DESCRIPTIONS OF MEDICAL FUNGISECOND EDITION DAVID ELLIS STEPHEN DAVIS HELEN ALEXIOU ROSEMARY HANDKE ROBYN BARTLEY MYCOLOGY UNIT WOMEN’S AND CHILDREN’S HOSPITAL SCHOOL OF MOLECULAR & BIOMEDICAL SCIENCE UNIVERSITY OF ADELAIDE ADELAIDE AUSTRALIA 2007 Cover: Cryptococcus neoformans, and montages including Microsporum, Candida, Schizophyllum, Sordaria, Conidiobolus, Fusarium, Bipolaris, Aspergillus, Curvularia, Saksenaea, Gliocladium, Trichophyton and Phialophora. Published by the Authors Mycology Unit Women’s and Children’s Hospital North Adelaide 5006 AUSTRALIA Direct Phone: (08) 8161 7365 International + 618 8161 7365 Direct Fax: (08) 8161 7589 International + 618 8161 7589 Email:
[email protected] www.mycology.adelaide.edu.au © Copyright 2007 The National Library of Australia Cataloguing-in-Publication entry: Descriptions of medical fungi. 2nd ed. Bibliography. Includes index. ISBN 9780959851267 (pbk.). 1. Fungi - Indexes. 2. Mycology - Indexes. I. Ellis, David (David H.). 579.5 Printed in Adelaide by Nexus Print Solutions 153 Holbrooks Road Underdale, South Australia 2032 PREFACE The Mycology Unit at the Adelaide Women’s and Children’s Hospital has played a key role in the provision of the Mycology component of the Microbiology Quality Assurance Program (QAP) organised by the Royal College of Pathologists of Australasia since its inception in 1979. The idea to provide all laboratories with a set of description sheets covering medical fungi evolved in the late 1980s and the first edition of this book was published in 1992. We now provide an updated edition which includes new and revised descriptions. We have endeavoured to reconcile current morphological descriptions with more recent genetic data, however in some cases, especially for the anthropophilic dermatophytes this is currently not possible. These descriptions have by necessity been kept brief and many have been based on previous descriptions by other authors. For further information regarding any of the mycoses or pathogenic fungi mentioned, the reader is referred to the references cited. For the precise definitions of the mycological terminology used, the reader is referred to Ainsworth and Bisby’s Dictionary of the Fungi (Kirk et al. 2001). For many species, antifungal susceptibility data has also been provided. This has been derived from both the literature and in-house data from Australian clinical isolates generated by using the CLSI M27-A2 protocol for yeasts and the CLSI M38-A protocol for moulds. This composite data is provided as a guide only. MIC90s for Aspergillus, Candida, Cryptococcus and Scedosporium species are provided from large Australian studies based predominantly on primary isolates. In many cases the clinical relevance of in vitro antifungal susceptibility results remains difficult to interpret, and expert advice from a consulting microbiologist or infectious disease specialist may be required. Risk group (RG) recommendations are based on published data and on current laboratory safety procedures in accordance with the Australian/New Zealand Standard AS/ NZS 2243.3:2002. Safety in laboratories Part 3: Microbiological aspects and containment facilities. David Ellis BSc (Hons), MSc, PhD, FASM, FRCPA (Hon). Associate Professor School of Molecular & Biomedical Sciences University of Adelaide Head, Mycology Unit Women’s and Children’s Hospital North Adelaide, Australia 5006 September, 2007 distortum Microsporum canis var. equinum Microsporum cookei Microsporum ferrugineum Microsporum fulvum Microsporum gallinae Microsporum gypseum Microsporum nanum Microsporum persicolor Mortierella wolfii Mucor Mucor amphibiorum Mucor circinelloides Mucor indicus Mucor ramosissimus Nattrassia mangiferae Ochroconis gallopava Onychocola canadensis Paecilomyces Paecilomyces lilacinus 55 57 58 59 60 61 62 63 65 66 67 68 69 70 71 72 73 74 75 77 78 79 80 81 82 83 84 85 86 88 89 90 91 92 93 94 95 96 97 98 99 100 100 100 101 102 103 104 105 .CONTENTS Absidia corymbifera Acremonium Acrophialophora fusispora Alternaria Aphanoascus fulvescens Apophysomyces elegans Aspergillus Aspergillus flavus Aspergillus fumigatus Aspergillus nidulans Aspergillus niger Aspergillus terreus Aureobasidium pullulans Basidiobolus ranarum Beauveria Bipolaris Blastomyces dermatitidis Candida Candida albicans Candida colliculosa Candida dubliniensis Candida fabianii Candida famata Candida glabrata Candida guilliermondii Candida haemulonii Candida inconspicua Candida kefyr Candida krusei Candida lipolytica Candida lusitaniae Candida norvegensis Candida parapsilosis Candida pelliculosa Candida rugosa Candida tropicalis Chaetomium Chrysosporium tropicum Cladophialophora bantiana Cladophialophora carrionii Cladosporium Coccidioides immitis Colletotrichum Conidiobolus coronatus Cryptococcus Cryptococcus albidus Cryptococcus laurentii Cryptococcus gattii Cryptococcus neoformans 1 2 3 4 5 6 8 9 10 11 12 13 14 15 16 17 19 20 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 48 49 50 51 51 52 53 Cunninghamella bertholletiae Curvularia Cylindrocarpon Drechslera Epicoccum purpurascens Epidermophyton floccosum Exophiala dermatitidis Exophiala jeanselmei complex Exophiala spinifera complex Exserohilum Fonsecaea Fusarium Fusarium oxysporum Fusarium solani Geotrichum candidum Geotrichum capitatum Gliocladium Graphium Histoplasma capsulatum Hortaea werneckii Lasiodiplodia theobromae Lecythophora hoffmannii Madurella grisea Madurella mycetomatis Malassezia Malbranchea Microsporum Microsporum audouinii Microsporum canis Microsporum canis var. mentag. quinckeanum 156 Trichophyton rubrum 158 Trichophyton rubrum granular type 160 Trichophyton schoenleinii 162 Trichophyton soudanense 163 Trichophyton terrestre 164 Trichophyton tonsurans 165 Trichophyton verrucosum 167 Trichophyton violaceum 169 Trichosporon 170 Trichosporon asahii 171 Trichosporon asteroides 172 Trichosporon cutaneum 172 Trichosporon inkin 172 Trichosporon mucoides 173 Trichosporon ovoides 173 Trichothecium roseum 174 Ulocladium 175 Veronaea botryosa 176 Verticillium 177 Microscopy Stains & Techniques 178 Calcofluor White with 10% KOH 178 KOH with Chlorazol Black 178 India Ink Mounts 178 Lactophenol Cotton Blue (LPCB) 179 Direct Microscopic Preparations 179 Cellotape Flag Preparations 179 Slide Culture Preparations 180 Specialised Culture Media 181 Bird seed agar 181 Bromcresol Purple Milk Agar 181 CDBT media 182 CGB media 182 Cornmeal agar 183 Cornmeal glucose sucrose agar 183 Czapek Dox agar 183 Dixon’s agar 183 Hair perforation test 184 Lactritmel agar 184 Littman oxgall agar 184 Malt extract agar 185 1% Peptone agar 185 Potato dextrose agar 185 Rice grain slopes 185 Sabouraud dextrose agar 186 Sabouraud dextrose agar 5% NaCl 186 Tap water agar 187 Urease agar with 0. rhizopodiformis 123 Rhizopus oryzae 124 Rhodotorula 125 Rhodotorula glutinis 126 Rhodotorula mucilaginosa 127 Saccharomyces cerevisiae 128 Saksenaea vasiformis 129 Scedosporium apiospermum 131 Scedosporium aurantiacum 131 Scedosporium prolificans 134 Schizophyllum commune 135 Scopulariopsis 136 Sepedonium 137 Sporothrix schenckii 138 Stemphylium 140 Syncephalastrum 141 Trichoderma 142 Trichophyton 143 Trichophyton ajelloi 144 Trichophyton concentricum 145 Trichophyton equinum 147 Trichophyton erinacei 149 Trichophyton interdigitale 151 T. microsporus var.5% glucose 187 Vitamin free agar 187 References 188 . microsporus var. oligosporus 123 R.CONTENTS Paecilomyces variotii. microsporus 122 R. microsporus var. 106 Paracoccidioides brasiliensis 107 Penicillium 108 Penicillium marneffei 110 Phaeoacremonium parasiticum 111 Phialophora 112 Phialophora richardsiae 112 Phialophora verrucosa 113 Phoma 114 Pithomyces 115 Prototheca 116 Ramichloridium 117 Ramichloridium schulzeri 117 Rhinocladiella 118 Rhinocladiella atrovirens 118 Rhizomucor 119 119 Rhizomucor miehei Rhizomucor pusillus 120 Rhizopus 121 Rhizopus azygosporus 122 R. nodulare 153 Trichophyton mentagrophytes 154 T. var. interdigitale var. A. Espinel-Ingroff (2003. antifungal susceptibility testing of individual strains is recommended. globose sporangia without an apophysis. Nottebrock et al. Samson et al.1 0. (1980). which have large. Colonies are fast growing. pyriform or pear-shaped and are supported by a characteristic funnel-shaped apophysis. Singh et al. corymbifera is a known human pathogen causing pulmonary. (2005). where the sporangia arise from the nodes and are therefore found opposite the rhizoids.5 µm). floccose. arising solitary from the stolons. . The sporangia are relatively small. de Hoog et al. Key Features: zygomycete. maximum 45OC. Sporangiophores are hyaline to faintly pigmented. (2001). and rhizoids formed at the point of contact with the substrate (at the node). Absidia currently contains 21 mostly soil-borne species. RG-2 organism. and up to 1. Sun et al. globose. Temperature: optimum 35-37OC. Hesseltine and Ellis (1964 and 1966).5 Posaconazole 0. Espinel-Ingroff et al.03 . This distinguishes Absidia from the genera Mucor and Rhizomucor. (1995). corymbifera showing a typical pyriform-shaped sporangium with a conical-shaped columella and pronounced apophysis (arrow).5-4.03-2 0. often with a short projection at the top. Sporangia are small (10-40 µm in diameter) and are typically pyriform in shape with a characteristic conical-shaped columella and pronounced apophysis. This feature separates species of Absidia from the genus Rhizopus. (2002). rapid growth at 40OC. rhinocerebral. Rhizoids are very sparingly produced and may be difficult to find without the aid of a dissecting microscope to examine the colony on the agar surface. in groups of three. simple or sometimes branched. keys to taxa and additional information see Ellis and Hesseltine (1965 and 1966).5 cm high.03-2 1 Flucytosine >256 >256 Fluconazole >16 >16 Itraconazole 0. Antifungal MIC µg/mL Range MIC90 Amphotericin B 0. white at first becoming pale grey with age. (2003). hyaline to light grey and smooth-walled. small pyriform-shaped sporangia with a characteristic conical-shaped columellae and pronounced apophysis. (2000) and Ellis (2005b). O’Donnell (1979). For descriptions of species. CNS or cutaneous zygomycosis. 2006).25 Voriconazole 2->64 >16 Very limited data. Sporangiospores vary from subglobose to oblong-ellipsoidal (3-7 x 2. Dannaoui et al.Descriptions of Medical Fungi Absidia corymbifera (Cohn) Saccardo & Trotter The genus Absidia is characterised by a differentiation of the hyphae into arched stolons bearing more or less verticillate sporangiophores at the raised part of the stolon (internode). McGinnis (1980). disseminated. Domsch et al. or in whorls of up to seven. (2006) and WCH inhouse data. (1974). 15 µm A. Sabatelli et al. Cuenca-Estrella et al. causing mycetoma. but they usually grow faster and have colonies with a characteristic fluffy appearance. Microconidial Fusarium isolates may be confused with Acremonium. mostly in slimy heads. pink. mycotic keratitis and onychomycosis. For descriptions of species. Domsch et al. globose to cylindrical conidia. keys to taxa and additional information see Gams (1971). most are saprophytic being isolated from dead plant material and soil. (2006) and WCH inhouse data. Pfaller et al. alabamensis. (1998. Antifungal . Guarro et al. globose to cylindrical. (1995) and de Hoog et al. RG-2 for species isolated from humans. and may be white. (2000). recifei. suede-like or floccose with age. (1980). Samson et al. A. awl-shaped phialides producing single-celled. MIC µg/mL MIC µg/mL Antifungal Range Range Itraconazole 0. However a number of species including A. Hyphae are fine and hyaline and produce mostly simple awl-shaped erect phialides.5->8 Very limited data. grey.5->8 Amphotericin B 0. hyaline. A. A. one-celled conidia mostly aggregated in slimy heads at the apex of each phialide. falciforme. The genus Acremonium currently contains 100 species.03->8 Voriconazole 0. kiliense. strictum are recognised as opportunistic pathogens of man and animals.06-4 Caspofungin 0. Conidia are usually one-celled (ameroconidia). erect. and mostly aggregated in slimy heads at the apex of each phialide. often compact and moist at first. 2002a). Espinel-Ingroff (2003). 