II.

Mycology
study of the fungi
A. Introduction
1. FORMS
a. Molds
-Multicellular
-Filamentous (hyphae)
-Can live at room temp (25 C)
b. Yeasts
-Unicellular
-Non filamentous (except candida albicans)
-Can live at body temp (37 C)
2. CHARACTERISTICS
a. Plant like organisms
-Also have a cell wall (chitin)
b. Saprophytic
-Eats dead/ decomposing organic matters
c. Filamentous
d. Multicellular
e. Dimorphic (same fungi)
-Able to live at room temp & body temp
3. MORPHOLOGY
a. Hyphae
-Tubular like structure
-Group of hyphae (mycelium)
b. Septae
-Walls formed inside a hyphae
c. Spores & conidia
-Serves as mode of reproduction
-Serves as major classification of fungi
3 TYPES OF CONIDIA
1. Arthroconidia
2. Blastoconidia
3. Chlamyconidia
4. Phyla
a. Phylum Glomerulomycota, order Mucorales
-Formerly known as phylum zygomycota
-Sexual reproduction: zygosphores
-Asexual reproduction: sporangium
Ex: rhizopus & Mucor (causes mucorcytosis)
Cunninghamella

b. Ascomyota termed as SAC FUNGI

-LARGEST species/phylum

-Sexual reproduction: ascospores

-Asexual reproduction: conidia
ex. Saccharomyces
Candida
coccidioides
blastomyces
trichophyta
c. Basidiomycota
-Termed as club fungi
-Sexual rep: basidiospores
Ex. Cryptococcus
Mushrooms
B. Medical Mycology
-Study of fungal diseases & its associated tx
1.

Hypersensitivity rxns
-Causative agents: respiratory allergens

2.

Mycotoxicosis
-Ingestion of pre formed toxin from a
fungus
Ex: stale peanuts has aspergillus spp. w/ a toxin of
Aflatoxin, that causes neoplasm, hepathocellular
carcinoma.
Wheat claviceps purpurea can give
ergotoxin
3.

Mycetisma
-Ingestion of a poisonous fungi
Ex: amanita phalloides
4.

Fungal infections
-Known to be mycoses
-Fungi loves keratin
A.

Superficial mycoses
-Found in the epidermis
-Most common
-Affects: hair, nails, skin

a.1. Black piedra

-Known as Tinea nodosa Medical term
-CA: Piedraia hortae
-CM: Black nodules at hair shaft
a.2. white piedra
-CA: Trichosporon beigelli
-CM: Beige nodules at the hair shaft
a.3. Pityriasis
-Aka: Tinea versicolor
-CA: Malassezia furfur
-CM: Patches of hyper/hypopigmentation of the
skin.

a.4. Tinea Nigra

CA: Hortae werneckii
CM: Dark pigments (brown to black) or the
palms of the hands

B. Cutaneous mycosis
Caused by dermatophytes

B.1. Epidermophyton
-Affects the skin &nails
B.2.Microsporum
-Affects the skin &hair
B.3. Trichophyton
PART OF THE
TINEA
BODY
Tinea pedis
1. Feet
(athletes foot)

2.

3.

4.
5.
6.

DERMATOPHYTE
S
Trichophyton
rubrum
E. flocosuum
T.
metagrophytes
Tinea cruris
Trichophyton
Groin
(jockitch/hadhad
rubrum
area
)
E. flocosuum
T.
metagrophytes
Tinea
manuum
Trichophyton
Hands /
(hands)
rubrum
nails
Tinea unguium
E. flocosuum
(nails)
T.
(onchomysis)
metagrophytes
Tinea corporis
T. rubrum
Trunk
E. flocossum
Tinea barbae
T.
Beard
mentagraphytes
area
Tinea
capitis
T.
Scalp
mentagraphytes
M. canis
-Affects the skin, hair & nails

-CM: Tinea (aka: ring worm)

C. Subcutaneous Mycoses

C.1.
-

Chromoblastomycosis
CA:
Phialophora Verruscosa
Fonsacaea Pedrosoi
Fonasacaea Compacta
Cladophialophora Carrionii
Rhinocladiella Aquaspersa
CM: Verrucous or warty like lesions
along the draining of Lyphatics.

