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BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Q :- Define the fungi imperfecti /hyphomycetes /deueromycetes ? Ans :- it is provisional group consisting of fungi whose sexual phase ( perfect stage ) have not been identified .they form septate hyphae and asexual spore or no spores. Most of fungi pathogenic for humans are in imperfecti stage ( asexual ).

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Mycology microbiology Toxonomical classification

Thallophyta Fungi (non chlorophyll) Algae(chlorophyll) Zygomycetes Lower fungi Nonseptate hyphae Form asexual spore Called sporangiospore Form sexual spore called zygospore and oospore Ascomycetes Septate hyphae Sexual spore called ascospore which present with in a sac/ascus Basidiomycetes Septatehyphae Sexual spore called basidiosporewhich present on basidium Deuteromycetes( fungi imperfecti )/hyphomycetes Septate hyphae Lack of sexual stage ( perfect stage )

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Formasexual spore and may or may not be form spore Morphological classification Yeast Cryptococcus neoformans Reproduction by budding Yeast like fungi Candida albicans Reproduction by pseudohyphae Moulds Dermatophytes Aspergillus Penicillium Rhizopus Reproduction by mycelium / spore Dimorphic fungi Histoplasma capsulatum Reproduction by budding and mycelium

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SUPERFICIAL MYCOSES:Pityriasis versicolor:- malassazia furfur Tinea nigra:- exophiala werneckii White piedra:- trichosporum beigelii Black piedra :-piedraia hortae

CUTANEOUS MYCOSES ( dermatophytosis ):Trichophyton spp. Microsporum spp. Epidermophyton spp. Sub cutaneous mycosis:Mycetoma:- madurella mycitomatis Rhino sporidiosis:- rhinosporidium seeberi Systemic mycosis:Cryptococcosis :- Cryptococcus neoformans Histoplasmosis :- hystoplasma capsulatum

OPPORTUNISTIC MYCOSES:Aspergillosis :- aspergillus flavus a. fulmigatus

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Candidiasis :- candida albicans Q :- Stain which use in fungal diagnosis ? Ans :-KOH stain Periodic acid Schiff stain Gomori methen amine silver stain Calcoflour white staining Indian ink stain Lectophenol cotton blue ( LPCB ) Mucicarmine stain Nigrocin stain Gram stain Giemsa stain Haematoxylin & Eosin stain

Q :- culture media which use in fungal culture ? Ans :-1. sabourauds dextrose agar Ph-5.6 Contains: 4% dextrose 1% peptone 2% agar

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50mg/L chloramphenicol : to minimize bacterial contamination 500mg/L cycloheximide to minimize the contamination of saprophytic fungi 2. brain heart infusion agar ( histoplsmosis ) 3. routone media ( candidiasis ): 4. corn-meal agar ( candidiasis ): nutritionally poor media 5. czapek dox media 6. sheep blood agar 7. humen blood ( serum )agar 8. niger seed agar

Q :- example of anti fungal agents ? Ans :-most of antifungal agent are used only topically Ex.- amphotericin-B Nystatin Miconazola ,ketoconazole ,fluconazole , itraconazole

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Fluorocytosine Griseofulvin Naftifine Terbinafine KI saturated solution

Q:-Non cultivated fungi ? Ans:- Rhinosporidium Pneumocystis Locazia Q:-direct microscopic examination ? Ans:- 1. specimen wet mount with KOH 2. wet film stained by lactophenol cotton blue 3. smear stained by gram/giemsa/H&E stain etc. Q:-Give name of Dimorphic fungi & diseases caused by them ?

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Ans:Fungi Target organ 1. Exophiala werneckii Skin 2. Histoplasma capsulatum Lung 3. Histoplasma duboisii Lung 4. Blastomyces dermatitidis Lung & Skin 5. Candida albicans Skin, Nail&Mucosa 6.Sporothrix schenckii & Subcutaneous tissue

Disease Tinea nigra Histoplasmosis African histoplasmosis North American-blastomycosis Candidiasis

Sporotrichosis -

Skin

Q :- chlamydospores

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Ans :- these are large thick walled resting spores developed from hyphae ( modified haphal cells) for existence during long period dormancy. Chlamydospores should be 1.intercalary Dig. 2.terminal 3.lateral

Q :- Arthrospores Ans :- these are formed by production of numerous cross septa into haphae resulting in production of rectangular thick walled vegetative spore Q :- reynolds braude phenomenon/germ tube test /germ tube

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Ans :- when candida albicans is grow in humen serum agar at 37c for 2-3 hrs, a filamentous out growths occurs which represent by wet mount with KOH stain called germ tube . It is rapid method of identification of C. albicans within 2 hrs . this phenomenon called reynolds braude phenomenon . Dig .