10 µm Acremonium showing long awl-shaped phialides producing cylindrical. hyaline or pigmented. roseogriseum and A. antifungal susceptibility testing of individual strains is recommended. rose or orange in colour.5-16 Posaconazole 0.06-4 Anidulafungin 0. (1997). A. Key Features: hyphomycete with solitary. becoming powdery. Descriptions of Medical Fungi Acremonium Link ex Fries Colonies are usually slow growing. rough-walled. Phialides flask-shaped with a swollen base and a long.Descriptions of Medical Fungi Acrophialophora fusispora (S.03 Very limited data.25-2 Itraconazole 0. with indistinct spiral bands. narrow neck. hyaline.5 μm in the broadest part. For descriptions of species. fusispora. Saksena) Samson Colonies fast growing. smooth to finely echinulate with indistinct spiral bands. phialides and conidia with striations (arrows) of A. limoniform. RG-1 organism.125 Flucytosine >64 Voriconazole 0.06 Posaconazole 0. Key Features: hyphomycete with flask-shaped phialides producing long chains of one-celled. fusispora is a rare human pathogen. one-celled. Temperature: optimum 40OC. up to 15 μm long. (1980). (2000) and WCH in-house data. straight or slightly flexuose.B. maximum 50OC. smooth-walled or echinulate. tapering towards the apex. 2-5 μm wide. Conidiophores arising singly. keys to taxa and additional information see Domsch et al. especially from India. greyish-brown with a black reverse. Conidia in long chains. de Hoog et al. pale brown conidia. A. Antifungal . terminally and laterally from the hyphae. 9-15 x 3-4. with whorls of phialides on the upper part. Al-Mohsen et al. pale brown. erect.06-0. MIC µg/mL MIC µg/mL Antifungal Range Range Fluconazole 8-32 Amphotericin B 0. (2000) and Al-Mohsen et al. antifungal susceptibility testing of individual strains is recommended. 10 μm Culture. (2000). pale brown 5-12 x 3-6 μm. limoniform. The genus Acrophialophora contains 3 species and is most commonly associated with soil. most are plant parasites. Although usually seen as saprophytic contaminants.25 0. McGinnis and Pasarell (1998). Descriptions of Medical Fungi Alternaria Nees ex Fries Colonies are fast growing.125-2 1 Flucytosine >128 >128 Voriconazole 0. smooth-walled or verrucose. alternata is the most common of these. Ellis (1971). sometimes branched. ovoid to obclavate dictyoconidia. antifungal susceptibility testing of individual strains is recommended. obclavate to obpyriform conidia with short conical beaks.5-2 1 Posaconazole 0. pale brown. black to olivaceous-black or greyish. keys to taxa and additional information see Simmons (1967).125->16 2 (4) Itraconazole 0. obpyriform. Alternaria species are recognised causative agents of mycotic keratitis. (2000). (1980). Pujol et al. Alternaria species soon lose their ability to sporulate in culture. short or elongate conidiophores. often with a short conical or cylindrical beak. Espinel-Ingroff et al. (2006) and WCH in-house data. de Hoog et al. Temperature: optimum 2528OC. 20 μm Alternaria alternata showing branched acropetal chains and multi-celled. Microscopically. Samson et al. and incubation under near ultra-violet light is recommended to maintain sporulation. (1995). Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Fluconazole 16->64 >64 Amphotericin B 0. Sabatelli et al. and are suede-like to floccose. branched acropetal chains (blastocatenate) of multicellular conidia (dictyoconidia) are produced sympodially from simple. . Potato dextrose agar and cornmeal agar are the most suitable media to use. often with short conical or cylindrical beaks. RG-1 organism. (2000).06-0. but a few species are ubiquitous and are also frequently soil-borne.25 Limited data. Conidia are obclavate. maximum 31-32OC. sometimes ovoid or ellipsoidal. For descriptions of species. The genus contains 44 species. Domsch et al. A. Key Features: dematiaceous hyphomycete producing chains of darkly pigmented. Espinel-Ingroff (2003). (2001). Key Features: keratinolytic ascomycete with a Chrysosporium anamorph. RG-2 organism. 3. For descriptions of species. (1980). 15. Ascospores light brown.5 µm. (2000). laterally or terminally. which are formed either intercalary. yellowish to pale brown in mass. buff to light brown cleistothecia (non-ostiolate ascocarps).5-3. Asci are subspherical to ellipsoidal and eight-spored. .Descriptions of Medical Fungi Aphanoascus fulvescens (Cooke) Apinis Colonies are moderately fast growing. Aphanoascus fulvescens has a Chrysosporium anamorph showing typical pyriform to clavate-shaped conidia with truncated bases. pseudoparenchymatous. keys to taxa and additional information see Domsch et al. 100 μm 10 μm Culture. lens-shaped.5 x 3.7-6.5-4. McGinnis (1980) and de Hoog et al. irregularly reticulate.7 x 2. white to tan with the production of numerous spherical.0-17. Aphanoascus fulvescens is a soil keratinolytic ascomycete which occasionally causes dermatomycosis in man and animals.0 µm. cleistothecium and conidia of Aphanoascus fulvescens. 03-4 Antifungal Amphotericin B Flucytosine Voriconazole MIC µg/mL Range 0. rare human pathogen usually associated with invasive lesions following the traumatic implantation of the fungus through the skin. Descriptions of Medical Fungi Apophysomyces elegans Misra. Dannaoui et al. Sabatelli et al. downy with no reverse pigment. slightly tapering towards the apex. Sporangia are multispored. and hyaline when young but developing a light to dark brown pigmentation and a conspicuous sub-apical thickening 10-16 µm below the apophysis with age. straight or curved. Soil fungus with a tropical to sub-tropical distribution. de Hoog et al. keys to taxa and additional information see Cooter et al. or by using the agar block method described by Ellis and Ajello (1982) and Ellis and Kaminski (1985). Czapek Dox agar. Apophysomyces elegans is readily distinguishable from other zygomycetes of medical importance. Ellis and Ajello. (1986). sparsely septate (coenocytic) hyphae typical of a zygomycetous fungus. . (1982). Sun et al. Lawrence et al. subhyaline to sepia in mass. occasionally subglobose. hyaline at first. (2002). antifungal susceptibility testing of individual strains is recommended. (1985). Sporulation may be stimulated by the use of nutrient deficient media. columellate and strongly apophysate. (2003). Wieden et al. (2006) and WCH in-house data. there is a conspicuous pigmented sub-apical thickening which constricts the lumen of the sporangiophore below the apophysis. Characteristic “cocktail glass” apophysate sporangial morphology with conspicuous sub-apical thickening of the sporangiophore. and there are also distinctive foot cells. sepia-coloured when mature. Sporangiophores arise at right angles from the aerial hyphae and often have a septate basal segment resembling the “foot cell” commonly seen in Aspergillus. typically pyriform in shape. Good growth at 26OC. (2000) and Ellis (2005b). 37OC and 42OC. mostly oblong.03-8 0. (3-4 x 5-6 µm). (1979).5 µm in width near the apophysis. Srivastava & Lata Colonies are fast growing. For descriptions of species. (1990). Columellae are hemispherical in shape and the apophyses are distinctively funnel or bell-shaped. Rhizoids are thin-walled. In addition. Antifungal Fluconazole Itraconazole Posaconazole MIC µg/mL Range >64 0. like cornmeal-glucose-sucrose-yeast extract agar. Sporangiospores are smooth-walled. up to 200 µm long. strongly apophysate pathogen Absidia corymbifera. 3. Sporangiophores are unbranched. white. becoming creamy white to buff with age.03-2 >256 8->64 Very limited data. rapid growth at 42OC. Padhye and Ajello (1988). RG-2 organism. by having sporangiophores with distinctive funnel or bell-shaped apophyses and hemispherical-shaped columellae. small (20-50 µm diameter). subhyaline and predominantly unbranched. Laboratory identification of this fungus may be difficult or delayed because of the mould’s failure to sporulate on the primary isolation media or on subsequent subculture onto potato dextrose agar. and are composed of broad. Misra et al. Key Features: zygomycete. especially the morphologically similar. oblong and subhyaline. multispored. elegans showing a typical funnel-shaped apophysis but without the sub-apical thickening of a more mature sporangiophore. . elegans showing distinctive funnel-shaped apophyses. and a conspicuous pigmented sub-apical thickening which constricts the lumen of the sporangiophore below the apophysis (arrow). (b) Mature sporangium of A.Descriptions of Medical Fungi Apophysomyces elegans Misra. columellae. Sporangiospores are smooth-walled. Srivastava & Lata 10 μm a 10 μm b (a) Young. pyriform sporangium of A. Most species sporulate within 7 days. hyaline or pigmented are produced in long dry chains which may be divergent (radiate) or aggregated in compact columns (columnar). Microscopic mounts are best made using cellotape flag or slide culture preparations mounted in lactophenol cotton blue. Samson et al. isolates are usually inoculated at three points on Czapek Dox agar and 2% malt extract agar and incubated at 25OC. phialides. A drop of alcohol is usually needed to remove bubbles and excess conidia. Samson and Pitt (1990). McGinnis (1980). . Key Features: hyaline hyphomycete showing distinctive conidial heads with flaskshaped phialides arranged in whorls on a vesicle. Descriptions are primarily based on colony pigmentation and morphology of the conidial head. Conidiophores terminate in a vesicle covered with either a single palisade-like layer of phialides (uniseriate) or a layer of subtending cells (metulae) which bear small whorls of phialides (the so called biseriate structure). (1980). conidia phialides vesicle metulae stipe a b Conidial head morphology in Aspergillus (a) uniseriate. Domsch et al. (1995). For descriptions of species. brown to black or shades of green. The vesicle. For identification. Descriptions of Medical Fungi Aspergillus Micheli ex Link Colonies are usually fast growing. Conidia are one-celled. smooth or rough walled. metulae (if present) and conidia form the conidial head. yellow. white. yellow-brown. (2000) and Klich (2002). Some species may produce Hülle cells or sclerotia. mostly consisting of a dense felt of erect conidiophores. (1981). Onions et al. (b) biseriate. keys to taxa and additional information see Raper and Fennell (1965). de Hoog et al. 03-8 0. pale green and conspicuously echinulate. often more noticeable near the vesicle. (2002a). flat. flavus. rough-walled stipes. Espinel-Ingroff (2001. (2003). Conidiophore stipes are hyaline and coarsely roughened. MIC90s from Australian clinical isolates (nd = not done). (2006). however.Descriptions of Medical Fungi Aspergillus flavus Link ex Grey On Czapek Dox agar. Conidial heads are typically radiate. (2003). it is also a recognised pathogen of humans and animals. Key Features: spreading yellow-green colonies. Conidia are globose to subglobose (3-6 µm in diameter).06->8 4 Itraconazole 0. A. Pfaller et al.03->8 nd Espinel-Ingroff et al. Diekema et al. 10mm 10 μm Culture and conidial head of A. flavus has a world-wide distribution and normally occurs as a saprophyte in soil and on many kinds of decaying organic matter. yellow at first but quickly becoming bright to dark yellow-green with age. RG-2 organism. biseriate but having some heads with phialides borne directly on the vesicle (uniseriate). Some strains produce brownish sclerotia. mature vesicles bearing phialides over their entire surface and conspicuously echinulate conidia.125 nd Caspofungin <0. Sabatelli et al. Serrano et al. Cuenca-Estrella et al. colonies are granular. 2003).03-2 0. later splitting to form loose columns (mostly 300-400 µm in diameter).5 Anidulafungin <0. MIC µg/mL Range MIC90 Antifungal Amphotericin B 0.03-0. (2001).5 Voriconazole 0.5 Posaconazole 0. . (2006).03-1 0. often with radial grooves. Note: rough-walled stipe near vesicle (arrow) and that both uniseriate and biseriate conidial heads may be present. smooth-walled and have conical-shaped terminal vesicles which support a single row of phialides on the upper two thirds of the vesicle. Culture and conidial head morphology of (2003). (2001).03-0.015->8 nd 10 μm Espinel-Ingroff et al.0 µm in diameter). (2003). Serrano et al. Key Features: uniseriate and columnar conidial heads with the phialides limited to the upper two thirds of the vesicle and curving to be roughly parallel to each other. fumigatus is truly a cosmopolitan mould and has been found almost everywhere on every conceivable type of substrate. A.5-3. . Note: This species is thermotolerant and grows at temperatures up to 55OC. tralian clinical isolates (nd = not done). Cuenca-Estrella et al. Espinel-Ingroff (2001.03->8 2 Itraconazole <0. fumigatus. Antifungal MIC µg/mL Range MIC90 Amphotericin B 0. green and rough-walled to echinulate. Pfaller et al. A. RG-2 organism.25 Posaconazole <0. Diekema et al. Conidial heads are typically columnar (up to 400 x 50 µm but often much shorter and smaller) and uniseriate.5 Voriconazole <0. 10 Descriptions of Medical Fungi Aspergillus fumigatus Fresenius On Czapek Dox agar. (2002a). Conidiophore stipes are short.125 Anidulafungin <0.125 nd 10mm Caspofungin 0.ides on the upper two thirds of the vesicle. Note: uniseriate row of phialSabatelli et al.03-8 0. Conidia are produced in basipetal succession forming long chains and are globose to subglobose (2. It is an important pathogen of humans and animals.03-2 0. MIC90s from Aus. (2006).03->16 0. 