Respiratory Mycoses

Respiratory Mycoses

1. Coccidioidomycoses

   • C. immitis

2. Coccidioidomycosis

   • C. immitis
     • Pathogen
       • Geographic distribution: Mexico, Central America and South africa
       • Morphology: Spherules (20 - 60 um), containind endospores (2-4 um)
       • Ecology: Soil and dust
       • C. Posadasii
         • Clinical manifestation
           • Asymptomatic lung infection (60%) in healthy people; Spontaneously resolved flu-like process characterized by the presence of fever, cough, chest pain, and weight loss; Maculoerythematous rash, erythema multiforme, and erythema nodosum.(≈10%)
         • Diagnosis
           • Culture: Sputum, BAL, tissue, CSF
           • Pathological anatomy: Spherules (20-60 μm) containing endospores
           • Serology:
             • Antibodies: PT, FC, ID, APL (diagnostic and prognosis) Antigen: urine, CSF

3. Paracoccidioidomycosis

   • Paracococcidioides brasiliensis
     • pathogen
       • Geographical distribution
         • South America and Central America
       • P. lutzii
       • Morphology:
         • Multiple budding yeast Thin to moderately thick wall Steering wheel shape
       • Ecology
         • Probable association with soil.
   • Clinical manifestation
     • Self-resolving lung disease Progressive lung infection and spread (skin, mucosa, bones, lymph nodes, viscera, and meninges) More common in children and immunosuppressed patients
   • Diagnosis
     • microscopic examination, standing methods or laboraoty samples.
       • Fluorescence with calcofluorine blank, H-E, GMS, PAS or Papanicolaou
       • Fluid from bronchoalveolar lavage, scraping or biopsy specimens of ulcers, drainage of pus from lymph nodes, CSF, or tissue
     • Serology: Antibodies: ID, FC (variable specificity; FC useful for monitoring response)

4. Histoplasmosis

   • H. capsulatum var. duboisii
     • Morphology
       • Yeast forms are thin-walled, oval, and between 2 and 4 μm
     • Geographical distribution: Mexico, Central America
   • Pathogen
     • Both varieties present thermal dimorphism
   • H. capsulatum var. capsulatum
     • Morphology
       • Yeast forms have a thicker wall and a size between 8 and 15 μm
   • Clinical manifestation
     • A flu-like process with fever, chills, headache, cough, myalgia, and chest pain. There may be radiographic evidence of hilar or mediastinal lymphadenopathy and patchy pulmonary infiltrates.
     • Diagnosis
       • Disseminated disease, Chronic lung disease