Fungi

Text Review: Study Questions
Lecture 12: Chapter 22
Lecture 12: Outline
Chapter 22:
M/C: 1 -7, 9 -12
Concept: 1 -3, 8, 10, 11, 14, 15
Critical Thinking: 1, 5, 8
Part 1:
Fungal pathogens: Chapter 22
Part 2:
Review
Fungi as infectious agents

molds & yeasts are widely distributed in air,
dust, fomites & normal flora
humans are relatively resistant
fungi are relatively nonpathogenic
of the 100,000 fungal species, only 300
have been linked to disease in animals
fungi are the most common plant pathogens
The Fungi of Medical Importance

Chapter 22
Fungi as infectious agents
Levels of invasion
Mycosis (or mycoses) disease process caused by fungi

Infectious fungi can be grouped based on the virulence of
the organism and the level of involvement of the disease
Systemic
Subcutaneous
Cutaneous
Superficial
Fungal pathogens can be classified in 2 categories:

Primary (true) pathogens : have virulence factors that
allow them to invade and grow in a healthy host
Opportunistic pathogens : weak virulence; causes disease
in only weakened or compromised hosts
5
Pathogenesis of Fungi
Mycoses
Enter body through respiratory, mucous, and

cutaneous routes
In general, primary pathogens have a respiratory
portal of entry
Spores, hyphal elements, and yeast can all be
infectious; more often spores due to their
durability
Mycoses are not usually communicable (except
dermatophytes and Candida species)
most fungal pathogens do not require a host to

complete their life cycles and infections are not
communicable
dermaphytes & Candida sp naturally inhabit
human body & are transmissable
dermaphytoses most prevalent
most cases go undiagnosed or misdiagnosed
systemic, subcutaneous, cutaneous or superficial
infections
7
10
immunity to fungal infections consist of

nonspecific barriers, inflammation & cell
mediated defenses
diagnosis & identification require microscopic
examination of stained specimens, culturing in
selective & enriched media & specific
biochemical & serological tests
control involves intravenous amphotericin B,
flucytosine, azoles & nystatin
Fungi of Medical Importance
Primary Fungal Pathogens
Primary Pathogens
Histoplasma capsulatum
Blastomyces dermatitidis
Coccidioides immitis
Paracoccidiodes brasiliensis
Pathogens with Intermediate Virulence
Dermatophytes
Secondary Pathogens
Cryptococcus neoformans
Candida albicans
Aspergillus species
Pneumocystis carinii
11
Cause primary pulmonary infections

Endemic to specific regions of the world
Virulence factors include resistant spores, thermal dimorphism, toxin
production, and invasive factors
Thermal dimorphism ability to switch between hyphal (mold) and
yeast cells based on temperature
While many fungi exhibit both hyphal and yeast cell types, few show
thermal dimorphism
Infection typically occurs when spores are inhaled
Spores germinate to yeast cells and produce a primary pulmonary
infection (PPI)
In some hosts, the infection becomes systemic and creates severe ,
chronic lesions
12
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or dis play.
Systemic mycoses caused by true

pathogens
Paracoccidioidomycosis brasiliensis
13
14
Figure 22.1 Thermal Dimorphism
cause histoplasmosis
typically dimorphic
distributed worldwide, most prevalent in eastern &
central regions of US
grow in moist soil high in nitrogen content
inhaled conidia produce primary pulmonary
infection that may progress to systemic
involvement of a variety of organs & chronic lung
disease
amphotericin B, ketoconazole
Figure 22.6
15
16
Figure 22.7
Histoplasma capsulatum: Histoplasmosis
Events of Histoplasmosis
Most common true fungal pathogen

Endemic on all continents except Australia
Highest incidence rates in the Ohio River valley; 500 000 case/y r, few
requiring hospitalization
Has been found in poultry house litter, caves, areas harboring b ats, and in bird
roosts
Spores are dispersed by wind and animals
Upon inhalation of spores, growth of yeast cells occur in macrophages
Identified by fish -eye yeast cells in macrophages
Mild symptoms include aches, pain, and coughing
More serious forms in children and AIDS patients
Systemic disease can lead to liver and spleen enlargement, anemi a, circulatory
collapse and death
Chronic pulmonary histoplasmosis occurs in emphysema patients and
resembles Tuberculosis
17
18

pathogens
Histoplasma in a neutrophil
19
20
Coccidioides immitis:
Coccidioidomycosis
cause coccidioidomycosis
distinctive morphology blocklike arthroconidia
in the free-living stage & spherules containing
endospores in the lungs
lives in alkaline soils in semiarid, hot climates &
is endemic to southwestern US
arthrospores inhaled from dust, creates spherules
& nodules in the lungs
amphotericin B treatment
The most virulent of all fungal pathogens