Q :- dimorphic fungi Ans :- dimorphic fungi exist either as yeasts or as filaments ( mycelia ), depending upon the condition of growth :1.yeast form ( parasitic phase) :- occurs in host tissue and on culture media at 37c 2. filamentous form ( mycelial/ hyphae /saprophytic phase ):- occurs in soil and in culture media at 22c Fungi responsible for systemic infection are mostly dimorphic

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Ex. Histoplasma capsulatum , H. duboisii, C. albicans ( only) .etc. Q :- difference b/w actinomycotic & eumycotic mycetoma ? Actinomycotic mycetoma 1.caused by Bacteria 2.filament Bacilli 3.tumour Multiple tumour masses with ill define margins 4.sinuses Appear early & numerous 5.discharge purulent 6.granules White / red & thin 7.bone 8.Ex. Osteolytic lesion Actinomadura medurae Nocardia. Actinomyces. Streptomyces. Eumycotic mycetoma fungi hyphae Single tumour with well define margins Appear late & few serous Black / white & broad Osteosclerotic lesion Madorella mycetomatis Exophiala jeanselmei. Aspergillus. Fusarium spp.

Q :- dermatophytes causing infection in humen Ans :-1. Trichophyton genus :- T.rubrum , T. schoenleinii, T. violaceium T. tonsurans 2. microsporum genus :- M.audouini 3. epidermophyton genus :- E. floccosum

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Q :-differece b/w Candida & Cryptococcus ? Candida 1.ex. 2.capsule 3. reproductn by C. albicans Non capsulated fungi Hyphae Cryptococcus Cry. Neoformans Capsulated fungi Budding Absent Sexual spore present:Basidiospore

4.pseudohyphae Present (pseudomycelium) 5.spore No sexual spore bt vegetative spore produce:Chlamydospore and Conidiospore/ Conidia/Asexual spore present 6.antigen Carbohydrate extract act as a Ag

Capsular polysaccharide act as a Ag Not produce Faeces of pigeon Inhalation

7.culture (in humen serum) 8.source of infection 9.mode of infection

Germ tube produce Normal flora of humen Opportunistic endogenous infection

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10.melanin pigment 11.pathogenicity

Not produce

Produce Mostly pulmonary infection Filamentous /mycelial fungi Negative Basidiomycetes True yeast

Mostly mucosal candidiasis 12.morphologically Dimorphic fungi 13.gram status 14.class 15.fungi 16. 17. Positive Fungi imperfecti (C. alb.) Yeast like fungi

Q :- Endothrix hair infection Ans :- causative organism :- Trichophton violaceum ,T. tonsurans Arthospore formation by it occurs entirely with in the hair shaft resulting BREAK OFF of hair . it is caused endothrix of hair infection . Dig .

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Q :- write the short note on SUPERFICIAL MYCOSES ? Ans :PITYRIASIS VERCICOLOR

1. Introduction :- tinea vercicolor is chronic superficial fungal infection ( skin infection) which characterised by blotchy hypopigmented /hyperpigmented macular lesions that may be accompanied by itching . It is non inflammatory & chronic recurrent infection . 2. Causative organism :- Malassezia furfur . 3. Classification :- many species of Malassezia identified but M.furfur is common clinical spp. M.furfur is a lipophilic yeast like non dermatophyte ; dimorphic fungi which found in sebaceous gland rich area of body . 4. source of infection :- sebaceous gland rich area of humen body 5. mode of infection :- direct contact 6. morphology & reproduction :- yeast cell are oval & reproduce by unipolar budding In culture:- bottle shaped budding yeast . 7.clinical diseases :- It is chronic superficial infection of skin which is characterised by blotchy hypo/hyper pigmented macular lesion accompnied with itching but

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remain asymptomatic and giving dry chalky appearance to affected area. 8. lab. Diagnosis :(a.) specimen :- skin scale ,scraping of lesion (b.) method :(A) direct microscopy :-> Skin scale mount with KOH -> Cluster of round yeast cell with shot curved stout hyphy ( non branched ) (B) urease test :- positive (C) culture :- -> Scraping inoculated in Sabourauds dextrose agar (SDs agar) overlaid with a filn of olive oil at 37c for 2-4 days . -> Creamy fried egg colony with bottle shaped budding yeast cells appear (9.) treatment :- ketoconazole.etc .

