Yeast-Associated Syndromes

Yeast-Associated Syndromes

 

Yeasts are capable of causing a spectrum of human diseases that range from colonization to uniformly fatal disease.

  • Invasive fungal disease occurs in at-risk patient populations
    • Immunocompromised patients
    • Patients on immunomodulatory therapy
    • Patients with indwelling devices
    • Critically ill patients
  • Species that most likely cause disease include:
    • Yeasts – Cryptococcus neoformans, Candida spp
      • Emerging infectious yeasts agents such as Rhodotorula spp and Trichosporon spp
    • Dimorphic fungi – Blastomyces dermatitidis, Histoplasma capsulatum and Coccidioides immitis
  • Manifestations of infection may occur in one or more body sites

Respiratory

  • Pneumonia
    • Risk factors for severe pneumonia and disseminated disease
      • Presence of immunocompromised status
      • Disease-specific factors such as:
        • Cryptococcus – sarcoidosis, diabetes mellitus, HIV
        • Histoplasma – young children, HIV
        • Coccidioides – pregnancy, Filipino, Native American or African American heritage
        • Trichosporon, Rhodotorula (in severely ill patients, e.g., leukemia)
    • Acute primary infection
      •  Histoplasma – clinical picture similar to tuberculosis with fever, weight loss and lymphadenopathy
        • Diagnosis – sputum fungal stain, Histoplasma EIA serum and/or urine, tissue culture
      • Cryptococcus – fever, chest pain, cough, sputum and weight loss
        • X-ray commonly shows multiple noncalcified nodules that may have cavitation, pleural effusion and hilar lymphadenopathy
        • Diagnosis – fungal stain, serum Cryptococcus antigen, culture
      • Candida – local or diffuse bronchopneumonia
        • Diagnosis – tissue biopsy specimen showing invasion, tissue culture
      • Coccidioides – clinical picture similar to tuberculosis with fever, weight loss and lymphadenopathy
        • Diagnosis – sputum fungal stain, tissue culture, serum ID
      • Blastomyces – clinical picture similar to influenza
        • Diagnosis – sputum fungal stain; serum ID, CF; tissue culture
    • Chronic pulmonary disease
      • Histoplasma – calcified nodes, chronic cavitary disease, most frequent in patients with chronic obstructive pulmonary disease, mediastinal granuloma and fibrosis
        • Diagnosis – EIA serum or urine, tissue culture, antibody detection
      • Coccidioides – coin lesions (coccidiomas), cavitary disease (thin-walled), granulomas
        • Diagnosis – CF antibodies
      • Blastomyces – chronic granulomatous disease (Gilchrist disease)
        • Diagnosis – serum CF, ID

  • Ophthalmologic

    • Histoplasma – uveitis and panophthalmitis, presumed ocular histoplasmosis syndrome (POHS) consists of posterior uveitis with choroidal scars and neovascularization and loss of central vision
      • Diagnosis – culture, serum, Histoplasma antigen, antibody detection
    • Cryptococcus – ocular palsies, papilledema, keratitis, endophthalmitis
      • Diagnosis – culture , serum Cryptococcus antigen
    • Candida – fungal keratitis, endophthalmitis
      • Diagnosis – culture (vitreous fluid), blood culture, B 1,3 glucan level

    Otorhinolaryngologic

    • Cryptococcus – gingivitis, sinusitis, salivary gland enlargement
      • Diagnosis – fungal stain, serum Cryptococcus antigen, culture
    • Candida – thrush, nasal ulcers, otitis externa
      • Diagnosis – culture, fungal stain