Endemic to salty soils in arid regions of the U.S. (Southwest)
Identified by highly distinctive spherules in sputum, spinal fluid, and
biopsies
In 60% of cases infection is asymptomatic
In 40% of cases, symptoms include fever, chest pain, cough, head ache,
and malaise
Rare cases (5/1000) progress to chronic pulmonary or systemic disease
Chronic pulmonary disease is manifested by fungomas (tumor) and
compromised respiration
Disseminated disease occurs in only compromised patients and can
manifest as subcutaneous abscesses
21
22
Figure 22.8
Events in Coccidioides infection
Figure 22.9
23
24

pathogens
25
causes blastomycosis
dimorphic
free-living species distributed in soil of a large
section of the midwestern and southeastern US
inhaled 10-100 conidia convert to yeasts &
multiply in lungs
symptoms include cough & fever
chronic cutaneous, bone, & nervous system
complications
Treatment with amphotericin B
Blastomyces dermatitidis:
Blastomycosis
Figure 22.11
a) Hyphae and
conidia (25C)
b) Yeast form (37C)
26
Endemic to North America, Africa, and the Middle East

Inhabits areas high in organic matter: forest soil, decaying wood,
manure, abandoned buildings
Can infect through lungs or skin
In pulmonary form, symptoms include cough, chest pain, hoarseness
and fever
Chronic blastomycosis can result in abscesses and tumors often
mistaken for cancer
The cutaneous form is rather common; frequently begins on face,
hands, or leg
Can disseminate to bones resulting in arthritis and osteomyelitis
Chronic systemic blastomycosis of spleen, liver, and urogenital tract
can last for years and eventually destroy host defenses
27
28

Primary Pathogens

Dermatophytes
Secondary Pathogens
29
Candida albicans
Aspergillus species
30
Dermatophytes (Medical Microfile 22.2)
Cutaneous mycoses
Named for derma skin and plant phyte

Cause cutaneous mycoses strictly confined to epidermis
and its derivatives (hair and nails)
All are communicable diseases
Well adapted to breaking down keratin; termed
keratinophiles
Most diseases are termed ringworm or tinea because
they develop in circular scaly patches
Treatments include topical antifungal cream, debridement
of skin and UV treatments
Difficult infections can be treated with griseofulvin;
however, this drug is both hepatotoxic and nephrotoxic
infections strictly confined to keratinized

epidermis (skin, hair, nails) are called
dermatophytoses - ringworm & tinea
39 species in the genera Trichophyton,
Microsporum, Epidermophyton
communicable among humans, animals, &
soil
infection facilitated by moist, chafed skin
31
Ringworm of scalp (tinea capitis) affects scalp & hairbearing regions of head; hair may be lost
Ringworm of body (tinea corporis) occurs as inflamed,
red ring lesions anywhere on smooth skin
Ringworm of groin (tinea cruris) jock itch affects
groin & scrotal regions
Ringworm or foot & hand (tinea pedis & tinea
manuum) is spread by exposure to public surfaces;
occurs between digits & on soles
Ringworm of nails (tinea unguium) is a persistent
colonization of the nails of the hands & feet that
distorts the nail bed
32
Tinea capitis
Tinea corporis
33
34

Primary Pathogens

Dermatophytes
Secondary Pathogens
Tinea pedis
Tinea unguium
35
Candida albicans
Aspergillus species
36
Cryptococcus neoformans:
Cryptococcosis
Diagnosis and treatment
Widespread; associated with birds, and bird guano