C.2. Mycetoma
CA:
A. Bacterial (More infectious):

Actinomyces

B.
-

Fungal:
Pseudallescheria Boydii
Madurella Mycetomatis
Madurella Grisea
Exophilia Jeanselmei
Acremonium Falciforme

Associated with: BAREFOOTED

INDIVIDUALS
CM:
Suppuration / Abcesses formation
Granulomata Formation
Formation of draining sinuses cont.
granules

C.3.
-

C.4.
-

Sporotrichosis
Occupational disease of gardeners
MOT: Trauma / wound
Source: ROSE THORNS, soil, free bark
CA: Sporothrix SHenkii
CM: Nodules and lesions are found
along the draining of the lyphatics
Tx: KI Soln (DOC)
Phaeohyphomycosis
Caused by Dermateceous Fungi
Dermeteceous Melanin Pigments
CA:
Exophilia Jeanselmei
Phialophora Richardsiae
Bifolera Specifera
Wangella Dermatitidis
Alternatta Spp.
Cervucaleria Spp.
Exhorhilum Rostratum
CM: Solitary encapsulated cyst
Sinusitis
Brain abcess formation

D. Endemic / Systemic Mycoses

-

CA: Thermally Dimorphic Fungi

Primary Site of infection: LUNGS
TX: ITROCONAZOLE Mild to Moderate
AMPHOTERICIN B Moderate to
Severe

D.1. Coccidioidomycosis

a. Coccidioides Immitis
b. Coccodioides Posadasi
AKA: DESSERT RHEUMATISM / Valley
Fever
1st outbreak: San Joaquin Valley, CA
Dx: Spores inside the spherules

E.

D.2. Histoplasmosis
Most common fungal respiratory
infection
CA: Histoplasma Capsulatum
Non Capsulated
MOT: Inhalation of Bat Droppings
CM: SPELUNKERS DISEASE
SSxs: Mimics SSxs of PTB
Dx: Ovoid cells in Macrophage

D.3. South American Blastomycosis

CA: Paracoccidiodes Brasiliensis
CM: Respiratory lung lesions
(Granulomas)
Oral Ulcers
Ulcers in the Pharyngeal Mucosa
Dx: Multiple Budding Yeast

D.4. North American Blastomycosis

CA: Blastomyces Dermatitidis
CM: Respiratory infiltrates lesions in
the bone, genitalia, and the brain
Dx: Thick walled single budding yeast

Opportunistic Mycoses

E.1. Candidiasis
Most common opportunistic fungal
infection.
CA: Candida Albicans
Candida Lusitaei*
Candida Crusei*

* Fluconazole Resistant
CM: Cutaneous and Mucocutaneous
A. Intertrigenous Infections
Assoc. with obese patients
B. Oral Thrush
Pseudomembrane Formation
White Cottage cheese like deposits
C. Onchomycosis
Nail Infections
D. Vaginosis

E.2. Cryptococcosis
One of the Biomarkers of AIDS
CA: Cryptococcus Neoformans
(capsulated)
MOT: Inhalation of PIDGEON
DROPPINGS
CM: Cryptococcal Meningitis
Dx: INDIA INK
Tx: Fluconazole (DOC)
Standard tx : Amphotericin B +
Flucytosine

E.3. Pneumocystis Jiroveci

Pneumonia
One of the biomarkers of AIDS
Former: Pneoumonitis Carinii (Rodents)
Tx: Cotrimoxazole (DOC)
Pentamidine

E.4. Aspergillosis
CA: Aspergillus Fumigatus (Common)
Aspergillus Flavus
CM: Pulmonary Aspergilloma
AKA: Fungal Bail
Invasive Aspergillosis
Allergy Bronchopulmonary
Aspergillosis
Tx: Voriconazole (DOC)

E.5. Mucormycosis / Zygomycosis

CM: Acute inflammation of soft tissues
Fungal invasion, Inflammation of blood
vessels
Severe Form: RHINOCEREBELLAR
INFECTION
Tx: Posaconazole (DOC)