TINEA NIGRA

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1. introduction :- tinea nigra is a superficial asymptomatic , painless skin disease which characterized by light-brown /black macular patches on thickly keratinized resion of palm & sole . 2. causative organism :- Exophiala werneckll which is dimorphic fungi. 3. Source of infection :soil 4. Mode of infection :- direct contact with soil 5. Morphology :E. werneckii is branched septate hyphae and yeast cell which is dermatophytes and dimorphic fungi 6. Clinical feature :- it is asymptomatic skin disease of mainly sole & palm area where light-brown/black macular patches are seen 7. Lab.diagnosis :(a) Specimen :- skin scraping (b)method :(A) direct microscopy :- -> specimen mount with KOH -> brownish branched septate hyphae and budding cells r seen (B) culture :- -> incubated in SDs agar -> light to gray colony appear

8. Treatment :- miconazole etc.

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WHITE PIEDRA 1. Introduction :- It is disease of hair which characterized by formation of white nodules on the hair shaft which composed of fungus elements. 2. Causative organism:- Trichosporum beigelii. 3. Clinical feature:- white nodules on hair shaft of axilla. 4. Lab. Diagnosis :(a): specimen:- infected pluged hair from affected area. (b) Method:(A) Direct microscopic:- -> mount with KOH ->It show branched hyphae & arthrospore within & outside the hair. (B) Culture:- -> On SDs agar show Blastospores, mycelium & arthrospore.

BLACK PIEDRA 1.Introduction:-It is disease of hair which is characterised by formation of black nodules on the hair shaft which composed of fungus element.

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2. Causative organism:- Piedraia hortae. 3. Clinical feature:- black nodules on hair shaft of bread & scalp. 4. Lab. Diagnosis:(a) specimen:- infected pluged hair from affected area. (b) Method:(A) Direct microscopy:- -> mount with KOH -> It show Clubed shaped asci which contain 8 fusiform ascospores. (B) Culture:- In SDs agar P. hortae produce asci & ascospores.

Q:- write short note on CUTANEOUS MYCOSES ? DERMATOPHYTOSIS 1.. Introduction:- Cutaneous mycosis/Tinea/Ring-worm are fungal infection of keratinized tissue (hair/nail/skin) of humen. 2.. Organism Causative:- group of mould fungi called Dermatophytes like Trichophyton, Microsporum, Epidermophyton spp T. rubrum, M. audouinii E. floccosum

T. schoenleinii M. canis

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T. violaceum 3 source of infection:- animal& its product and soil (combs). 4 mode of infection:- Close contact , Direct exposure to soil born keratinized debris. 5 Morphology:- Hyphae & Arthrospore of Dermatophytes present in lesion. Septate hyphae & asexual spores are present in Culture. 6Classification:- It is based on nature of macroconidia:Genus Trichophyton Microsporum shaped Epidermophyton Shaped of macroconidia pencil shaped multicellular & spindle

club shaped

7Epidemiology:- Habit & mode of transmition (a) Anterophilic Dermatophytes:- exclusively infect the Humen. --> Transmition from person to person by close contactexcomb. (b) Zoophilic Dermatophytes:- Are non humen mammals associated organism.

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-> transmition to humen 4m animal by close contact. (c) Geophilic Dermatophytes:- Its are soil associated organisms and transmited to Humen by Direct exposure to soil borne keratinious debris.

8..Etiopathogenesis:(a) Trichophyton:- It infect the Skin , Hair , Nails. T. rubrum is most common spp.. T. violaceum & T. tonsurans produce Arthrospore within the Hair shaft & caused BREAK OFF of Hair called Endothrix. M. audouinii & M.canis grow around but outside the Hair and produse Arthrospore called Ectothrix. Both Ectothrix & Endothrix fungi destroy the keratin of Hair & Brocken the Hair. T. schoenleinii cause FAVUS , fungal activity minimal inside the Hair shaft bt intense growth occurs within & around follicle which ( FAVUS ) is characterised by by HONEY COMB appearance on scalp. (b) Microsporum:- -> Infectthe Skin & Hair . They are Ectothrix fungi & penetrate the Hair & Extend down. (c)Epidermophyton:- infect the Skin & Nail only.

