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Opportunistic Fungi

 Opportunistic fungi are able to causes disease


in immunocompromised patients.
 Opportunistic fungi includes:
a. Candida albicans.
b. Cryptococcus neoformans.
c. Aspergillus fumigatus.
d. Mucor & Rhizopus species.
e. Pneumocystis carinii.
Candida albicans
 Characteristics:
● Normal flora of mucous membranes of upper
respiratory tract, gastrointestinal tract and
genital tract.
● Yeast as normal flora, Pseudohyphae and
hyphae when invade tissue.
Candida albicans
 Transmission: As part of normal flora, no
need of transmission.
 Clinical findings:
 Thrush: Over growth of C. albicans occurs
in the mouth and produces white patches.
Common in infants, immunocompromised
patients.
 Vulvovaginitis: Itching and whitish
discharge.
Candida albicans
Skin lesion: Warm & moist areas become red
and weeping. Fingers and nails of persons
employed as dish washers are involved.
 Disseminated infection: Such as
endocarditis, esophagitis, &
endophthalmitis can occur.
 Chonic mucocutaneous
candidiasis: Occurs in children
with T- cell defect immunity.
mucocutaneous
candidiasis
Laboratory diagnosis
 Sample: According to the site of lesion.
 Microscopy: Microscpic examination of tissue
reveals yeast and pseudohyphae. The yeast is
gram-positive.
 Culture: On sabouraud’s agar media colonies
are formed. Germ tube formation and production
of chlamydospores distinguish C. albicans from
other species of Candida.
Laboratory diagnosis
 Germ tube test:
 Inoculate yeast into
serum
 Results in germinated
hyphae (within 2 hrs at
37OC for C.albicans)
 Specific for C.albicans
although C.tropicalis
sometimes (rarely)
produces germ tubes
Germ tube test
Candida albicans

Colony on SDA
Candida albicans

Mycelium and
Vaginal swab blastospores
in urine
Cryptococcus neofornans
 Characteristic:
 Oval budding yeast.
 Have a wide polysaccharide
capsule.
 Habitat in the soil containing
bird dropping.
 Transmission: by inhalation.
Cryptococcus neofornans

 Clinical feature:
‫ ٭‬Lung infection is often asymptomatic or may
produce flu-like disease or pneumonia.
‫ ٭‬They spread via blood stream to the
meninges and other system in patients with
reduced cell mediated immunity.
‫ ٭‬But some cases of meningitis may occur.
Laboratory Identification
 Microscopy: Visualization of encapsulated
yeast in India ink preparation. Gram stain is
unreliable but stains such as methenamine-
silver, periodic acid-Schiff will allow the
organism to be visualized.
 Culture: On sabouraud’s agar produces
colonies of yeast.
 Serlogy: Capsular polysaccharide antigen can
be detected by latex-agglutination test.
Cryptococcus neoformans

Colonies on SDA CSF, India ink, capsule

Lung section, ecapsulated cells India ink, phase contrast


Aspergillus
 Common species: A. fumigatus, A. flavus, A.
niger.
 Medical importance: Aspergillus species
especially, A. fumigatus cause infections of skin,
ears, eyes, “fungus ball” in the lungs.
Aspergillus
 Transmission: Inhalation of airborne spores.
 Clinical feature: Can colonize and invade
abraded skin, wound, burn, cornea, ear and
paranasal sinuses.
 In immunocompromised persons invade blood
vessels causing thrombosis and infarction.
 A person with lung cavity e.g; from tuberculosis
may develop a fungal ball.
Laboratory Identification
 Microscopy: Biopsy specimen shows septate,
branching hyphae.
 Culture: On sabouraud’s agar produces colonies with
characteristic radiating chains of conidia from central
stalk.

Colony on SDA Hyphae in lung section


Aspergillus
 Detection of antibody: Patients with allergic
bronchopulmonary aspergillosis have high titer
of specific IgE antibody.
 Detection of antigen: Patients with invasive
aspergillosis, their may be high titer of
galactomannan antigen.
Pneumocystis carinii
 Trophozoite and cyst forms, therefore thought to
be a protozoan
 Responds to protozoan drugs, not to fungal
drugs
 But now classified as a fungus (by rRNA
sequencing)
 Pneumonia-like disease, especially in
immunocompromised
 Common killer in AIDS

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