2003). colonies show typical blue-green surface pigmentation with a suede-like surface consisting of a dense felt of conidiophores. (2006). nidulans is a typical soil fungus with a world-wide distribution. On Czapek Dox agar. Reverse may be olive to drab-grey or purple-brown. 20 μm a 10 μm b 20 μm c (a) Cleistothecium of Emericella nidulans (anamorph Aspergillus nidulans) showing numerous reddish-brown ascospores and thick-walled hülle cells. brownish and smooth-walled. it has also been reported causing disease in human and animals. (c) conidial head and stipe and (d) culture of A. brownish and smoothwalled.03-8 0.Descriptions of Medical Fungi 11 Aspergillus nidulans (Eidam) Wint. (2006).03-1 0.25 Voriconazole 0. A. Key Features: conidial heads are short columnar and biseriate. (b) cleistothecia are often surrounded by a mass of hülle cells which are up to 25 µm in diameter. Conidia are globose and rough-walled. Teleomorph: Emericella nidulans (Eidam) Vuill. Conidial heads are short columnar (up to 70 x 30 µm in diameter) and biseriate. Espinel-Ingroff (2003). colonies are typically plain green in colour with dark red-brown cleistothecia developing within and upon the conidial layer. Cuenca-Estrella et al. Conidia are globose (3-3.125-4 2 Itraconazole 0. MIC90s from Australian clinical isolates (nd = not done). (2001).5 µm in diameter) and rough-walled.25 Caspofungin 0. d .25 Posaconazole 0. Antifungal MIC µg/mL Range MIC90 Amphotericin B 0. Conidiophore stipes are usually short. Stipes are usually short. nidulans. RG-1 organism.125-4 0.125-8 nd Espinel-Ingroff et al. 12 Descriptions of Medical Fungi Aspergillus niger van Tieghem On Czapek Dox agar, colonies consist of a compact white or yellow basal felt covered by a dense layer of dark-brown to black conidial heads. Conidial heads are large (up to 3 mm by 15 to 20 µm in diameter), globose, dark brown, becoming radiate and tending to split into several loose columns with age. Conidiophore stipes are smooth-walled, hyaline or turning dark towards the vesicle. Conidial heads are biseriate with the phialides borne on brown, often septate metulae. Conidia are globose to subglobose (3.5-5 µm in diameter), dark brown to black and rough-walled. A. niger is one of the most common and easily identifiable species of the genus Aspergillus, with its white to yellow mat later bearing black conidia. This species is very commonly found in aspergillomas and is the most frequently encountered agent of otomycosis. It is also a common laboratory contaminant. RG-1 organism. Key Features: conidial heads are dark brown to black, radiate and biseriate with metulae twice as long as the phialides. Conidia brown and rough-walled. Antifungal MIC µg/mL Range MIC90 Amphotericin B 0.125-2 2 Itraconazole 0.03->8 0.5 Voriconazole <0.03-4 0.5 Posaconazole 0.03-1 0.25 Anidulafungin 0.03 nd Caspofungin 0.015-0.25 nd Espinel-Ingroff et al. (2001), Pfaller et al. (2002), Diekema et al. (2003), Espinel-Ingroff (2003), Serrano et al. (2003), Cuenca-Estrella et al. (2006). MIC90s from Australian clinical isolates (nd = not done). 10 μm Culture and conidial head morphology of A. niger. Note: conidial heads are biseriate, large, globose, dark brown, becoming radiate with the phialides borne on metulae. Descriptions of Medical Fungi 13 Aspergillus terreus Thom On Czapek Dox agar, colonies are typically suede-like and cinnamon-buff to sand brown in colour with a yellow to deep dirty brown reverse. Conidial heads are compact, columnar (up to 500 x 30-50 µm in diameter) and biseriate. Conidiophore stipes are hyaline and smooth-walled. Conidia are globose to ellipsoidal (1.5-2.5 µm in diameter), hyaline to slightly yellow and smooth-walled. A. terreus occurs commonly in soil and is occasionally reported as a pathogen of humans and animals. RG-2 organism. Key Features: cinnamon-brown cultures, conidial heads biseriate with metulae as long as the phialides. For descriptions of species, keys to taxa and additional information see Raper and Fennell (1965), Domsch et al. (1980), McGinnis (1980), Onions et al. (1981), Samson and Pitt (1990), Samson et al. (1995), de Hoog et al. (2000) and Klich (2002). Antifungal MIC µg/mL Range MIC90 Amphotericin B 0.06-16 4 Itraconazole 0.03-1 0.25 Voriconazole 0.06-2 0.25 Posaconazole 0.03-2 0.125 Anidulafungin 0.03 nd Caspofungin 0.015-0.5 nd Espinel-Ingroff et al. (2001), Pfaller et 10 μm al. (2002), Diekema et al. (2003), Espinel-Ingroff (2003), Serrano et al. (2003), Cuenca-Estrella et al. (2006). MIC90s Culture and conidial head and conidiofrom Australian clinical isolates (nd = not phore of A. terreus. Note: conidial heads are biseriate. done). 14 Descriptions of Medical Fungi Aureobasidium pullulans (de Bary) Arnaud Colonies are fast growing, smooth, soon covered with slimy masses of conidia, cream or pink to brown or black. Hyphae hyaline and septate, frequently becoming darkbrown with age and forming chains of one- to two-celled, thick-walled, darkly pigmented arthroconidia. These arthroconidia actually represent the Scytalidium anamorph of Aureobasidium and are only of secondary importance in recognising members of this genus. Conidia are produced synchronously in dense groups from indistinct scars or from short denticles on undifferentiated, hyaline to sub-hyaline hyphae. Conidia are hyaline, smooth-walled, single-celled, ellipsoidal but of very variable shape and size (8-12 x 4-6 µm), often with an indistinct hilum (= a mark or scar at the point of attachment). Temperature: optimum 25OC; maximum 35-37OC. This species has two varieties: A. pullulans var. pullulans, with a colony which remains pink, light brown, or yellow for at least three weeks, and A. pullulans var. melanogenum which soon becomes black or greenish-black due to dark hyphae which often fall apart into separate cells. A. pullulans has a world-wide distribution and is usually isolated as a saprophyte, occasionally from skin and nails. However, it has also been reported as a rare causative agent of phaeohyphomycosis, mycotic keratitis and peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). RG-1 organism. Key Features: hyphomycete (so called black yeast) producing hyaline blastoconidia simultaneously from the vegetative hyphae, which may also form chains of darkly pigmented, thick-walled arthroconidia. For descriptions of species, keys to taxa and additional information see HermanidesNijhof (1977), Domsch et al. (1980), McGinnis (1980) and de Hoog et al. 2000. 20 μm A. pullulans showing chains of one- to two-celled, darkly pigmented arthroconidia of the Scytalidium anamorph of Aureobasidium and the presence of numerous hyaline, single-celled, ovoid-shaped conidia which are produced on short denticles. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0.125-2 0.03-0.25 0.03-0.5 Very limited data, antifungal susceptibility testing of individual strains is recommended. McGinnis and Pasarell (1998), Espinel-Ingroff et al. (2001) and WCH in-house data. Descriptions of Medical Fungi 15 Basidiobolus ranarum Eidem Synonyms: Basidiobolus meristosporus Drechsler; Basidiobolus heterosporus Srinivasan & Thirumalachar; Basidiobolus haptosporus Drechsler. Colonies are moderately fast growing at 30OC, flat, yellowish-grey to creamy-grey, glabrous, becoming radially folded and covered by a fine, powdery, white surface mycelium. Note: satellite colonies are often formed by germinating conidia ejected from the primary colony. Microscopic examination usually shows the presence of large vegetative hyphae (8-20 µm in diameter) forming numerous round (20-50 µm in diameter), smooth, thick-walled zygospores that have two closely appressed beak-like appendages. The production of “beaked” zygospores is diagnostic for the genus. Two types of asexual conidia are formed, although isolates often lose their sporulating ability with subculture and special media incorporating glucosamine hydrochloride and casein hydrolsate may be needed to stimulate sporulation (Shipton and Zahari, 1987). Primary conidia are globose, one-celled, solitary and are forcibly discharged from a sporophore. The sporophore has a distinct swollen area just below the conidium that actively participates in the discharge of the conidium. Secondary (replicative) conidia are clavate, one-celled and are passively released from a sporophore. These sporophores are not swollen at their bases. The apex of the passively released spore has a knob-like adhesive tip. These spores may function as sporangia, producing several sporangiospores. RG-2 organism. Basidiobolus ranarum is commonly present in decaying fruit and vegetable matter, and as a commensal in the intestinal tract of frogs, toads and lizards. It has been reported from tropical Africa, India, Indonesia and South East Asia including Australia. For descriptions of species, keys to taxa and additional information see Strinivasan and Thirumalachar (1965), Greer and Friedman (1966), Dworzack et al. (1978), McGinnis (1980), King (1983), Rippon (1988), Davis et al. (1994), Jong and Dugan (2003), de Hoog et al. (2000) and Ellis (2005a). 20 μm a 20 μm b (a) Sporophore and conidia and (b) zygospores of Basidiobolus ranarum. For descriptions of species. mostly not exceeding 2 cm in ten days at 20OC. at first white but later often becoming yellow to pinkish. keys to taxa and additional information see de Hoog (1972). Key Features: hyphomycete showing sympodial development of ameroconidia on a geniculate or zig-zag rachis emanating from a flask-shaped conidiophore. RG-1 organism. . (1980). Conidia are hyaline and globose or ovoid in shape. 2-3 mm diameter (phase contrast image). Domsch et al. Conidia are hyaline and globose or ovoid in shape. Beauveria species are occasionally isolated in the clinical laboratory as saprophytic contaminants. proliferating sympodially and are often aggregated into sporodochia or synnemata. Conidiogenous cells are flask-shaped. bassiana is the most common species and is best known as the causal agent of the disastrous muscardine in silkworms. rachiform. The genus Beauveria is characterised by the sympodial development of single-celled conidia (ameroconidia) on a geniculate or zig-zag rachis. 20 μm Beauveria bassiana showing sympodial development of conidia on a geniculate or zig-zag rachis. proliferating sympodially and are often aggregated into sporodochia or synnemata. Three species are recognised. 16 Descriptions of Medical Fungi Beauveria Vuillemin Colonies are usually slow growing. Conidiogenous cells are flask-shaped. rachiform. two of which are well known parasites of insects. B. McGinnis (1980) and de Hoog et al. downy. (2000). (2000). rounded at both ends. hawaiiensis and B. the point at which the germ tube originates from the basal cell and. Bipolaris. keys to taxa and additional information see Ellis (1971 and 1976). Rippon (1988) and de Hoog et al. (1980). . germination bipolar. Curvularia and Exserohilum are causative agents of phaeohyphomycosis which is an emerging mycotic infection of humans and lower animals caused by a number of dematiaceous (brown-pigmented) fungi where the tissue morphology of the causative organism is mycelial. Anamorph Drechslera Bipolaris Main characters Teleomorph Conidia cylindrical. McGinnis et al. suede-like to floccose with a black reverse. RG-1 organisms. notably B. Curvularia Exserohilum Species of Bipolaris. Domsch et al. germinating only from the ends (bipolar). with or without a prominent hilum. australiensis. Conidia with 2-3 broader and darker central Cochliobolus cells. straight. the presence or absence of a protruding hilum. For descriptions of species. fusiform to ellipsoidal poroconidia. smooth to finely roughened. germinating from any cell. the contour of the basal portion of the conidium and its hilum. pseudoseptate. the sequence and location of the first three conidial septa.Descriptions of Medical Fungi 17 Bipolaris Shoemaker Teleomorph: Cochliobolus Drechsler Colonies are moderately fast growing. The genus Bipolaris contains about 45 species which are mostly subtropical and tropical plant parasites. Microscopic morphology shows sympodial development of pale brown pigmented. central cells not Cochliobolus much darker and broader than the distal ones. often curved. Key Features: dematiaceous hyphomycete producing sympodial. Alcorn (1983). to a lesser degree. The genera Drechslera. Pyrenophora hilum not protuberant Conidia fusiform-ellipsoidal. with Setosphaeria a protuberant hilum germination bipolar. pseudoseptate conidia on a geniculate or zig-zag rachis. however several species. Also see Descriptions for Curvularia. germination bipolar. fusiform to ellipsoidal. Luttrell (1978). grey to blackish brown. pale brown. Conidia fusiform-cylindrical to obclavate. Padhye et al. This separates it from other clinical types of disease involving brown-pigmented fungi where the tissue morphology of the organism is a grain (mycotic mycetoma) or sclerotic body (chromoblastomycosis). Sivanesan (1987). Conidia are produced through pores in the conidiophore wall (poroconidia) and are straight. Curvularia and Exserohilum are all closely related and differentiation of the genera relies upon a combination of characters including conidial shape. B. which are rounded at both ends. (1986). hilum not protuberant. effuse. (1980). Drechslera and Exserohilum. spicifera are well documented human pathogens. The table below is modified from Domsch et al. (1986b). McGinnis and Pasarell (1998) and WCH in-house data.05 MIC µg/mL Range 0. pseudoseptate. (2001). poroconidia on a geniculate or zig-zag rachis.06-0. Espinel-Ingroff (2003).06-2 1-4 1-4 Antifungal Itraconazole Posaconazole Voriconazole Antifungal Amphotericin B Anidulafungin Caspofungin Limited data. antifungal susceptibility testing of individual strains is recommended.05 0. (2002a). . fusiform to ellipsoidal. Pfaller et al. MIC µg/mL Range 0.03-1 0. 