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Fungal infections 400 out of 75,000 Primary infections Opportunistic infections Myco-toxins Allergy
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Mycoses Superficial and cutaneous Subcutaneous Deep (systemic)
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Superficial and Cutaneous Mycoses Skin, hair, nail, mucus membranes Most common World-wide Ringworm infections Yeast infections
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Subcutaneous Mycoses Skin, subcutaneous tissues, fascia and bone Localized Trauma More in tropics Mycetoma, chromomycosis and sporotrichosis
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Systemic Mycoses Deep-seated Inhalation Primary (restricted) Opportunistic (world-wide)
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GIT Mycoses
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DANGEROUS ORGANISMS AROUND US
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Source of microbes Food Drinks Spices Dishes Cutlery
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Dishwashers! Found in 40% of homes in UK They are perfect breeding niche for fungi associated with potentially deadly illnesses Study on 189 dishwashers in 101 different cities around the world: – 62 % of dishwashers contained fungi on the rubber band in the door – More than half of these included the black yeasts: – Exophiala dermatitidis – Exophiala phaeomuriformis – Scedosporium apiospermum
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Source of many fungi Food, drinks and spices (Aspergillus, Peinicillim And human own microflora (e.g. Candida)
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Could these microbes pass through intestinal barriers and reach our internal organs ?
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Microbial translocation Microbial translocation is defined as the passage of viable microbes from the gastrointestinal tract to extra-intestinal sites, such as the mesenteric lymph node, spleen, liver, kidneys, and blood
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Systemic mycoses due to opportunistic pathogens Immune deficiencies: – AIDS – Alteration of normal flora by antibiotics – Immunosuppressive therapy – Cancer Examples: – Candidiasis, Cryptococcosis, Zygomycosis and Aspergillosis
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Candida albicans translocation J Infect Dis. 1993 Nov;168(5):1314-8. Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces species
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Systemic mycoses due to primary pathogens AgentinfectionDissemination Blastomyces dermatitidis BlastomycosisSkin and bone Later nervous system and visceral organs Coccidioides immitisCoccidioidomycosisSkin, bones, joints, subcutaneous tissues, and visceral organs Paracoccidioidoes brasiliensis ParacoccidioidomycosisOro-nasal mucosa latter spleen, liver, intestine and skin Histoplasma capsulatum Histoplasmosis Acute pneumonia (cave disease) Chronic pneumonia (smoker) Disseminated (immunocompromised) Primary cutaneous (lab accidents)
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Treatment of invasive intestinal infections Depending on causative agent: – Amphotericin B Posaconazole or Voriconazole (filamentous fungi) – Fluconazole, Caspofungin, Amphotericin B or Voriconazole (yeast infection) – Amphotericin B (dimorphic and zygomycetes)
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Polyene antifungal agents Amphotericin B Nystatin
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Azoles antifungal agents Clotrimazole Econazole Ketoconazole Miconazole Fluconazole Itraconazole Posaconazole Voriconazole
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Other antifungal agents Echinocandins – Anidulafungin – Caspofungin – Micafungin Terbinafine 5-fluorocytosine
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