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Dig. Ectothrix

Endothrix

Favus

9..Clinical form:- Symtoms & appearance of lesionare variable according to site of infection. Typically lesion are circular which spread with scaling & inflammation. Dermatophytes grow only on the keratinized layer of epidermis & its appendage . Local inflammation is due to irritation by fungal product & hypersensitivity reaction . 10..Lab. Diagnosis:(a) specimen:- -> scraping of skin/ nail . -> short length of plucked hair from infected area of scalp. Hair brush sampling technique also used . (b)Method:-

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(A) Direct microscopy:- keratinized specimen mount with KOH which show filamentous branching Hyphae. Arthrospore formation is seen in Hair . (B)Culture:- specimen incubated into SDs agar with cycloheximide & chloramphenicol & inoculated aerobically at 27c for 3 wees. Identification (in culture):Genus Macroconidia Microconidia

1..Epidermophyton Numerous , smoothAbsent walled, clubbed shaped 2..Trichophyton Spare thin-walled , smooth septate pencil shaped Abundant

3..Microsporum

Numerous thick walled , Rare rough, spiny, multicellular, spindle shaped ( on scalp infected Hair show Bright-Green appearance with ultraviolet wools light. It is on direct observatn not in culture. )

11..Treatment:-

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In mild infection:- clotrimazole / miconazoleetc. In severe infection:- tab. Griseofulvin for 4-6 weeks for skin inf..& 1yr for nails inf.. 12..Dig..of:Macroconidia of Microsporum spp..

Macroconidia of Trichophyton spp..

Macroconidia of Epidermophyton spp..

Q:- Write the short note on SUBCUTANEOUS MYCOSES MYCETOMA

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1Introduction:- Mycetoma is a localized granulomatous infection of subcutaneous tissue which most often affect the foot. It is also called madurafoot/ maduramycosis. 2..causative organism:- -> filamentous bacteria:Actinomycetes & Nocardia. -> filamentous fungi:- The four most common species of fungi responsible for Eumycetoma are: Acremonium falciforme-> white grain Madurella mycetomatis -> black grain Exophiala jeanselmei grain Pseudo-allescheria boydii -> white grain 3..source of infection :- soil 4..mode of infection:- acquired by direct inoculation of soils particles on minor trauma (remain localized to feet & leg ). Botryomycosis is caused Staphylococcus aureous which is similar to mycetoma. Madura foo t = Padavalmika = Foot anthill. 5..Pathogenesis:- Disease=> Mycetoma/ Madura foot/ Maduramycosis . -> white

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-> mycetoma is localized swollen condition that begins as small subcutaneous LESION of foot. -> LESION burrow into deeper tissue and produce characteristic ABSCESS . -> organism multiply in center of ABSCESS & form GRANULAR COLONY with push cell and proteinaceous suppurative material . It is called GRANULAR ABSCESS . -> Abscess brusts and form CHRONIC SINUS which discharging the Seropurulent fluid which contain Granules . -> Granules may be White/Black/Brown depending upon causative organism . 6Lab. Diagnosis.:(a)Spcimen:- Biopsy material with granules. / Pus / Exudate from draining sinus. (b) Method:(A)Macroscopy:- granular size & color are variable. (B)Direct Microscopy:- -> specimen is mount with KOH . -> GRAM staining help to differenciat b/w Actinomycetoma & Eumycetoma . (01) Actinomycotic granules :- made of gram positive , interwoven thin filamentous along with some Coccoid & Bacillary forms .

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(02) Eumycotic granules:- made of broad interwoven , septate hyphae with firmly large numbers of Bizarrely shaped swollen cells . (C) Culture :- -> specimen is incubated in SDs agar at 25c & 37c. -> Specimen is also culture on Blood agar for Actinomycetes . IDENTIFICATION:(oa. Fungi producing white granules in tissue are generally produce Hyline mycelia & conidia whereas M. mycetomatis produce Black granules in tissue . (ob) Mycelial phase slowly develop at 25-30c . Identification confirmed by SUBCULTURE at 37c to convert it into the Yeast phase. (oc) Eumycotic mycetoma agents are composed of Hyphae with conidia. (D) Biopsy :- Mycetomas granules often elicit an immunogenic response in tissue called SPLENDORE HOEPPLi Reaction which Histologically characterized by deposition Eosinophilic material around the Granules .

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(E) Serological Test :- ELISA Test used for detection of Ag which is 90% specific .

RHINOSPORIDIOSIS 1..Introdution:- It is subcutaneous mycosis . Rhinosporidiosis is chronic granulomatous disease( lesion produce hoga ) of mucocutaneous tissue of mostly nasal & nasopharynx of mostly male who frequently contact with stagnant water / aquatic life . 2Causative organism:- Rhinosporidium seeberi . 3source of infection:- water & aquatic life . 4mode of infection:- frequent contact with stagnant water / aquatic life . 5Epidemiology:- Habbitat::- normal habitat of these fungi is water / aquatic life . 6Clinical feature :- Rhinosporidiosis is a chronic granulomatous disease which characterized by formation of Friable pedunculated / sessile polyp or wart like Lesions in the nasal & nasopharyngeal mucosa. Mostly that infection occurs in males .

