Fungi: Characteristics and Types in Medical Mycology

Objectives

•

By the end of this lecture the student must be:

A)

I

d

e

n

t

i

f

y

t

h

e

C

h

a

r

a

c

t

e

r

s

o

f

F

u

n

g

i

B)

describe the chemical tests for this genus

•

C) Differentiate between different sps.

•

D) List and match the symptoms, diagnosis

and treatment for different sps.

Medical Mycology



Myco = Fungi



Ology = Science



Mycology

 is the science deals with fungi



Mycoses

 = Fungal infection



Dermatophytosis

 - "ringworm" disease of the

nails, hair, and/or stratum corneum of the skin

caused by fungi called dermatophytes 



Dermatomycosis

  - more general name for any

skin disease caused by a fungus

2

What is the FUNGUS?



Eukaryotic

 → a true nucleus



Do not contain chlorophyll



Organoheterotrophic



Cannot photosynthesize their own food



Live either as saprophytes or parasites



Have chitin cell walls



Produce filamentous structures



Reproduce by spores (sexual & asexual)



Are aerobic life forms

3

What are Actinomyces?



True Bacteria (Prokaryotic)



Similar to fungi (fungi-like bacteria) 

WHY?

1.

Clinical infection resembles mycoses

2.

Grow on mycotic media

3.

Grow slowly >48 h

4.

Gross colonies resemble fungi



(rough, heaped, short aerial filaments)

5.

Resemble mycelia microscopically, with

branched mycelia in tissue and smears

4

Fungi vs. Bacteria

•

Chitin is not found in any other microorganisms

5

Types of fungi

1.

Multicellular: 

Molds

- filamentous



Penicillium

, 

Aspergillus

2.

Unicellular: 

Yeasts



Candida, Cryptococcus

3.

Dimorphic Fungi



Dermatophytes, 

Histoplasma

6

YEAST



Facultative Anaerobes



Fermentation=ethanol and CO

2



Non-filamentous unicellular fungi



Spherical or oval



Reproduction by



Fission or budding

7

DIMORPHIC FUNGI



Growth as a mold or as a yeast



Most pathogenic fungi are dimorphic fungi



At 37

o

 C yeast-like



At 25

o 

C mold-like



Can also occur with changes in CO

2



Fungi grow differently in tissue vs

nature/culture; often dictated by temp

8

Basic structure of fungi

1.

Hyphae



Main body of most fungi is made up of fine,

Cylindrical, 

branching threads called 

hyphae



Tubular cell wall filled with cytoplasm & organelles



Most hyphae are 2-10 



m 

diameter

2.

Mycelia



When formed of many cells, cellular units connect

together (intertwining) to form long filamentous

A.

Aerial mycelium



Part projects above the surface of medium

B.

Vegetative mycelium



Part penetrate into medium and absorb food

9

Basic structure of fungi

•

Septa

—regular cross-walls formed in hyphae

•

Septate: 

Hyphae with septa - or

•

Aseptate

 or 

coenocytic

: Lacking septa except to

delimit reproductive structures & aging hyphae

•

Primary septa

: 

Formed as a process of hyphal

extension & generally have a septal pore, which

allows for cytoplasmic & organelle movement

•

Secondary

 or 

adventitious

septa are

imperforate, formed to wall off ageing parts of

the mycelium

10

Reproduction

•

Propagate via 

formation of spores

•

Sexual and asexual spores

•

The shape and type of spores are

–

Different from one type of fungi to another

–

Important in the classification &

identification of different species of fungi

11

Asexual spore

•

Conidiospore

•

Multiple (chains) or single spores formed at the

end of an aerial hypha

•

Not enclosed by a SAC

–

Aspergillus

 spp.

–

Penicillium

 spp

•

Conidiophore

: filament that forms Conidospore

12

ConidioSpores



Arthrospores



Cells in hyphae develop thick wall & separate by

disarticulation



Coccidioides- 

 genus of dimorphic Ascomycete



Blastospores



Thickened wall



Bud from the parent cell



Candida, Cryptococcus

13

Chlamydospores

•

Spore contained within hypha

•

Rounded & Thick cell wall

•

Chlamydophores

–

Aerial hypha with chlamydospores

•

e.g. 

