A Case of Mycosis Fungoides Occurring after Primary Gamma ...
Primary systemic mycosis
description
Transcript of Primary systemic mycosis
PRIMARY SYSTEMIC MYCOSIS
PRIMARY SYSTEMIC MYCOSIS Blastomycosis
Blastomyces dermatitidis
Coccidioidomycosis Coccidioides immitis
Paracoccidioidomycosis Paracoccidioidoes brasiliensis
Histoplasmosis Histoplasma capsulatum
SYSTEMIC MYCOSIS CAUSED BY DIMORPHIC ONYGENALESRelated dimorphic fungiMost of them restricted to
particular endemic areasPrimary pathogens Inhalation from dustIn most cases exposure:
No clinical diseasePositive skin test (14 days)
SYSTEMIC MYCOSIS CAUSED BY DIMORPHIC ONYGENALES Acute reactions:
Asymptomatic or Symptomatic, which may heal or develop into
chronic lung disease Endogenous reactivation Occasionally disseminate to:
Skin CNS Visceral organs
Drug of choice Amphotericin B
SUMMARYAgent infection Dissemination Drug of
choiceBlastomyces dermatitidis
Blastomycosis Skin and bone Later nervous system and visceral organs
Amphotericin B itraconazole
Coccidioides immitis
Coccidioidomycosis Skin, bones, joints, subcutaneous tissues, and visceral organs
Amphotericin B
Paracoccidioidoes brasiliensis
Paracoccidioidomycosis
Oro-nasal mucosa latter spleen, liver, intestine and skin
Amphotericin B + sulfas or azoles
Histoplasma capsulatum
Histoplasmosis Acute pneumonia (cave disease)
Chronic pneumonia (smoker)
Disseminated (immunocompromised)
Primary cutaneous (lab accidents)
Amphotericin B
Blastomycosis
Skin lesions resulting from the dissemination of the fungus from the lungs
Coccidioidomycosis
Extension of pulmonary coccidioidomycosis
showing a large superficial ulcerated lesion
Chronic cutaneous granulomatous lesions of the
face, neck and chin
Paracoccidioidomycosis
Ulcerated lesion on the pharyngeal
mucosa
Extensive destruction of facial features
Ulcerated lesion on the nasal mucosa
LABORATORY DIAGNOSIS1. Clinical material:
Skin scrapings Respiratory specimens CSF Pleural fluid and blood Bone marrow Urine Tissue biopsies from various visceral organs
2. Direct Microscopy: 10% KOH, PAS, Silver or Gram stain
3. Culture: SDA + BHIA at 37°C
Tissue sections showing large,
broad-base, unipolar budding
yeast-like cells
Blastomycosis
Broad based budding and
thickened cell walls and globose
shape are characteristic of the
yeast form of Blastomyces
dermatitidis
One-celled conidia formed
on short conidiophores.
Blastomyces dermatitidis
Tissue section showing typical endosporulating spherules of
C. immitis
Coccidioidomycosis
Coccidioides immitis showing typical single-celled, hyaline, rectangular to barrel-shaped, alternate arthroconidia
Paracoccidioidoes brasiliensis
Multiple, narrow base, budding yeast cells "steering wheels" of P. brasiliensis
Paracoccidioidoes brasiliensis
Multiple, narrow base, budding yeast cells "steering wheels" of P. brasiliensis
PAS stain showing Histoplasma capsulatum yeast cells in liver specimen
Rough-walled macroconidia
Macroconidia and microconidia
Histoplasma capsulatum
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