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DIMORPHIC MYCOSES

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Title: DIMORPHIC MYCOSES


1
DIMORPHIC MYCOSES
  • CONTINUED

2
DIMORPHIC FUNGI
  • DISEASES
  • Blastomycosis
  • Histoplasmosis
  • Coccidioidomycosis
  • Paracoccidioidomycosis
  • Sporotrichosis

3
HISTOPLASMOSIS
  • Histoplasma capsulatum

4
Histoplasmosis
  • An intracellular mycoses of the
    reticuloendothelial system, attacking lungs,
    liver, spleen, bone marrow and occasionally
    kidneys, adrenals and intestines.

5
PORTAL OF ENTRY
  • INHALATION
  • INOCULATION
  • (rare)

6
HISTOPLASMOSIS
  • ACUTE PULMONARY
  • ASYMPTOMATIC
  • SYMPTOMATIC
  • CHRONIC PULMONARY
  • DISSEMINATED

7
Pulmonary Symptoms
  • Shortness of breath
  • Productive cough (purulent or bloody)
  • Anorexia
  • Weight loss
  • Night sweats

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ECOLOGICAL ASSOCIATION
  • Blackbird roosts
  • Bats
  • Bat guano
  • Chicken houses

10
Histoplasmosis outbreak Laurens County, S. C.
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ISOLATION OF H. CAPSULATUM FROM ENVIRONMENTAL
SOURCES S. C.
15
CLINICAL SPECIMENS
  • SPUTUM
  • BONE MARROW
  • BIOPSY MATERIAL
  • BRONCHIAL WASHINGS
  • PERIPHERAL BLOOD
  • GASTRIC WASHINGS

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Identification
  • 1. Microscopic observation
  • 2. Conversion
  • 3. DNA Probe

24
SEROLGICAL TEST
  • COMPLEMENT FIXATION
  • MYCELIAL FORM ANTIGEN
  • YEAST FORM ANTIGEN
  • IMMUNODIFFUSION
  • H ACUTE INFECTION
  • M PAST, PRESENT OR SKIN TEST

25
SEROLGICAL TESTS
  • EIA detects antibody
  • EIA to detect ANTIGEN
  • (systemic disease)

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DRUGS OF CHOICE
  • ITRACONAZOLE
  • (mild disease static)
  • AMPHOTERICIN B
  • (severe disease - cidal)

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COCCIDIOIDOMYCOSIS
30
COCCIDIOIDOMYCOSIS
  • Coccidioides immitis

31
COCCIDIOIDOMYCOSIS
  • It may occur as either an acute, benign,
    self-limited disease or a chronic, malignant
    disseminated disease involving the cutaneous,
    subcutaneous, visceral or osseous tissue.

32
PORTAL OF ENTRY
  • INHALATION
  • INOCULATION
  • (Rare)

33
Pulmonary Symptoms
  • Anorexia
  • Shortness of breath
  • Weight loss
  • Productive cough
  • Night sweats
  • Arthralgia
  • Erythema multiforme

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ECOLOGICAL ASSOCIATION
  • Desert soil
  • Archeological middens
  • Pottery
  • Rodent burrows
  • Cotton
  • Construction sites

40
SOIL
____________
ARTHROCONIDIA
ANIMAL HUMAN
ENDOSPORES
SPHERULE
41
SPHERULES
42
CLINICAL SPECIMENS
  • Sputum
  • Pus
  • Gastric washings
  • CSF
  • Bronchial washings
  • Biopsy material

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ARTHROCONIDIA
45
Spherules
46
SOIL
____________
ARTHROCONIDIA
ANIMAL HUMAN
ENDOSPORES
SPHERULE
47
SEROLOGICAL TESTS
  • Complement fixation
  • Immunodiffusion
  • Slide agglutination
  • EIA

48
DRUGS OF CHOICE
  • Fluconazole
  • Itraconazole
  • Amphotericin B
  • (severe infections)

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PARACOCCIDIOIDOMYCOSIS
  • Paracoccidioides brasiliensis

51
PARACOCCIDIOIDOMYCOSIS
  • A chronic granulomatous disease of the lungs,
    mucous membranes, skin and lymph nodes.

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5 25 u
A. Restrepo
54
Wanke/Londero
55
ECOLOGICAL ASSOCIATION
  • Probably soil
  • Armadillos

56
Paracoccidioidomycosis Triad
  • Pulmonary lesion
  • Cervical adenopathy
  • Edentulous

57
Paracoccidioidomycosis Triad
  • Pulmonary lesion

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Paracoccidioidomycosis Triad
  • Pulmonary lesions
  • Cervical adenopathy

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Paracoccidioidomycosis Triad
  • Pulmonary lesion
  • Cervical adenopathy
  • Edentulous

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Prolonged latency
  • 10 20 years

64
CLINICAL SPECIMENS
  • Sputum
  • Biopsy material
  • Pus
  • Crusts
  • Bronchial washings

65
Mycology
  • At 25 degrees it is a white, dense, septate
    mycelium
  • Terminal or intercalary spores (non-diagnostic)
  • Slow growing 20 30 days

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A. Restrepo
69
Mycology
  • At 37 degrees it is a white-tan, creamy,
    cerebriform colony.
  • Single or multiple buds
  • Narrow base.

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A. Restrepo
71
THE CAPTAINS WHEEL
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SEROLOGICAL TEST
  • IMMUNODIFFUSION
  • Sensitivity - 99
  • Specificity - 84

74
DRUGS OF CHOICE
  • Amphotericin B
  • Sulphonamide-trimethoprim
  • Itraconazole

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SPOROTRICHOSIS
  • Sporothrix schenckii

77
SPOROTRICHOSIS
  • Primarily a disease of the cutaneous tissue and
    lymph nodes. Recently, pulmonary disease.

78
PORTALS OF ENTRY
  • Inhalation
  • Inoculation

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ECOLOGICAL ASSOCIATIONS
  • Rose thorns
  • Sphagnum moss
  • Timbers
  • Soil

81
SPOROTRICHOSIS
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DISSEMINATION
  • Alcohol abuse
  • Sarcoidosis
  • HIV infection
  • Malignancy
  • Diabetes

85
GEOGRAPHIC DISTRIBUTION
  • World-wide

86
CLINICAL SPECIMENS
  • Pus
  • Biopsy material
  • Sputum
  • Bronchial washings

87
Indiana Pathology Images
88
Indiana Pathology Images
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Daisies
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Cigar-shaped
94
SEROLGICAL TEST
  • No commercial serologic reagents

95
DRUGS OF CHOICE
  • CUTANEOUS OR SYSTEMIC FORM
  • Itraconazole
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