* Fungal infections = mycotic infections = mycoses

*Fungi are divided into :

1. Yeasts
2. Moulds
3. Dimorphic : thermal dimorphism ; temp-dependent colony growth as
mould at room temp & as yeast at body temp.
* Pathogenesis : Includes:
- Primary direct invasion.
- Secondary toxic effects of inflammatory response. (No toxin secretion.)
* Types of mycotic infections :
1. Superficial mycoses
2. Cutaneous
3. Subcutaneous
4. Systematic or deep
1. Superficial mycoses :
Outermost areas of human body , include outer surfaces of hair shafts &
outermost , nonliving layer of skin (epidermis)

2. Cutaneous, hair & nail mycoses

- (Dermatophytoses, Tinea or Ringworm infections)
- There is a difference between tinea or ringworm and taenia saginata
(which is a cestodes)
- Occur in living layers of skin (dermis), hair shafts, & nails.
- caused by dermatophytes (filamentous moulds).
- Ringworm (nothing to do with worms) = Tinea infections: some of
superficial & cutaneous mycoses with circular & raised lesions as worms lay
coiled beneath skin surface
- According to the anatomical site tinea infections are divided into:
1- Tinea capitis (head, eyebrows, eyelashes) capitis -->
2- Tinea corporis (trunk, major limbs, face) corporis -->
glabrous{hairless} skin

3- Tinea cruris (groin, perineal & perianal areas) cruris -->

It affects the

4- Tinea pedis (Athletes foot [soles & between toes]) pedis -->
5- Tinea unguium (nails) unguium -->

6- Tinea barbae(beard & moustache). Barbae -->

3. Subcutaneous mycoses (S/C) :

A. Sporotrichosis (caused by dimorphic fungus Sporothrix schenckii):
cutaneous lymphatic
- typically affects skin of extremity
- The fungus try to spread through the lymphatic drainage vessels.
- Affect mostly gardeners so it is called rose-thron disease.
B. Chromomycosis (chromoblastomycosis) (caused by various moulds):
chronic, spreading
infection of skin & S/C tissues, usually affecting lower extremity

C. Mycetomas (caused by various moulds): chronic granulomatous

infections which involve
feet (usually), hands, or other areas of body (Aslo called Euomycetoma)
4. Systemic, generalized or deep-seated mycoses :
- Infection of more than one anatomical site (sometimes 2 internal organs
of body
simultaneously).
- most serious.

4- Fungal infections of Skin Dermatomycoses = Dermatophytoses

- Pathogens: dermatophytes (filamentous moulds) including species of
Microsporum,
Epidermophyton & Trichophyton.
- Lab Diagnosis: microscopic examination of KOH preparations of skin
scrapings or hair or
nail clippings for fungal hyphae.
- Culture on various media, including Sabouraud dextrose agar (SDA) ; which
is the agar used
to cultivate the fungi.
- We use KOH to facilitate the microscopic observation of fungal elements.

5- Fungal infections of lower respiratory tract (LRT)

1. Coccidioidomycosis (Valley Fever)
- It is geographically restricted (related to certain areas)
- Most common in USA
- Pathogen: Coccidioides immitis, dimorphic fungus
- All lab work must be in biosafety level (BSL)-2 or (BSL)-3 facility (very
dangerous in the lab)

2. Histoplasmosis
- Most common systemic mycosis in AIDS pts.
- Pathogen: Histoplasma capsulatum
- Reservoirs: bird droppings (ex. bat droppings)
- Most common systemic mycosis in US
- Mode of Transmission: inhalation of conidia
- NO person-to-person transmission.
3. Pneumocystis Carinii Pneumonia (PCP, Interstitial Plasma-Cell Pneumonia)
- common contributory cause of death in AIDS pts.
- Pathogen: Pneumocystis jiroveci.
- P. jiroveci cannot be cultured and it can be seen with special stains.
4. Pulmonary Zygomycosis (mucormycosis or phycomycosis)
- Cause a diseases in vulnerable patients specially patients with DM (may
lead to death)
- Mode of Transmission: inhaling airborne spores
- NO person-to-person transmission.
5. Cryptococcosis (common cause of Cryptococcus meningitis)
6. Aspergillus & Penicillium
6- Fungal infections of Oral region, Oral Candidiasis, Moniliasis,
Thrush
- Common in infants, elderly & immunosuppressed.
- Pathogen: yeast C. albicans (most common) & related spp.
- Lab diagnosis: microscopic examination of wet mounts for yeast cells
&pseudohyphae (strings of elongated buds).
- Culture: C. albicans is yeast & fungus most commonly isolated from clinical
specimens

