-DR.AKIF A.

B
 SEXUAL SPORES
Mnemonic : ZAB

Z- Zygospores (Phycomycetes)

A-Ascospores (aspergillus)

B-Basidiospores (Cryptococcus)

Basidiospores
Ascospores
 BEST FUNGAL STAIN
Methanamine silver

Mucicarmine stain and Alcian stain is used for Cryptococcus

 Gomori methenamine silver
stain
- used to stain for fungi and for Pneumocystis jiroveci (carinii).

-The cell walls of these organisms are stained, so the organisms are outlined by
the brown to black stain.

-There is a tendency for this stain to produce a lot of artefact from background
staining, so it is essential to be sure of the morphology of the organism being
sought.
GMS stain for Pneumocystis carinii
GMS stain for Coccidoides immitis.
GMS stain for Cryptococcus
neoformans
 DIMORPHIC FUNGI
-These can exist in 2 forms His = Histoplasma
At 25* C = Mould
Pistol =Penicillium
At 37*C = Yeast
Shoots = Sporothrix

Bullets & = Blastomyces

Cartridge =Coccidiodes/Paracocci

- Sporothrix is Subcutaneous Dimorphic fungi whereas rest are systemic fungi

 EXO ANTIGEN TEST
-Gel immunodiffusion precipitin test

-Antigens are detected using specific antibodies

- Detects mould form of dimorphic fungi

 YEAST LIKE FUNGUS
Candida forms pseudohyphae apart from existing as
Unicellular cells.

Pseudohyphae
 YEAST
Cryptococcus

Saccharomyces

- Multiply by budding
 MOULDS: (MYCELIA)

clumps of intertwined branching hyphae

M – Mucor

A -Aspergillus

R - Rhizopus

D –Dermatophytes
 DEUTEROMYCOTA
(FUNGI IMPERFECTI)

Fungi without identifiable sexual stage

e.g: most medically important fungi

 ARTHROSPORES
Produced by fragmentation of hyphae.

E.g: Coccidiodes,

Paracoccidiodes
 SABOURAUD’S DEXTROSE AGAR
MC media used for culture of fungi

Antibiotics incorporated are : Cycloheximide,

Chloramphenicol

Gentamycin
 MYCOSIS FUNGOIDES
Cutaneous T cell lymphoma
 CRYPTOCOCCUS
-C.neoformans : Soil with pigeon droppings

-C.gatti : Eucalyptus tree (Gumtree)

-CD4<200

-MC cause of meningitis in HIV/AIDS

-Encapsulated budding yeast

-Causes Buschke disease

-MC form : Pulmonary Cryptococcus

-Confirmatory test : Latex agglutination test for polysaccharide antigen

- Stains: 1) Mucicarmine stain

2) Alcian stain
3) Indian Ink stain : -ve stain i.e it stains background rather than organism

- In HIV with CNS involvement : Induction: Amphotericin B +/- Flucytosine

Maintenance: Fluconazole
The cytoplasm of the cells lining this are pink with the mucicarmine stain,
indicative of mucin production.
 TINEA NIGRA
Hortae(Exophilia) wernickii

Painless, non scaly patches present on Palms and soles.

White Piedra Black Piedra

Trichosporon Beigelii (Bhijli i.e current is white Piedrae hortae

when sparks)

Loosely attached to hair shaft (white hairs are Tightly attached to hair shaft
loosely attached to scalp)

Arthrospores Ascospores
 TINEA (PITYRIASIS) VERSICOLOR
-malassezia furfur (Pityrosporum orbiculare)

Infects Stratum corneum

Microscopy: Sphaggetti and meat ball appearance

SDA culture: Fried egg appearance

Wood lamps : Golden yellow fluorescence

TINEA (PITYRIASIS) VERSICOLOR
TINEA (PITYRIASIS) VERSICOLOR

Microscopy: Sphaggetti and meat ball

appearance
TINEA (PITYRIASIS) VERSICOLOR

Wood lamps : Golden yellow fluorescence

-Tinea /Ringworm

-MC superficial mycosis

-MC type : Anthrophilic (Humans)

 Microsporon Trichophyton Epidermophyton
Infects Skin,Hair Skin,hair and Nail Skin, Nail
Microconidia Rare Abundant absent
Macroconidia Spindle shaped Pencil shape Club
/clavate/paddle
shaped
1) T.equinum

2) T.verrucosum

3) M.canis

4) M.equinum
-M.canis

-T.tonsurans

-Seen on scalp

-Commonly in Children
Tinea corporis Tinea cruris Tinea pedis
body ringworm Groin or jock itch athlete foot

M.Canis T.Rubrum T.Rubrum

T.mentagraphytes T.Mentagraphytes T.Mentagraphytes

E.floccosum E.floccosum
-form of T.capitis

-caused by T.schoenlenii
-Hypersensitivity reaction to Dermatophyte antigens

- Secondary lesion appears distal to primary lesion.

