Fungal Infections in Humans

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Author: Timothy Walls, M.D., M.S.
Reviewer: Ryan Relich, PhD, D(ABMM), MLS(ASCP)^SM

Upon completion of the course, the reader will have accomplished several skills: recognize the geographic distribution and anatomical predilection of the primary fungi causing human disease, recognize the clinical manifestation of disease, and identify pathogenic fungi through their unique distinguishing features such as culture growth characteristics and morphology.

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Continuing Education Credits

P.A.C.E.® Contact Hours: 2 hour(s)
Florida Board of Clinical Laboratory Science CE - General (Microbiology/Mycology/Parasitology): 2 hour(s)

Objectives

Identify the primary fungi that cause disease in humans and their anatomic areas of predilection
Recognize the clinical manifestations of mycotic infection
Understand the current and emerging techniques for diagnosis of infection

Course Outline

Medically important fungi

Yeast, Molds, and Thermally Dimorphic Fungi

Yeast

Yeast
Cryptococcus - Introduction
Cryptococcus Around the World
Cryptococcal Infections
Cryptococcus - Identification
What is a useful stain for the identification of Cryptococcus?
Cryptococci are commonly found in soil contaminated by bird droppings and in decaying wood and in tree hollows.
Candida species
Candida glabrata
Which features distinguishes Candida glabrata from other infectious Candida species?
Rhodotorula
Rhodotorula spp. are yeasts that produce a pyocyanin pigment ranging from yellowish to red that can be visualized with individual colonies.
Malassezia
Which supplement is necessary to add to culture media to ensure proper growth of Malassezia species?
Saccharomyces cerevisiae
Trichosporon
Trichosporon, continued
Trichosporon yeast forms arthroconidia and hyphal elements are larger than those of Candida spp.
Blastoschizomyces (Geotrichum)

Molds

Molds

Aspergillus

Aspergillus
Aspergillus, continued
Aspergillus niger
What is a distinguishing feature of Aspergillus spp. in tissue identification?

Fusarium

Fusarium
What shape is commonly associated with the description of the macroconidia of Fusarium spp.?

Dermatophytes

Dermatophytes (Epidermophyton, Microsporum, Trichophyton) - Introduction
Which enzymes do dermatophytes employ to digest hair, nails, and the stratum corneum of skin?
Dermatophytes (Epidermophyton, Microsporum, Trichophyton)
Epidermophyton floccosum always produces microconidia.
Which antibiotic is used in growth media to help isolate dermatophytes?
Dermatophytes (Epidermophyton, Microsporum, Trichophyton)
Dermatophytes (Epidermophyton, Microsporum, Trichophyton)
Dermatophytes (Epidermophyton, Microsporum, Trichophyton)
Dermatophytes (Epidermophyton, Microsporum, Trichophyton)

Dematiaceous Molds

Dematiaceous molds - Introduction
Dematiaceous molds are darkly pigmented on both the surface and reverse side of the culture plate.
Dematiaceous Molds, continued
Which is a feature that can differentiate a rapidly growing dematiaceous mold from a slowly growing dematiaceous mold?
Dematiaceous molds - Alternaria
Dematiaceous molds - Scedosporium
Lomentospora prolificans has a gray or black surface and reverse.

Mucormycetes

Mucormycetes (Zygomycetes) - Introduction
If zygomycosis is clinically suspected, then how should the specimen be prepared prior to culture?
Mucormycetes, continued
The Mucor spp. do not produce rhizoids.

Dimorphic Fungi

Dimorphic Fungi
Dimorphic Fungi - Introduction
How does one confirm that a fungus is thermally dimorphic?
Dimorphic fungi-Coccidioides spp.
Arthroconidia of Coccidioides spp. are oblong shaped and alternate with empty cells.
Dimorphic fungi-Coccidioides spp.
In addition to culture, diagnosis of coccidioidomycosis can be accomplished by which of the following?
Dimorphic fungi - Paracoccidioides brasiliensis
Paracoccidioides brasiliensis gives the appearance of a mariner's wheel in tissues sections or primary wet preparations.
Dimorphic fungi-Paracoccidioides brasiliensis
Dimorphic fungi-Blastomyces spp.
Dimorphic fungi-Blastomyces spp., continued
What is the characteristic budding morphology that can help identify Blastomyces spp.?
Diagnosis of blastomycosis can also be made with an antigen test performed on urine or serum.
Dimorphic fungi- Histoplasma spp.
Which cells are H. capsulatum yeast cells often found within?
Dimorphic fungi - Histoplasmosis
Dimorphic fungi - Sporothrix schenckii
Microscopically, S. schenckii mold-forms produce very delicate hyaline septate hyphae producing conidiophores topped by clusters of macroconidia ("ros...
Dimorphic fungi - Talaromyces marneffei
How do T. marneffei yeast-forms replicate?

References

References

Additional Information

Level of instruction: Basic to intermediate

Intended audience: This course is intended for microbiology bench technicians and technologists, supervisors, and administrators.

Course Description: Upon completion of the course, the reader will have accomplished several skills: recognize the geographic distribution and anatomical predilection of the primary fungi causing human disease, recognize the clinical manifestation of disease, and identify pathogenic fungi through their unique distinguishing features such as culture growth characteristics and morphology.

Author information: Timothy Walls, M.D., M.S., is an AP/CP boarded pathologist. He has completed fellowships in medical microbiology as well as molecular genetic pathology. Currently he is the Director of Clinical Laboratories at Sentara Reference Laboratories. Timothy has earned his B.S. in Biochemistry, Cellular and Molecular Biology at the University of Tennessee, his M.S. in Forensic Science at Drexel University and his M.D. from the University of Tennessee Health Science Center.

Reviewer information: Ryan Relich, PhD, D(ABMM), MLS(ASCP)^SM is a medical microbiologist. He serves as the interim Medical Director of the Indiana University (IU) Health Division of Clinical Microbiology, Medical Director of the IU Health Special Pathogens Unit Laboratory, Associate Medical Director of the IU Health Division of Molecular Pathology, and Section Director of Clinical Microbiology and Serology Laboratories for Eskenazi Health. Dr. Relich is an Assistant Professor of Clinical Pathology and Laboratory Medicine at IU School of Medicine, and conducts both applied and translational research in the areas of diagnostic test development and evaluation; novel and emerging virus ecology, epidemiology, and pathogenesis; and pandemic preparedness. Dr. Relich holds a PhD in microbiology (Miami University), a BS in medical technology (Clarion University of Pennsylvania), and a BS in molecular biology and biotechnology (Clarion University of Pennsylvania), as well as certifications through the American Board of Medical Microbiology and American Society for Clinical Pathology.

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Alternaria Lactophenol cotton blue demonstrating a chain of conidia. The spores of Alternaria species are multicellular, pigmented, and are produced in straight chains, or branching chains. The end of the conidium nearest the conidiophore is rounded, and tapers towards its apex, imparting a beak-lik

Epidermophyton floccosum lactophenol cotton blue demonstrating septate hyphae, and smooth, thin-walled, club-shaped, multicellular macroconidia.

Tricophyton rubrum culture plate demonstrating colonial morphology which is flat to cottony, and raised and ruffled at its center. The frontal coloration can range from a white to bright yellowish-beige and even to a red-violet coloration. From the reverse, the colonies display a coloration that is

Aspergillus fumigatus demonstrating filamentous conidiophore, which ends in a bulbous, spheroid-shaped vesicle. Atop the distal two-thirds of this vesicle, a uniseriate, i.e., single row, of phialides sprout, each of which anchors its respective chain of spherical conidiospores, which are the asexua