Oppurtunistic mycosis
Ordinary fungi causing extraordinary
disease
Infections due to fungi of low
virulence in patients who are
immunologically compromised
Opportunistic fungi
1. Saprophytic - from the environment
e.g.,Cryptococcus sp. , Aspergillus,
Zycomycetes.
2. Endogenous – a commensal organism e.g.,
Candida sp.
Include many species from: A (Aspergillus)
To Z (Zygomyces)
Predisposing Factors: Providing a
Route/ Source
• Antibiotics
• Burns and other skin problems
• Catheter- related problems
• Devices (prosthetic)
• Effects on mucosal integrity
• Fungus isolated previously
Inducing Immunosuppression
• AIDS
• Bone marrow/ organ transplantation
• Cancer: Leukemia, lymphoma etc
• Drugs: Cytotoxic drugs,steroids etc
• Endocrine related: Diabetes
• Failure of organs: multi-organ
Candida albicans and
other Candida species
• Harmless inhabitants of the skin
and mucous membranes of all
humans
• Normal immune system keeps
candida on body surfaces
THE MOST IMPORTANT RISK
FACTORS
1. Neutropenia(less than 100 N/L)
2. Diabetes mellitus
3. AIDS
5. Myeloperoxidase defects
6. Broad-spectrum antibiotics
THE MOST IMPORTANT RISK FACTORS
7. Indwelling catethers
8. Major surgery
9. Organ transplantation
10. Neonates
11. Severity of any illness
12. Intravenous drug addicts
INVASIVE CANDIDIASIS
• If phagocytic system is
compromised, infection spreads
to many organs and causes focal
infection in these organs (kidney
,eye ,heart , liver , meninges)
• mortality of candidemia is 30-
40%
• Prophylactic antifungal drugs
during cytotoxic course of
therapy
DIAGNOSIS OF INVASIVE
CANDIDIASIS
• Gram stain and isolation from
blood, CSF , urine ,sputum or
peritoneal fluid
• Serology
• PCR (promising)
• isolation and/or pathology positive
of organ involved
EPIDEMIOLOGY
Although candidiasis is
endogenous in most cases,
cross infections are described,
especially in intensive care unit
patients.
• Account for 80% of nosocomial fungal
infections
• Account for 30% of deaths from
nosocomial infections
Cryptococcosis and Cryptococcus
neoformans
• Cryptococcus neoformans causes cryptococcosis.
• A widespread encapsulated yeast that inhabits soil
around pigeon roosts
• Common infection of AIDS, cancer or diabetes
patients
• Infection of lungs leads to cough, fever, and lung
nodules
• Dissemination to meninges and brain can cause
severe neurological disturbance and death.
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Diagnosis
Microscopic
– India Ink for capsule stain (50-80% + CSF)
– Gram
– Silver stain
Culture
– Bird seed agar
– Routine blood culture
Serology
Aspergillosis: Diseases of the
Genus Aspergillus
• Very common airborne soil fungus
• 600 species, 8 involved in human disease; A. fumigatus
most commonly
• Serious opportunistic threat to AIDS, leukemia, and
transplant patients
• Infection usually occurs in lungs – spores germinate in
lungs and form fungal balls; can colonize sinuses, ear
canals, eyelids, and conjunctiva
• Invasive aspergillosis can produce necrotic pneumonia,
and infection of brain, heart, and other organs.
• Amphotericin B and nystatin
13
Zygomycosis
• Zygomycota are extremely abundant saprophytic fungi
found in soil, water, organic debris, and food.
• Genera most often involved are Rhizopus, Absidia, and
Mucor.
• Usually harmless air contaminants invade the membranes
of the nose, eyes, heart, and brain of people
(Rhinocerebral mucormycosis) with diabetes and
malnutrition, with severe consequences.
• main host defense is phagocytosis
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Diagnosis is made by direct smear
and by isolation of molds from
respiratory secretions or biopsy
specimens.
Treatment:
Control Diabetes ,surgery &
amphotericin B
Prognosis: very poor
Diagnosis of opportunistic infections
requires a
high index of suspicion
1. Atypical signs or symptom...M.furfur
2. Unusual organ affinity…liver candidiasis
3. Outside the endemic area
4. Unusual Histopathology…necrosis
5. Etiologic agent may be a “saprophyte”
6. Serological response may be suppressed
IMPROVING TREATMENT
1. New Drugs…Echinocandin
2. New therapeutic regimen
3. Aggressive therapy…prophylactic
4. Conjunctive therapy..Immunotherapy
5. IL, IFN,CSF
“Only the prepared mind can help the impaired host”
Libero Ajello, Chief Mycology Division, CDC 1972
MYCOLGISTS have more
FUNGI
