organ infected by dermatophytes

skin

State the 3 genuss of the 6 most common dermatophytes

6 most common species in US: epidermophyton floccosum, microsporum

canis, Trichophyton mentagrophytes
o

All 6 species produce delicate, narrow, hyaline hyphae

Describe the type of infections typically caused by dermatophytes

Tinea Pedis: dermatophyte infection of the feet

o

athletes foot

Affect soles of feet & between toes

Localized to feet because there are no sebaceous glands

Sebum inhibits fungal growth

Infection normally produces scaling & itchy skin, but in rare instances
produces lesions

Fungi produce an enzyme called kaertinase to break down the top

layer of the skin

Approximately 70% of the US population will experience this infection

Secondary infections with bacteria or candida pose a problem if not

treated

Ring worm: not really a worm

o

Dermatophytes cause ring worm infections

Characterized by scaly or blistered itchy skin in a ring formation

Transmitted through shared personal items : hates, combs, clothing,

towels

Common in children, but also seen in adults

Describe the general characteristics of subcutaneous mycoses

Usually the result of skin trauma or puncture wound introducing fungi to deep
layers of skin

Affects individuals that work outside

o

Landscapers, farmers, etc.

Most causative agents belong to the class: hyphomycetes

Many are darky pigmented

Give an example of a subcutaneous fungal infection

Chromoblastomycosis
o

Common in tropical & subtropical regions

Numerous causative agents:

Subcutaneous lesions form on the extremities over a period of months

to years

Forms nodules

crusted appearance

Cauliflower like appearance

Describe the general characteristics of a systemic mycoses

Serious fungal infections that infect various regions of the body

o

Many fungal infections affect the lungs

Inhalation of spores from kicking up dust

Often caused by organisms

Many organism that cause serious diseases are dimorphic

o

Two phases

Discuss bloastomycosis and its causative agent

Infections caused by blastomyces dermatitidis are called

blastomycosis

About half infected are asymptomatic

If illness occurs: starts as flu-like/respiratory tract infection symptoms

but can spread throughout the body

Illness appears 3-15 weeks after exposure

Most common symptoms are illness resembling bacteria pneumonia

Acute onset: high fever, lung infiltrates, and productive cough

Symptoms can also mimic TB or lung cancer

Most severe forms: acute respiratory distress syndrome (ARDS) with:

High fever, infiltrates, progressive respiratory failure

B. dermatitidis:

Soil mold

Colony morphology
o

Gray-white or light buff colored with delicate, silky, hairlike mycelium

Microscopically: mold
o

Delicate hyphae, 1 to 2 um in diameter hyline, & septate

Oval or pyriform conidia measuring 1 to 4 um in diameter, borne at tips

of long or short conidiophores

Form lollipop-like structure

There is a clinically significant yeast form found in skin lesions too

Discuss valley fever and its causative agent

Causative agent: coccoidies immitis

Valley fever: influenza-like syndrome (also called grippe)

o

Onset of symptoms is 1-3 weeks after exposure

Usually resolves in weeks to months

Asymptomatic in 60% of skin test- positive individuals

Highly infectious: spreads easily through coughing

Acute symptoms
o

Acute short-term lower respiratory tract infection with varying degrees

of cough, sputum production, chest pain, fever, and arthralgia

Chronic symptoms:
o

1% of infected individuals

Solitary coin lesions or granulomas, solid or cavity within the lung

parenchyma

More about coccoidies immitis:

Endemic to soil of southwestern United States

o

Colony morphology
o

Easily windborne in clounds of dust & penetrate deep into the

repiratory tree, into the alveoli

Variable but usually delicate, cobweb-like, with gray-white mycelium

Microscopically
o

Mold form

Hyphae are delicate & break up into barrel-shaped

arthroconidia that are separated by empty spaces when
stained (every other one)

Arthroconidia: reproductive feature of fungi that result from

joining hyphae

Spherule form (do not form yeast)

Observed in tissue sections

Spherules are 20 to 200 um in diameter, filled with 2 to 4um

diameter endospores

Discuss histoplasmosis and its causative agent

Histoplasma capsulatum: causative agent for histoplasmosis

Histoplasmosis
o

Reticuloendothelial cytomycosis

Cave or spelunkers disease

Darlings disease

Infection is usually limited & asymptomatic

o

Inhalation of spores

Flu-like symptoms

Calcification in the lungs, liver, & spleen

Acute & chronic diseases

o

Chronic obstructive pulmonary disease (COPD)