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7Lab. Diagnosis:(a)Sample:- TISSUE section , Exudate of lesion , Mucosal scraping. (b)Method:(A) Direct microscopy:- Tissue section is examined with H&E Stain and show large number of mature & immature spores within sporangia in a stroma which infiltrated with lymphocyte , plasma cells & macrophages. (B) Culture:- Its cultivation is not possible because it dont grow in culture media . 8..Dig:- Rhinosporidiosis :- tissue showing mature sporangium with numerous Endospore & several developmental stage of sporangium.

9Treatment:- Amphotericin-B is the drug of choice .

Q:- write the short note on SYSTEMIC MYCOSES ? CRYPTOCOCCOSIS 1.. Introduction:- Cryptococcosis is subacute / chronic infection caused by CAPSULATED yeast Cryptococcus neoformans .

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2Epidemiology :- Reservoirs:- wild birds (pigeon & chicken) & soil.

Cryptococcal infection is now seen most frequently in

Immuno-compromised patient (ex..AIDS ). 3Morphology:- C. neoformans is a spherical budding cell having a prominent polysaccharide capsule which have Antigenic property . 4Reproduction:- It is reproduced by Budding . the single buds are characteristically narrow at the base. It does not produce Pseudomycelium. 5source of infection :- dust particles of soil & wild Birds which are reservoirs ( faeces of pigeon ) . 6mode of infection :- usually by Inhalation of infected dust particles from environment . 7Classification:- On the basis of Antigenicity C. neoformans are four type : A , B , C , D . Infection due to serotype A & D is more common . 8Virulence factors:- Antiphagocytic polysaccharide capsule is major virulence factor .

MELANIN pigment: It produce melanin which

deposit on inner surface of cell wall which protect itself from oxidant agents which release by phagocytic cells .

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9Pathogenecity ( clinical disease ):Cryptococcosis .

Disease =

It is primary & symptomless granuloma of the Lungs . C. neoformans is pathogenic for Human & animals . (a) Cryptococcal meningitis:Haematogenous spread , resulting in subacute / chronic meningitis . (b) Skin & other infection:(c) Lung infection:- Pulmonary disease is mostly found in Immuno -compromised host . Reactivation of old healed lesion may be occurs. 10Lab. Diagnosis:(a)Specimen: CSF , Biopsy material , Urine & Blood . (b)Method:(A) Examination of CSF :- Biochemical examination of CSF show : ^es protains level ^es glucose level ^es leucocyte ( especially LYMPHOCYTE ) (B) Microscopy:- INDIAN Ink preparation show Capsulated yeast cells in CSF , Urine & Exudates . (C) Culture:- specimen incubated in Sabourauds Dextrose agar for 24-48 hrs , creamy white & mucoid colony appear . C. neoformans is identified by 1. Urease production.

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2. Carbohydrate assimilation test & confirm by 3. Direct immuno-fluorescence Test . (D) Detection of Ag :- by LATEX Agglutination Test . Ag = cryptococcal polysaccharide capsule . (E)Serological Test ( detection of Ab ):- By --> Agglutination Test --> Immunofluorescence Test 11Treatment:- therapy of Amphotericin-B combind with 5-Fluorocytocine 12Diag

HISTOPLASMOSIS 1.. Introduction:- Histoplasmosis is a primarily a disease of the Reticulo-Endothelial system . It is most frequently seen as asymptomatic or relatively mild , self limiting Pulmonary infection . 2Causative organism :Histoplasma capsulatum .

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3..source of infection :Birds /Bats.

soil enriched with the dropping of

4..Mycology ( morphology ):- H. capsulatum is Dimorphic fungi. Grow well in soil & artificial culture as Septate Mycelium ( filamentous ) at 22c. in animal tissue grow as INTRACELLULAR yeast at 37c . In culture the Mycelial phase produce two type of unicellular ASEXUAL Spore . Microconidia:- smaller elliptical . Macroconidia:- large rounded tuberculate . 6.. Epidemiology :- Reservoirs/ Habitat: is soil enriched with the dropping of Birds /Bats. 7.. Virulance factor :- Ability of organism to survive & proliferate INTRACELLULARLY in Phagocytic cell & resistance to Intracellular killing . 8.. Clinical syndrome :- Lesion are produced . (a). Acute Pulmonary Histoplasmosis :It is acute infection like self-limited illness (fever ) & non-productive cough .

