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Pathology of Fungal Infection

Three types of fungal infection (Mycoses)

1. Superficial and cutaneous mycoses:
Skin, hair, and nails

2. Subcutaneous mycoses:
deeper layer of skin

3. Systemic or deep mycoses:

internal organ involvement

Julintorn Somran, MD.

Including opportunistic infection

Growth form of fungi

Filamentous or hyphae Yeasts

Superficial and cutaneous mycoses

Tinea (Ringworm) Ptyriasis versicolor

Subcutaneous mycoses

Systemic or deep mycoses

Mucormycosis or Zygomycosis

Eumycotic mycetoma

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Systemic or deep mycoses

Pulmonary aspergilllosis

Host Agent relationship

Immunocompetent host Pathogenic agents

Nosocomial infection

Environment

Organisms

Host

Infectious disease

Impaired Defense mechanism Immunocompromise host

Opportunistic infection

Superficial and cutaneous mycoses

Representative disease
Dermatophytosis

DERMATOPHYTOSIS
Definition and Epidemiology:
Common superficial infection caused by fungi that able to invade keratinized tissue stratum corneum, hair, and nails. World wide in distribution The source of infection another person, animal or soil

Causative organisms
Microsporum, Trichophyton, and Epidermophyton Malassezia

Growth form in Tissue

Filamentous form

Pityriasis versicolor or skin infection via malassezia Tinea nigra or keratomycosis nigrican palmaris Onychomycosis

Yeast and filamentous form Filamentous form (pigmented) Filamentous form

Exophialia (Phaeoanellomyces) wernekii Microsporum, Trichophyton, Epidermophyton etc.

Etiologic agents:
Microsporum, Trichophyton, and Epidermophyton T rubrum most common for tinea pedis and onychomycosis in temperate climate, and tinea cruris and tinea corporis in the tropics.

Clinical Presentations of Dermatophytosis

Infection Tinea capitis Tinea favosa Kerion Majocchi Granuloma Tinea faciei Tinea barbae Tinea corporis Tinea cruris Tinea manumm (manus) Tinea pedis Tinea unguium Scalp Scalp Scalp, Hair Hair Face Beard Skin (general) Groin Hand Feet Nails Ringworm Tinea corporis A ring inflammation scaling with diminution of inflammation toward the center Clinical Site

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Tinea Pedis

Tinea Unguium
Tinea capitis
Fungi invade the hair shaft producing scaling and hair loss

Pathology of Dermatophytosis
Routine or H&E stain in typical cases:
Unaffected epidermis or mild hyperkeratosis with patchy parakeratosis Mild to intense perivascular infiltrate with lymphocytes and plasma cells in dermis Fungal hyphae not seen in H&E stain

Special stains:
Gomoris methenamine silver (GMS) and periodic acid-Schiff (PAS) demonstrate filamentous elements or hyphae in stratum corneum or hair follicles Confirmational Testing and Diagnosis
Direct microscopy of skin scrapings, nail clippings, or hair samples mounted in 10% potassium hydroxide (KOH) demonstrates septate hyphae

PITYRIASIS VERSICOLOR
Synonyms: - Tinea versicolor Definition and Epidemiology:
An asymtomatic benign infection of the stratum corneum layer of skin flat or slightly raised macules which are oval, may be hypo or hyperpigmented with scaling on the upper trunk, shoulder, arm, and neck. Worldwide in distribution but common in warm climate

Pathology of Pityriasis versicolor

Routine or H&E stain in typical cases:
Minimal epidermal change with mild hyperkeratosis, follicular plugging and acanthosis Oval yeast form and short curved hyphae (2.5-4 um wide) not easily seen in H&E stain Diagnosis rarely require for tissue biopsies

Special stains:
Gomoris methenamine silver (GMS) and periodic acid-Schiff (PAS) demonstrate fungal elements

Etiologic Agents:
Malassezia furfur and other Malassezia sp.

Confirmational Testing and Diagnosis:

Direct microscopy of skin scrapings mounted in 10% potassium hydroxide

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Pityriasis (Tinea) Versicolor

Multiple hypopigmented oval to confluent macules

Confirmational Testing and Diagnosis Oval yeast form and short curved hyphae
(2.5-4 um wide) are demonstrated by 10% KOH

Other forms of Malassezia infection

Malassezia folliculitis:
Yeast forms occupying the hair follicles causing perifollicular infiltrate of neutrophils and, in later stages, lymphocytes.