Candida albicans

14

S

p

o

r

a

n

g

i

o

s

p

o

r

e



Spore contained in a sporangium at the end of a

sporangoiphore



Sporangium:



A sac or cell containing spores produced asexually



Sproangiophore

- aerial hypha with sporangium



Rhizopus

 spp

15

Sexual spores

•

Sexual spores - exhibit fusion of nuclei

•

Ascospore

–

Formed in sac-like cell (ascus)

–

Often 8 spores formed

–

Ascomycetes

•

Basidiospore

–

Produced on a specialized club-shaped structure

(basidium)

–

Basidiomycetes

•

Zygospore

–

Thick-walled spore formed during sexual

reproduction

–

Zygomycetes

/

 Mucor and Rhizopus 

16

Classification of Fungi



Comprised of 

over 100,000 species



Classified into 4 orders according to the presence or absence of sexual

reproductive cycle and the nature of sexual spores

17

ZYGOMYCETES

•

Phylum Zygomycota/Sexual/Non-septate

•

Lower fungi

•

< 1000 species

•

Produce 

zygospore

, or 

sporangiospores

•

Include the common bread molds and other fungi

that cause food spoilage 

•

Mucor and Rhizopus are most familiar example

18

Ascomycetes

•

Phylum Ascomycota,  Septate/Sexual/Higher fungi

•

Certain yeasts & some fungi that causes  plant disease

•

Contains more than 30,000 species of unicellular and 

multi-cellular fungi

•

Produce sexual spores (

ascospores

)

•

Produce asexual exospores (

conidia

)

•

Unicellular e.g. Saccharomyces, Candida

•

Multicellular e.g. Penicillum, Asperigullus, 

Claviceps, Dermatophytes,

Sporothrix schenckii, 

Histoplasma

19

Basidomycetes

•

Phylum Basidiomycota/Septate/Sexual

•

 Higher Fungi-Over 30,000 different species

•

Sexual spores borne on clublike stalks (basidia)

•

Mushrooms

(

Agaricus bisporus, Agaricus

campestris

) are the most familiar members

•

Among Basidiomycota, only 

Malassezia

& 

Cryptococcus

 are frequent human pathogens

20

Septate mycelium: Deutromycetes:

•

Fungi imperfecti

•

Sexual life cycle is either unknown or absent

•

Reproduce by various types of asexual spores

including budding

•

Have an abundant mycelium at times while at other

times they grow as yeast-like cells

•

Includes majority of pathogenic to man & animal

•

Resemble Ascomycetes in morphology

•

Examples: Trichophyton, Epidermophyton,

Microsporon, Candida, Cryptococcus, Histoplasma

21

Fungal cell wall composition



Consists of





 80% of polysaccharides



Polysaccharide fibrils provide rigidity/integrity of wall





 20% 

of the wall consists of Proteins

1.

Structural components (Fibrous)

A.

Chitin microfibrils



Polymers of 

ß (1-4)-linked N-acetylglucosamine

B.

Chitosan

(in Zygomycota only)



De-acetylated chitin

C.

ß-linked glucans



Polymers of 

β

-1,3-linked glucose 

residues with

short 

β 

-1,6-linked 

side chains

22

Fungal cell wall composition

2.

Matrix components

 (

Gel-like components)



Structural polymers are contained in gel-like

matrix

A.

Mannoproteins



Glycoproteins (form matrix throughout wall)





 (1,3) glucan

23

Structure of cell membrane



Semi-permeable



Phospholipid bilayer



Involved in uptake of nutrients



Anchorage for enzymes/proteins, e.g., 

chitin synthase

,

glucan synthase

, etc.



Signal transduction



Differs in that it contains 

ERGOSTEROL



Site of action for certain antifungal drugs



Human cell doesn't contain 

ergosterol



Human cell contains 

cholesterol

24

Medical Effect of Fungi

•

I. 

Mycotoxicoses:

•

Mould produces secondary metabolite (

MYCOTOXINS

)

•

Highly toxic to humans

•

Ingestion of toxic fungi or their metabolites

•

Ergotism

 is caused by eating bread prepared from rye

infected with 

Claviceps purpurea

•

Historically, several large scale outbreaks of madness in

populations have been attributed to ergotism

•

Ergot are 



-adrenergic blockers



inhibits response to

adrenaline



 vasoconstriction



 necrosis



gangaren

•

Symptoms consisted of inflammation of infected tissue,

followed by necrosis and gangrene

25

Medical Effect of Fungi



Natural occurrence:



Food products contaminated with 

AFLATOXINS

 include

cereal (maize, rice & wheat), oilseeds (groundnut,

soybean & cotton), spices (black pepper, coriander &

zinger), tree nuts (almonds, and coconut) & milk



Physical and chemical properties:



Aflatoxins are potent toxic, carcinogenic, mutagenic,

immunosuppressive agents, produced as secondary

metabolites by 

Aspergillus flavus

 and 

A. parasiticus

26

Medical Effect of Fungi



II. Hypersensitivity Disease:



Fungal spores are inhalated



They can be an antigenic 



 elicit immune

response 



production of Ig or sensitized

lymphocyte



Example is hypersensitivity pneumonitis

27

Medical Effect of Fungi



III. Colonization and resultant disease:



They may attack:

1.