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(b). Chronic Pulmonary Disease :Formation of cavity in Lung either due to primary lesions or reactivation of healed old lesion . Clinical features resembling close to PULMONARY TUBERCULOSIS bt chest radiological graph show BILATERAL INFILTRATEs which are usually not found in T.B. . (c)..Disseminated Disease :- Fungus first estabilise the pulmonary infection then disseminated in other organ particularly in old pts , immunocompromised pts . (d).. Ocular Histoplasmosis:- It is Hypersensitivity reaction in endemic area bt not a true infection . 9..Lab. Diagnosis :(a)Specimen:- Blood , Sputum , Biopsy material from pulmonary , Exudates of LESION . (b) Method :(A) Direct Examination :- Specimen is stain with GIEMSA Stan . It appear small oval yeast cells packed with in macrophage / monocyte . (B) Culture :- Media:- Saubourauds Dextrose agar Brain Heart infusion agar . White cottony mycelium yield when incubated at 25c for 4 weeks

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Whitish colony produced with small & oval yeast cells when incubated at 37c . (C)Histoplasmin Skin Test :- Histoplasmin is culture filtrate Ag of mycelial phase of H. capsulatum . A positive skin test indicate past/present infection . (D)Serological Test (detection of Ab ):- By CFT , Precipitation Test , Latex Agglutination Test . Ag used = Histoplasmin / Killed whole Yeast cells . (E)Histopathological Test :- Tissue section stained with H&E and GRAM stain then H. capsulatum (yeast form) seen with in mononuclear cell in a Background of chronic granuloma. 10.. Treatment :- Ampotricin-B

Q:- write the name of fungi which cause opportunistic infection in Human ? Ans:- Fungi which normally dont produce bt under special condition suc as in immunocompromised patient ; Treatment stage of chronic disease condition ; in AIDS patient & with Antibiotic / steroid / immunosuppressive drugs used patients cause Fungi called Opportunistic Fungi & infection called Opportunistic Infection .

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Group:- Yeast like fungi:- Candida , Torulopsis , Cryptococcusetc. Filamentous fungi :- Aspergillus. , Mucour. , Rhizopus , Fusarium , Penicillium , Cephalosporium ..etc.

Q:-Write the short nort on OPPORTUNISTIC MYCOSES ?

CANDIDIASIS

1 Introduction:- Candidiasis are usually superficial infection of Mucous membrane , Nails & Skin bt internal organs are occasionally affected. 2Causative organism:- mainly Candida albicans . 3Classification:- mainly eight types medically important species of Candida found in man bt C. albicans is most important & infectious species in Human .

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4Morphology & Reproduction :two form of C. albicans are present in specimen & culture and both are Gram positive . (a) Spherical / oval Budding cells :- These are Yeast / Yform cells. Diag C. albicans.

(b)Elongated filamentous cells :Resembling Hyphae ( pseudomycelium) and produce Buds ( Blastospores ) both are seen in tissue & culture media . Diag.

5Source of infection:- Immunocompromised patient itself because Candida is normal flora of Human intestine . 6mode of infection :- Opportunistic Endogenous infection. 7Epidemiology:HABITAT: ->C. albicans is present in normal flora of intestine in Healthy peoples .

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8Predisposing factor:- -> Diabetes mellitus , -> Premature baby , Immunodefficiency with AIDS & malignancy -> immunocompromised person due to wide use of antibiotic /steroid /immunosuppresant drugs . 9Pathogenecity:- superficial Candidiasis is usually OpportunisticEndogenous infection under certain condition bt may cross infection from mother to baby & baby to baby . Candidiasis mainly characterised by LESION . 10Type of Candidiasis:(A)Superficial candidiasis:- It is superficial lesion (infection ) of Mucous membranes , Skin & Nails . (oa). Mucous membrane :-> infection of mouth occurs most frequently in infants & old age . characterised by descrete White patches on mucosal surface . vaginal thrush (lesion) is characterized by typical White lesion on epithelial surface of vulva , vagina & cervix . (ob) Skin :Infection of Skin occurs at abnormally moist & warm site of Axillae , Groin , Perineum & Toe clefts . (oc). Nails :Infection of finger webs , nails & folds are associated with frequent immersion of Hands and feet in water . (od).Chronic mucocutaneous candidiasis is sign of deficient CMI.