TINEA NIGRA
Synonyms:
Pityriasis nigra, Keratomycosis nigricans palmaris, Microsporosis nigra, and ladosporiosis epidermica

Seborrheic dermatitis:
Particularly in AIDS, this be precipitated , but not caused by these organism

Definition and Epidemiology:

Superficial mycosis - asymtomatic, minimal scaly, pigmented macules on palms or/ and soles Tropical and subtropical areas

Fungemia and systemic infection:

M furfur rarely cause aggressive deep infection. Reported in new born in ICU or patients receiving intravascular lipid infusion.

Etiologic Agent:
Exophialia (Phaeoanellomyces) wernekii pigmented mycelial fungus

TINEA NIGRA

Pathology of Tinea Nigra

Routine or H&E stain in typical cases:
Hyperkeratosis and mild mononuclear perivascular infiltrate in dermis Presence of pigmented hyphae in the stratum corneum not need to do the special stains

Confirmational Testing and Diagnosis:

10% KOH preparation found septate hyphae

Direct microscopy of skin scrapings mounted in 10% potassium hydroxide

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ONYCHOMYCOSIS
Definition:
Fungal infection of nail plate material

ONYCHOMYCOSIS

Etiologic Agents:
Microsporum, Trichophyton, Epidermophyton, Trichosporon etc.

Clinical and Pathologic features:

Irregular, discolored, and distorted nails Nail biopsies with GMS and PAS confirm the presence of fungus in nail tissue.

Subcutaneous mycoses
Representative disease
Mycetoma (Eumycotic)

Causative organisms
White grain: Acremonium falciforme , Aspergillus nidulans, Fusarium moniliforme, pseudallescheria boydii etc. Black grain: Chaetosphaeronema larense, Medurella grisea etc.

Growth form In Tissue

Yeasts or filamentous forms

MYCETOMA
Definition and Epidemiology:
Chronic, localized, progressive infection of skin, subcutaneous tissue, muscle, fascia, and bone caused by a wide variety of free-living or exogenous aerobic actinomycetes or fungi. Not contagious but infected from sources in nature by traumatic percutaneous implantation of the causal organism into those parts of body (usually foot or hand) Most prevalent in tropical and subtropical regions

Chromoblastomycosis

Fonsecaea pedrosoi, Cladophialophora carrionii etc. Sporothrix schenckii

Filamentous forms

Sporotrichosis

Yeast form

MYCETOMA
Eumycotic Mycetoma
Causative agents Fungus: Several species depend on the geographical areas

MYCETOMA
Eumycotic Mycetoma Actinomycotic Mycetoma Actinomycotic Mycetoma
Morphology of organisms Septate, fungal hyphae ( 2 to 6 or more width) and some pigmented (black grain) Delicate, branched, grampositive and sometime beaded or fragmented bacterial filaments (< or= 1 um)

Filamentous bacteria: Actinomadura madurae, Nocardia asteroides, Streptomyces somaliensis etc.

Clinical features

Chronic, localized, progressive infection of skin, subcutaneous tissue, muscle, fascia, and bone with multiple abscesses and sinus drainage and presence of granules or grain (0.2 to 5 mm) White or Black White, red, or yellow

Pathologic features Multiple abscesses in dermis containing neutrophilic exudates and clusters or grains of organism and surrounded by chronic inflammation with epithelioid histiocytes and multinucleated giant cells, and fibrosis Special stains Treatment GMS and PAS Surgical excision or Amputation Gram stain Antibiotic treatment

Grain colors

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Dermis and subcutaneous contains multiple abscesses

Medura Foot Or Maduromycosis

The granule or grain of organism is identified in the central portion of the abscess

Actinomycotic Mycetoma
Delicate, branched, grampositive and sometime beaded or fragmented bacterial filaments (< or= 1 um)

Eumycotic Mycetoma
The granule or grain of organism are bordered by refractile, intensely eosinophilic, finely to coarsely dentate SplendoreHoeppli material that represent a localized antigen-antibody reaction in hypersensitized host.
Septate, fungal hyphae ( 2 to 6 or more width) and some pigmented (black grain)

Eumycotic Mycetoma
Black grain White grain

CHROMOBLASTOMYCOSIS
Definition:
Chronic fungal infection of the skin and subcutaneous tissue by dematiaceous (pigmented) fungi. No report of person to person spread, but most infected by traumatic implantation of certain organisms

Etiologic agents:
Most common causative agents - Fonsecaea pedrosoi and Cladophialophora carrionii

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CHROMOBLASTOMYCOSIS
Epidemiology:
World wide in distribution, but most common in tropical or subtropical areas especially in barefooted agriculture workers.

