Preface xvii
Acknowledgments xix
Part One Introduction to Fundamental Medical Mycology, Laboratory Diagnostic Methods, and Antifungal Therapy
1. Introduction to Fundamental Medical Mycology3
1.1 Topics not Covered, or Receiving Secondary Emphasis 3
1.2 Biosafety Considerations: Before You Begin Work with Pathogenic Fungi... 3
1.3 Fungi Defined: Their Ecologic Niche 5
1.4 Medical Mycology 5
1.5 A Brief History of Medical Mycology 6
1.6 Rationale for Fungal Identification 9
1.7 Sporulation 11
1.8 Dimorphism 11
1.9 Sex in Fungi 13
1.10 Classification of Mycoses Based on the Primary Site of Pathology 13
1.11 Taxonomy/Classification: Kingdom Fungi 14
1.12 General Composition of the Fungal Cell 21
1.13 Primary Pathogens 25
1.14 Endemic Versus Worldwide Presence 26
1.15 Opportunistic Fungal Pathogens 26
1.16 Determinants of Pathogenicity 27
2. Laboratory Diagnostic Methods in Medical Mycology 31
2.1 Who Is Responsible for Identifying Pathogenic Fungi? 31
2.2 What Methods are Used to Identify Pathogenic Fungi? 31
2.3 Laboratory Detection, Recovery, and Identification of Fungi in the Clinical Microbiology Laboratory 33
2.4 Genetic Identification of Fungi 64
3A. Antifungal Agents and Therapy 75
3B. Antifungal Susceptibility Tests 107
Part Two Systemic Mycoses Caused by Dimorphic Environmental Molds (Endemic Mycoses)
4. Blastomycosis 125
4.1 Blastomycosis-at-a-Glance 125
4.2 Introduction/Disease Definition 125
4.3 Case Presentations 126
4.4 Diagnosis 127
4.5 Etiologic Agent 127
4.6 Geographic Distribution/Ecologic Niche 128
4.7 Epidemiology 129
4.8 Risk Groups/Factors 129
4.9 Transmission 129
4.10 Determinants of Pathogenicity 130
4.11 Clinical Forms 131
4.12 Veterinary Forms 133
4.13 Therapy 133
4.14 Laboratory Detection, Recovery, and Identification 134
5. Coccidioidomycosis 141
5.1 Coccidioidomycosis-at-a-Glance 141
5.2 Introduction/Disease Definition 141
5.3 Case Presentations 142
5.4 Diagnosis 143
5.5 Etiologic Agents 143
5.6 Geographic Distribution / Ecologic Niche 144
5.7 Epidemiology 147
5.7.1 Incidence and Prevalence 147
5.8 Risk Groups / Factors 149
5.9 Transmission 150
5.10 Determinants of Pathogenicity and Pathogenesis 151
5.11 Clinical Forms 155
5.12 Veterinary Forms 156
5.13 Therapy 156
5.14 Laboratory Detection, Recovery, and Identification 158
6. Histoplasmosis 165
6.1 Histoplasmosis-at-a-Glance 165
6.2 Introduction / Disease Definition 165
6.3 Case Presentations 166
6.4 Etiologic Agents 169
6.5 Geographic Distribution/Ecologic Niche 170
6.6 Epidemiology 171
6.7 Transmission 171
6.8 Determinants of Pathogenicity 172
6.9 Clinical Forms 175
6.10 Veterinary Forms 178
6.11 Therapy 179
6.12 Laboratory Detection, Recovery, and
7. Paracoccidioidomycosis 187
7.1 Paracoccidioidomycosis-ata-Glance 187
7.2 Introduction/Disease Definition 187
7.3 Case Presentation 188
7.4 Etiologic Agent 188
7.5 Geographic Distribution/Ecologic Niche 189
7.6 Epidemiology 189
7.7 Transmission 191
7.8 Determinants of Pathogenicity 191
7.9 Clinical Forms 192
7.10 Veterinary Forms 193
7.11 Therapy 194
7.12 Laboratory Detection, Recovery, and Identification 195
8. Penicilliosis 201
8.1 Penicilliosis-at-a-Glance 201
