PRIMARY SYSTEMIC MYCOSIS

PRIMARY SYSTEMIC MYCOSIS Blastomycosis

Blastomyces dermatitidis

Coccidioidomycosis Coccidioides immitis

Paracoccidioidomycosis Paracoccidioidoes brasiliensis

Histoplasmosis Histoplasma capsulatum

SYSTEMIC MYCOSIS CAUSED BY DIMORPHIC ONYGENALESRelated dimorphic fungiMost of them restricted to

particular endemic areasPrimary pathogens Inhalation from dustIn most cases exposure:

No clinical diseasePositive skin test (14 days)

SYSTEMIC MYCOSIS CAUSED BY DIMORPHIC ONYGENALES Acute reactions:

Asymptomatic or Symptomatic, which may heal or develop into

chronic lung disease Endogenous reactivation Occasionally disseminate to:

Skin CNS Visceral organs

Drug of choice Amphotericin B

SUMMARYAgent infection Dissemination Drug of

choiceBlastomyces dermatitidis

Blastomycosis Skin and bone Later nervous system and visceral organs

Amphotericin B itraconazole

Coccidioides immitis

Coccidioidomycosis Skin, bones, joints, subcutaneous tissues, and visceral organs

Amphotericin B

Paracoccidioidoes brasiliensis

Paracoccidioidomycosis

Oro-nasal mucosa latter spleen, liver, intestine and skin

Amphotericin B + sulfas or azoles

Histoplasma capsulatum

Histoplasmosis Acute pneumonia (cave disease)

Chronic pneumonia (smoker)

Disseminated (immunocompromised)

Primary cutaneous (lab accidents)

Amphotericin B

Blastomycosis

Skin lesions resulting from the dissemination of the fungus from the lungs

Coccidioidomycosis

Extension of pulmonary coccidioidomycosis

showing a large superficial ulcerated lesion

Chronic cutaneous granulomatous lesions of the

face, neck and chin

Paracoccidioidomycosis

Ulcerated lesion on the pharyngeal

mucosa

Extensive destruction of facial features

Ulcerated lesion on the nasal mucosa

LABORATORY DIAGNOSIS1. Clinical material:

Skin scrapings Respiratory specimens CSF Pleural fluid and blood Bone marrow Urine Tissue biopsies from various visceral organs

2. Direct Microscopy: 10% KOH, PAS, Silver or Gram stain

3. Culture: SDA + BHIA at 37°C

Tissue sections showing large,

broad-base, unipolar budding

yeast-like cells

Blastomycosis

Broad based budding and

thickened cell walls and globose

shape are characteristic of the

yeast form of Blastomyces

dermatitidis

One-celled conidia formed

on short conidiophores.

Blastomyces dermatitidis

Tissue section showing typical endosporulating spherules of

C. immitis

Coccidioidomycosis

Coccidioides immitis showing typical single-celled, hyaline, rectangular to barrel-shaped, alternate arthroconidia

Paracoccidioidoes brasiliensis

Multiple, narrow base, budding yeast cells "steering wheels" of P. brasiliensis

Paracoccidioidoes brasiliensis

Multiple, narrow base, budding yeast cells "steering wheels" of P. brasiliensis

PAS stain showing Histoplasma capsulatum yeast cells in liver specimen

Rough-walled macroconidia

Macroconidia and microconidia

Histoplasma capsulatum

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