Clinical features:
Chronic, pruritic, progressive, indolent lesion spreading by patient scratches and cutaneous lymphatics; a small scaly papule superficial nodule irregular plaque large papillomatous lesion involving large portion of the limb

Morphologic features of organisms: Cells with internal septation; vertical and horizontal lines or Muriform cells and hyphae that are chestnut brown in color

SPOROTRICHOSIS
Definition and Etiologic agent:
Chronic cutaneous or systemic mycosis caused by the thermally dimorphic fungus Sporothrix schenckii , but mostly confined to skin, subcutaneous, and contiguous lymphatics Infected via the accidental percutaneous inoculation of organisms growing in soil and on plant materials occupational disease (gardener, farmer, etc)

Epidemiology:
Inflammatory reaction in dermis consist of suppurative and granulomatous inflammation with dermal fibrosis and pseudoepitheliomatous hyperplasia

Worldwide in distribution, but most in temperate as well as tropical region

SPOROTRICHOSIS
Clinical features:
Cutaneous (Lymphocutaneous) form; most familiar clinical features consisting of a linear chain of painless subcutaneous nodules that extend indolently along the course of lymphatic drainage from the primary nodular-ulcerative lesion developing at the site of traumatic percutaneous inoculation of fungus Systemic form; often localized in a single organ system such as bone, joint, or lower respiratory tract

A linear chain of painless subcutaneous nodules that extend indolently along the course of lymphatic drainage

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Pathological features
Florid pseudoepitheliomatous hyperplasia with ulceration and intraepidermal abscesses Mixed suppurative and granulomatous reaction in dermis and subcutaneous tissue with fibrosis

Pathological features
Spherical, oval, or elongated (cigar shape) single or budding yeastlike cells (2-6 um) demonstrated by GMS or PAS Budding yeasts - Teardrop or pipestem configuration

The asteroid body

Yeast formed organism

Systemic or deep mycoses

Representative disease Causative organisms
capsulatum var capsulatum Blastomyces dermatitidis Coccidioides immitis Paracoccidioides brasiliensis Yeast form Endospore in spherule Yeast form

Growth form In Tissue

Yeast form

enveloped by SplendoreHoeppli material intense eosinophilic material with elongated and radiated spicules Asteroid body almost always in microabscess

Histoplasmosis Capsulati Histoplasma Blastomycosis Coccidioidomycosis Paracoccidioidomycosis

Systemic or deep mycoses, opportunistic infection

Representative disease Cryptococcosis Candidiasis Aspergillosis Zygomycosis Penicilliosis Maneffei Causative organisms
Cryptococcus neoformans Candida albican, other candida sp Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, etc The order Mucorales The order Entomophthorales Penicillium marneffei

HISTOPLASMA CAPSULATI
Definition:
A systemic fungal infection by airborne infectious agents Histoplasma capsulatum var capsulatum Not contagious

Growth form In Tissue

Yeast form Yeast form Filamentous form

Epidemiology:
Primary source of these organisms Avian but they originate from soil, enriched with feces Global distribution but endemic areas including USA and South America countries

Filamentous form

Yeast form

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HISTOPLASMA CAPSULATI
Clinical Features:
90-95% Asymptomatic or subclinical primary pulmonary lesion and heal without treatment detected by CXR 5-10% Symptomatic cases; 1. Acute pulmonary infection 2. Disseminated infection 3. Chronic pulmonary infection

Acute pulmonary infection

Influenza-like symptoms and recovery in a few day to 2 weeks later Rare sequelae; persistent lymphadenopathy with bronchial obstruction, granulomatous and sclerosing mediastinitis Resolving need bed rest and other supportive treatment and infrequently for antifungal therapy

Chronic pulmonary infection

Common for middle-age men Symptoms and lesions similar to other chronic lung lesions Tuberculosis; cavity and /or solitary residual nodule with central necrosis and hilar lymph node involvement Histoplasmomas Residual nodule can found in CXR coin lesion because of its calcification

Disseminated histoplasmosis capsulati

Severe and life-threatening Usually occur in infant, elderly, and profoundly immunodeficiency patient, especially defect in CMI Hematogenous dissemination to various organs via mononuclear phagocytic system Mortality rate = 80% without antifungal therapy

Pathologic Features
Morphology of organisms
Yeastlike, hyaline, spherical to oval, uniform, 2-4 um in diameter, some with single bud (narrow base) aggregate in cluster within cytoplasm of the macrophages Easily demonstrated by GMS