Transmission is through spore inhalation
Common infection of AIDS, cancer or diabetes patients
Infection of lung leads to cough, fever, and lung nodules
Dissemination to meninges and brain can cause severe
neurological disturbances and death
Systemic cryptococcosis requires immediate treatment
with amphotericin B and fluconazole over a period of
weeks or months
Initially: negative staining of samples to detect

encapsulated budding yeast
Confirmation by pigmentation on birdseed agar or
fluorescent antibody tests
Birdseed Agar: - Cryptococcus neoformans produces
phenol oxidase, which breaks down the substrate resulting
in the production of melanin and developing dark brown or
black colonies. Other yeasts will appear cream-colored.
Systemic cryptococcosis requires immediate treatment
with amphotericin B and fluconazole over a period of
weeks or months
37
38
Figure 22.25
Figure 22.24
39
Candida albicans
Primary Pathogens
widespread yeast
infections can be short -lived, superficial
skin irritations to overwhelming, fatal
systemic diseases
budding cells of varying size that my form
both elongate pseudohyphae & true hyphae
forms off-white, pasty colony with a yeasty
odor

Dermatophytes
Secondary Pathogens
40
Candida albicans
Aspergillus species
41
42
Candida albicans
Candida albicans: Candidiasis
Normal flora of oral cavity, genitalia, large
intestine or skin of 20% of humans
Account for 80% of nosocomial fungal
infections
Account for 30% of deaths from nosocomial
infections
Can cause short-lived superficial skin
irritations to fatal systemic disease
Candidiasis is usually endogenous, but can be
communicable
Thrush occurs as a thick, white, adherent growth on the

mucous membranes of mouth & throat
Vulvovaginal yeast infection painful inflammatory
condition of the female genital region that causes
ulceration & whitish discharge
Cutaneous candidiasis occurs in chronically moist areas
of skin and burn patients
Esophageal candidiasis afflicts 70% of AIDS patients,
causing painful bleeding ulcerations, nausea and vomiting
Treatment: topical antifungals; amphotericin B in systemic
infections
Diagnosis of Candidiasis
Candida albicans
43
44
Presumptive diagnosis by observing

budding yeast cells and pseudohyphae in
specimen
Culturing on selective and differential yeast
media ie trypan blue media Candida
appears light blue
Also rapid yeast identification kits (multiple
biochemical tests)
45
Figure 22.23
46
Candida albicans
Candida albicans: Candidiasis
Thrush
47
48
Aspergillus
Primary Pathogens
very common airborne soil fungus

600 species, 8 involved in human disease
inhalation of spores causes fungus balls in
lungs and invasive disease in the eyes,
heart, & brain
Distinguished by septate mycelium with
characteristic conidial heads
amphotericin B & nystatin treatment

Dermatophytes
Secondary Pathogens
Candida albicans
Aspergillus species
49
50
Aspergillus species: Aspergillosis
Aspergillus
Poses a serious threat to AIDS, leukemia, and organ

transplant patients
Transmission is through inhalation of spores; usually in
barns, granaries, and silos
Spores germinate in the lungs and form fungus balls
In the more invasive form, the fungus produces a necrotic
pneumonia and disseminates to the brain
It can also cause noninvasive infections of the sinuses, ear
canal, eyelids, and conjunctiva
Apergillus flavus produces a powerful toxin, aflatoxin, that
is hepatotoxic and carcinogenic
Figure 22.28
51
Aspergillus species: Aspergillosis
52
Aspergillus
Aspergillus infection of the eye
Chest x-ray shows where the fungus has invaded the lung tissue.
The cloudiness on the left side of this x-ray is caused by the fungus
53
54
Primary Pathogens
a small, unicellular fungus that causes

pneumonia (PCP), the most prominent
opportunistic infection in AIDS patients
this pneumonia forms secretions in the
lungs that block breathing & can be rapidly
fatal if not controlled with medication
PCP is diagnosed by symptoms and by
examination of lung secretions

Dermatophytes
Secondary Pathogens
Candida albicans
Aspergillus species
55
56
Pneumocystis carnii
Small, unicellular fungus; has a weak cell wall
Obligate parasite; normally a relatively harmless resident
of the upper respiratory tract
Transmission is likely through droplets
Multiplies intracellularly and extracellularly in
compromised patients
Causes inflammation in the lungs; lung cells die and
slough off forming a foamy exudate
Heavy secretions can block breathing
Symptoms include cough, fever, shallow breathing, and
cyanosis
Traditional antifungals are ineffective; primary treatments
are pentamide and cotrimoxazole (10-day period)
Figure 22.26
57
58
Diseases of the GI tract
Lecture 12: Outline
Microbial Agent
59
Disease Features
Small intestine mucosa
diarrhea, fever,
abdominal pain and
vomiting (mostly in
infants.)
Noroviruses (Norwalklike agents)
fecal-oral
Small intestine
fever, abdominal pain,

