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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5853_Библиотеки_им_академика_М_И_Перельмана
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Key features: Germ tube negative yeast and sugar assimilation pattern. Colonies fuzzy, pale pink on
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CHROMagar™ Candida.
Antifungal susceptibility: (Table 76.1).
Table 76.1. Pichia kudriavzevii (Australian national data); MIC μg/mL. Note: Pichia kudriavzevii is intrinsically resistant
to fluconazole.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 252 1 2 25 47 89 71 16 1
FLU 286 1 11 123 151
ISAV 80 1 4 12 25 29 9
VORI 290 5 43 135 83 16 5 2 1
POSA 260 1 9 36 111 89 11 1 2
ITRA 252 2 3 31 125 76 13 2
ANID 231 10 77 100 43 1
MICA 231 2 1 68 141 19
5FC 252 2 3 28 11 4 71 12 1 3 12 5 1
76.2. Pichia norvegensis Leask & Yarrow
Synonymy: Candida norvegensis Dietrichson ex van Uden & Buckley.
Pichia norvegensis is a very rare clinical isolate that has been reported as a causative agent of peritonitis
and disseminated candidiasis in a patient on CAPD.
RG-1 organism
Culture: Colonies (SDA) white to cream coloured, smooth, glabrous, yeast-like.
Microscopy: Ovoid to ellipsoid, budding blastoconidia, 2.0-4 x 3-10 μm.
India ink preparation: Negative - no capsules present.
Dalmau plate culture: Spherical to ovoid budding yeast cells only. Abundant pseudohyphae produced.
Molecular identification: ITS sequencing recommended.
MALDI-ToF MS: Able to accurately identify this species.
Germ tube formation: Negative.
Physiological tests: (+ Positive, – Negative, v Variable, w Weak, s Slow, n not done).
Fermentation:
Glucose s Sucrose – Lactose –
Galactose – Maltose – Trehalose –
Descriptions of Medical Fungi 206
Growth reactions:
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Glucose + L-Sorbose – myo-Inositol –
Sucrose – L-Rhamnose – DL-Lactate w
Raffinose – D-Xylose – D-Gluconate –
Melibiose – L-Arabinose – 2-Keto-D-gluconate –
Galactose – D-Arabinose – D-Glucosamine +
Lactose – D-Ribose – N-Acetyl-D-glucosamine –
Trehalose – Glycerol + D-Glucuronate –
Maltose – Erythritol – Nitrate –
Melezitose – Ribitol – Urease –
Methyl-⍺-D-glucoside – Galactitol – 0.1% Cycloheximide –
Soluble starch – D-Mannitol – Growth at 37oC +
Cellobiose + D-Glucitol –
Key features: Germ tube negative yeast, sugar assimilation pattern.
Antifungal susceptibility: (Table 76.2).
Table 76.2. Pichia norvegensis very limited data (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 5 1 2 1 1
FLU 5 1 4
ISAV 1 1
VORI 4 1 2 1
POSA 4 1 3
ITRA 5 1 2 2
ANID 3 2 1
MICA 3 1 1 1
5FC 5 1 1 2 1
References: Kurtzman (2011c).
DOI: 10.1079/9781800622340.0076
Descriptions of Medical Fungi 207
Reblova & Jaklitsch
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Synonymy: Phialophora richardsiae (Nannf.) Conant; Pleurostomophora richardsiae (Nannf.) Mostert et al.
Pleurostoma richardsiae was separated from Phialophora based on molecular data (Vijaykrishna et al.,
2004; Reblova et al., 2015). P. richardsiae is a soft rot fungus of wood and is an uncommon cause of human
infection, usually through traumatic implantation causing subcutaneous phaeohyphomycosis.
RG-2 organism
Morphological description: Colonies grow rapidly, and are powdery to woolly or tufted, greyish-brown with
a grey-brown to olivaceous-black reverse. Two conidial types are produced: (1) hyaline conidia which are
allantoid or cylindrical, 3-6 x 1.5-2.5 μm in size, formed on inconspicuous, peg-like phialides on thin-walled
hyphae; and (2) brown, thick-walled conidia which are spherical to sub-spherical, 2.5-3.5 x 2-3 μm, formed
on dark brown, slender, tapering phialides with flaring collarettes (Fig. 77.1).
Key features: Pleurostoma richardsiae is characterised microscopically by phialides with prominent flaring
collarettes bearing globose, brown conidia while phialides with indistinct collarettes bear pale allantoid to
cylindrical conidia.
Molecular identification: ITS sequencing is recommended (Vijaykrishna et al., 2004).