Pathologic Features
Tissue response
Immunocompromise Host; Diffuse aggregation of yeast-laden macrophages within tissue with or without necrosis Immunocompetent Host; Epithelioid and giant cell granulomatous response with or without necrosis and sparse fungal cells

BLASTOMYCOSIS
Definition and Etiologic Agent:
A systemic fungal infection via Blastomyces dermatitidis

Epidemiology:
Endemic region - North America Not contagious but infected by inhaling aerosolized infectious agent growing in soil Primary infectious site Lung Other than human, Dogs are the most susceptible and infectious rate = 10 time more than human

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Morphology and Pathology

Organisms in tissue; Non-encapsulated yeastlike cells with broad-base bud; Typical form = 8-15 um, multinucleated yeasts with vacuolated cytoplasm and thick double contoured wall Tissue response: Acute form suppurative with infiltrate of neutrophils and abscesses Chronic form Mixed suppuration and granulomatous response

COCCIDIOIDOMYCOSIS
Definition and Etiology:
A infectious disease caused by Coccioides immitis and causing variety of lesions from silent infection (most people) to progressive infection and death Infected via inhaling fungal conidia

COCCIDIOIDOMYCOSIS
Epidemiology:
These organisms exists in soil within specific area Northern California to Argentina

Clinical features :
1. Pulmonary (symptomatic or asymptomatic) 2. Disseminated 3. Residual pulmonary 4. Primary cutaneous

Morphology of Organism
In host tissue, the organism form thick-walled endosporulating spherules 20 to 100 um in diameter, some rupture and release uninucleate endospores 2 to 5 um in diameter.

PARACOCCIDIOIDOMYCOSIS
Definition and Etiologic Agent:
A systemic infectious disease caused by Paracoccioides brasiliensis which grow soil No human to human transmission, but the organism entering the body via respiratory passage

Epidemiology:
Numbers of case base on case reporting The endemic area along rivers from the Amazonian jungle to small forest in Uruguay

Clinical features many clinical forms:

Subclinical, Primary pulmonary, Acute pulmonary, Acute or subacute disseminated, chronic pulmonary, chronic disseminated, and opportunistic forms

Morphology of Organism
In host tissue, there are diversity of organism - Large thick walled yeast

cells with oval bud (narrow base), some with multiple buds

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CRYPTOCOCCOSIS
Definition and Etiologic Agent:
A systemic mycosis caused by Cryptococcus neoformans (Most common var neoformans) The organisms grow in soil and more abundant in avian habitats, particularly in Pigeon excreta

Clinical Features
Two basic forms;
1. Pulmonary cryptococcosis 2. Hematologic or lymphatic dissemination from pulmonary focus to various organs, especially cerebromeningeal

Epidemiology:
Worldwide in distribution Infected via inhaling aerosolized fungal cells from environment Infection can occurs in immunocompetent as well as immunocompromise hosts, but prominent in patients with CMI defect or severe underlying diseases including AIDS

Cerebromeningeal cryptococcosis predominant clinical form, most common in AIDS Diagnostic testing;
Demonstrate fungal cells in CSF via indian ink preparation or tissue by GMS, PAS, and Mucicarmine stain Detect antigen via latex agglutination in CSF

Diagnostic test for Cryptococcosis

Presence of spherical or oval encapsulated, yeast-like cells, 2 to 20 um in diameter with narrow budding base and demonstrate mucinous material in capsule with Mucicarmine stain pink color Presence of budding yeasts in CSF in dark background of india ink

Pathology of Cryptococcosis,
depend on host immunity
In patient with AIDS, there is a paucireactive pattern presence of numerous and closely packed fungal cells replacing the normal tissue. Abundant mucoid capsule give the lesion a glistening appearance In immunocompetent patients, there is a mixed suppurative and granulomatous reaction with varying degree of necrosis

Pulmonary cryptococcosis

CANDIDIASIS
Definition and Etiologic Agent:
An infection caused by species of the genus Candida (Most common Candida albican) Most candida sp are common inhabitants of respiratory, Gastrointestinal, and genitourinary tracts, but immunodeficient patients can be infected or invaded by these organisms

Epidemiology:
Worldwide in distribution Candida sp have human and animal reservoirs Mechanical barrier, inflammation, HMI, CMI as well as bacteria normal flora restrict the growth of these fungus.