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(B) Systemic Candidiasis:It is encountered with serious abnormality of host and in Hospitalised patients . (oa)Candidal Endogenous :valve > due to surgery of Heart

(ob)Internal Organs :- like Lungs , Kidney and other organs may be invaded secondarily by C. albicans when person suffer from T.B. / cancer already . 11Lab. Diagnosis:(a)Specimen:- scraping from skin lesions. (b).Method:(A)Direct microscopy:- Specimen is wet mount with KOH / GRAM staining and se under microscope . Gram positive & Budding yeast cells like appearance show and form Pseudomycelium . (B)Culture:- Media:- Routane media & Sabourauds dextrose agar . (Ba) ..Routone agar:- colony are white with foot like extentions from margins . (Bb)..Sabourauds dextrose agar:- colony are smooth creamy white with yeast odour . IDENTIFICATION of C. albicans :(0b1) GERM TUBE Test/ REYNOLDs BRAUDe Phenomenon:-

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In Humen serum ; Candida form filamentous outgrowth (germ- tube) at 37c . Diag..

(0b2)Clamydospores develop in Ntritionally Poor medium such as CORN MEAL Agar at 28c. Blastoconidial germination with constriction of C. tropicalis bt not found with germ tube of C. albicans. Diag..

(C) Serological Test (Detection of Ab) :- PRECIPITATION Test with carbohydrate Extract of group- A Candida show positive result in 50% normal individuals with mucocutaneous candidiasis . (D).. Ag detection :By ELISA , Radio-immuno assay .

(E)..Skin Test :- Candida show universal positive SKIN Test and it is useful as an indicator of deficient CMI . 12Treatment :- superficial infection => Nystatin / Miconazole.

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

systemic infection => Ampotericin-B along with 5-Fluorocytosine .

ASPERGILLOSIS

1..INTRODUTION:- Aspergillosis are opportunistic infection in which usually affect respiratory system , paranasal sinus , external ear & other organ & produce spectrum of disease from Superficial to invasive lesions affecting all tissue . 2..Causative organism:- Aspergillus fumigatus , A. niger , A. flavus.etc. 3..source of infection:- Soil , Food , Paint , Airvents . 4..mode of infection:- Opportunistic Exogenous infection . Inhalation of spore of Aspergillus . 5..Epidemiology:- Habit : Extremely common in the environment such as Soil , food , paint , airvent .

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

6..Predisposing factor :- T.B. , -> Immunocompromised host , -> Bronchiectatic pts , -> Diabetes mellitus . 7..Morphology :- It is Filamentous fungi . Aspergillus show non pigmented septate Hyphae (mycelium) with characteristic DICOTOMOUS branching & produce Conidiophores and Conidiospores . 8.. Clinical syndrome :(0A) Respiratory Disease :(a)Aspergillus Asthma :is Hypersensitivity state to Aspergilli. (b)Bronchopulmonary Aspergillosis :Fungus grow in lumen of Bronchiole and produce plugs of mycelium & mucus that lumen . (c)Aspergilloma = Fungus Ball :in which the fungus colony occurs in pre-existing cavity like in T.B.

(0B) Disseminated (invasive) Aspergillosis :- fungus first establise the Pneumonia and then disseminates in other organs particularly in immune-compromised host .

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

(0C) Superficial infection :- A. flavus & A. fumigatous colonies in Para-nasal sinus = sinusitis ; Eye= Mycotickeratitis ; External ear= oto-mycosis . 9..Lab. Diagnosis:(a) Specimen:- Sputum , Blood , Scraping of lesion , Bronchoalveolar lavage . (b) Method :(0A) Direct Microscopy :specimen mount with KOH which show non-pigmented septate mycelium of fungus with characteristic DICHOTOMOUS branching & irregular outline & also seen Conidiophore and conidio-spore .

(0B) Isolation:colony in SDs agar show a valvety to powdery surface & are coloured .

(0C) Skin Test : Intradermal skin test to Aspergillus Ag extracts is used for pts with suspected allergic Bronchopulmonary Aspergillosis .

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

(0D) Serological Test (detection of Ab ):Ab to A. fumigatous can be detected by :Precipitation Test Immunodiiffusion Test ELISA Test . 10Treatment :surgical drainage / Excision Ampotericin-B and

Q:- write the sort note on TOXICOSIS /MYCOTOXICOSIS ? ?? MYCOTOXICOSIS MYCOTOXICOSIS Ans: (A) Mycotoxicosis is most often the result of the accidental consumption of feeds and food products contaminated by toxins e break of Toutproducing fungi. The toxins are by products of fungal metabolism on the substrate. The alkaloids cause marked peripheral vasoconstriction leading to necrosis and gangrene.

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

1.Ergot alkaloids :- are produced when grain is infected with Claviceps purpura Several outbreaks of mycotoxicosis occurring following consumption of bread and backery products made with contaminated rye. 2. Aflatoxins:- metabolites produced by A.flavus resulted in Turkey-X disease. Contaminaed feed was the cause of outbreak. P.M examination revealed gross hemorrhage and necrosis of liver.