Outermost layers 

of Skin, hair and/or mucous

membrane 



superficial mycoses

2.

Epidermis

 as well as nail and hair 



cutaneous

mycoses

3.

Dermis

, subcutaneous tissues, muscle and face 



Subcutaneous mycoses

4.

The internal organs 

as the lungs, CNS, bones etc. 



systemic mycoses

5.

Opportunistic

 - cause infection only in the

immunocompromised

28

A. Superfacial mycosis

1.

Tinea versicolor 

(Pityriasis versicolor)

2.

Tinea nigra

•

They are extremely superficial mycoses

•

Primary Manifestation is pigment change of the

skin

•

Both are named for their respective skin

manifestation

29

Tinea versicolor

(Pityriasis versicolor)

•

Causative agent: 

Malassezia globosa

–

Less common-

Malassezia furfur

•

Lipophilic Yeasts 

belongs to Basidomycota

•

Normal flora of skin and scalp 

•

S

uperficial opportunistic pathogens of the skin

•

Associated with seborrheic dermatitis, dandruff (Pityriasis

capitis) and atopic dermatitis

•

Pityriasis versicolor  

is chronic superficial mycoses

•

Characterized by a blotchy discoloration of skin which may

itch

•

With sunlight exposure the skin around patches will tan, but

patches remains white

30

Pityriasis versicolor

•

Chronic superficial mycoses

•

Characterized by 

hyperpigmented lesions

–

Well-demarcated white, pink, or brownish lesions,

often coalescing and covered with thin furfuraceous

scales

•

The colour varies according to;

–

The normal pigmentation of the patient

–

exposure of the area to sunlight

–

the severity of the disease.

•

Lesions occur on the trunk, shoulders and arms,

•

Rarely on the neck and face

•

Fluoresce a pale greenish colour under Wood's ultra-

violet light.

31

B. cutaneous Mycoses



Dermatophytes

 attack keratinous structure of

skin, hair and nail and cause the group of disease

known as 

Ringworms or Tinea



Candida

 can attack the skin, the mucous

membranes and rarely the internal organs



Non-dermatophyte moulds 

e.g. Hendrsonula

toruloidea, 

Scytalidium hyalium, Scopulariopsis

brevicaulis

32

i. Dermatophytes

•

Confined to the outer layers of skin, hair & nails

•

Do not invade living tissues

•

Called dermatophytes (keratinophilic fungi)

•

Produce extracellular keratinas 



 hydrolyze keratin

•

Utilize keratin for their nutrition

•

Keratin is the chief protein in skin, hair and nail

•

They caused dermatophycosis“Ringworm" or “Tinea"

•

Dermatophycosis refers to the characteristic central

clearing that often occurs in dermatophyte infections

33

I. dermatophytes

1.

Trichophyton

 (

19 species

)



Affect hair, skin & nails



Infect both children & adults 

2.

Epidermophyton



Infect skin, nails (rarely hair)



Infect adults, rarely in children (ringworm)



Epidermophyton floccosum

3.

Microsporum

 (

13 species)



Affect

 hair, skin (rarely nails)



Frequently in children, rarely in adults



M. canis

 is the most common infect man

34

Ecology and Mode of transmission

•

To determine the source of infection

•

Anthrophilic

–

Some Dermatophytes affect man only

–

Person -to-person transmission

 through

contaminated objects (comb, hat, etc.)

