1. CRYPTOCOCCOSIS PARACOCCIDIOIDOMYCOSIS COCCIDIOIDOMYCOSIS

2. CRYPTOCOCCOSIS It is also known as TORULOSIS
Sub acute or chronic infection
Caused by :- Cryptococcus neoformans
HABITAT: soil saprophyte and particularly abundant in feces of pegeons

3. MORPHOLOGY Round or ovoid budding cell 4 – 20 µm in diameter
Prominent polysaccharide capsule

4. PATHOGENICITY Source – dust containing basidiospores
Route: mostly by inhalation and some times through skin or mucosa
Most infections are asymptomatic
Can produce disease in animals [mastitis in cattle]

5. Pulmonary cryptococcosis
It may lead to mild pneumonitis
No calcification occur
Dissemination of infection may lead to : visceral , cutaneous and meningeal diseases

8. LABORATORY DIAGNOSIS Direct microscopy:
Specimens –serum, CSF and other body fluid
indian ink or 10%nigrosin with formalin wet mount shows round budding yeast cells with distinct halo
A wide refractile gelatinous capsule surrounds the organism

9. diagram

10. CULTURE Grows readyly on Sabouraud’s Dextrose Agar.
smooth, mucoid , cream coloured colonies are formed

11. SEROLOGY
There are 4 serological types of Capsular polysaccharide – A, B, C, & D.
Demonstration of Capsular antigen by precipitation is valuable in diagnosing some cases of Cryptococcal meningitis when the CSF is negative by smear or culture

12. TREATMENT
Amphotericin B
5 –fluorocytosine
Clotrimazole
miconazole

13. EPIDEMIOLOGY World wide in distribution
Known as European blastomycosis
It is Only deep mycosis common in our country

14. COCCIDIOIDOMYCOSIS Caused by Coccidioides immitis
Infection is usually self limited
The disease is endemic in the dry and arid regions of Southwestern USA, where the fungus is present in soil and rodents.

16. MORPHOLOGY
It is a dimorphic fungus at 37°C – Yeast form °C – Mould form

17. PATHOGENECITY Source: Dust containing Arthrospores Route: Inhalation
After inhalation, these spores become spherical and enlarged forming SPHERULES.

18. Thick, double layered refractile wall is present
SPHERULES
15-75µm in diameter
Thick, double layered refractile wall is present
Filled with endospores
Spherules are the diagnostic features of C. immitis.

19. Possible sites of infection CNS & Bone

20. Contd.. In 60% of cases, the infection is assymptomatic
This leads to immunization and is demonstrated by “positive” skin test with COCCIDIOIDIN
The other 40% develops self limited influenza like illness with Fever, Malaise, Cough, Arthralgia and Headache. This condition is known as VALLEY FEVER or DESERT RHEUMATISM.

21. DIAGNOSIS
Specimens: Sputum Exudate from cutaneous lesions Spinal fluid Blood and Urine

22. Microscopy
Specimen stained with KOH or Calcoflour white stain
Shows Spherules and endospores

24. Culture
Culturing on SDA incubated at 37°C and at room temp. shows Mycelial form.
The colonies are white to tan cottony colonies.

25. Serology
With in 2-4 weeks after infection IgM Ab – Latex Agglutination
IgG Ab – CFT or ID

26. Skin test
After of cutaneous injection with 0.1ml of standard dilute solution containing Coccidioidin Ag there is a formation of induration >5mm diameter.
It is known as Positive skin test

27. Treatment
Amphotericin B
Itraconazole
Fluconazole

28. PARACOCCIDIOIDO MYCOSIS
It is a chronic granulomatous disease of skin, mucous membranes, lymphnodes and internal organs like spleen, liver..
Caused by Paracoccidioides brasiliensis
South American Blastomycosis

29. Morphology Dimorphic fungi
Mycelial form produces Chlamydiospores and Conidia

30. Pathogenesis & Clinical findings
Source: Dust containing chlamydiospores and conidia
Route: Inhalation
Chronic, progressive pulmonary diseases occurs.
Dissemination to other organs like skin, mucocutaneous tissue, spleen, liver, lymphnodes etc..

31. Contd..
Many patients present with painful sores involving the oral mucosa.
The yeasts are generally observed in Giant cells or directly in exudate from mucocutaneous lesions.

32. DIAGNOSIS
Microscopy
Culture
Serology
Skin test

34. Treatment
Itraconazole
Ketoconazole
Amphotericin - B