Blastomycosis of Eye brow

SYSTEMIC
MYCOSES PREDILECTION

BLASTOMYCOSIS • Men
• Persons who have more than normal contact with soil
• Synonyms –
Gilchrist’s TISSUE FORM
disease, North
American • grows as thick walled yeast cells with broad based bud
balstomycosis
DIAGNOSIS
• Chronic
infection found
mainly in the lungs with suppurative and granulomatous • Direct microscopy
lesions with • Sputum
characteristic • skin scrapings
skin lesions • biopsy material
• Etiology – • Culture
Blastomyces
dermatitides
MICROSCOPIC EXAMINATION
EPIDEMIOLOGY

• Mississippi
River Valley Blastomyces dermatitidis
basin
Microscopic examination of sputum and
• Reported also in other parts of the world
Skin scrappings showed an oval conidia borne laterally on branching hyphae
• Organism is thought to grow in soil but it has rarely been
cultured from nature

CLINICAL FORMS:
. dermatitidis, mycelial form, showing oval conidia borne laterally on
branching hypae

B. dermatitidis, yeast form, showing thick-walled, oval to round, single-

budding, yeastlike cells

BIOPSY MATERIAL
1. Pulmonary
– radiographically, it may mimic PTB

Blastomycosis. Microscopic examination shows

Prominent pseudoepitheliomatous hyperplasis, Diffuse infiltration of the

Pulmonary Blastomycosis of dermis with Inflammatory cells
lungs
( B. dermatitidis )

Blastomycosis.

This micrograph shows histiocytic infiltration of the dermis with

multinucleated giant cells in the dermis or free in the micropurtules of the
epidermis
1. Systemic
– extension of
the pulmonary form CULTURE MATERIAL
– granulomatous lesions and abscesses often occur
• Dimorphic fungus
• Room temp.
1. Cutaneous ○ fluffy white fungus on SDA/Mycosel
– lesions appear crusty, elevated with well defined ○ Pyriform spores (infection particles)
margins, usually with microabscesses • 37C on BHI agar – yeast cells identical to the
tissue forms are produced

Blastomycoses:skin lesions Blastomyces dermatitidis colonies (Brain heart infusion agar with 10% sheep
occurs after systemic blood, gentamycin, and chloramphenicol.)
dissemination of
Blastomyces dermatitidis At 25°C the mold produces white to tan, cottony colonies that grow fairly
from a primary pulmonary rapidly in a week. With age they turn dark brown. AT 37°C the yeast form
focus. Lesions are produces cream brown, wrinkled, waxy-looking colonies
vegetating plaques with
slowly advancing, raised,
hyperkeratotic, or
verrucous borders with TREATMENT
central healing and
scarring. • Itraconazole
• Oriental consideration
Blastomycosis of forearm ( B. ○ Blastomycosis is not an oriental disease; but it
dermatitidis) has been recorded in other countries possibly
as a result of fomite transmission
PARACOCCIDIOIDOMYCOSIS

• Synonyms – South American blastomycosis

Paracoccidioides brasiliensis:
• Chronic granulomatous disease (skin, lymph nodes, mycelial form, showing
mucous membranes and internal organs) septate hyphae and pyriform
• Etiology – Paracoccidioides brasiliensis conidia singly borne

EPIDEMIOLOGY

• South American esp. Brazil

• Organism probably resides in the soil

CLINICAL FORMS • Culture

○ Dimorphic fungus
• most commonly involve nasal and oral mucosa with ○ RT – SDA – non-sporeforming septate fungus
resulting lymph node enlargement ○ 35°C – BHI agar – yeast cells with multiple buds
• skin lesions usually develops in the face
• Other tests : serology
○ complement fixation
Mucocutaneous
paracoccidioidomycosis (upper lip) ○ immunodiffusion

TREATMENT

Mucocutaneous • Amphotericin B
paracoccidioidomycosis. • Itraconazole
The gingival ridge shows
granulomatous infiltration and loss COCCIDIOIDOMYCOSIS
of all teeth.
– Synonyms – San Joaquin Valley fever, desert fever
PREDILECTION – Etiology – Coccidioides immitis

CLINICAL FORMS:
• Men
• 20 to 30 years old
1. Primary pulmonary
TISSUE FORM – after inhalation of spores conversion to a positive skin
test & flu-like symptoms
• large yeast cells (larger than Blastomyces) with multiple – some may develop rashes (erythema nodosum/
buds (mariner’s wheel) multiforme)
DIAGNOSIS – no progression of disease, the infected person develops
resistance
• Direct Microscopic Examination Biopsy
1. Benign form
– Positive for skin test, precipitin tests and complement
fixation titers
– Well defined lung cavitation (which may go
unnoticed as far as symptoms)
– It may progress into the disseminated form

1. Disseminated form
– spreads to internal organs like the brain
– Precipitin titers disappear but complement fixing titers
continue to rise
– A state of anergy may exist
Microscopic examination: Large yeast cells with multiple buds. – Prognosis is usually grave

Paracoccidioides brasiliensis
Disseminated coccidioidomycosis

A warty whitish plaque over the right upper eyelid.