–

T. rubrum 

and 

T. mentagrophytes 

•

Zoophilic

–

Other affect animal mainly

–

Direct transmission to humans by close

contact with animals

–

M. canis

 and 

T. verrucosum

35

Ecology and Mode of transmission

•

Geophilic

–

Other live in soil and can affect man 

–

Transmitted to humans by direct exposure

–

M. gypseum

•

Each geographic locality has its own

dermatophyton

–

T. violacium

is the prevalent causative

organism of Tinea capitis in Egypt

–

M. audouini

is prevalent cause in England

36

Tinea corporis



Small lesions occurring anywhere 

on the body



Causative agent:



Trichophyton rubrum, T. mentagrophytes

, M

.

canis

, and  

M. audouinii



Live on the skin surface (opportunistic)



Reservoir: 

Humans, soil & animals



Acquired by 

person-to-person transfer usually

via direct skin contact 

with infected individual



Animal-to-human transmission is common

37

Tinea pedis "athlete's foot"



Infection of toe webs and soles of feet



Causative agent: 



Trichophyton rubrum

, 

T. mentagrophytes

 and

Epidermophyton floccosum



Requires warmth and moisture to survive and grow



Causes scaling, flaking & itch of affected areas



Reservoirs: 

Humans



Athlete's foot is a communicable disease



Transmission:

 when people who regularly wear

shoes go barefoot in a moist environment

38

Tinea capitis



Infection of the scalp



Causative agent: 



Trichophyton

 and 

Microsporum

 invade the hair shaft



Trichophyton

  infection prevail in Central America to

USA & in parts of Western Europe



Microsporum

 infection are in South America, Southern

& Central Europe, Africa & Middle East



Reservoirs:

 Humans & animals (dogs, cats and cattle)



Transmitted

 by humans, animals or objects that harbor

the fungus

39

Dermatophytes

4.

Tinea cruris - "jock itch"



Infection of the groin, perineum or perianal area



Trichophyton rubrum



Some other contributing fungi are 

Candida albicans

, 

T.

mentagrophytes

 and 

Epidermophyton floccosum

.

5.

Tinea barbae 



Ringworm of the bearded areas of the face and neck



Trichophyton mentagrophytes

 and 

T. verrucosum

40

Dermatophytes

6.

Tinea unguium (onychomycosis)

–

Infection of nails

–

Common - 

Trichophyton rubrum

–

Less common-

 T. interdigitale

, 

Epidermophyton

floccosum

, 

T. violaceum

, 

Microsporum gypseum

, 

T.

tonsurans

, 

T. soudanense

–

Reservoirs: Humans and rarely animals or soil

41

Treatment of Dermatophytes



All are sensitive to 

grisofulvin



Tolfnatate

 available over the counter – Topical



Terbinifine

 (Lamisil) - oral, topical.



Ketoconazole

 seems to be most effective for

tinea versicolor and other dermatophytes



Itraconazole

 - oral



Echinocandins

 (caspofungin)

42

Lab diagnosis of Dermatophytes

•

Specimen collection

–

Skin Scrapings, nail scrapings and epilated hairs

•

Direct Microscopy

–

Specimens should be examined using 10% KOH

and Parker ink or calcofluor white mounts

–

Characteristic hyphae can be seen

43

Lab diagnosis of Dermatophytes

•

Culture

•

Specimens should be inoculated onto

•

Sabouraud's dextrose agar (

General purpose)

•

Selective – Mycosel agar

–

Gentamicin

: inhibits normal bacterial flora

–

Cycloheximide

: inhibits saprophytic fungi

–

containing cycloheximide and incubated at

25

0

C for 4 weeks

–

The growth of any dermatophyte is significant

44

II. Candida

•

Yeast-like organism that lives as a commensal in oral mucosa, 

throat,

skin, scalp, vagina, fingers, nails, bronchi, lungs, or 

intestine and vagina

•

Opportunistic organism

•

The causative agent of candidiasis

–

C. albicans

, 

C. tropicalis 

& 

C. glabrata

•

Candidiasis encompasses infections that range from superficial

such as thrush and vaginitis

•

Rarely 

become systemic i

n immunocompromised patients

–

Septicaemia, endocarditis and meningitis

45

Symptoms of Candida albicans

•

Thrush

 appears as 

creamy-white or bluish-white patches on

the tongue

 - which is inflamed and sometimes-beefy red -

and on the lining of the mouth, or in the throat.

•

Diaper rash 

caused by candida is an inflammation of the

skin, usually red and sometimes scaly.

•

Vaginitis

is characterized by a white or yellow discharge.

–

Inflammation of the walls of vagina and of the vulva

(external genital area) causes burning and itching.

•

Infections of the fingernails and toenails 

appear as red,

painful swelling around the nail.

•

Later, pus may develop.

46

Laboratory diagnosis of candida

•

Specimen:

–

A scraping or swab of the affected area or blood

(candidemia) is placed on a microscope slide

•

Microscopic examination

–

A drop of 10% KOH solution is added to the specimen.