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Clinical Features
Clinical features are so varied; Depending on site or location of Candida infection Localized or Systemic infection with candidemia Internal organ involvement including liver, spleen, heart, and CNS is the manifestation of disseminated infection via hematogenous spreading Oropharyngeal and esophageal candidiasis are common in patients with CMI defect Vulvovaginitis candidiasis and balantitis the most common candida infection Lower urinary tract infection usually occurs in catheterized patients treated with antibiotics

www.oralcancerfoundation.org/den...ions.htm

Oropharyngeal candidiasis or Oral thrush

Classic symptoms of oral Candidiasis include the appearance of whitish, velvety plaques on the mucous membranes of the mouth and tongue.

Vulvovaginitis candidiasis

Morphologic Features of Candida

In tissue:
Pale blue, oval yeast cells 3 5 um, some with budding Pseudohyphae 3 -5 um wide having periodic constriction at points where budding yeast cells are joined end to end Occasion true hyphae Clear visible in GMS and PAS
overcomingcandida.com/candida_al...ures.htm

Pap or cervicovaginal smear

Vaginal smear with KOH preparation

student.ccbcmd.edu/courses/bio14...tis.html

Pathology
Three varieties 1. Superficial candidiasis
Most common Infection limited to the lining surface , especially skin, oropharynx, GI tract, and respiratory tract and no deep tissue or vascular involvement In Patients with immunodeficiency Local invading to deep tissue causing ulceration of GI, respiratory, and GU tracts The most severe form with internal organ involvement multiple organ abscesses

ASPERGILLOSIS
Definition and Etiologic Agents:
A disparate group of disease of varying pathogenesis, having in common their association with mycelial pathogens of the genus Aspergillus (Most common A. Fumigatus, A. Flavus, and A niger)

2. Locally invasive candidiasis

Epidemiology:
Common throughout the world Outcome of infection depending more on host factors than virulence or pathogenesis of the fungus The respiratory tract most frequent and important of entry for human infection

3. Disseminated candidiasis

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Clinical Features
Allergic aspergillosis involving the nasal cavity, paranasal
sinuses, and lower respiratory tract in hypersensitized host

Morphologic Features of Aspergillus

In tissue
Homogeneous and uniform, septate hyphae 3-6 um in width with dichotomous branching, usually in acute angle Producing conidal head when exposed to air Usually visible with routine H&E, but clear hyphae demonstration via GMS and PAS

Colonizing form of Aspergillosis include obstructed

paranasal sinuses, bronchi, and preformed pulmonary cavities, with formation of fungal ball true aspergilloma in persons with normal immunity

Necrotizing pseudomenbranous bronchial aspergillosis and Chronic necrotizing pulmonary aspergillosis -limited invasive infection of bronchi and
pulmonary parenchyma in mildly immunodeficient patients

Invasive pulmonary aspergillosis and disseminated aspergillosis - Frankly invasive pulmonary infection in
severely immunodeficient patients with disseminated infection
www.medical-look.com/Allergies/A...sis.html

granuloma.homestead.com/infectio...ial.html

Pathology
Allergic bronchopulmonary aspergillosis or Allergic aspergillosis sinusitis
Mucoid impact in bronchi or sinuses which consists of eosinophils, cellular debris, Charcot-leyden crystals, and eosinophilic mucous Granulomatous inflammation with destruction of small bronchial wall Bronchogenic granulomatosis Diffuse infiltrate of inflammatory cells, predominant eosinophils in alveolar septae and spaces Chronic eosinophilic pneumonitis

Granulomatous inflammation in Bronchogenic granulomatosis

Pathology

Pathology
Necrotizing bronchial aspergillosis
Inflamed or pseudomembrane replacing the epithelium and hyphae or inflammation extend to peribronchial parenchyma No hematologic spreading

Colonizing aspergillosis
Characterized by presence of fungal ball (Macrocolonies of mycelium) in a preexisting lung cavity, often with focal erosion and hemorrhage

Invasive pulmonary aspergillosis and disseminated aspergillosis

The pathologic hallmark vascular invasion of fungal hyphae with thrombotic occlusion and parenchymal infarction and hemorrhage Presence of septic emboli in other organs with tissue infarction and hemorrhage

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ZYGOMYCOSIS
Definition and Etiologic agents:
An infection causing various diseases which are caused by fungi of the class Zygomycetes (Phycomycetes) There are two different forms of Zygomycosis; 1. Mucormycosis via the order Mucorales 2. Entomophthoromycosis via the order Entomopthorales 1. Aspergillus invasion in the cerebrum with recent hemorrhage into bilateral ventricles. 2. GMS highlights angioinvasion of Aspergillus sp These lesions were observed in the patient with leukemia
The Internet Journal of Pathology. 2008 Volume 7 Number 2

