OPPORTUNISTIC FUNGAL INFECTIONS

As a rule, these organisms generally cause disease in immunosuppressed patients or those with some kind of underlying disease, which compromises the immune or inflammatory response. They may cause different disease syndromes in different patients; however, skin and nail as well as respiratory infections are very common. Most are Saprophytic fungi (or saprobes). They originate on decaying organic matter found in soil and on vegetation, but spores may be come airborne. The majority are rapid growers producing a visible colony in 4-5 days. As a result, they may also be common contaminants of laboratory cultures. It is paramount to know which they are when found in the lab. ZYGOMYCETES - Commonly known as fruit or bread molds. Wide, aseptate hyphae with sporangiophores rising from hyphal stalk. Rhizoid (roots) present in most species. High risk to patients in acidosis (uncontrolled diabetics) or those on corticosteroids, long-term antibiotics, anti-leukemic drugs. Often infect nasal passages and in these patients rapidly spreads to sinuses and the orbital area then to adjacent blood vessels becoming systemic and rapidly fatal. A chronic self-limiting form can be found in skin infections Absidia - rapidly growing, wooly gray top/bottom colorless, branching sporangiophore rising from stolens between rhizoids, slight swelling below the columella, pear-shaped sporangia. Involved in keratomycosis and general zygomycosis

Cunninghamella - White cottony turn gray with age. Sporangiophores end in swollen spherical vesicles with one celled sporangiola. Important cause of zygomycosis in neutropenic patients !

Mucor - rapid growing, cottony dirty white colonies - may turn gray to brown with age. Single or branching sporangiophores with round sporangia. No rhizoids seen !! Otomycosis, allergies, and general zygomycosis.

Rhizopus - rapid growing, white dense cottony - later top is dotted with dark sporangia; root structures directly opposite unbranched sporangiophores; sporangia may be very dark in color. Otomycosis and general zygomycosis.

Syncephalastrum - wooly dark colony, branched sporangiophores end in merosporangia and then round sporangiospores. Not known to be a human pathogen. Can be confused with Aspergillus.

SEPTATE OPPORTUNISTS - May involve fungi that are dematiaceous (naturally dark pigmented) or hyaline (light colored). DEMATIATIOUS FUNGI - dark colored hyphae or conidia - may also produce pigment in tissues. (phaeohyphomycosis)

Alternaria - light gray woolly, later darkens with black reverse. Poroconidia form chains that resemble drum stick shapes with horizontal and vertical septa. Allergies and phaeohyphomycosis

Bipolaris woolly to cottony olive green to black. Conidiophores geniculate with multicelled fusoid to cylindrical conidia. Transverse septa only.

Chaetomium moderately rapid growing, dirty gray. Develop numerous perithecia. Asci are pigmented with lemon shaped ascospores

Cladosporium other species of the same group involved in Chromoblastosis. Slow growing brown to live to black hyphae and conidia.

Curvularia Rapidly growing, woolly olive green to black. Conidiophores geniculate. Multicellular conidia with enlarged central cell which causes unit to curve. Keratomycosis

Epicoccum Short conidiophores bearing multicellular spherical to club-shaped macroconidia. Transverse and longitudinal septa. Yellow to orange hyphae with brown to black conidia

Ulocladium The club-shaped conidia are more rounded than Alternaria, do not chain. Borne on short geniculate conidiophores. Conidia have both transverse and longitudinal septa.

HYALINE MOLDS no base color in hyphae color of conidia may impart color to colony in laboratory. (hyphomycosis)

Acremonium rapid growing, white to yellow flat colony. Conidiophores thin erect with one celled phialoconidia clustered at ends

Aspergillus fumigatus and Aspergillus flavus - very common color of colony is from the conidia (black to white). Usual mode of infection is inhalation. Pneumonia, otomycosis, allergic reactions, can all be manifestations of Aspergillus infection. A. flavus has condia borne in 360 arrangement while A. fumigatus covers the upper 2/3 of the conidiophore head

Chrysosporium white to pale brown, granular to woolly. May be confused with Blastomycosis or Histoplasma.

Fusarium rapid growing, wooly to cottonly, white to pink to purple, multicellular distinctive sickle shaped macroconidia. Keratomycosis, burn infections

Paecilomyces rapid growing white to brown (no blue/green), branching conidiophores, phialides with tapered ends in pairs or groups, chains of unicellular conidia. Endocarditis, opportunistic

Penicillium rapid growing white to khaki green, conidiophores branched or unbranched with flask shaped phialides. Conidia are unbranched in chains. Common laboratory contaminant

Scopulariopsis rapid growing, granular white to tan, branched or unbranched conidiophores, annellide conidia formed in chains, unicellular, round rough-walled. Nail infections

MISCELLANEOUS ORGANISMS Pneumocystis carrini Once thought to be a parasite, the organism has now been classified as a fungus by DNA and RNA analysis. Almost everyone has been exposed to the organism in early childhood and as a rule it does not cause disease. However, in premature infants and others with severe immunosuppression, it can cause a devastating pneumonia. Cysts are the form seen in tissues. A GramWeigert or Methanamine Silver stain is used to demonstrate the organisms in tissue sections.