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Mycology Intro, Infections-bypass defenses: -fatty acid in skin, epith turnover, bac flora Primary sites: Superficial-outermost-low inflam -non-living:hair, epidermis Cutaneous-more inflam (diff from sup) -keratinized epid, hair, nails, Mucocutaneous-mouth, esoph, vag SubQ-deeper skin, non-invasive -traumatic inoculation Systemic-invasive Superficial Hair- Tx-shave hair, hygiene Black Piedra-Piedraia hortae -hard nodules on hair shafts -house asci (contains ascospores) -Dx-microscopic exam of hair -exclude pediculosis (head lice) White Piedra-Trichosporon spp. (& Blastoschizomyces) -culture on all lab media (not w. cycloheximide) -grows as septate hyphae w/ arthroconidia -risk factors-neutropenia, corticosteroids -fungemia w/ cutaneous & ocular lesions -false (+) cryptococcal Ag test w/ T. beigelii -Tx-Amp B + Fluconazole, Mycology Intro Properties Eukaryotic No Chlorophyll - Heterotrophic Plasmalemma-cell membrane -glycoprotein, lipids, ergosterol Cell Wall-chitin (N-acetyl glucosamine) (KOH dissolves everything but wall) "Capsule"-mannans, glucans, Infections-bypass defenses: -fatty acid in skin, epith turnover, bac flora Primary sites: Superficial-outermost-low inflam -non-living:hair, epidermis Cutaneous-more inflam (diff from sup) -keratinized epid, hair, nails, Mucocutaneous-mouth, esoph, vag SubQ-deeper skin, non-invasive -traumatic inoculation Systemic-invasive Subcutaneous Mycetoma-"fungal tumor" -AKA-Madura Foot-most often FOOT affected -edema, induration, draining sinuses w/ granules -caused by bac, Actinomycetoma, Eumycotic m'toma -C, S America-90% by Nocardia brazilienis-actin. -Africa-Madurella mycetomatis-eumycotic -Dx-examine granules on gauze over sinuses Chromoblastomycosis-verrucous lesions->cauliflower-like -cause: demetiaceous (brown/black pigmetnt in walls) -Fonsecaea pedrosoi, Cladosporium carrionii, Phialophora verrucosa ->granulomatous skin lesions-crusty -Dx-skin Bx-copper-colored cells-sclerotic/Medlar bodies -AKA copper pennies -Tx-5-Fluorocytosine, Itraconazole, Posaconazole, Infections-bypass defenses: -fatty acid in skin, epith turnover, bac flora Primary sites: Superficial-outermost-low inflam -non-living:hair, epidermis Cutaneous-more inflam (diff from sup) -keratinized epid, hair, nails, Mucocutaneous-mouth, esoph, vag SubQ-deeper skin, non-invasive -traumatic inoculation Systemic-invasive Cutaneous: Dermatophytes Skin-Tinea ______ (anatomic site) -"ringworm" -dermatophytes have keratinases -"Keratinophilic fungi": Epidermophyton floccosum -hyphal in culture-large club-shaped MACROCON ->tinea pedia most often Microsporum - pet owners, outdoor occupations -M.canis(zoophilic), M.gypseum(geophilic) ->FLUORESCENT TINEA CAPITIS (children) -culture-thick-walled, spindly, spiny MACROCON Trichophyton rubrum-MOST COMMON D'PHYTE -MICROCONIDIA IN CULTURE -T. verrucosum->ringworm (dairy cattle) ->pustular tinea barbae (farmers) (abuts cow) -r/o S. aureus -T. tonsurans-Tinea Capitis (no longer Microsporum), Mycology Intro Reproduction Anamorph-asexual Teleomorph-sexual -diff names for each phase, Yeast - unicellular, asexual budding pseudohyphae can form during budding -on culture at body temp-pathogenic Moulds-w/ hyphae - branching, thread-like -grow via apical extension (intense