(B) Mycetimus :Caused by ingestion of fungi containing preformed toxin(mushroom) Mycotoxin producing fungi Mycotoxin Aflatoxin Mycotoxin Mycotoxin Fumagatin Muscarine Fungus A.flavus Fusarium graminarium Mushroom(toad stools) A.fumigatus Amnita muscaria

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Penicillic acid Ergot alkaloid

Penicillum puberulum Claviceps species

Ques :- Write a short note on SEVERE ACUTE RESPIRATORY SYNDROME. SARS (SEVERE ACUTE RESPIRATORY SYNDROME)

1. Sars is emerging viral infective disease which present severe atypical pneumonia. 2. Causative viruse is Sars corona virus-4 3. Portal of entry-Respiratory tract epithelium 4. Incubation period is <10 days. 5. Source of infection respiratory secretions as droplet/aerosol 6. Mode of transmission- inhalation of virus particle present in droplets/aerosol of respiratory secretion of patient and close contact with patient. 7. Properites of SARS co-4 Virion spherical/helical neucleocaspid Genome-ss Rna,linear,non segmented,positive sense,infection Protien-two gylcoprotien,one phosphoprotien,hemagglutinin esterase

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Envelope-enveloped with petal shaped spikes. Replication-cytoplasm 8. Clinical and radiological features Onset symtomsFever(Temp>38c),chills,rigor,headache,dizziness, malaise,myalgia After 3-8days(moderate respiratory illness)Dry and non productive cough,Dyspnea,shortness of breath,hypoxia and diarrhea. Radiological Pneumonia like evidence Finally death due to respiratory failure. 9. Lab diagnosis of SARS-Co-V Non-specific investigation :Lymphopenia,thrombocytopenia,elevated level of LDH,Normal to decrease total WBC,Elevated level of CPK and hepatic transaminase. Specific Investigation PCR RT-PCR Specific fpr viral RNA Specimen >10 day after onset Specimen-serum,faeces,nasal secretion.body tissue. Method-Reverse transcriptase-PCR Confirmed by second PCR with new sample and primers

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

SARS-Co-V isolationIn Vero cell culture lines Detection of ab to SARS-Co-V Specimen-during acute illness >21 days after onset of illness. ELISA Test IFA(Indirect fluorescent Ab) Histopathological findingDiffuse alveolar damage Denudation of bronchial epithelium Loss of cilia Squamous metaplasia Sec. bacterial infection Infiltration of giant cells 10. Management of suspected SARS

Isolate the patient Perform diagnostic studies. Provide treatment

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Ques:- Write the diff. b/w herpes simplex viruseS-1 and 2.

HSV-1

HSV-2

Biologic No No

Animal vector of reservoirs

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Site of latency

Trigeminal ganglion Sacral

Clinical

Primary infection Gingivostomatitis Pharyngotonsilltis Keratoconjuctivitis

+ + +

Eczema herpeticum

Herpes encephalitis

In general Lesion above waist Lesion below waist Oral facial infection Genital infection

+ More common Less common

+ Less More

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Perinatal infection during delivery

30%

70%

Reactivation of oral-facial site

More common

Less

Grow in chick embryo Resistant to antiviral drug Heat labile Congenital infection Bells palsy Sacral neuralgia Epidemiology Age of primary infection Transmission

Poorly Less common Less Less Occurs No

Well More More More Not Yes

Young child Contact

Young adult Sexual

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Ques :- Write Diff b/w Orthomyxovirus and paramyxovirus.

Size of virion Shape

Orthomyxovir Paramyxovirus us 80-120nm 100-300nm Spherical,fila mentous Pleomorphic,variable

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Genome Nucleocapsid Diameter Site of synthesis of RNP Genetic resortment dependent RNA synthesis Effect of actinomycinB Antigenic stability Hemolysin

Segmented- 8 Single linear rna piece RNA 9nm 18nm Nucleus Cytoplasm

Common Absent (Required for multiplication ) Inhibit No effect multiplication Variable Absent Stable Present

Ques:Difference between Enterovirus and rhinovirus

Enterovirus Pathogenicity Acid labile Infantile paralysis Less

Rhinovirus Common cold More

SUKHARAM GEHLOT

BATCH 2010

B.J.MEDICAL COLLEGE AHMEDABAD

Heat stable

Less

More Chimpanzee Human/Simian origin Nasal secretion Droplet infection Impossible Short Self limiting

Experiment animal Monkey Tissue culture cell Neural tissue

Source of infection Fecal matter Route of infection Vaccination Incubation period Symptoms Faeco-oral route Possible Long Not progress to paralysis.