Epidemiology:
Mucormycosis Worldwide in distribution Entomophthoromycosis predominantly in tropical Africa, Southeast Asia, and South America

ZYGOMYCOSIS
Mucormycosis
Pathogenic genera

ZYGOMYCOSIS
Mucormycosis
Clinical feature Several forms; Rhinoorbitocerebral , Pulmonary , Gastrointestinal, cutaneous, and Disseminating forms Pathology Aggresive angioinvasion, septic thrombosis and tissue infarction, but suppurative or granulomatous may be seen

Entomophthoromycosis

The order Mucorales: The order Entomophthorales : Absisidia, Apophysomyces, Basidiobolus and Cunninghamella, Mortierella, Conidiobolus Mucor, Rhizomucor, Rhizopus, Saksenaea and Synceohalastrum but the most common Rhizopus arrhizus Immunodeficiency, particularly in patients with acidosis, leukemia or lymphoma Immunocompetent

Entomophthoromycosis
Subcutaneous and Rhinofacial

Host factor

Granulomatous inflammation with presence of hyphae ensheathed by amorphous intensely eosinophilic Splendore-Hoeppli material Shorter and more conspicuous septate

Route of Entry

Exposure to sporangiospores Percutaneous implantation of via inhale, ingest, or deposite fungus to the mucous membrane in burn case, but not contageous

Morphology of Broad (5-20um wide) Organisms nonseptate , thin hyphae with irregular contour and right angle branching, some collapse or twisted.

Rhinoorbitocerebral Mucormycosis

GMS highlights fungal hyphae invading blood vessel - Angioinvasion

webeye.ophth.uiowa.edu/eyeforum/...osis.htm

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Differential diagnosis:
Mucormycosis VS Aspergillosis
Features
Width Caliber Branching

PENICILLIOSIS MARNEFFEI
Definition and Etiologic Agent:
A disseminated fungal infection involving the mononuclear phagocytic system and caused by Penicillium marneffei Occurring primarily in HIV-infected patients living in Thailand and South China

Aspergillous sp
Narrow, 3-6 um Uniform Regular, dichotomous branching with acute angle Parallel or radial Frequent

Rhizopus sp and other Zygomycosis

Broad, 5-20 um Variable Haphazard, and right angle Random Infrequent

Orientation of branching Septation

Epidemiology:
Endemic in Thailand, Some provinces of China including Hong Kong, Vietnam, and Indonesia Occurring in immunodeficient cases, especially in Thailand

Clinical Features
In AIDS patients

Fever with or without Chills Respiratory signs; persistent cough and pulmonary infiltrate Cutaneous and Subcutaneous lesions Septicemia Gastrointestinal lesion

In other immunocompromise conditions including poor nutrition, SLE, Lymphoma etc.

Fever with or without Chills Respiratory signs Cutaneous and Subcutaneous lesions Lymphadenopathy Hepatomegaly and Splenomegaly Osteoarticular lesion

Cutaneous lesion
Skin papules with central necrotic umbilication or Acne-like pustules in Penicillosis Marneffei
http://www.med.cmu.ac.th/dept/pediatrics/06-interest-cases/ic-45/case45.HTM

www.conganat.org/7congreso/traba...ema%3D22

Wright stain from skin lesion

Aggregation of yeast organisms, 2-4 um in cytoplasm of the macrophage. Central fission (Binary fission) is the characteristic feature of Penicillium marneffei

Morphology of Organism in Tissue

In human tissue, P marneffei grows as a yeast with the same size as Histoplasma capsulatum. The difference in reproduction can separate P marneffei from H capsulatum; Binary fission (fission at the center) in P marneffei but Budding in H capsulatum

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Pathology
Non-AIDS Infected tissue Lymph node, Liver, Lung, and Kidney Suppurative and Granulomatous AIDS Lymph node, Skin, Bone and Bone marrow Necrotizing

Reference
Daniel H Connor et al. Pathology of Infectious Disease ( 1997) Vinay Kumar et al. Robbins and Cotran: Pathologic Basis of Disease 7th eds. Cedric Mims et al. Medical microbiology 3rd eds.

Tissue reaction

Yeast-like organisms aggregate in intracellular (in macrophages) and extracellular areas with binarry fission

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