18 Descriptions of Medical Fungi Bipolaris Shoemaker 10 μm Bipolaris australiensis showing sympodial development of pale brown. Espinel-Ingroff et al.06-0. 03-2 4-16 0.5-8 0. b). (2001). They may grow rapidly. keys to taxa and additional information see McGinnis (1980). smooth-walled conidia (2-10 µm in diameter) of the Chrysosporium type.03->16 0. Espinel-Ingroff et al. Kaufman and Standard (1987) and Rippon (1988).25 2 0. unipolar budding yeastlike cells.125 b Antifungal Amphotericin B Caspofungin 10 μm MIC µg/mL Range MIC90 0. Note: tissue sections need to be stained by Grocott’s methenamine silver method to clearly see the yeast-like cells. producing a fluffy white mycelium or slowly as glabrous. Sugar and Liu (1996). a). however.03-16 0. are borne on short lateral or terminal hyphal branches. ovoid to pyriform. onecelled. the organism produces the characteristic yeast phase as seen in tissue pathology. .125-64 0. Microscopically. (2006). a Antifungal Fluconazole Itraconazole Posaconazole MIC µg/mL Range MIC90 0. Cultures of Blastomyces dermatitidis may represent a biohazard to laboratory personnel and should be handled in an appropriate pathogen handling cabinet. tissue pathology. hyaline. Most strains become pleomorphic with age. which are often difficult to observe in H&E preparations.Descriptions of Medical Fungi 19 Blastomyces dermatitidis Gilchrist & Stokes Colonies (SDA) at 25OC are variable in morphology and rate of growth. culture identification by exoantigen test is now the method of choice. broad-based. For descriptions of species. ie. Microscopically. Chandler et al. (2005) and Sabatelli et al. with some larger forms up to 30 µm in diameter. (1980). conversion from the mould form to the yeast form was necessary to positively identify this dimorphic pathogen from species of Chrysosporium or Sepedonium.125-2 Voriconazole Limited data available. culture identification by positive exoantigen test. which may vary in size from 8-15 µm (Fig. Key Features: clinical history. glabrous and yeast-like. tan. Histopathology: Tissue sections show large. WARNING: RG-3 organism. Gonzales et al. B. Espinel-Ingroff (2003). nonsporulating colonies (Fig. In the past. Colonies on blood agar at 37OC are wrinkled and folded. Growth and sporulation may be enhanced by yeast extract.03-1 0. dermatitidis is a dimorphic fungus.5 0. In the past. parapsilosis. inconspicua 1 0. in 1978 Yarrow & Meyer amended the description of Candida to include all species previously included in Torulopsis. most commonly C. On microscopy.1 C. C. Chromogenic agars are now being used for primary isolation for both the detection of mixed flora and rapid species identification. Identification: Ensure that you start with a fresh growing pure culture. however all inositol positive strains form pseudohyphae.1 C. kefyr 5 0. colliculosa 1 0. tropicalis. rugosa 2 0. lipolytica 1 0.3 C. is lightly inoculated with the test organism and incubated at 35OC for 2-3 hours.3 C. Species distribution from 944 patients with candidemia (Australian Candidemia Study 2002-2004). However.5 C. C. Species No % C. especially from non-sterile sites. Germ Tube Test. dubliniensis 22 2. However a number of other species may also be isolated (see table below). the production of germ tubes by the cells is diagnostic for Candida albicans. 20 Descriptions of Medical Fungi Candida Berkhout The genus Candida is characterised by globose to elongate yeast-like cells or blastoconidia that reproduce by multilateral budding.5% glucose. glabrata 167 17. the genus Torulopsis was separated from the genus Candida by the absence of pseudomycelium. A rapid screening test for Candida albicans and Candida dubliniensis.8 C. polar budding if present on a narrow base. famata 1 0.1 C.2 C. .2 C. 0. krusei 46 4. albicans 447 47. lusitaniae 8 0.3 C. fabianii 1 0.9 C.1 C.8 C.9 C. ballistoconidia and colony pigmentation are always absent. Arthroconidia. krusei and C. glabrata. parapsilosis 182 19. Several species of Candida may be aetiological agents. pelliculosa 3 0.3 C. Fermentation or not: Nitrate assimilation or not: Inositol assimilation or not. streak for single colony isolation if necessary.1 10 μm Production of germ tubes by C. followed by C. pseudohyphae and occasionally true hyphae may also be present. All are ubiquitous and occur naturally on humans. albicans. guilliermondii 11 1. containing 0.5 mL of serum. tropicalis 46 4. albicans. Reference “The Yeasts: a taxonomic study”. (1983). physiological and biochemical tests are essential. morphological (Dalmau plate culture). keys to taxa and additional information see Barnett et al. thick-walled vesicles (often called chlamydospores). Utrecht. Elsevier Science Publishers B. thick-walled vesicles (often called chlamydospores) in Dalmau plate cultures. Candida albicans also produces characteristic large. . For descriptions of species. Amsterdam. For specific identification of species see appropriate text book. Dalmau morphology plates are examined in-situ directly under the lower power of a microscope for the presence of pseudohyphae which may take up to 4-5 days at 26OC to develop. Reliable commercially available yeast identification kits are the API 20C. (2000). The key features to remember are to use a light inoculum and to scratch the surface of the agar with the wire when inoculating. The Netherlands. (b) Physiological and biochemical tests including fermentation and assimilation studies should be performed based on those used at the Centraalbureau voor Schimmelcultures. (b) Confirmatory test for C. albicans. rice/tween 80 or yeast morphology agar plate. Kurtzman and Fell (1988) and de Hoog et al. (a) Dalmau Plate Culture: To set up a yeast morphology plate. terminal. edited by Kurtzman and Fell (1998).Descriptions of Medical Fungi 21 Candida Berkhout For the full identification of germ tube negative yeasts. round. ID32C. 5 mm a 10 μm b (a) Dalmau plate culture showing colonies of C. Note: a coverslip has been placed onto the agar surface covering the scratches. Production of large round.V. MicroScan and Vitek systems. dip a flamed sterilised straight wire into a culture to make a light inoculum and then lightly scratch the wire into the surface of a cornmeal/tween 80. albicans growing out from scratches on the surface of a cornmeal/tween 80 agar plate. then place a flamed coverslip onto the agar surface covering the scratches. glabrata (pink). 10 μm Direct smear of urine from a patient with candidiasis of the kidney showing C. C. smooth surfaced. C. albicans (green). 10 μm . 22 Descriptions of Medical Fungi Candida albicans (Robin) Berkhout CHROMagar Candida plate showing chromogenic colour change for C. Microscopic morphology of C. albicans showing budding spherical to ovoid blastoconidia. albicans in mycelial or tissue phase with blastoconidia budding from the pseudohyphae. waxy colonies. parapsilosis (white) and C. tropicalis (blue). Candida albicans on Sabouraud’s dextrose agar showing typical cream coloured. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + + v -(s) + v + L-Sorbose v v + +(s) v + + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v v -(s) v v v + D-Glucitol -(s) v -(s) + + + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0. stellatoidea have proven to be synonymous with C. MIC90s from the Australian Candidemia Study (nd = not done). known as C. (2005) and Cuenca-Estrella et al. sugar assimilation profile and a distinctive green colour on CHROMagar. w Weak. (2006).No capsules present.008->8 2 Amphotericin B 0. glabrous yeast-like. Physiological Tests: + Positive. (2004).008->8 0.Negative. albicans. Spherical chlamydospores.008->8 0. (2001). C.25 0. v Variable.Descriptions of Medical Fungi 23 Candida albicans (Robin) Berkhout Culture: Colonies (SDA) white to cream-coloured smooth.125 Flucytosine 0. India Ink Preparation: Negative . 2007). (2002b. RG-2 organism. fermentation of glucose.008->4 0. often on a slightly swollen subtending cell are formed near the edge of the cover slip. and sucrose-negative variants described as C.03->64 0. Microscopy: Spherical to subspherical budding blastoconidia. claussenii. Note: germ tube negative variants. Richter et al. albicans is a commensal of mucous membranes and the gastrointestinal tract. . 2006. air and plants.03->64 0.03 Anidulafungin MIC µg/mL Range MIC90 0. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Branched pseudohyphae with dense verticils of blastoconidia. 2-7 x 3-8 µm in size. Espinel-Ingroff (2003). production of chlamydospores on Dalmau plate culture. Hajjeh et al. Espinel-Ingroff et al.03-4 0. .016 Caspofungin 0. Environmental isolations have been made from sources contaminated by human or animal excreta.125 nd Good data available.5 0. Pfaller et al. mostly terminal.008->8 0. Antifungal Fluconazole Itraconazole Posaconazole Voriconazole MIC µg/mL Antifungal Range MIC90 0.1% Cycloheximide + Key Features: germ tube positive. soil. such as polluted water. 25 Flucytosine 0. Ascospores may be produced on 5% malt extract or cornmeal agar after 5-30 days at 25OC.25 Caspofungin 0.06 Voriconazole 0. .s v v v L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v v + D-Glucitol v v v v + v v Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. 24 Descriptions of Medical Fungi Candida colliculosa (Hartmann) S. antifungal susceptibility testing of individual stains is recommended. No pseudohyphae or true hyphae produced.1% Cycloheximide - Key Features: asci containing 1-4 spheroidal ascospores. . RG-1 organism.Negative. colliculosa is a rare cause of candidemia. Microscopy: Spherical to ellipsoidal budding blastoconidia. Data from the Australian Candidemia Study (nd = not done). v Variable.No capsules present. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Budding yeast cells only. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + v + v v v v L-Sorbose v v v -. 2-6 x 3-7 µm in size. C. variable growth at 37OC and a variable sugar assimilation profile.06 Anidulafungin nd Very limited data. Culture: Colonies (SDA) white to cream-coloured smooth. w Weak. MIC µg/mL Range MIC µg/mL Range Antifungal Antifungal Fluconazole 8 Amphotericin B 0. glabrous yeast-like. Meyer & Yarrow Teleomorph: Torulaspora delbrueckii (Lindner) Lindner.A.25 Itraconazole 0.03 Posaconazole 0. India Ink Preparation: Negative . Physiological Tests: + Positive. Descriptions of Medical Fungi 25 Candida dubliniensis Sullivan et al. Culture: Colonies (SDA) white to cream-coloured smooth, glabrous yeast-like. Microscopy: Spherical to subspherical budding blastoconidia, 3-8 x 2-7 µm in size. India Ink Preparation: Negative - No capsules present. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Branched pseudohyphae with dense verticils of blastoconidia and spherical, mostly terminal chlamydospores. Physiological Tests: + Positive, - Negative, v Variable, w Weak, s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + + v + v + L-Sorbose + + + v + + v L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine -,s +,s +,s + D-Glucitol + +,s -,s + + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0.1% Cycloheximide + Key Features: germ tube positive, similar to C. albicans, except for absence of growth at 45oC; glycerol (mostly +), methyl-a-D-glucoside (-), trehalose (-), and D-xylose (-). Initial colonies dark green colour on CHROMagar and producing rough colonies on bird seed agar. C. dubliniensis is an uncommon cause of candidemia and mucosal infection, especially in HIV patients. RG-2 organism. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 0.05->64 1 Amphotericin B 0.03-2 0.125 Itraconazole 0.008->8 0.125 Flucytosine 0.03-64 0.125 Posaconazole 0.03-1 0.125 Caspofungin 0.008-1 0.25 Voriconazole 0.008-2 0.016 Anidulafungin <0.125-8 nd Good data available. Espinel-Ingroff et al. (2001), Pfaller et al. (2002b, 2007), EspinelIngroff (2003) and Hajjeh et al. (2004). MIC90s from the Australian Candidemia Study (nd = not done). 26 Descriptions of Medical Fungi Candida fabianii (Hartmann) S.A. Meyer & Yarrow Teleomorph: Pichia fabianii (Wickerham) Kurtzman Culture: Colonies (SDA) white to cream-coloured smooth, glabrous yeast-like. Microscopy: Spheroidal to ellipsoidal budding blastoconidia, 3.0-6.5 x 2-5.5 µm in size. No pseudohyphae produced. Asci when present spherical, containing 1-4 spherical, faintly roughened ascospores. India Ink Preparation: Negative - No capsules present. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Spherical to ovoid budding yeast cells and occasional pseudohyphae produced. Physiological Tests: + Positive, - Negative, v Variable, w Weak, s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + + +,s L-Sorbose + + + + + + + + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine + + D-Glucitol + + + + + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern. Molecular identification may be required. Candida fabianii is a rare cause of candidemia. RG-1 organism. Antifungal MIC µg/mL Range Antifungal MIC µg/mL Range Fluconazole 8 Amphotericin B 0.125 Itraconazole 0.5 Flucytosine 0.03 Posaconazole 0.5 Caspofungin 0.5 Voriconazole 0.125 Anidulafungin nd Very limited data, antifungal susceptibility testing of individual strains is recommended. Data from the Australian Candidemia Study (nd = not done). Descriptions of Medical Fungi 27 Candida famata (Harrison) S.A. Meyer & Yarrow Teleomorph: Debaryomyces hansenii (Zopf) Lodder & Kreger-van Rij. Culture: Colonies (SDA) white to cream-coloured smooth, glabrous yeast-like. Microscopy: Ovoid to broadly ellipsoidal budding blastoconidia, 3.5-5 x 2-3.5 µm in size. No pseudohyphae produced. Asci when present spherical, persistent, containing 1-2 spherical ascospores with rough walls. India Ink Preparation: Negative - No capsules present. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Spherical to ovoid budding yeast cells only. No pseudohyphae produced. Physiological Tests: + Positive, - Negative, v Variable, w Weak, s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + -,w -,w -,w -,w L-Sorbose v + + + + v v + v v + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine +,w D-Glucitol v v v v + v + v + α-M-D-glucoside D-Gluconate DL-Lactate +,w + +,w v + v +,w Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine v Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0.1% Cycloheximide v Key Features: germ tube negative yeast and sugar assimilation pattern. Candida famata is a common environmental isolate, however it is only rarely recovered from clinical specimens, usually associated with skin. RG-1 organism. MIC µg/mL Range MIC µg/mL Range Antifungal Antifungal Fluconazole 0.125->64 Amphotericin B 0.06-2 Itraconazole 0.03->8 Flucytosine 0.06-128 Posaconazole 0.06-1 Caspofungin 0.06->16 Voriconazole 0.03-1 Anidulafungin 0.008->16 Limited data, antifungal susceptibility testing of individual strains is recommended. Espinel-Ingroff et al. (2001), Pfaller et al. (2003, 2007), Espinel-Ingroff (2003), Cuenca-Estrella et al. (2006) and the Australian Candidemia Study. 28 Descriptions of Medical Fungi Candida glabrata (Anderson) S.A. Meyer & Yarrow Synonym: Torulopsis glabrata (Anderson) Lodder & de Vries Culture: Colonies (SDA) white to cream-coloured smooth, glabrous yeast-like. Microscopy: Ovoid to ellipsoidal budding blastoconidia, 3.4 x 2.0 µm in size. No pseudohyphae or chlamydospores produced. India Ink Preparation: Negative - No capsules present. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Ovoid budding yeast cells only. No pseudohyphae produced. Physiological Tests: + Positive, - Negative, v Variable, w Weak, s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + v L-Sorbose - L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine +,s - D-Glucitol v + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern. Candida glabrata is one of the most common yeast species to be found on the body surface and is often isolated as an incidental finding from skin and urine. It has been implicated as an “opportunistic” cause of both superficial and systemic infections, especially in immunocompromised patients, and it has been isolated from patients with septicemia, pyelonephritis, pulmonary infections, endocarditis and hyperalimentation. Approximately 10% of clinical isolates show azole cross resistance. RG-2 organism. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 0.03->128 128 Amphotericin B 0.008-2 0.5 Itraconazole 0.008->16 16 Flucytosine 0.008-16 0.03 Posaconazole 0.008-8 8 Caspofungin 0.008->8 0.25 Voriconazole 0.008-16 2 Anidulafungin 0.008-8 nd Good data available. Espinel-Ingroff et al. (2001), Pfaller et al. (2002b, 2006, 2007), Espinel-Ingroff (2003), Hajjeh et al. (2004), Richter et al. (2005) and Cuenca-Estrella et al. (2006). MIC90s from the Australian Candidemia Study (note: in this study 10% of primary blood isolates were azole cross-resistant, nd = not done). No capsules present.03-8 0.03-8 0. fish.03-8 1. faeces of animals.0 x 3.125 Posaconazole 0. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 0. Culture: White to cream-coloured smooth. glabrous yeast-like colonies. mostly of cutaneous origin. v Variable.03-8 0.125->128 16 Amphotericin B 0.04.1% Cycloheximide v Key Features: germ tube negative yeast and sugar assimilation pattern. Espinel-Ingroff (2003) and Cuenca-Estrella et al. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + + v + + L-Sorbose v + + v + v + v + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v v + v + + + v v D-Glucitol v v v v + v Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. . RG-1 organism. (2001). Physiological Tests: + Positive.5 µm. MIC90s from the Australian Candidemia Study (nd = not done). Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Branched pseudohyphae with dense verticils of blastoconidia.03-1 0. w Weak. India Ink Preparation: Negative . 2007).Negative.5 Voriconazole 0. (2003. 2. Candida guilliermondii has been isolated from numerous human infections. fig wasps. Pfaller et al. . Espinel-Ingroff et al. leather.5 Itraconazole 0. and beer.0-6. It is also found from normal skin and in sea water.125->8 0.0 Flucytosine 0. 2006.Descriptions of Medical Fungi 29 Candida guilliermondii (Castellani) Langeron & Guerra Teleomorph: Pichia guilliermondii Wickerham.25 Anidulafungin 0.06-4 nd Good data available. buttermilk.5 Caspofungin 0. (2006). Microscopy: Spherical to subspherical budding yeast-like cells or blastoconidia. s L-Sorbose + + + +. budding yeast-like cells only. Candida haemulonii has been reported from a few cases of fungemia but clinical isolations remain rare.s v -.s + D-Glucitol + + + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0.0-5.s +. (2007). famata using some commercial yeast identification systems due to data base limitations. India Ink Preparation: Negative . C. v Variable. Microscopy: Ovoid to globose. Physiological Tests: + Positive.s L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine -. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + -.5 µm. No pseudohyphae produced. Molecular identification may be required. budding yeast-like cells or blastoconidia. Rodero et al. (2002) and Khan et al. 3.06-0.0 x 3.s s -.s + + +. .No capsules present.5 Caspofungin 0.0-6.s -. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Spherical to ovoid. It has also been isolated from fish and a dolphin.125-4 Flucytosine 0.s -. No pseudohyphae produced.s +.1% Cycloheximide + Key Features: germ tube negative yeast and sugar assimilation pattern.s +. RG-1 organism. haemulonii may be difficult to distinguish from C. glabrous yeast-like. antifungal susceptibility testing of individual strains is recommended.Negative.5 Very limited data. .125 Voriconazole 0.s +.03-0.008-0. w Weak. Antifungal MIC µg/mL Range Antifungal MIC µg/mL Range Fluconazole 32->256 Amphotericin B 2-8 Itraconazole 0. 30 Descriptions of Medical Fungi Candida haemulonii (van Uden & Kolipinski) Meyer & Yarrow Synonym: Torulopsis haemulonii van Uden & Kolipinski Culture: Colonies (SDA) white to cream-coloured smooth. 1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern. .25-8 Flucytosine 1-64 Posaconazole 0. RG-1 organism.125->8 Itraconazole 0. glabrous yeast-like.Negative.Descriptions of Medical Fungi 31 Candida inconspicua (Lodder & Kreger-van Rij) S. Candida inconspicua is a rare cause of candidemia.008-0. India Ink Preparation: Negative .A.0 µm. w Weak. . Culture: Colonies (SDA) white to cream-coloured smooth.No capsules present. Primitive pseudohyphae may be produced after 14 days. Physiological Tests: + Positive.0-5 x 5. Pfaller et al.5-8 Caspofungin 0. (2003).25 Voriconazole 0. Espinel-Ingroff (2003) and the Australian Candidemia Study (nd = not done). Microscopy: Ovoidal budding blastoconidia. MIC µg/mL Range MIC µg/mL Range Antifungal Antifungal Fluconazole 4-128 Amphotericin B 0. 2.125-4 Anidulafungin nd Very limited data. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + L-Sorbose - L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine + + - D-Glucitol + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0. v Variable.Meyer & Yarrow Synonym: Torulopsis inconspicua Lodder & Kreger-van Rij.0-11. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Spherical to ovoid budding yeast cells only. antifungal susceptibility testing of individual strains is recommended. wavy.1% Cycloheximide + Key Features: germ tube negative yeast and sugar assimilation pattern. v Variable.5 x 5. sometimes becoming elongate (up to 16.0 µm). (2003. antifungal susceptibility testing of individual strains is recommended.125 Voriconazole 0. 32 Descriptions of Medical Fungi Candida kefyr (Beijerinck) van Uden & Buckley Synonym: Candida pseudotropicalis (Castellani) Basgal. MIC90s from the Australian Candidemia Study (nd = not done). India Ink Preparation: Negative .03-1 0. Pfaller et al.No capsules present. Environmental isolations have been made from cheese and dairy products.125-4 0. long.06 Flucytosine 0.0 µm. w Weak. Microscopy: Short-ovoid to long-ovoid. . Espinel-Ingroff et al. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 0. budding blastoconidia.5-11. Teleomorph: Kluyveromyces marxianus (Hansen) van der Walt. . often in a verticillated position.03-0.5 0.008-0.03-0.25 Caspofungin 0.5 Amphotericin B 0. with ovoid blastoconidia.03-0.s + v L-Sorbose v + v -. Physiological Tests: + Positive. Note: in some strains pseudohyphae may be scarce or almost absent. branched pseudohyphae usually formed. RG-1 organism. in pairs or chains. glabrous yeast-like. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + s + +. budding off singly. 2006). 3. Candida kefyr is a rare cause of candidiasis and is usually associated with superficial cutaneous manifestations rather than systemic disease.w v + s L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v v s s v D-Glucitol v + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0.016 Anidulafungin 0.5 nd Limited data. Culture: Colonies (SDA) white to cream-coloured smooth.25 0. (2001).125 0. Espinel-Ingroff (2003) and Cuenca-Estrella et al.Negative. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Abundant. (2006).125->8 1 Itraconazole 0.03-64 16 Posaconazole 0.0-6. 5-64 16 Posaconazole 0. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Abundant long. (2001). .5 x 4. 2007). respiratory and urinary tracts of patients with granulocytopenia. Richter et al.1% Cycloheximide v Key Features: germ tube negative yeast and sugar assimilation pattern. (2006). Environmental isolations have been made from beer. v Variable.03->8 0. MIC90s from the Australian Candidemia Study (nd = not done). elongated to ovoid budding blastoconidia.06->8 1 Itraconazole 0. wavy. faeces of animals and birds and pickle brine. w Weak. glabrous yeast-like. Pfaller et al. .125->4 1 Voriconazole 0. 2003.Descriptions of Medical Fungi 33 Candida krusei (Castellani) Berkhout Teleomorph: Issatchenkia orientalis Kudryavtesev. Hajjeh et al. (2002b. branched pseudohyphae with elongated to ovoid blastoconidia.03-1 1 Caspofungin 0. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + L-Sorbose - L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine + + - D-Glucitol + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 0.25->128 64 Amphotericin B 0. Culture: Colonies (SDA) white to cream-coloured smooth.008-8 nd Good data available. Physiological Tests: + Positive.5 Anidulafungin 0. (2004).0-15. Espinel-Ingroff et al. skin.0-5. India Ink Preparation: Negative .5 Flucytosine 0. budding off in verticillate branches.Negative.03-4 0. It has also been reported to colonise the gastrointestinal. 