–

KOH dissolves the skin cells, but leaves  

Candida

 intact,

permitting visualization of pseudohyphae and

budding yeast cells typical of many 

Candida

 species.

•

Culture

–

Swab/blood is streaked on a culture SDA medium

–

The culture is incubated at 37°C for several days

–

The characteristics of colonies may allow initial

diagnosis of organism causing disease symptom

47

Laboratory diagnosis of candida

•

A germ tube test

 is a diagnostic test in which a

sample of fungal spores are suspended

in serum and examined by microscopy for the

detection of any germ tubes

•

It is particularly indicated for colonies of white or

cream color on fungal culture, where a positive

germ tube test is strongly indicative of 

Candida

albicans

48

Treatment of candidacies

–

Oral drugs: Amphotericin B, fluconazole, and

ketoconazole, are the drugs most commonly

used to treat candidiasis

–

Topical administration of antifungal drugs such

as clotrimazole, miconazole , tioconazole, and

nystatin

–

The drug of choice is nystatin

49

c. Subcutaneous Mycoses



Rare 



Confined to subcutaneous tissue & rarely spread

systemically



Confined mainly to tropical regions



Include heterogeneous group of soil fungal infections



Introduced into the extremities by trauma/wound



Tend to be slow in onset and chronic in duration



The main subcutaneous fungal infections include



Sporotrichosis

, chromoblastomycosis, 

MYCETOMA

,

lobomycosis, rhinosporidiosis, subcutaneous

zygomycosis, & subcutaneous phaeohyphomycosis

50

C. Subcutaneous Mycoses

1.

Sporotrichosis 

caused by 

Sporothrix schenckii



The fungus is saprophyte on dead plant material



Dimorphic fungi



Colonies of media at 25

0

C have delicate radiating forms

that appear as white at first but turned black with

prolonged incubation



Microscopic examination reveals branched hyphae with

numerous conidia

51

Sporotrichosis

•

It was once common in Europe but cases are now rare

•

Most prevalent in Americas, South Africa & Australia

•

Infection usually follows and insect bite, thorn pricks or

scratches from a fish spine.

•

Certain occupation groups appear to have increased risk

from infection

•

These include florists, farm workers and others who

handle hay and moss

•

The most common symptom is an 

ulcerative lesion that

may develop into lymphangitis

•

Treated by saturated solution of KI and Amphotericin B

52

2. 

Chromoblastomycosis



Chronic, localized, 

slowly progressive

 infection

of the subcutaneous tissue caused by several

species of dematiaceous fungi



Tissue proliferation occurs around the area of

inoculation producing crusted, verrucose, wart-

like lesions



Causative agent



Most common: 

Cladophialophora carrionii 

&

Fonsecaea pedrosoi



Less common: 

Fonsecaea compactum, Phialophora

verrucosa

53

Chromoblastomycosis

•

Mode of Transmission

•

Traumatic implantation of fungal elements into skin

•

The infection occurs in tropical or subtropical

climates, often in rural areas.

•

Traetment

•

Chromoblastomycosis treated by surgical

removal and 5-flurocytosine

54

Mycetoma



Also called Maduromycosis or Madura foot



Madura foot referring to first case seen in Madura

region of India which was in the foot of patient



Syndrome involving cutaneous & subcutaneous

tissues, fascia, and bone



Infection focused in one area of the body (Foot)



Distribution:

World-wide but most common in bare-

footed populations in tropical sub- or regions



Characterized by draining sinuses, granules (vary in

size, colour & degree of hardness) & tumefaction

55

Mycetoma

•

Mode of transmission

–

Traumatic implantation of causative agent

•

Causative agent 

(

50% bacteria & 50% fungi)

•

Soil-inhabiting bacteria (actinomycotic

mycetoma or actinomycosis)

–

Actinomadura madurae, 

Actinomyces israelii

and 

Nocardia brasiliensis

•

Soil-inhabiting fungi (eumycetoma)



Madurella mycetomatis

 & 

Madurella grisea

56

Treatment



Treatment for eumycetoma is less successful than

for actinomycetoma



EUMYCETOMA



surgical treatment is still usually required



Ketoconazole 400mg daily, itraconazole 300 mg

daily & IV amphotericin B 50 mg daily



Therapy is suggested for 1-2 years



Flucytosine, Topical nystatin & potassium iodide



ACTINOMYCOTIC MYCETOMA



Penicillin, gentamicin & co-trimoxazole for 5 weeks



Followed by maintenance therapy with amoxicillin &

co-trimoxazole

57

Systemic Mycoses



Invasive infections of the internal organs with the

organism gaining entry by;



Lungs, GIT or through intravenous lines



They may be caused by:

1.