Potentially fatal if disease disseminated

Other types of infections

o

Mediastinitis, pericarditis, mycocutaneous lesions

Commonly found in the north American river basins

o

St.lawrence, ohio, Mississippi, & Missouri river valleys

Soil rich in organic content ( bird & bat excreta)

Colony morphology
o

Mold

Mycelium initially white but turning gray or gray-brown

Yeast

(if owner has bird)

Typically smooth, yellow-white, & glistening with pasty

consistency

Microscopically
o

Yeast ( form found in body)

Small (2 to 4 um in diameter)

Single bud connected by a delicate filament

In tissue, yeast cells are clustered in macrophages surrounded

by clear space

Discuss aspergillosis and its causative agent

Aspergillus species are filamentous ubiquitous fungi found in nature

Aspergillus causes the disease aspergillosis

o

almost any organ or system can be involved: being the most common
one in invasive infections

second most often isolated fungi in the clinical lab

neutropenia (from radiation) is a predictor of infection

mortality is 90% in immunocompromised patients

causes allergic reactions

produce mycotoxins which can cause cancer

microscopic:

hyphae are hyaline & septate

unbranched conidiophores with foot cell, large vesicle at tip

vesicle supports short, flask-shaped phialides (sterigmata)

each phialide produces chains of round phialoconidia

Common Clinical species:

o

Aspergillus fumigatus

THE MOST PATHOGENIC SPECIES

Causes a pulmonary disease called farmers lung

Also causes eye & ear infections

Colony morphology:

Surface blue-green to gray: reverse is white to tan

Microscopic:

Septate hyphae, short or long conidiophores with characteristic

of foot cell at base

Aspergillus Niger
o

Commonly seen in clinical laboratory

Cause of fungus ball and otitis externa

Pulmonary disease, coughing up blood: fungus ball

Discuss the clinical significance of candida albicans

Candida are the most isolated fungal pathogen

o

Normal flora but can be opportunists in immunocompromised

Disease ranges from superficial disease to systemic

Candida Albicans:
o

Thrush leading to systemic infections

Babies, elderly, IV antibiotics & immunocompromised

Yeast infections

State C. albicans habitation (on/in humans)

Mouth, & intestines

State the types of infections caused by C. albicans

State the diseases caused by Cryptococcus neoformans

Opportunistic infection

Meningitis, pneymonia, & septicemia

Compare and contrast the India Ink morphology of Candida and Cryptococcus
Discuss the unique threat that fungal pathogens pose for immunocompromised
individuals

Any fungus has the potential to become invasive & move away from the site
of an infection in an immunocompromised individual

Immunocompromised individuals

Undergoing chemotherapy

Organ transplant (immunosuppressive drugs)

HIV infection

Immune disorders

Opportunistic pathogens
o

Saprobe- organism that lives in the environment & doesnt usually

cause disease

Opportunistic pathogens cause multiple clinical presentation

Wounds & inhalation are most common transmission

Discuss safety considerations that need to be taken when dealing with fungal
pathogens in the lab

Never smell a mold culture

o

Fungal pathogens are usually BSL2

Typically handle specimens in a biological safety cabinet

The formation of aerosols is a HUGE concern b/c lung diseases

Discuss the importance of microscopy in the diagnosis of fungal pathogens

Rapid diagnostic tool

Observations:
o

Septate versus sparsely sepatate

Hyal9ine or phaeoid hyphae

Fruiting structures

Types, size, shape, & arrangement of conidia

Gram stains only useful for yeast

Wet mount & KOH

India ink to detect C.albicans in CSF

Cacofluor white

Wright-Giemsa for tissue ID of pathogen

Discuss how KOH is used in the microscopic identification of fungal pathogens

KOH preparations

KOH breaks down keratin in skin & nails so fungi can be seen better
o

1 drop of 10-20% KOH is added to a slide

Scrapings are added

Slide is covered

Genlty heated

Cooled for 15 minutes

Discuss the morphologic traits that are used to identify fungal pathogens

Color, texture, growth rate all critical to ID

Growth rate
o

Fast: 1-3 days

Intermediate: 5-9 days

Slow: 2 weeks

Disease

Dermatophytes:
Egs. Athletes foot
Ring worm
Chromoblastomycosis

Blastomycosis

Valley fever

Histoplasmosis

Aspergillus

Yeast infections with

Candida
Thrush, etc.
Cryptococcal
meningitis, pneumonia

Symptoms

Causative Agent (only

specific when given)
List the three genuss
given

Geographic regions, at
risk populations and # of
infections

Macroscopic and
microscopic
characteristics

or septicemia

Example of a Mycoses Study Chart