8.2 Introduction/Disease Definition 201
8.3 Case Presentation 202
8.4 Diagnosis 203
8.5 Etiologic Agents 203
8.6 Geographic Distribution / Ecologic Niche 203
8.7 Epidemiology 204
8.8 Risk Groups/Factors 205
8.9 Transmission 205
8.10 Determinants of Pathogenicity 205
8.11 Clinical Forms 206
8.12 Veterinary Forms 208
8.13 Therapy 208
8.14 Laboratory Detection, Recovery, and Identification 208
9. Sporotrichosis 215
9.1 Sporotrichosis-at-a-Glance 215
9.2 Introduction/Disease Definition 215
9.3 Case Presentations 216
9.4 Diagnosis 218
9.5 Etiologic Agents 218
9.6 Geographic Distribution/Ecologic Niche 219
9.7 Epidemiology 219
9.8 Transmission 220
9.9 Determinants of Pathogenicity 220
9.10 Clinical Forms 223
9.11 Human–Animal Interface 224
9.12 Therapy 225
9.13 Laboratory Detection, Recovery, and Identification 227
10A. Less Frequent Mycoses Caused by Dimorphic Environmental Molds: Adiaspiromycosis 233
10B. Less Frequent Mycoses Caused by Dimorphic Environmental Molds (Endemic Mycoses): Lobomycosis (Jorge Lobo's Disease) 241
Part Three Systemic Mycoses Caused by Opportunistic Yeasts andPneumocystis
11. Candidiasis and Less Common Yeast Genera251
11.1 Candidiasis-at-a-Glance 251
11.2 Introduction/Disease Definition 251
11.3 Case Presentations 252
11.4 Diagnosis 255
11.5 Etiologic Agents and their Ecologic Niches 255
11.6 Epidemiology 258
11.7 Risk Groups/Factors 264
11.8 Transmission 265
11.9 Clinical Forms 266
11.10 Determinants of Pathogenicity 273
11.11 Therapy 282
11.12 Laboratory Detection, Recovery, and Identification 286
11.13 Less Common Opportunistic Yeast Genera 292
12. Cryptococcosis 303
12.1 Cryptococcosis-at-a-Glance 303
12.2 Introduction/Disease Definition 303
12.3 Case Presentations 304
12.4 Etiologic Agents 307
12.5 Geographic Distribution/Ecologic Niche 311
12.6 Epidemiology 312
12.7 Risk Groups/Factors 315
12.8 Transmission 316
12.9 Determinants of Pathogenicity 316
12.10 Clinical Forms 321
12.11 Veterinary Forms 323
12.12 Therapy 324
12.13 Laboratory Detection, Recovery, and Identification 326
13. Pneumocystosis 333
13.1 Pneumocystosis-at-a-Glance 333
13.2 Introduction/Disease Definition 333
13.3 Case Presentation 334
13.4 Etiologic Agent 335
13.5 Geographic Distribution/Ecologic Niche 336
13.6 Epidemiology 337
13.7 Risk Groups/Factors 339
13.8 Transmission 340
13.9 Determinants of Pathogenicity 340
13.10 Clinical Forms 343
13.11 Therapy 346
13.12 Laboratory Detection, Recovery, and Identification 348
Part Four Systemic Mycoses Caused by Opportunistic Hyaline Molds
14. Aspergillosis 357
14.1 Aspergillosis at-a-Glance 357
14.2 Introduction/Disease Definition 358
14.3 Case Presentations 358
14.4 Etiologic Agents 361
14.5 Geographic Distribution/Ecologic Niche 362
14.6 Epidemiology and Risk Groups/Factors 363
14.7 Transmission 369
14.8 Determinants of Pathogenicity 370
14.9 Clinical Forms 375
14.10 Veterinary Forms 378
14.11 Therapy 379
14.12 Laboratory Detection, Recovery, and Identification 383
15. Fusarium Mycosis 397
15.1 Fusarium Mycosis-at-a-Glance 397
15.2 Introduction/Disease Definition 398
15.3 Case Presentation 398
15.4 Etiologic Agents 399
15.5 Geographic Distribution/Ecologic Niche 399