diarrhea, and vomiting
Giardia lamblia
Ingestion of
contaminated water or
food.
attach to microvilli of
small intestine
giardiasis- fatty, foul

smelling diarrhea,
flatulence (gas).
Cryptosporidium
parvum
Ingestion of
contaminated water or
food.
Small and large

intestine
mild nausea, cramping

and watery diarrhea,
Toxoplasma gondii
Ingestion of oocysts/
cat feces
Lymph nodes
Toxoplasmosis
Trichinella spiralis
Ingestion of cysts/ bear

and pork
Intestine
Trichinosis
Part 2:
Review
Virulence/Tissue
tropism
fecal-oral
contamination
Part 1:
Fungal pathogens: Chapter 22
Mode of
Transmission
Rotavirus
60
10
Diseases of the GI tract

Microbial Agent
Entamoeba histolytica
Enterobius
vermicularis
Ascaris lumbricoides
Taenia saginata
Taenia solium
Mode of
Transmission
Transmitted by the 4F's; food, fingers,
feces, and flies.
Virulence/Tissue
tropism
Caecum, appendix,
colon, rectum
Ingestion of eggs/ oral- Rectum, anus

fecal
Oral-fecal
Intestinal mucosa
Ingestion of larva from

beef
Large intestine
Ingestion of larva from

pork
Large Intestine ; brain
Skin and Eye Infections

Disease Features
Microbial Agent
Mode of Transmission
Nerve cells; latency
Chickenpox: vesicular lesions

Shingles: severe localized
pain, dermatome
HSV -1
Contact with secretions
Nerve cells, mouth and lips
-Cold sores, Herpes simplex

labialis; vesicular painful
lesions
HSV -2
Contact with secretions, STD
Nerve cells, genitals

genitalis; vesicular painful
lesions
Human herpes virus 6
Contact with droplets
Skin; trunck
Roseola
Papilloma virus
Contact with warts, fomites;

STD
Skin (hands); genitalia
Warts; Condyloma
Acuminatum
Rubeola virus
Contact with oral secretions
Skin on head and trunk
Red measles; red macular rash
Pork tapeworm
Rubella virus
Contact with respiratory

secretiosn
Skin on head and trunk
German measles; Rubella; skin

rash
Contact with infected humans

or animals via direct or
indirect means
Intermediate fungal pathogen
Cutaneous mycoses ( Tineas)
Endogenous; communicable
Moist/ damaged skin; mucous

membranes
Candidiasis
Amebic dysentery;
bloody mucoid
diarrhea, erosion of
colon.
Pinworm
Ascariasis
Beef tapeworm
Paramyxovirus
Contact with salivary

droplets
Parotid salivary gland
Mumps - parotitis
Hepatitis A
Oral-fecal
Liver
Infectious hepatitis
Candida albicans
Poliovirus
Oral-Fecal
Intestinal mucosa;
CNS
Poliomyelitis
61
62
Respiratory Infections
Microbial Agent
Inhalation of spores
Virulence / tissue tropisms

True pathogen/ lower RT
Disease Features
Contact with skin or

respiratory secretions
Dermatophytes: Trichophyton
sp., Microsporum sp., and
Epidermophyton sp.
Virulence factors/Tissue tropism
Varicella-zoster virus
Sexually transmitted disease (STDs)

Disease Features
Microbial Agent
Virulence factors/Tissue
tropism
Disease Features
HSV -2
Contact with secretions, STD
Transmission
Nerve cells, genitals

genitalis; vesicular painful
lesions
Papilloma virus
Contact with warts, fomites;

STD
Skin (hands); genitalia
rough cauliflower -like lesions,
Molluscum contagiosum
Pox lesions; STD
Skin; mucous membranes
Molluscum contagiosum
Histoplasmosis
Blastomycosis
Coccidioidomycosis
Cryptococcusneoformans
Inhalation of yeast
Opportunistic pathogen/ lower

RT, lungs
Cryptococcosis
Pneumocystis carnii

RT, lungs
Pneumocystic pneumonia
(PCP)
Trichomonas vaginalis
STD
Vagina; urethra
Trichomoniasis
Aspergillus