The skin lesion is described as verrucous plaques.

Disseminated coccidioidomycosis
(Adrenal tissue)
A large subcutaneous mass on the chest wall
Gomoris methenamine silver stain
The stain showed numerous thick-walled yeast cells, spherical to oval with
multiple narrow-based buds that give the appearance of a steering wheel

Disseminated coccidioidomycosis

Paracoccidioides brasiliensis in A warty hyperkeratotic lesion on

bone marrow showing yeast cells the thumb
having multiple buds

EPIDEMIOLOGY
Parcoccidioides brasiliensis
stained with • Southwestern part of the US (Great Desert Area)
Lactophenol cotton blue. • Mexico
• Central and South America
Culture showed thick-walled cells • Organism resides near the surface of the soil
with multiple buddings.
• Arthrospores which become airborne are the infectious
particles
 microorganism from Geotrichum spp. The arthroconidia produce an
infection in susceptible individuals.
PREDILECTION

• Any person present in an endemic area

• Individuals who
work with the soil
Coccidioides immitis (Periodic acid-Schiff staining of skin section)
• Darker skinned
individuals Lesions showed yeast forms and spherules in the dermis
TISSUE FORM

• Present as
sporangia (thick
walled) in varying Coccidioides immitis
sizes (Calcifluor stain of fluid aspirated from the chest wall)
• Best stain is PAS
Lesions demonstrated the yeast form
DIAGNOSIS

• Direct microscopy
○ Sputum HISTOPLASMOSIS

○ Skin – Etiology – Histoplasma capsulatum

○ other tissues
CLINICAL FORMS

1. Primary acute
Coccidioides immitis (KOH mounth)

Mature spherules of C. immitis are

– after inhalation of microconidia, person maybe
round or oval, have a well demarcted asymptomatic or develop flu-like symptoms
wall and produce endospores. – Becomes skin test positive

1. Chronic cavitary

– development of large pulmonary cavities which maybe

Coccidioides immitis (Calcofluor white preparation) asymptomatic or may progress into disseminated disease
– often mistaken for PTB
Mature spherules of C. immitis are round or oval, have a
well demarcated wall and produce endospores 1. Severe disseminated

– spreads to the RES

– often fatal

C. immitis, tissue form, showing

spherule containing numerous
spherical endosphores
Histoplasmosis.
Indurated ulcer on the tongue

Coccidioides immitis spherules

(Silver stain) EPIDEMIOLOGY

• worldwide
• US - Mississippi River Valley Basin
• Organism resides exclusively in soil containing feces of
• Culture certain birds (starlings, chicken, black birds) and bats.
○ Dimorphic fungus In the soil, organism exists in mycelial form and the
○ RT – SDA – fluffy white fungus, arthrospores microconidia are the infectious particles.
○ In vivo – spherules
PREDILECTION
TREATMENT
• Persons who are exposed to massive numbers of
• Therapy – Amphotericin B microconidia may develop severe form of Histoplasmosis

TISSUE FORM
Coccidioides immitis (Sabourauds
dextrose agar) • Exists as small (3-5u),non-encapsulated intracellular
yeast cells. (Maybe mistaken with Leishmania spp.)
The colony has a powdery, cottony • Best stain - PAS
appearance resulting from the
formation of arthroconidia from LABORATORY DIAGNOSIS
the hyphae.
• Direct microscopy

Coccidioides immitis spherules

(Silver stain)

Arthroconidia of Coccidioides
immitis (Lactophenol Cotton Blue
preparation)

The organism appear in the

branches of the hyphae as thick-
walled, barrel-shaped structures.
Alternating with the arthoconidia
are weakly stained empty cells, Histoplasma capsulatum
a characteristic that
differentiates this
H. capsulatum, yeast form, showing intracellular, oval yeast cells, deeply
stained

Histoplasma capsulatum taken

from a cultures material.

It demonstrates the characteristic

mycelia, microconidia and
tuberculate macroconidia.

Histoplasma capsulatum, mycelial

form showing characteristic
macroconidia

• Culture
○ Dimorphic fungus
○ RT – SDA
 white, fluffy fungus
 septate hyphae with microconidia
and tuberculate macroconidia
(diagnostic feature)
 35-37°C – BHI broth/agar – smooth
yeast colony (nonspecific features
except for the small size)
• Other lab tests
○ Histoplasmin skin test
○ Precipitin test
○ Complement fixing Ab titer

TREATMENT

• therapy – Itraconazole

• Oriental Consideration – Bat caves are usually heavily

infected

AFRICAN HISTOPLASMOSIS

– Mycotic infection that localizes in skin, lymph nodes and

bone, producing subcutaneous abscesses and skin lesions
– Etiology – Histoplasma capsulatum var. duboisii

TISSUE FORM

• Exists as large yeast cells (7-15u) inside giant cells

DIAGNOSIS

• Culture
○ RT – SDA :Mycelial form with tuberculate
macroconidia and microconidia
○ 35-37°C – BHI agar :yeast cells, larger than
the yeast cells of H. capsulatum