2. Espinel-Ingroff (2003). (2005) and Cuenca-Estrella et al. milk products.No capsules present. RG-2 organism. Microscopy: Predominantly small. Candida krusei is regularly associated with some forms of infant diarrhoea and occasionally with systemic disease.0 µm. No capsules present. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + v L-Sorbose v w.5 Limited data. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Pseudohyphae and true hyphae are produced. (2001). .06-8 Flucytosine 0.0 µm. Harrison) Diddens & Lodder Teleomorph: Yarrowia lipolytica (Wickerham et al.125-64 Posaconazole 0.0-5 x 3. glabrous yeast-like. Espinel-Ingroff (2003) and Australian Candidemia Study. Culture: Colonies (SDA) white to cream-coloured smooth.Negative. Espinel-Ingroff et al. RG-1 organism. Candida lipolytica is a rare cause of candidemia. . 3. antifungal susceptibility testing of individual strains is recommended. ellipsoidal to elongate budding blastoconidia.06-1 Itraconazole 0. (2003). 34 Descriptions of Medical Fungi Candida lipolytica (F. w Weak. MIC µg/mL Range MIC µg/mL Range Antifungal Antifungal Fluconazole 1->64 Amphotericin B 0.125-0. v Variable.03-4 Caspofungin 0.03-1 Anidulafungin 0.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern. Microscopy: Spherical.C. Physiological Tests: + Positive.) van der Walt & von Arx. Pfaller et al.3-15.- L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v + + v + D-Glucitol + v + v Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. India Ink Preparation: Negative .25-2 Voriconazole 0. 5-6. 2003).25 Caspofungin 0.125-64 8 Amphotericin B 0. . RG-2 organism.03->8 nd Some data available.0 x 2.008-2 0.Descriptions of Medical Fungi 35 Candida lusitaniae van Uden & do Carmo-Sousa Teleomorph: Clavispora lusitaniae Rodrigues de Miranda.03-128 0.5-10. including septicemia and pyelonephritis. w Weak.125 Itraconazole 0. India Ink Preparation: Negative .125 Anidulafungin 0.0 µm. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Abundant pseudohyphae with short chains of blastoconidia. MIC90s from the Australian Candidemia Study (nd = not done).125 Flucytosine 0. Microscopy: Ovoid to ellipsoidal budding blastoconidia. v Variable. Espinel-Ingroff (2003) and Cuenca-Estrella et al. lusitaniae may also be difficult to distinguish from C. . and milk from cows with mastitis.03-8 0. Culture: Colonies (SDA) white to cream-coloured smooth.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern. glabrous yeast-like. C.5 Voriconazole 0. Pfaller et al. (2006).No capsules present. C. Physiological Tests: + Positive.w + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0. Candida lusitaniae is a known cause of disseminated candidiasis.03 Posaconazole 0. Espinel-Ingroff et al. citrus peel. fruit juices.008-0. lusitaniae was first isolated from the alimentary tract of warm blooded animals and environmental isolations have been made from cornmeal.5 0.Negative. 1. (2001). s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + + v v v v L-Sorbose + + + + + + + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v v + s + D-Glucitol + v s +. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 0.06-2 0.125-4 0. tropicalis using some yeast identification systems. (2002b. RG-1 organism. .25 Flucytosine 8 Voriconazole 0.5-5. Culture: Colonies (SDA) white to cream-coloured smooth. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Spherical to ovoid budding yeast cells only. Microscopy: Ovoid.5 x 3. glabrous yeast-like. w Weak.0 µm.0-3. MIC µg/mL Range MIC µg/mL Range Antifungal Antifungal Fluconazole 16 Amphotericin B 1 Itraconazole 0. 36 Descriptions of Medical Fungi Candida norvegensis Dietrichson ex van Uden & Buckley Teleomorph: Pichia norvegensis Leask & Yarrow.125 Posaconazole 0. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + s L-Sorbose + - L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine + + - D-Glucitol w + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. Candida 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. 2. No pseudohyphae produced. budding blastoconidia. Pfaller et al.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern.Negative. Pseudohyphae rarely produced. (2002b).125 Very limited data.No capsules present. Physiological Tests: + Positive. v Variable. India Ink Preparation: Negative . antifungal susceptibility testing of individual strains is recommended. . 125->64 8 Amphotericin B 0.s + + + + + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine + v v + +. Espinel-Ingroff et al. (2006). Physiological Tests: + Positive.5 x 3. MIC90s from the Australian Candidemia Study (nd = not done). 2007). (2005) and Cuenca-Estrella et al.008->8 nd Good data available. globose to ovoid budding blastoconidia. orthopsilosis and C. . with some larger elongated forms present. olives and normal skin. These three species are phenotypically indistinguishable and are best distinguished by genetic analysis.0-4. especially endocarditis.008-2 0. C. Culture: Colonies (SDA) white to cream-coloured smooth. RG-1 organism.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern. Hajjeh et al.s -. India Ink Preparation: Negative .5 0. metapsilosis (Tavanti et al.03 Caspofungin 0.25 Posaconazole 0.03->8 1 Voriconazole 0. . much-branched pseudohyphae in a delicate tree-like pattern with 2-3 blastoconidia in small clusters at intervals along the pseudohyphae. cured meats.s -.5 µm.016-2 0.03->64 0. v Variable. especially of the nail and systemic disease. glabrous yeast-like. Richter et al.0-3. Antifungal susceptibility data from the Australian Candidemia Study also shows no significant differences between the species.Descriptions of Medical Fungi 37 Candida parapsilosis Complex Recently Candida parapsilosis has been recognised as 3 species: C. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + + v -. (2001).5 Itraconazole 0.Negative.25 Anidulafungin 0. Espinel-Ingroff (2003). Environmental isolations have been made from intertidal and oceanic waters. (2004). (2002b. Other clinical manifestations include endophthalmitis and fungemia. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Abundant. Candida parapsilosis is an opportunistic human pathogen which may cause cutaneous infections. and faeces.008-0. w Weak. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Fluconazole 0.015-2 0.25 Flucytosine 0. Microscopy: Predominantly small.s + D-Glucitol + + +. parapsilosis.s L-Sorbose +. pickle brine.No capsules present. 2. Pfaller et al. 2005). 2006.s + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. 25-2 Flucytosine 0.5 Voriconazole 0. India Ink Preparation: Negative . glabrous yeast-like. containing 1-4 hat-shaped ascospores. (2006) and the Australian Candidemia Study (nd = not done). w Weak. Antifungal MIC µg/mL Range Antifungal MIC µg/mL Range Fluconazole 2-16 Amphotericin B 0. Physiological Tests: + Positive. Microscopy: Spherical to ellipsoidal budding blastoconidia. 38 Descriptions of Medical Fungi Candida pelliculosa Redaelli Teleomorph: Pichia anomala (Hansen) Kurtzman. Cuenca-Estrella et al.125-1 Caspofungin 0. v Variable. . Pfaller et al. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Spherical to ellipsoidal budding yeast cells and abundant pseudohyphae in most strains. fruit and warm blooded animals. (2003). antifungal susceptibility testing of individual strains is recommended. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + v + v + v L-Sorbose + + + + + + + v L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v v + + v + D-Glucitol + + v + n + v Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. Culture: Colonies (SDA) white to cream-coloured smooth. grains. Asci when present. Candida pelliculosa has been reported from cases of candidemia and catheter related infections in humans and has been isolated from soil.25 Anidulafungin nd Limited data available. Pseudohyphae may be present.03-64 Posaconazole 0.125-2 Itraconazole 0. . RG-1 organism. 2-4 x 2-6 µm.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern.No capsules present.06-0.Negative. Espinel-Ingroff (2003).06-0. glabrous yeast-like. (2001). Microscopy: Ellipsoidal to elongate budding blastoconidia.Negative.s +. sea water and soil.25 Caspofungin 0. Pfaller et al. .25-4 Antifungal Fluconazole Antifungal Amphotericin B Itraconazole 0. antifungal susceptibility testing of individual strains is recommended. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Ellipsoidal budding yeast cells only and densely branched pseudohyphae produced. Espinel-Ingroff (2003) and the Australian Candidemia Study. w Weak.03-1 Flucytosine 0. MIC µg/mL Range 1-16 MIC µg/mL Range 0. Sometimes short pseudohyphae may be produced.25 Anidulafungin 0.s + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine s Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0.s D-Glucitol +.5 µm.25-2 Voriconazole 0.06-0.Descriptions of Medical Fungi 39 Candida rugosa (Anderson) Diddens & Lodder Culture: Colonies (SDA) white to cream-coloured smooth.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern.No capsules present.s v +. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + L-Sorbose v v L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine + -. v Variable. (2003). India Ink Preparation: Negative .008-0. Espinel-Ingroff et al. . 6-10 x 2-3.03-4 Limited data. RG-1 organism.06-16 Posaconazole 0. Physiological Tests: + Positive. Candida rugosa has been associated with catheter related fungemia and has been isolated from human and bovine faeces. 3-5.s + D-Glucitol + v v v + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine + Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0. (2005) and Cuenca-Estrella et al. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 0. Espinel-Ingroff (2003). Terminal vesicles (chlamydospores) are not produced. Pfaller et al.125->128 2 Amphotericin B 0.25 Anidulafungin 0. Physiological Tests: + Positive. Microscopy: Spherical to subspherical budding yeast-like cells or blastoconidia. (2006). India Ink Preparation: Negative .5 Itraconazole 0. budding off.008->8 0. glabrous yeast-like. Hajjeh et al. wavy. 40 Descriptions of Medical Fungi Candida tropicalis (Castellani) Berkhout Culture: Colonies (SDA) white to cream-coloured smooth.s + v + + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine -. long. branched pseudohyphae with numerous ovoid blastoconidia.Negative.03->64 0.03->8 0. It is also found as part of the normal human mucocutaneous flora and environmental isolations have been made from faeces. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + + + v + +.s v v +.125 Posaconazole 0. (2001). v Variable. and soil. (2004).03-8 0.No capsules present. RG-2 organism.008->8 0.06 Caspofungin 0. Richter et al. 2006. .1% Cycloheximide + Key Features: germ tube negative yeast and sugar assimilation pattern. Candida tropicalis is a major cause of septicemia and disseminated candidiasis. w Weak.s L-Sorbose v v + +. Espinel-Ingroff et al. MIC90s from the Australian Candidemia Study (nd = not done).03->8 nd Good data available. shrimp.03->8 0. kefir. 2007). . Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Abundant. (2002b.5 Flucytosine 0.5 x 4-9 µm.25 Voriconazole 0. and all are saprophytic being isolated from soil. RG-1 organism. For descriptions of species. terminal hairs.5 Very limited data. dung and plant debris. branched or curved. Seth (1970). mostly ovoid. straw. Ellis (1981) and de Hoog et al. antifungal susceptibility testing of individual strains is recommended. Chaetomium species are important agents for the decomposition of cellulose waste and plant materials. ostiolate ascocarps (perithecia) beset with dark-coloured terminal hairs (setae) which are straight. Asci are clavate to cylindrical. Key Features: ascomycete producing darkly-pigmented ostiolate perithecia beset with long dark terminal setae. ovoid.125-0. Ellis and Keane (1981). typically eight-spored and evanescent. globose. (1980). barrel to flask-shaped. smooth-walled.Descriptions of Medical Fungi 41 Chaetomium Kunze ex Fries This genus is a common ascomycete (pyrenomycete) characterised by the formation of darkly-pigmented. ellipsoidal or lemon-shaped. of varying shape. darkly-pigmented. keys to taxa and additional information see Ames (1963). McGinnis and Pasarell (1998) and WCH in-house data. 100 μm 10 μm Ascocarp (perithecia).125-16 Itraconazole 0. Antifungal Amphotericin B MIC µg/mL Range Antifungal MIC µg/mL Range Antifungal MIC µg/mL Range 0. However. (2000). Millner (1975). quite a few species are thermophilic and can grow at temperatures above 37OC. The genus contains between 160 and 180 species. Domsch et al. asci and ascospores of Chaetomium.125 Voriconazole 0. . and are only rarely isolated in medical mycology laboratories.03-0. Ascospores are one-celled. Chlamydospores and solitary conidia may also be produced. white to cream-coloured with a very granular surface. Reverse pigment absent or pale brownish-yellow with age. often with a powdery or granular surface texture. (1980) and de Hoog et al. 10 μm Chrysosporium tropicum showing typical pyriform to clavate-shaped conidia with truncated bases which may be formed either intercalary. on short or long lateral branches. smooth. or sessile along the hyphae (intercalary). Chrysosporium tropicum Carmichael Colonies are flat. (2000). and cultures may closely resemble some dermatophytes. one-celled conidia are produced directly on vegetative hyphae by non-specialised conidiogenous cells. No macroconidia or hyphal spirals are seen. keys to taxa and additional information see Carmichael (1962). Microscopically. especially Trichophyton mentagrophytes. Rebell and Taplin (1970). For descriptions of species. There are about 22 species of Chrysosporium. laterally or terminally. Domsch et al. Reverse pigment absent or pale brownish-yellow with age. conidia are numerous. clavate to pyriform. . hyaline. Sigler and Carmichael (1976). single-celled. especially from feet. and have broad truncate bases and pronounced basal scars. flat. RG-2 organism. several are keratinolytic with some also being thermotolerant. Van Oorschot (1980). and some strains may also resemble cultures of Histoplasma and Blastomyces. laterally (often on pedicels) or terminally.5-4 µm). slightly thick-walled (6-7 x 3. Hyaline. white to tan to beige in colour. Conidia are typically pyriform to clavate with truncate bases and are formed either intercalary (arthroconidia). 42 Descriptions of Medical Fungi Chrysosporium Corda Colonies are moderately fast growing. Species of Chrysosporium are occasionally isolated from skin and nail scrapings. but because they are common soil saprophytes they are usually considered as contaminants. The conidia are formed at the tips of the hyphae. and Cladosporium species which have a maximum of less than 35OC).5 Voriconazole 0. The fungus is neurotropic and may cause brain abscesses in both normal and immunosuppressed patients. (2000).Descriptions of Medical Fungi 43 Cladophialophora bantiana (Saccardo) de Hoog et al. pale brown. Synonym: Xylohypha bantiana (Saccardo) McGinnis. sparsely branched. Conidia are one-celled (very occasionally two-celled). Conidia are formed in long. KwonChung and Bennett (1992) and de Hoog et al.008-0. Cladophialophora bantiana has been isolated from soil and is a recognised agent of cerebral phaeohyphomycosis.06 Itraconazole 0.06 0.03-2 0. smooth-walled. (1986a). acropetal chains from undifferentiated conidiophores. Cladophialophora bantiana may be distinguished from Cladosporium species by the absence of conidia with distinctly pigmented hila.5 Posaconazole 0. .03-1 0. the absence of characteristic shield cells and by growth at 42OC (compared with Cladophialophora carrionii which has a maximum growth temperature of 35-36OC. (2001). suede-like to floccose and grow at temperatures up to 42-43OC. flexuose. ellipsoid to oblong-ellipsoid and are 2-3 x 4-7 µm in size.5 0.125 Limited data. McGinnis and Borelli (1981). Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Amphotericin B 0. antifungal susceptibility testing of individual strains is recommended. Espinel-Ingroff (2001) and WCH in-house data. Borelli and Ajello Colonies are moderately fast growing. For descriptions of species. RG-2 organism. olivaceous-grey.03-0. Espinel-Ingroff et al. keys to taxa and additional information see McGinnis (1980). McGinnis and Pasarell (1998). Rippon (1988). 10 μm Conidiophore and conidia of Cladophialophora bantiana. McGinnis et al. 0 x 2. Madagascar and South America.25 Itraconazole 0. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Amphotericin B 0.0 µm in size.5 0. 1. Venezuela.07. (2001). (2005) and WCH in-house data.06-4 1 Posaconazole 0. keys to taxa and additional information see McGinnis (1980). Isolates from phaeomycotic cysts and opportunistic infections have also been reported. For descriptions of species.03-0. McGinnis and Pasarell (1998). carrionii are commonly found in Australia. smooth-walled or slightly verrucose. 44 Descriptions of Medical Fungi Cladophialophora carrionii (Trejos) de Hoog et al. RG-2 organism. limoniform to fusiform.03-0. antifungal susceptibility testing of individual strains is recommended. de Hoog et al.06-0.5-3. elongate conidiophores producing branched acropetal chains of smooth-walled conidia. olivaceous-green.25 Limited data. (2000).5 0. hyaline conidia are occasionally formed on nutritionally poor media. apically branched. Key Features: conidia are smaller and comprise heavily branched systems which fall apart much more easily than in the other Cladophialophora species. Cladophialophora carrionii is a recognised agent of chromoblastomycosis and it has been isolated from soil and fence posts made from Eucalyptus sp. Rippon (1988). Bulbous phialides with large collarettes and minute. 10 μm Conidiophores and conidia of Cladophialophora carrionii. Synonym: Cladosporium carrionii Trejos Colonies are slow growing. with a compact suede-like to downy surface and are olivaceous-black in colour. Microscopy shows ascending to erect. Gonzales et al.5 Voriconazole 0. Espinel-Ingroff et al.5 0. Conidia are pale olivaceous. Cases of chromoblastomycosis caused by C. reaching 3-4 cm in diameter after one month. Maximum growth temperature 35-37OC. . (1995) and de Hoog et al. one. The pathogenic species have now been transferred to the genus Cladophialophora. antifungal susceptibility testing of individual strains is recommended. Note: the conidia closest to the conidiophore. . McGinnis and Pasarell (1998) and WCH in-house data. buff or brown. The presence of shield-shaped conidia. are usually “shield-shaped”. Conidiophores are more or less distinct from the vegetative hyphae. and chains of conidia that readily disarticulate. Some 500 species have been described. mostly olivaceous-brown to blackish brown but also sometimes grey. straight or flexuose. (1980).03-32 0. verrucose or echinulate. (2000). a distinct hilum. The term blastocatenate is often used to describe chains of conidia where the youngest conidium is at the apical or distal end of the chain. being smooth. conidiophores and conidia are equally pigmented. and have a distinct dark hilum. RG-1 organisms. with geniculate sympodial elongation in some species. unbranched or branched only in the apical region. 10 μm Conidiophores and conidia of Cladosporium cladosporioides. and where the chains branch.Descriptions of Medical Fungi 45 Cladosporium Link ex Fries Colonies are rather slow growing. keys to taxa and additional information see Ellis (1971 and 1976). Domsch et al. each with a distinct hilum. Vegetative hyphae.to four-celled. being erect. For descriptions of species.06-1 Very limited data. Conidia are produced in branched acropetal chains. Key Features: dematiaceous hyphomycete forming branched acropetal chains of conidia. suede-like to floccose. McGinnis (1980) and de Hoog et al. are diagnostic for the genus Cladosporium. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. Cladosporium species have a world-wide distribution and are amongst the most common of air-borne fungi. Isolates of Cladosporium are frequently isolated as contaminants. often becoming powdery due to the production of abundant conidia.03-8 0. posadasii is found in the desert regions of the USA southwest. Endospores (sporangiospores) are later formed within the spherule by repeated cytoplasmic cleavage. 46 Descriptions of Medical Fungi Coccidioides immitis/posadasii complex Recently Coccidioides immitis has been recognised as 2 species: C. greyish white with a tan to brown reverse. immitis/posadasii is a dimorphic fungus. Young spherules have a clear centre with peripheral cytoplasm and a prominent thick-wall. C. 20 μm Tissue morphology showing typical endosporulating spherules of C. immitis/posadasii on Sabouraud’s dextrose agar at 25OC are initially moist and glabrous. immitis and C. Colonies of C. and in soil or culture in a mycelial form. This arthroconidial state has been classified in the genus Malbranchea and is similar to that produced by many non-pathogenic soil fungi. The two species appear to coexist in the desert regions of the USA southwest and Mexico. Gymnoascus species. Cultures of Coccidioides immitis/posadasii represent a severe biohazard to laboratory personnel and must be handled with extreme caution in an appropriate pathogen handling cabinet. tissue pathology. e. . separated from each other by a disjunctor cell. existing in living tissue as spherules and endospores. Culture identification by exoantigen test is now the method of choice. 2002). culture identification by positive exoantigen test. 2. immitis is geographically limited to California’s San Joaquin Valley region. whereas C. posadasii grows more slowly). Mexico and South America. immitis. posadasii (Fisher et al. however considerable variation in growth rate and culture morphology has been noted. Microscopy shows typical single-celled. but rapidly become suede-like to downy. C. hyaline. alternate arthroconidia. WARNING: RG-3 organism. Rupture of the spherule releases endospores into the surrounding tissue where they re-initiate the cycle of spherule development.5-4 x 3-6 µm in size.g. The two species are morphologically identical and can be distinguished only by genetic analysis and different rates of growth in the presence of high salt concentrations (C. Key Features: clinical history. rectangular to barrel-shaped. Antifungal Amphotericin B Fluconazole Itraconazole MIC µg/mL Range MIC90 0.03-1 0.Descriptions of Medical Fungi 47 Coccidioides immitis/posadasii complex 5 μm Culture and arthroconidia separated from each other by disjunctor cells of Coccidioides immitis/posadasii. McGinnis (1980). Espinel-Ingroff et al. (1977).5 Limited data available. (1980).06-2 2-64 0. keys to taxa and additional information see Ajello (1957). For descriptions of species. Chandler et al. (2006). (2005) and Sabatelli et al.03-2 1 32 0. Espinel-Ingroff (2003). (2002).5 Antifungal Posaconazole Voriconazole MIC µg/mL Range MIC90 0. (2001).03-1 0. Steele et al. . de Hoog et al. (2000) and Fisher et al. Gonzalez et al. Rippon (1988).5 0. Catanzaro (1986). Sclerotia are usually abundant. (2000). For descriptions of species. Appressoria are common. Asia. and the Americas. consisting of numerous black sclerotia and light brown-coloured conidial masses. Australasia. coccodes. McGinnis (1980) and de Hoog et al. 50 μm 20 μm 10 μm Sclerotia with setae. 16-22 x 3-4 µm. attenuated at the ends. setose. Over 500 Colletotrichum species have been reported. C. RG-1 organism. . reverse is dark brown. clavate. variable in shape. Hughes Colonies usually darkly pigmented with white aerial mycelium. Conidia are straight. 11-16. Europe. spherical and are often confluent. 48 Descriptions of Medical Fungi Colletotrichum coccodes (Wallroth) S. keys to taxa and additional information see Domsch et al. fusiform.5 x 6-9. brown.5 µm. conidia and appressoria of C. (1980). coccodes is a common soil and plant pathogen widely distributed in Africa. It has been reported from a case of human mycotic keratitis. coronatus grow rapidly and are flat. RG-2 organism. Each subspherical conidium is discharged as a result of the pressure developed within the conidium. however C. white surface mycelium and conidiophores.Descriptions of Medical Fungi 49 Conidiobolus coronatus (Costantin) Batko Synonym: Entomophthora coronata (Costantin) Kevorkian The species of the genus Conidiobolus produce characteristic multinucleate primary and secondary (replicative) conidia on top of unbranched conidiophores. The genus contains 27 species. glabrous becoming radially folded and covered by a fine. For descriptions of species. powdery. terminal conidia which are spherical. Rippon (1988). and each bears a more or less prominent papilla after discharge (King 1983). (2000) and Ellis (2005a). 1976b. incongruus are the only species that are known to cause human disease. 