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 208
(a) (c)
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(b)
10 ˜m
2
1
Fig. 77.1. Pleurostoma richardsiae showing (a) culture and (b) phialides which produce two types of conidia:
(1) hyaline conidia, formed on inconspicuous, peg-like phialides on thin-walled hyphae; and (2) brown, thick-walled
conidia formed on dark brown, slender, tapering phialides with flaring collarettes.
10 ˜m
Antifungal susceptibility: (Table 77.1).
Table 77.1. Pleurostoma richardsiae, limited data (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 15 1 1 5 1 5 2
ISAV 1 1
VORI 15 4 8 3
POSA 13 1 2 3 6 1
ITRA 15 2 5 6 2
References: Ellis (1971); McGinnis (1978b, 1980); Vijaykrishna et al. (2004); Domsch et al. (2007);
Revankar and Sutton (2010); de Hoog et al. (2015).
DOI: 10.1079/9781800622340.0077
Descriptions of Medical Fungi 209
Pneumocystis was initially considered a protozoan and was subsequently assigned to the kingdom Fungi
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based on phylogenetic studies of the rRNA (Edman et al., 1988). Pneumocystis is included in the phylum
Ascomycota, subphylum Taphrinomycotina, and is related to Saccharomyces cerevisiae and Schizosaccharomyces
pombe. Despite these similarities, Pneumocystis is considered an “atypical fungus” as it has cholesterol in its
cell membrane instead of ergosterol and is difficult to culture (Edman et al., 1988). Initially considered a
single species, Pneumocystis carinii, it has since been discovered that different species infect different mammals
and the species are both phenotypically and genetically distinct (Sinclair et al., 1991). The human form was
renamed Pneumocystis jirovecii and other species-specific forms have been named P. murina in mice, P. carinii
and P. wakefieldiae in rats and P. oryctolagi in rabbits (Cushion, 2010).
Pneumocystis jirovecii is ubiquitous and causes P. jirovecii pneumonia (PCP) in patients with T cell deficiencies,
including those with HIV infection, solid organ transplant recipients and patients with cancer as well as
adults and children with other underlying immunological diseases (Alanio et al., 2016). P. jirovecii is not
cultivable in vitro and diagnosis of proven PCP is based on clinical and radiologic criteria and demonstration
of P. jirovecii by microscopy.
Morphological description: Diagnosis relies on microscopic detection of trophic forms and cysts of P. jirovecii
in induced sputum, expectorated sputum and bronchoalveolar lavage fluid or washings. The most commonly
used stains, i.e. Giemsa, toluidine blue O, calcofluor white and Grocott-Gomori’s methenamine silver, stain
the cyst form only. Cysts are non-budding, 4-8 μm in diameter, round, oval or collapsed crescent in shape,
resembling crushed ping pong balls or parentheses facing one another, often found in honeycomb-like clusters
(Fig. 78.1). Immunofluorescent staining exhibits superior sensitivity to conventional microscopy detecting
both the cyst and trophic forms, which are 10 x more abundant than the cyst forms in clinical specimens
(Alanio et al., 2016). Trophozoites are 1-8 μm long, pleomorphic and contain a single nucleus.
Key features: Intracystic bodies resembling parentheses facing one another or crushed ping pong balls often
found in honeycomb-like clusters.
Molecular identification: PCR-based assays are more sensitive than microscopic examination for the detection
of P. jirovecii, but they cannot distinguish between colonisation and infection. The multi-copy mitochondrial
large subunit ribosomal RNA (mtLSU) gene is the most common PCR target, but assays targeting the mito-
chondrial small subunit RNA (mtSSU) gene, major surface antigen gene, 18S rRNA, ITS, β-tubulin, DHPS
and HSP70 genes have also been developed (Lagrou et al., 2021).
References: Edman et al. (1988); Sinclair et al. (1991); Cushion (2010); Alanio et al. (2016); de Hoog et al.
(2020); Lagrou et al. (2021).
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 210
20 ˜m
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Fig. 78.1. Pneumocystis jirovecii cysts in a Grocott-Gomori’s methenamine silver-stained tissue section from a lung
biopsy (Photograph courtesy Yee Khong, Anatomical Pathology, SA Pathology, Adelaide, Australia).
10 ˜m
DOI: 10.1079/9781800622340.0078
Descriptions of Medical Fungi 211
79 Prototheca Kruger
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Prototheca species are not fungi, but achlorophyllous algae with phylogenetic affinities to the genus Chlorella.
These organisms are commonly handled in mycology laboratories due to their macroscopic similarity to yeasts
and susceptibility to antifungal agents. To date only P. wickerhamii and P. ciferrii (formerly P. zopfii) have
been involved in human or animal infections (Lass-Florl and Mayr, 2007; Bakuła et al., 2021).