 MYCETOMA
Triad : Eumycetoma Actinomycetoma
Subcutaneous swelling
Fungus –(40%) Bacteria – (60%)
+
Discharging sinuses Single mass with well defined Multiple, ill defined margins,
+ margins, osteolytic,Purulet,
Granules in sinuses Serous, black in colour, White/Red
. Osteosclerotic
Black granules : Madurella MC: Nocardia
>Actinomadura madurae>
Granules contains Silver Streptomyces : white
granules

White granules: Actinomadura pelletieri :Pink

Pseudoallescheria, to Red granules
Aspergillus fusarium

Mycetoma- Histology Showing Splendore Hoeppli Phenomenon

MYCETOMA
 MYCETOMA

Mycetoma- Histology Showing Splendore Hoeppli Phenomenon

 BOTRYOMYCOSIS
Similar to mycetoma but is caused by :

Staphylococci
Streptococci
Pseudomonas
E.coli
 CHROMOBLASTOMYCOSIS
-Sclerotic /Medlar bodies (copper pennies) : Brown septate bodies forming pus

-Subcutaneous fungal infection

- Darkly pigmented fungi

 RHINOSPORIDIOSIS
-MC in Tamil Nadu/A.P/KERELA/Orissa

-HPE : Polyp reveals spherules (Large sporangia containing numerous endospores)

-MC site : Nasal cavity

- Source : Stagnant water

 CANDIDA
-MC fungal infection in Humans both in HIV & non HIV pt.

-MC :Candida albicans (Thick wall terminal

chlamydospore on corn meal agar)

-Sugar assimilation/fermentation test : Used for species

other than Candida albicans

C.glabrata : Only species which doesn’t produce

Pseudohyphae

C.kefyr(Pseudotropicalis) :Used as standard strain for

antifungal drug susceptibility testing

Pseudohyphae
PSEUDOHYPHAE TRUE HYPHAE

Constricted septa No constriction

Origin of branch is constricted and septate No septum

Grows by budding Atypical elongation

 CANDIDA
GERM TUBE TEST (REYNAULD’S
BRAUDE PHENOMENON)
- Differentiates hyphae with pseudohyphae

- Serum at 37*C – True hyphae is formed

 ASPERGILLUS
MC cause of Paranasal sinus mycosis

MC form = Pulmonary aspergillosis : seen in prior lung disease

Narrowed septate hyaline hyphae with long conidiophores with terminal vesicles

Invades pulmonary cavities - Fungal balls

In immunocompromised : Invades blood vessel – causes Thrombosis

Treatment :
Invasive aspergillosis : Voriconazole
ABPA : Itraconazole
Single aspergilloma : Surgery
Chronic pulmonary aspergillosis : Itraconazole/Voriconazole
 A.FUMIGATUS

- Pulmonary and allergic

 A.FLAVUS
-Skin

- Ocular infections

Mnemonic : flame is seen by eyes and it burns skin

 A.NIGER

Otitis externa

Mnemonic: Nigear : ear otitis

 MUCORMYCOSIS/
ZYGOMYCOSIS/PHYCOMYCOSIS
-Caused by Rhizopus/Absidia/mucor

-Aseptate hyphae

-Sexual spores : Zygospores

-Asexually by : Sporangiospores

-MC form : Rhinocerebral mucormycosis(Presnts as orbital cellulitis,Proptosis and

vision loss) >Pulmonary mucormycosis

- Vascular invasion is very common : Mucormycosis >Aspergillus

- MC site of invasion ; Brain

 PNEUMOCYSTIS CARINII
-Non cultivable fungus

-Environment : Cyst form

-Humans : Trophozoite and cyst form

-Methenamine silver : Cyst appears black coloured Pink pong balls against black
background

-Best sample : Bronchoalveolar lavage

-Cyst inhaled – enters lung –FORMS TROPHOZOITES –Plasma cell infiltrates –Frothy
exudates filling the alveoli

-B/L Perihilar exudates

- Treatment ; Immunocompetent : Cotrimoxazole * 14days

Immunocompromised : Cotrimoxazole * 21days
PNEUMOCYSTIS CARINII

-Methenamine silver : Cyst appears black

coloured Pink pong balls against black
background
 SPOROTHRIX
-Rose gardener’s disease

-Thorn of rose plant injury

-Painless nodulo-ulcerative lesion

-Spreads along Lymphatics

cigar shape asteroid bodies
-R/F : Bare foot

-At 37*C : cigar shape asteroid bodies

-
-25*C : MOULDS

-Best test : Culture

-Portal of entry : Skin

- DOC :Itraconazole
 GRANULOMA FORMING FUNGI
B -Blastomycosis

P - Penicillium marnefii

Cuff - Coccidiodomycosis

Humerus - Histoplasmosis
 PENICILLIUM MARNEFII
-Hyaline thin septate hyphae

-Conidia arranged in brush border appearance

-At 37*C : Yeast cells : Oval or elliptical with central septation

- At 25*C : Brick red pigment mould

Brush Border Appearance

 BLASTOMYCOSIS
Gilchrist disease

North American blastomycosis

HPE: Figure of 8 appearance (8-15MICRON) : B looks like 8

MC form :Pulmonary >skin

Route : RespiratoryRoute

Doesnt involve git

DOC : Amphotericin B
 HISTOPLASMOSIS
Primarily infects Reticuloendothelial system