  • Central nervous system

    • Histoplasma – chronic meningitis, cerebritis and mass lesion
      • Diagnosis – cerebral spinal fluid (CSF) stain and culture, serum Histoplasma antigen
    • Cryptococcus – meningitis, intracranial abscesses, spinal granuloma
      • Diagnosis – India ink, serum Cryptococcus antigen, CSF Cryptococcus antigen, culture
    • Candida – meningitis, diffuse microabscesses in the brain
      • Diagnosis – culture, fungal stain, B 1,3 glucan level
    • Coccidioidomycosis – chronic meningitis with indolent course
      • Diagnosis – CSF stain and culture, CF, ID and ELISA antibodies
    • Blastomyces – abscesses, meningitis
      • Diagnosis – CSF stain and culture, CF and ID antibodies

  • Hepatosplenic/gastrointestinal

    • Histoplasma – hepatosplenomegaly, chronic granulomatous hepatitis
      • Diagnosis – serum Histoplasma antigen
    • Gastrointestinal manifestations of disseminated yeast infections
      • Cryptococcus – hepatitis, peritonitis, nodular or ulcerated lesions of the colon
        • Diagnosis – blood culture, serum Cryptococcus antigen, tissue biopsy
      • Candida – esophagitis, gastrointestinal ulcers, peritonitis, hepatic and splenic abscesses
        • Diagnosis – Candida mannan (latex agglutination); (1-3) Beta-D glucan assay

    Dermatologic

    • Histoplasma – discrete erythematous skin papules in HIV patients
      • Diagnosis – culture of skin biopsy, serum Histoplasma antigen
    • Cryptococcus – papules, subcutaneous abscesses, purpura, bullae, ulcers, draining sinuses
      • Diagnosis – culture of purulent material/fluid, serum antigen
    • Candida – folliculitis, generalized form, disseminated, intertrigo, paronychia, onychomycosis, diaper rash, vaginitis, chronic mucocutaneous candidiasis
      • Diagnosis – fungal stain, culture, Candida mannan, vaginal pathogens (DNA probe)
    • Coccidioides – maculopapular to verrucous lesions, subcutaneous abscesses, reactive eruptions (contain no organisms) include erythema nodosum, erythema multiforme, toxic erythema, Sweet syndrome
      • Diagnosis – fungal stain of purulent material, CF, ID and ELISA antibodies
    • Blastomyces – verrucous or ulcerative lesions, subcutaneous nodules
      • Diagnosis – fungal stain of purulent material, CF and ID antibodies
    • Trichosporon – red papular lesions
      • Diagnosis – culture
    • Rhodotorula spp – catheter-related fungemia
      • Diagnosis – culture

    Bone

    • Histoplasma – osteomyelitis
      • Diagnosis – bone marrow culture, serum Histoplasma antigen
    • Cryptococcus – osteolytic lesions with soft tissue abscesses
      • Diagnosis – bone marrow culture, cryptococcal antigen
    • Candida – osteomyelitis of spine, wrist, femur, ribs, scapula and proximal humerus, arthritis
      • Diagnosis – bone marrow culture, Candida mannan, (1-3) Beta-D glucan assay
    • Coccidioides – osteomyelitis most common in knees, hands, vertebrae and long bones, symmetric arthritis referred to as desert rheumatism
      • Diagnosis – bone marrow culture, CF, ID and ELISA antibodies
    • Blastomyces – osteomyelitis most common in long bones, vertebrae and ribs
      • Diagnosis – bone marrow culture, CF and ID antibodies

    Genitourinary

    • Histoplasma – epididymitis, testicular and prostatic abscesses (rarely symptomatic)
    • Cryptococcus – prostatitis, renal abscesses, genital lesions
      • Diagnosis – serum Cryptococcus antigen
    • Candida – vulvovaginitis, balanitis, papillary necrosis, fungus ball and perinephric abscess
      • Diagnosis – fungal stain, culture, Candida mannan, (1-3) Beta-D glucan assay
    • Blastomyces – prostatitis, epididymitis
      • Diagnosis – urine culture after prostatic massage, CF and ID antibodies
    • Trichosporon – hematuria, funguria
      • Diagnosis – urine culture

See Also