RG-1 organism
Morphological description: Colonies are smooth, moist, white to cream and yeast-like. Cultures are sensitive to
cycloheximide (actidione) and optimal growth occurs at 25
Vegetative cells are globose to ovoid, hyaline, varying in size from approximately 8-20 μm, and have a relatively
thick and highly refractile wall. No budding cells are present; reproduction is by the development of large spo-
rangia (thecae), which contain from 2-20 or more small sporangiospores (endospores or autospores), which are
asexually produced by nuclear division, and cleavage of the cytoplasm (Fig. 79.1; Table 79.1).
Molecular identification: ITS, D1/D2 sequencing may be used for accurate species identification (Ahrholdt
et al., 2012; Wang et al., 2014).
MALDI-ToF MS: Can provide reliable identification of Prototheca species (Ahrholdt et al., 2012; Murugaiyan
et al., 2012).
Key features: Achlorophyllous algae reproducing by sporangia (theca) and sporangiospores (autospores).
Prototheca species can be differentiated by assimilation tests and morphological criteria. The API 20C yeast
identification strip may be used for species identification.
o
C to 30oC. Mycelium and conidia are absent.
5 ˜m
Fig. 79.1. Prototheca wickerhamii thecae and autospores.
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 212
Table 79.1. Differentiation of Prototheca species of medical importance.
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P. wickerhamii P. ciferrii P. stagnora
Colony morphology Hemispheric, with smooth
margin
Cell diam. μm 3-10 7-30 7- 1 4
Growth at 37
Glucose + + +
Trehalose + – –
L-Propanol – + +/–
Acetate (pH5) – + +/–
Galactose +/– – +
Capsule – – +
o
C + + –
Flat, rough, central button,
corrugated margin
Flat, with smooth margin
Antifungal susceptibility: (Table 79.2).
Table 79.2. Prototheca wickerhamii (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 12 3 4 3 2
ISAV 2 1 1
VORI 10 2 1 5 2
POSA 10 1 3 5 1
ITRA 12 2 7 3
References: Kaplan (1977); McGinnis (1980); Pore (1985); Rippon (1988); Ueno et al. (2005); Lass-Flori and
Mayr (2007); Wang et al. (2014); Jagielski et al. (2019); Bakuła et al. (2021).
DOI: 10.1079/9781800622340.0079
Descriptions of Medical Fungi 213
80 Pseudopithomyces chartarum
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(Berk. & M.A. Curtis) Jun F. Li,
Ariyaw. & K.D. Hyde
Synonymy: Pithomyces chartarum (Berk. & M.A. Curtis) M.B. Ellis.
The genus Pseudopithomyces was introduced by Ariyawansa et al. (2015) to accommodate several species
which had previously been classified in the genus Pithomyces, notably Pithomyces chartarum. Pseudopithomyces
contains 13 species (Ariyawansa et al., 2015) that are commonly found from a very wide range of plant
material, also from air, soil, hay, sawn timber and ceiling plaster. Pseudopithomyces chartarum (formerly
Pithomyces chartarum) has long been reported as causing facial eczema of sheep. However, recent molecular
evidence has identified at least two additional species Pseudopithomyces sacchari (formerly Pithomyces
sacchari) and Pseudopithomyces maydicus (formerly Pithomyces maydicus) (da Cunha et al., 2014). Most
human isolates are recovered from skin, nail, respiratory and sinus specimens.
RG-1 organism
Morphological description: Colonies are fast growing, suede-like to downy and black. Conidiophores are
pale olive, smooth or verrucose, 2.5-10 x 2-3.5 μm. Conidiogenous cells integrated, intercalary or terminal,
indeterminate, with one to two loci of similar width in the conidiogenous cells. Conidia are muriform,
medium to dark brown, echinulate to verrucose, three (some up to five) euseptate, slightly constricted at the
septa, with one or both median cells divided by longitudinal septa, thick-walled, broadly ellipsoidal, apex
obtuse, base truncate and characteristically with part of the conidiogenous cell remaining attached as a small
pedicel, 18-29 x 10-17 μm (Fig. 80.1).
Key features: Darkly-pigmented, multi-celled conidia produced on small peg-like branches of the vegetative
hyphae.
Molecular identification: ITS and D1/D2 sequencing (da Cunha et al., 2014).
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 214
20 ˜m
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Fig. 80.1. Pseudopithomyces chartarum conidiophores and conidia.
Antifungal susceptibility: (Table 80.1).
Table 80.1. Pseudopithomyces spp. (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 6 1 2 1 1 1
FLU 6 1 1 1 1 2
ISAV 2 1 1
VORI 6 1 1 2 2
POSA 6 1 1 4
ITRA 6 1 1 1 3
References: Ellis (1971, 1976); Domsch et al. (2007); Rippon (1988); da Cunha et al. (2014); de Hoog et al.
(2015).
DOI: 10.1079/9781800622340.0080
Descriptions of Medical Fungi 215
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