15.6 Epidemiology 399
15.7 Transmission 401
15.8 Determinants of Pathogenicity 401
15.9 Clinical Forms 402
15.10 Veterinary Forms 404
15.11 Therapy 405
15.12 Laboratory Detection, Recovery, and Identification 407
16. Pseudallescheria/Scedosporium Mycosis 413
16.1 Pseudallescheria/Scedosporium Mycosis-at-a-Glance 413
16.2 Introduction/Disease Definition 414
16.3 Case Presentations 414
16.4 Diagnosis 416
16.5 Etiologic Agents 416
16.6 Geographic Distribution/Ecologic Niche 418
16.7 Epidemiology 419
16.8 Transmission 421
16.9 Determinants of Pathogenicity 421
16.10 Clinical Forms 422
16.11 Veterinary Forms 423
16.12 Therapy 424
16.13 Laboratory Detection, Recovery, and Identification 426
17A. Mucormycosis 431
17B. Entomophthoramycosis Caused by Basidiobolus ranarum 457
17C. Entomophthoramycosis Caused by Conidiobolus Species 467
Part Five Mycoses of Implantation
18. Chromoblastomycosis 479
18.1 Chromoblastomycosis-at-a-Glance 479
18.2 Introduction/Disease Definition 479
18.3 Case Presentation 480
18.4 Diagnosis 480
18.5 Etiologic Agents 481
18.6 Geographic Distribution/Ecologic Niche 482
18.7 Epidemiology and Risk Groups/Factors 482
18.8 Transmission 483
18.9 Determinants of Pathogenicity 483
18.10 Clinical Forms 485
18.11 Therapy 485
18.12 Laboratory Detection, Recovery, and Identification 487
19. Phaeohyphomycosis 493
19.1 Phaeohyphomycosis-at-a-Glance 493
19.2 Introduction 493
19A Cutaneous–Subcutaneous Phaeohyphomycosis 494
19B Cerebral Phaeohyphomycosis 499
19C Fungal Sinusitis 503
19.3 Laboratory Detection, Recovery, and Identification 506
20. Eumycetoma (Madura Foot, Maduramycosis) 513
20.1 Eumycetoma at-a-Glance 513
20.2 Introduction/Disease Definition 513
20.3 Case Presentation 514
20.4 Diagnosis 514
20.5 Etiologic Agent(s) 514
20.6 Geographic Distribution/Ecologic Niche 515
20.7 Epidemiology 515
20.8 Risk Groups/Factors 516
20.9 Transmission 516
20.10 Determinants of Pathogenicity 516
20.11 Clinical Forms (Fahal, 2004) 517
20.12 Veterinary Forms 518
20.13 Therapy 518
20.14 Laboratory Detection, Recovery, and Identification 520
Part Six Dermatophytosis and Dermatomycoses (Superficial Cutaneous Mycoses)
21. Dermatophytosis 527
21.1 Dermatophytosis-at-a-Glance 527
21.2 Introduction/Disease Definition 528
21.3 Case Presentations 529
21.4 Diagnosis 530
21.5 Etiologic Agents 530
21.6 Geographic Distribution/Ecologic Niche 534
21.7 Epidemiology 534
21.8 Risk Groups/Factors 537
21.9 Transmission 539
21.10 Determinants of Pathogenicity 540
21.11 Clinical Forms 542
21.12 Veterinary Forms 550
21.13 Therapy 552
21.14 Laboratory Detection, Recovery, and Identification 554
22. Dermatomycoses 567
22A Major Nondermatophytic Fungi from Skin and Nails 567
22B Superficial Mycosis of the Hair Caused by a Nondermatophyte Mold: Black Piedra 569
22C Superficial Mycoses Caused by Yeasts and Yeast-like Fungi 571
22D Chrysosporium and Other Nonpathogenic or Opportunistic Fungi Isolated from Skin and Resembling Dermatophytes in Culture 584
Selected References for
Dermatomycoses 585
Website Cited 587
Questions 587
Glossary 589
Answer Key 607
Index 611
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