7- Fungal infections of GUS Vaginal Candidiasis, Moniliasis, Thrush

- Disease: 3 most common causes of vaginitis: C. albicans (yeast),
Trichomonas vaginalis (protozoan) & mixture of bacteria (including bacteria
in genera Mobiluncus & Gardnerella.
- (microscopic examination of saline wet mount preparation is usually used
for diagnosis of vaginitis).
8- Fungal infections of CNS -->Cryptococcosis (Cryptococcal
Meningitis)
- common infection in AIDS pts.
- Pathogen: C. neoformans, encapsulated yeast (diagnosed by negative
staining [india ink])
- NO person-to-person transmission.

Parasitic Infections
* Protozoal infections of Skin
1- Leishmaniasis
- Disease: 3 forms
(1) cutaneous: starts with papule which enlarges into craterlike(
)

ulcer. Individual ulcers may coalesce( )lead to severe tissue

destruction &
disfigurement.
(2) mucocutaneous (or mucosal)
(3) Visceral (kala-azar)
- Mode of Transmission: zoonosis via bite of infected sand fly.

* Protozoal infections of Eyes

1. Amebic Eye Infections
- Parasites: Acanthamoeba capable of either free-living or parasitic
existence ; lead to a
serious acanthamoeba keratitis which is very hard to treat and may lead to
eye nucleation
- Resevoirs & mode of transmission: Infections occur primarily in wearers of
soft contact
lenses who use non sterile, homemade cleaning or wetting solutions, or in
spas or hot
tubs.
- Lab diagnosis: microscopic examination of scrapings, Culture on media
seeded with
Escherichia coli which serve as nutrients for amebas.
2. Toxoplasmosis
- Cerebral toxoplasmosis is common in AIDS pts.
- During early pregnancy lead to fetal death or serious birth defects.
- Parasite: Toxoplasma gondii, intracellular sporozoan.
- Mode of Transmission: human infection usually by eating infected raw or
undercooked meat (usually pork or mutton)
* Protozoal infections of GIT
1. Amebiasis (Amebic dysentery)
- May lead to a local expansion or may cause systematic extension to cause
amebic
abscesses in the liver , lungs , brainetc
- Pathogen: Entamoeba histolytica

- presence of RBCs within trophozoites indicates invasive amebiasis.

2. Balantidiasis
- Pathogen: Balantidium coli, (ciliated protozoan; only ciliate which causes
disease in
humans & largest of protozoa which infect humans).
- Reservoirs: Pigs

3. Cryptosporidiosis
- Cryptosporidium is very important as it is a cause of outbreaks associated
with waterborne.
- Cryptosporidium parvum oocysts and giardia cysts they can resist the
normal chlorine
conc. In potable water supply , thats why they might be involved in causing
waterborne
outbreaks.
- It is GIT related so it lead to cryptococcal enteritis.
- Pathogen: Cryptosporidium parvum
4. Cyclosporiasis
- Lead to diarrhea last for few days in immunocompetent and lasts for
months in immunocompromised patients.
- Pathogen: Cyclospora cayetanensis .
- primarily waterborne, but outbreaks have involved contaminated
raspberries()
(mainly by contaminated water)
5. Giardiasis
- Pathogen: Giardia lamblia , flagellated protozoan.