metabolic activity) -usually on culture at RT Many fungi have both forms-dimorphic -Blastomyces, Coccidioides, Histoplasma Hyphae Types SEPTATED? Coenocytic-hollow, mutinucleate Septate-divided by partitions, can have clamps HOW DOES IT GROW? Vegetative-on or under surface of medium Aerial-above surface w/ conidia->airborne; asexua Mycelium-mass of hyphae-mold, Infections-bypass defenses: -fatty acid in skin, epith turnover, bac flora Primary sites: Superficial-outermost-low inflam -non-living:hair, epidermis Cutaneous-more inflam (diff from sup) -keratinized epid, hair, nails, Mucocutaneous-mouth, esoph, vag SubQ-deeper skin, non-invasive -traumatic inoculation Systemic-invasive Subcutaneous Sporotrichosis-nodular, ulcerative lesions along lymphatics -drain "sporotrichoid"-inoc site-Sporothrix schenkii -sphagnum moss, rose thorn spliterns, rotting timbers -"alcoholic rose gardeners' dz"; Spook House from hay -also from cat scratches -Dx-asteroid bodies-Splendore-Hoeppli phenomenon -budding cigar-shaped yeast (37C) -hyphae w/ conidiophores in rosette (25C) -Tx-Itraconazole, SSKI, or Amp-B Rhinosporidiosis-Rhinosporidium seeberi -India, Sri Lanka -Painless, pedunculated polyps in nasal area -Dx-can't culture, large spherules w/ endospores Lobomycosis-Loboa loboi->keloidal nodules of face, ears, UL -can't culture, 10-15um yeasts in chaines -surgical excision is curative Phaeohyphomycosis-dematiaceous fungi from soil, Infections-bypass defenses: -fatty acid in skin, epith turnover, bac flora Primary sites: Superficial-outermost-low inflam -non-living:hair, epidermis Cutaneous-more inflam (diff from sup) -keratinized epid, hair, nails, Mucocutaneous-mouth, esoph, vag SubQ-deeper skin, non-invasive -traumatic inoculation Systemic-invasive Cutaneous: Dermatophytes Nails- Onychomycosis-increasing incidence -prevalence increases w/ age (70yo-50%) -disabling-embarrassment (75%), pain(44%) -limited ability to walk (15%) -toenails more common than fingers 4 patterns: Distal Subungual-most common-T. rubrum Proximal Subungual-d'phytes-immunocompromised White superficial-d'phytes-T.mentagrophytes, molds -directly invade nail plate-crumbled; in HIV Candida (albicans)-rare-chronic mucocut candidiasis -fingernails-yellow-brown thick nail plate -Dermatophytes (90%)-T. rubrum, E. floccosum, T. mentagrophytes -Yeasts (8%)-Candida spp. -Non-dermatophyte molds (2%) Tx-Itraconazole Pulse Tx-200mg bid 1 wk each mo x3 -Terbinafine (Lamasil)-qd 6-12 wks or 7 days q3mo x4 -topical-Ciclopirox, Amorolofine-combine w/ others, Anamorph-asexual Teleomorph-sexual -diff names for each phase Types Asexual/Vegetative-Imperfect -forms spores - 3 types: Conidia-spores borne on external hyphae Microconidia-small, unicellular Macroconidia-large, multicellular Conidiophores-hyphae for bearing spores Sporangiospores w/in sporangia (on sporangiophore) -formed by cytoplasmic division Arthrospores-formed w/ division of hypha, Non-infectious: -allergic/hypersens -poisoning-mycophagists eat -88% unintentional, 67% kids -6% w/ Sx (n/v/d) -psilocybin-hallucinations -mycotoxins-Ergot alkaloids, psychotropics, aflatoxins Mycetismus Amanita phalloides-"death cap" -95% of N. Amer fatalities -cool, coastal west coast; w/ rain -alpha-amantin-RNA pol II inhibitor -heat-stable, water insoluble Phase I-6-24 hrs post