Primary (TRUE) pathogenic fungi

2.

Opportunistic fungi 

that are of marginal

pathogenicity but can infect the

immunocompromised host

58

I. Primary Pathogenic Fungi

•

Histoplasma capsulatum 

(Histoplasmosis )

•

Blastomyces dermatidis 

(Blastomycosis )

•

Coccidioides immitis 

(Coccidiomycosis)

•

Paracoccidioides brasiliensis 

(

paracoccidioidomycosis)

•

Dimorphic fungi normally found in soil

•

Infection occurs in previously healthy persons

•

Arises through the respiratory route (inhalation)

59

Histoplasmosis

•

Caused by dimorphic 

Histoplasma capsulatum

•

H. capsulatum 

is endemic in many parts of the

world including North and South America

•

It is found in the soil and growth is enhanced by

the presence of bird and bat excreta

•

Environments containing such material are often

implicated as sources of human infection

60

Histoplasmosis

•

Lungs are the main site of infection but

dissemination to liver, heart & CNS can occur.

•

Pulmonary infection can resemble symptoms

seen in tuberculosis

•

Treatment:

–

Amphotericin B

–

Ketoconazole and other new azoles

61

II. Opportunistic Fungi

•

 Patients usually have some serious immune or

metabolic defect, or have undergone surgery

•

The diseases include aspergillosis, systemic

Candidiasis

, 

cryptococcosis, 

Zygomycosis,

Pneumocystis carinii

•

Exceptionally, other fungi that are normally not

pathogenic, such as Trichosporon, Fusarium or

Penicillium, may cause systemic infections.

62

Cryptococcosis

•

Systemic infection caused by encapsulated yeast -

Cryptococcus neoformans

•

Inhabits soil around pigeon roosts

•

Host defense is CMI

•

Affects both healthy & immunosuppressed individuals

•

Common infection of AIDS, cancer or diabetic

•

Primary infection in lungs via inhalation

•

Pulmonary infection 

leads to cough, fever & lung nodules

•

Polysaccharide capsule resists phagocytosis

•

Cryptococcal 

meningitis is most common disseminated manifestation

•

Can spread to skin, bone and prostate

63

Cryptococcosis



Lab. Diagnosis



Lumbar puncture and microscopic examination

of cerebrospinal fluid is diagnostic



India Ink for CSF



Culture on SDA



White mucoid colonies within 48hours



Cryptococcal antigen



Serum and CSF are 99% sensitive in AIDS



Serum is less sensitive in normal hosts



Treatment



Amphotericin B and fluconazole

64

Aspergillosis

•

Aspergillus

 is found in soil, on plants & in decaying

organic matter.

•

600 species, 

A. fumigatus 

is one of the most

ubiquitous of the airborne saprophytic fungi

•

A. fumigatus 

is the main causative agent of

Aspergillosis

•

Diseases of the soil fungus

 called 

Aspergillus

•

Major portal of entry is the respiratory tract

–

Via inhalation of conidia

•

Conidia are eliminated in immunocompetent host

by innate immune mechanism

•

For people with weakened immune systems,

breathing in conidia can lead to infection

65

Aspergillosis

•

Most commonly affects the sinuses or lungs

•

Symptoms of sinus infections include fever,

headache, and sinus pain

•

Lung infections can cause fever and cough

•

In the immunosuppressed host, Aspergillus can

disseminate throughout the body.

•

Treatment

•

Amphotericin B and nystatin

•

Voriconazole is currently the first-line treatment

for invasive aspergillosis

66

Candidiasis

•

 In severely immunocompromised patients, 

C.

albicans

 can proliferate and disseminate

throughout the body.

•

An infection in the bloodstream can affect the

kidneys, heart, lungs, eyes, or other organs

causing high fever, chills, anemia, and sometimes

a rash or shock

67

Symptoms of Candida albicans

•

Candida can cause the following problems

depending upon the organ infected:

–

in kidneys can cause blood in the urine

–

in heart can cause murmurs & valve damage

–

in the lungs can cause bloody sputum

–

in the eyes can cause pain and blurred vision

–

in the brain can cause seizures and acute

changes in mental function or behavior

68