RT, lungs
Aspergillosis
Hepatitis B
STD; body fluids, Blood
Liver
Hepatitis
Influenzavirus
Inhalation of droplets
Mucosal cells of trachea,

bronchi
Influenza
Candida albicans
STD; mother to fetus
Vagina; urethra
Candidiasis
Adenovirus, Rhinovirus,
Coronavirus
Direct contact with secretions,

fomites
Nasopharynx mucosal cells
Common cold
CondylomaAcuminatum
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64
Systemic/Nervous/ Circulatory system Infections

Microbial Agent
Virulence/Tissue tropism
Review: Chapter 23
Disease Features
Toxoplasmagondii
Ingestion of cysts; cat feces
Lymph nodes; muscle, brain
Toxoplasmosis
Plasmodium
Vector Anopheles mosquito
Liver, red blood cells
Malaria
Cytomegalovirus
Body fluids
Lymph and salivary glands
Congenital CMV
Epstein -Barrvirus
Oral contact, saliva, fomites
Lymph and salivary glands
Infectious mononucleosis
HIV
STD; blood
T cells (CD4)
AIDS; systemic
Histoplasmosis
Blastomycosis
Coccidioidomycosis
Cryptococcusneoformans
Inhalation of yeast

RT, lungs
Cryptococcosis
For the parasite pathogens:

Protozoa or helminth?
Ameba/Flagellate/Apicomplexa or
nematode/fluke/cestode?
Cyst/trophozoite stages
Disease
Transmission
Communicable or non-communicable
Treatment
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66
11
Review: Chapters 24-25
For a viral pathogen
Review: Chapter 22
For a fungal pathogen
DNA/RNA; single stranded or double stranded

Envelope/ no envelope
Special features
Disease
Transmission
Tissue Tropism
Treatment or vaccine
True pathogen , intermediate pathogen, or

opportunist
Disease
Transmission
Communicable or non-communicable
Diagnosis/Treatment
Compare Positive and Negative sense RNA viruses

Describe retroviruses
Compare Rubeola and Rubella
Compare the Hepatitis viruses
Know the common opportunistic diseases in AIDS patients
Compare the viruses involved in the common cold
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68
12

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Text Review: Study Questions

Lecture 12: Chapter 22

Lecture 12: Outline

Fungi as infectious agents

The Fungi of Medical Importance

Fungi as infectious agents

Mycosis (or mycoses) disease process caused by fungi

Fungal pathogens can be classified in 2 categories:

Enter body through respiratory, mucous, and

most fungal pathogens do not require a host to

immunity to fungal infections consist of

Fungi of Medical Importance

Primary Fungal Pathogens

Pathogens with Intermediate Virulence

Cause primary pulmonary infections

Systemic mycoses caused by true

Figure 22.1 Thermal Dimorphism

Histoplasma capsulatum: Histoplasmosis

Most common true fungal pathogen

Systemic mycoses caused by true

The most virulent of all fungal pathogens

Systemic mycoses caused by true

b) Yeast form (37C)

Endemic to North America, Africa, and the Middle East

Fungi of Medical Importance

Pathogens with Intermediate Virulence

Dermatophytes (Medical Microfile 22.2)

Named for derma skin and plant phyte

infections strictly confined to keratinized

Fungi of Medical Importance

Pathogens with Intermediate Virulence

Diagnosis and treatment

Widespread; associated with birds, and bird guano

Initially: negative staining of samples to detect

Fungi of Medical Importance

Pathogens with Intermediate Virulence

Thrush occurs as a thick, white, adherent growth on the

Presumptive diagnosis by observing

Candida albicans: Candidiasis

Fungi of Medical Importance

very common airborne soil fungus

Pathogens with Intermediate Virulence

Aspergillus species: Aspergillosis

Poses a serious threat to AIDS, leukemia, and organ

Aspergillus species: Aspergillosis

Aspergillus infection of the eye

Fungi of Medical Importance

a small, unicellular fungus that causes

Pathogens with Intermediate Virulence

Diseases of the GI tract

Lecture 12: Outline

Small intestine mucosa

Noroviruses (Norwalklike agents)

fever, abdominal pain,

giardiasis- fatty, foul

Small and large

mild nausea, cramping

Ingestion of cysts/ bear

Diseases of the GI tract

Ingestion of eggs/ oral- Rectum, anus

Ingestion of larva from

Ingestion of larva from

Large Intestine ; brain

Skin and Eye Infections