25*C : Tuberculate macronidia and thin micronidia

37*C : tiny oval yeast cell (2-4micron) with narrow based budding

Intracellular single budding yeast cells in tissue

Survives Within macrophage

Reservoir : Soil with bat or chicken faeces

 COCCIDIODOMYCOSIS
-Valley/ California fever

-Inhalation of arthrospores causes

disease

-MC form : Pulmonary

-Barrel shape arthrospores

-Barrel shape arthrospores
-Mostly Seen in Desert areas. Hence k/a
Desert Rheumatism

- DOC :Itraconazole
 PARACOCCIDIODOMYCOSIS
-South American blastomycosis

HPE : Mickey mouse appearance/ pilot wheel appearance

Arthrospores

DOC: Itraconazole
MC cause of Meningitis in AIDS : Cryptococcal

MC cause of Seizure in AIDS pt. : Toxoplasmosis

-DR.AKIF A.B
 -2 layered structure made of cell wall and cell membrane.

Cell wall Cell membrane

Made up of Chitins,Protein and beta Ergosterol
glucans
Contains beta glucan
synthase that synthesise
beta glucans for cell wall

Squalene
Squalene epoxide
Levonosterol
14-Alpha sterol
demethylase
Ergosterol
 Terbinafine

Squalene
Squalene epoxide
Levonosterol
14-Alpha sterol
demethylase

Ergosterol

Azoles

Amphotericin B

Echinocandins
-Amphipathic drug i.e it has both lipid and water soluble side

-water soluble side binds with ergosterol and forms pore in fungus

-Pores let water to accumulate inside cell and leads to lysis.

- Poor oral absorption and hence given i.v along with 5%Dextrose as carrier.

Amphotericin B
1)Systemic fungal infections

2)Mucormycosis

3)Kala azar

4)Cryptococcal meningitis
1) Nephrotoxic : To prevent patient is preloaded with 1-2L of Normal saline

-To prevent nephrotoxicity Amphotericin is combined with

liposomes,Lipid or colloid.

2) Hypokalemia

3) Hypomagnesemia

4) Anemia

5) Thrombocytopenia
-It is a Prodrug of anticancer drug 5-FU

-It is given along with Amphotericin B for Induction therapy in

Cryptococcal Meningitis

-It is given maximum for a duration of 2weeks because of risk of

bone marrow suppresion and colitis
 Treatment of
Cryptococcal meningitis

Induction: Amphotericin B +
Flucytosine (Only for 2weeks)

Maintenance : Azoles
 -Inhibits synthesis of ergosterol by inhibiting 14 alpha sterol demethylase

Fluconazole -DOC for Candidiasis and

coccidiomeningitis
Itraconazole -DOC for Endemic mycoses

-Antifungal of choice for Allergic

bronchopulmonary Aspergillosis

Voriconazole -DOC for invasive Aspergillosis

Ketoconazole -Inhibits Steroid synthesis and is
hence used in Cushings Sx
Squalene
Squalene epoxide
Levonosterol
14-Alpha sterol
demethylase

Ergosterol

Azoles
DRUG SIDE EFFECTS
Fluconazole -Hepatotoxic
Itraconazole Hepatotoxic,
CHF,
Hypokalemia
Voriconazole Hepatotoxic,
QT
prolongation
Ketoconazole Anti
androgenic
action and
causes
Gynecomastia
-Inhibits beta glucan synthase and hence breaks cell wall causing fungicidal
effect

-Poor oral absorption and hence given i.v.

-Caspafungin

- micafungin

Echinocandins
-Inhibits ergosterol synthesis by inhibiting Squalene epoxidase

-Given orally and it accumulates in Skin, Nail and fats. Hence, It is DOC for
Dermatophtosis.

- S/E: Steven Johnson Sx and hepatotoxicity

Squalene
Squalene epoxide
Levonosterol
14-Alpha sterol
demethylase

Ergosterol
-Stabilises Microtubules of Fungi and hence has fungistatic
effect

-Given orally and accumulates in S.corneum and hence is

used in
Dermatophytosis.

-DOC for treatment of Tinea Capitis in children

-S/E : Hepatotoxicity, Neutropenia, Neurological

B =Butenafine

H =Halprogin

U =Undencyclenic acid

T = Terbinafine

A =Azoles

N =Nystatin, Naftifine
1) Isuvaconazole : Used for Mucormycosis and Aspergillosis

2) Efinaconazole : used for Fungal toe nail infection