C. Antifungals
1.
a.
-

Treatment for superficial mycoses:

Griseofulvin
Fungistatic
MOA: Binds to KERATIN and it protects
the new skin from fungal infection.
PK: Higher absorption if given with
HIGH LIPID / FATTY MEAL.
Tx: Tinea / Dermatophytic Infection

b.
-

Nystatin
Chemical Polyene Antifungal
MOA: Binding to ERGOSTEROL
Limited use: Topical
Tx: Candida Infection

c.
-

Terbinafine
Fungicidal
MOA: INH. Of SQUALENE EPOXIDASE
Squalene Epoxidase Responsible for
synthesis of ergosterol
SQUALENE EPOXIDASE

Accumulation of SQUALINE
ERGOSTEROL( Toxic to Fungi)
d.
-

Azoles
MOA: INH. Of CYP450
Chem:

1.
2.
-

Imidazoles
Less selective in inhibiting CYP450
Ex: Ketoconazole (Nizoral) : Withdrawn
Topical azoles
EX:

2.1. Clotrimazole (Canesten)

2.2. Triconazole (Trosyd)

2.3. Miconazole(Daktarin)

1.
2.
3.
1.
-

3. Triazoles
Ex:

3.1. Itraconazole

3.2. Fluconazole

3.3. Voriconazole

3.4. Posaconazole
A/E:
1. Inhibition of Mammalian

2.
B.
C.
D.
-

CYP450
2. Antiandrogenic Effect
- Man boobs
(Gynecomastia)
- Women (Galactorrhea)

1.
2.
3.

e.

Miscellaneous Agents
E.1. AP-AP solution
AI: Salicylic Acid

E.2. Whitfields Ointment

Benzoic Acid + Salicylic Acid

E.3. Sekun Blue

AI: Selenium Sulfide
Use: Anti Seborrhic

E.4.Potassium Iodide Soln

DOC for sporotrichosis

2. Treatment of less serious Mycoses

A. Ketoconazole
First to be introduced clinically
High propensity for mammalian
CYP450 Inhibition
Withdrawn in the U.S. Market
B. Fluconazole
PK: Higher H2O Solubility
Higher ability to cross BBB
Use: Mucocutaneous Candidiasis (NonResistant)
Azole of choice for Tx and Prophylaxis
of: Cryptococcal Meningitis
2nd line for less serious Mycoses
C. Itraconazole
2nd line and alternative for
AMPHOTERICIN B for the Tx of
infections caused by:
Thermally Dimorphic Fungi

A.

3. Treatment of systemic Mycoses

Amphotericin B

Grandfather of Antifungal
MOA:
Binds to ERGOSTEROL
Creates Holes / Pores
Cytoplasmic Leakage
Use: DOC Life threatening Mycoses
Initially given to reduce fungal burden
Route: IV (common), PO
A/E:
Infusion Related
Mx: Slow Infusion + AH1

Renal Toxicity
Renal tubular acidosis with K+ and
Mg+ wasting.
Itroconazole
Substitute for AMPHOTERICIN B
Voriconazole
Use: Fluconazole resistant Candida
DOC for Aspergillosis
Eichinocandins
MOA: INH. Of Beta 1,3-D Glucan
Synthesis
Ex:
Caspofungin
Micafungin
Anidulafungin

E. Flucytosine
Combined with AMPHOTERICIN B
Pyrimidine Analog which comes from:
Derivative of: 5 Fluorouracil
Prodrug 5FU
MOA:
1. FC is taken inside by: CYTOSINE
PERMEASE
2. FC is converted into: 5-FU
3. 5-FU is converted into 2 active
metabolite which is antifungal:
3.1. FdUMD
Fluoro deoxy uridine mono phosphate
3.2. FUTP
Fluorouridine Tri Phosphate

Rationale of Combination:
To prevent secondary resistance with:
FLUCYTOSINE
To facilitate entry of FC to the fungal cell
Tx: Yeast Infection
F.
-

Posaconazole
DOC for Mucomycosis / Zygomycosis
Effective Tx of: ASPERGILLOSIS,
CANDIDA