- filtration is necessary as concentrations of Cl used in routine water

treatment do not kill cysts.
- it is water-borne
- it is associated with large community outbreaks.
* Protozoal infections of GUT
1- Trichomoniasis
- Disease: sexually transmitted disease (STD). Affect both sexes
- Female : usually symptomatic vaginitis (1 of 3 common causes; 1/3 each)
with
profuse(), thin, foamy, malodorous() , greenish-yellowish discharge
compared with yeast vaginitis which has a vaginal discharge looks like curvy
white cheese.
* Protozoal infections of Circulatory System
1. African Trypanosomiasis (African Sleeping Sickness)
- Pathogens: Trypanosoma brucei: gambiense, in western & central Africa
&rhodesiense, in eastern Africa
- Mode of Transmission: Tsetse flies
2. American Trypanosomiasis (Chagas Disease)
- It destroys the nerve plexuses in the intestinal tract & in the heart -->
thats why there is enlargement.
- enlarged esophagus (megaesophagus) & enlarged colon (megacolon).
- Parasite: Trypanosoma cruzi.
- Mode of Transmission: Vectors are large bugs (reduviid bugs, triatome
bugs, kissing
bugs & cone-nosed bugs).

- Xenodiagnosis (in endemic areas): sterile, uninfected, lab-raised reduviid

bugs take
blood meals from suspected pts with Chagas disease & are then taken to
lab where
their feces are periodically checked microscopically for presence of
parasite.
3. Babesiosis
- Parasites: Intraerythrocytic sporozoa , Babesia microti.
- Mode of Transmission: tick bite.
4. Malaria
- Parasites: Plasmodium vivax (most common), P. falciparum (most deadly),
Plasmodium malariae & Plasmodium ovale.
- Anopheles mosquito is the vector of malaria.
* Protozoal infections of CNS
1- Primary Amebic Meningoencephalitis (PAM)
- Parasite: Naegleria fowleri(free living ameba)
- Lab diagnosis: Post-mortem

Helminths
- Always endoparasites.
- Multicellular eucaryotes.

 3 Medically Important Arthropods

1. Insects include lice, fleas, flies, mosquitoes & reduviid bugs.
2. Arachnids( )include mites & ticks.
3. Crustaceans( )include crabs() , crayfish( & ) certain
Cyclops spp.

Inflammation
The fluid accumulating in the site of inflammation is of two types:
1. Transudative: with low protein and WBC content.
2. Exudative: with high protein and WBC content. It may even be purulent,
as it may contain a high concentration of pus cells (i.e. neutrophils)
Overview of Immune Disorders
Disorders affecting the immune system may cause a myriad of problems:
1. Immunodeficiency: As the main functions of the immune system are
protection against microbes and neoplasia, when the level of the immune

response falls down, it may cause increased risks of infectious diseases and
neoplasms (i.e. tumors).
2. Hypersensitivity: As the main functions of the immune system are
protection against foreign, harmful triggers, when the immune response
gets misguided, it will cause autoimmune diseases, allergy (in response to
environmental substances), and overzealous response to infection.
3. Transplantrelated disorders: When a foreign tissue is transplanted inside
the body to compensate for a lost function, ensuing problems include graft
rejection and graftversushost reaction.
Vaccination
Vaccines are divided into various types:
1. Live attenuated vaccines: where the vaccine is derived from pathogens
weakened to the degree that they are nonpathogenic anymore (e.g.
measles, mumps, rubella, varicella, polio, BCG).

2. Inactivated vaccines: where the vaccine is derived from killed pathogens

(i.e. influenza).
3. Subunit vaccines: where the vaccine is derived from an antigenic portion
of the antigen (e.g. hepatitis B, pertussis).
4. Conjugate vaccines: where microbial antigens are bound with other
antigens to increase their ability to elicit an immune response
(e.g.Haemophilus influenzae, pneumococci, meningococci).
5. Toxoid vaccines: where the vaccine is specifically derived from microbial
toxins (e.g. tetanus, diphtheria).
6. DNA vaccines: where genes that encode for microbial antigens are
injected into humans where they get expressed.

7. Autogenous vaccines: where the vaccine is prepared from microbes

isolated from the same person which will receive the vaccine back.