10 to 25 µm in diameter. called villae. KwonChung and Bennett (1992). King (1976a. coronatus and C. although C. lamprauges has also been reported once from a horse (Humber. cream-coloured. The lid of the petri dish soon becomes covered with conidia. (1) single or multiple hyphal tubes that may also become conidiophores which bear secondary conidia. . keys to taxa and additional information see Emmons and Bridges (1961). Conidia may also produce hair-like appendages. It has a world-wide distribution especially tropical rain forests of Africa. de Hoog et al. each bearing a small secondary conidium. or (2) replicate by producing multiple short conidiophores. Conidiobolus coronatus is commonly present in soil and decaying leaves. McGinnis (1980). single-celled and have a prominent papilla. All human infections have been confined to the tropics. Conidiophores are simple forming solitary. The colour of the colony may become tan to brown with age. Human infections are usually restricted to the rhinofacial area. 1983). 10 μm 10 μm Spherical conidia with hair-like appendages (villae) and prominent papillae characteristic of Conidiobolus coronatus. 1989). there are occasional reports of dissemination to other sites. However. Brown and Kornegay. Conidia germinate to produce either. which are forcibly discharged by the conidiophores. Colonies of C. subacute to acute pulmonary. (1983). gattii are regarded as the principle pathogenic species. Barnett et al. . neoformans surrounded by a characteristic wide gelatinous capsule. Under certain conditions of growth the capsule may contain starch-like compounds. 50 Descriptions of Medical Fungi Cryptococcus Kützing emend. and pseudohyphae being absent or rudimentary. keys to taxa and additional information see Rippon (1982). systemic or meningitic disease. For descriptions of species. Cryptococcus albidus and Cryptococcus laurentii have on occasion also been implicated in human infection. Cryptococcosis is a chronic. Casadevall and Perfect (1988) and de Hoog et al. bones and other visceral organs may also become involved. No fermentation: Nitrate assimilated or not: Inositol assimilated. initiated by the inhalation of basidiospores and/or desiccated yeast cells of Cryptococcus species. but young colonies of most species are usually non-pigmented. The genus Cryptococcus is similar to the genus Rhodotorula. by polar budding on a narrow base (may or may not be present). extent of capsule formation depends on the medium. Primary pulmonary infections have no diagnostic symptoms and are usually subclinical. On solid media the cultures are generally mucoid or slimy in appearance. 5 μm Culture appearances on Bird Seed Agar of Cryptococcus neoformans (brown colonies) and Candida albicans (white colonies) and India ink preparation of C. McGinnis (1980). Most strains have capsulated cells. which are released into the medium by many strains. The distinctive difference between the two is the assimilation of inositol. Kurtzman and Fell (1988). orange or yellow carotenoid pigments may be produced. Although C. the fungus usually shows a predilection for the central nervous system. On dissemination. which is positive in Cryptococcus. being cream in colour. however skin. Phaff & Spencer The genus Cryptococcus is characterised by globose to elongate yeast-like cells or blastoconidia that reproduce by multilateral budding. red. neoformans and C. (2000). Narrow but distinct capsules are present.Descriptions of Medical Fungi 51 Cryptococcus albidus (Saito) Skinner Culture: Colonies (SDA) are cream-coloured smooth. No pseudohyphae present. Budding yeast cells only. Microscopy: Spherical and elongated budding yeast-like cells or blastoconidia.Negative.5 x 3. Physiological Tests: + Positive. 2. v Variable. gattii does not. Budding yeast cells only.0-7. India Ink Preparation: Positive .5-10. . w Weak. laurentii assimilates both lactose and melibiose while C.1% Cycloheximide - C. RG-1 organism. and rare human infections have been reported however its pathogenicity is questionable. similar to C. . albidus has variable growth at 37OC. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + v L-Sorbose v + + + +. No pseudohyphae present.w v v + + v + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine + v v v v v v v + D-Glucitol + v + v + + + + + v Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0.Negative.8 x 5.5-8.0 μm. RG-1 organism. v Variable. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + v L-Sorbose v + + + + + + + + v + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine + + + + v v + + + D-Glucitol + + + v + + + + -.Distinct capsules are present. India Ink Preparation: Positive . No pseudohyphae present.05. Rare human infections have been reported however its pathogenicity is questionable. often becoming a deeper orange-yellow with age. however C. w Weak. gattii.2 μm. with a smooth mucoid texture.w Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. .1% Cycloheximide - Note: some strains of C. Cryptococcus laurentii (Kufferath) Skinner Culture: Colonies (SDA) are cream-coloured. 3. laurentii may develop a brown pigment on Bird Seed agar and turn CGB media blue. Microscopy: Globose to ovoid budding yeast-like cells. Physiological Tests: + Positive. mucoid glabrous yeast-like. C. Colonies are often more mucoid when compared to C. neoformans. causing human disease in climates ranging from temperate to tropical Australia. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Budding yeast cells only. raffinose. .3. Non-immunocompromised hosts are usually affected and large mass lesions in the lung and/or brain (cryptococcomas) are often present (Sorrell. wide gelatinous capsules are present. gattii generally has a more restricted geographical distribution than C. neoformans (Staib.0 x 3. erythritol and soluble starch. arabinose.9 µm. Brazil. growth on CGB agar turning it blue within 2-5 days. 2001). This simple biotype test is based on the ability of C. 1982) is the media of choice to differentiate C. Synonym: Cryptococcus neoformans var.0-7. gattii from C. and negative assimilation of nitrate. Paraguay and Southern California. India Ink Preparation: Positive . galactose. although recent infections have also been reported from Vancouver Island. Canada.7. parts of Africa. however mating experiments for the production of basidiospores should be done in an appropriate pathogen handling cabinet. rhamnose. absence of pseudohyphae. 52 Descriptions of Medical Fungi Cryptococcus gattii (Vanbreus. gattii turns CGB agar blue within 2-5 days. C. lactose. C. Papua New Guinea. inositol. melezitose and xylose. gattii isolates to grow in the presence of L-canavanine and to assimilate glycine as a sole carbon source. Key Features: encapsulated yeast.Distinct.colonies turn a dark brown colour. positive hydrolysis of urea. Canavanine-Glycine-Bromothymol Blue (CGB) Agar: turns blue within 2-5 days. India. growth on bird seed (Guizotia abyssinica seed) or caffeic acid agar . neoformans. sucrose. 1987). gattii Vanbreus & Takashio Cryptococcus gattii has two serotypes (B and C) and has recently been reclassified as a separate species (Kwon-Chung et al. Mexico. No pseudohyphae present. southeast Asia. Canavanine glycine bromothymol blue (CGB) agar (Kwon-Chung et al. 2002). melibiose. RG-2 organism. & Takashio) Kwon-Chung & Boekhout Teleomorph: Filobasidiella bacillispora Kwon-Chung. trehalose. growth at 37OC. maltose. Microscopy: Globose to ovoid budding yeast-like cells 3. negative fermentation of sugars and positive assimilation of glucose. neoformans does not grow on this medium Culture: Colonies (SDA) cream-coloured smooth. mucoid yeast-like colonies. cellobiose. Bird Seed Agar: Colonies turn dark brown in colour as they selectively absorb a brown pigment from this media. MIC90s Fluconazole 1->64 16 Itraconazole <0. neoformans var. Moreover. (2004) from the Australian Cryptococcus Study.25 Voriconazole <0. neoformans var. neoformans and Cryptococcus neoformans var. . the skin.1% Cycloheximide - Antifungal MIC µg/mL Range MIC90 Antifungal Amphotericin B Flucytosine Posaconazole and Cuenca-Estrella MIC µg/mL Range MIC90 0. grubii.03-2 0. wood. Synonym: Cryptococcus neoformans var. turning the medium a bright orange after 5 days (Irokanulo et al. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + L-Sorbose v + + +. parrots and budgerigars. Cryptococcus neoformans var. neoformans var. neoformans var. especially with pigeon excreta.w + +. The fungus has also been isolated from the dung of caged birds including canaries.25 0. (2006). C. 1994). Other environmental isolations of C. fruits and fruit juices. neoformans var.w D-Glucitol + v + v v + + α-M-D-glucoside D-Gluconate DL-Lactate + + + + + + + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine v Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. . neoformans. C. Trilles et al.3-0.w + + + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine +.03-64 4 0. grubii [serotype A] and C. and the use of corticosteroids (Franzot et al. Cryptococcus neoformans (Sanfelice) Vuillemin Teleomorph: Filobasidiella neoformans Kwon-Chung. Italy and Denmark. neoformans [serotype D].5 0.Negative.Descriptions of Medical Fungi 53 Cryptococcus gattii (Vanbreus. v Variable.25 Good data available. Creatinine dextrose bromothymol blue thymine (CDBT) agar is the medium of choice for the differentiation of Cryptococcus neoformans var.25 et al. This species has two varieties: C. grubii [serotype A] has a world-wide distribution. dairy products and soil. It has been isolated from various sources in nature and is noted for its association with accumulations of avian guano. 1999). neoformans [serotype D] has a more restricted distribution with infections being more prevalent in France. & Takashio) Kwon-Chung & Boekhout Physiological Tests: + Positive.03-1 0. neoformans grows as bright red colonies. infections are more strongly correlated to older patients. grubii have been from rotting vegetables.03-2 0. w Weak. maltose. . (2001).03-2 0. Canavanine-Glycine-Bromothymol Blue (CGB) Agar: leaves this medium unchanged. Creatinine dextrose bromothymol blue thymine (CDBT) agar: Cryptococcus neoformans var.0 x 3. 54 Descriptions of Medical Fungi Cryptococcus neoformans (Sanfelice) Vuillemin Culture: Colonies (SDA) cream-coloured smooth. positive hydrolysis of urea. growth on bird seed (Guizotia abyssinica seed) or caffeic acid agar . and negative assimilation of nitrate. cellobiose. Cuenca-Estrella et al.1% Cycloheximide - Key Features: encapsulated yeast.03-64 4 Voriconazole <0. No pseudohyphae present.25 Flucytosine 0. lactose.3.Negative.03-1 0.5 0. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + L-Sorbose v + + +.125 Posaconazole 0.w + +. sucrose. negative fermentation of sugars and positive assimilation of glucose. does not growth on CGB agar (no colour change).25 Good data available. w Weak. absence of pseudohyphae. India Ink Preparation: Positive . rhamnose. neoformans grows as bright red colonies. wide gelatinous capsules are present.Distinct. (2006). Microscopy: Globose to ovoid budding yeast-like cells 3.w + + + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine +.5 Itraconazole <0.colonies turn a dark brown colour. Espinel-Ingroff (2003). growth at 37OC. mucoid yeast-like colonies. raffinose.03-0. Trilles et al. v Variable. arabinose. . grubii. melibiose. galactose.7. No colour change is observed for C.0-7. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Budding yeast cells only. RG-2 organism. Espinel-Ingroff et al. neoformans var. MIC90s from the Australian Cryptococcus Study. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Fluconazole 1->64 8 Amphotericin B 0. 1987).03-2 0. inositol. however mating experiments for the production of basidiospores should be done in an appropriate pathogen handling cabinet. melezitose and xylose.9 µm. (2004). Bird Seed Agar: Colonies turn dark brown in colour as colonies selectively absorb a brown pigment from this media (Staib. erythritol and soluble starch. trehalose. Physiological Tests: + Positive. turning the medium a bright orange after 5 days.w D-Glucitol + v + v v + + α-M-D-glucoside D-Gluconate DL-Lactate + + + + + + + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine v Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. straight. (2002). one-celled. Key Features: zygomycete. 1988) preferred the name Cunninghamella bertholletiae because of the thermophilic nature of human isolates that grow at temperatures as high as 45OC. C. branching sporangiophores. Sporangiophores to 20 μm wide. Espinel-Ingroff (2001.125-4 0. globose to ovoid. elegans differs by having purely grey colonies and by not growing at temperatures above 40OC (Weitzman and Crist. Chlamydospores and zygospores may also be present. there has been some confusion as to the correct name of this zygomycete. elegans (Lendner) Lunn & Shipton The genus Cunninghamella is characterised by white to grey. Sabatelli et al. (2005). (2006) and WCH in-house data. Dannaoui et al. i. white at first. Cunninghamella species are mainly soil fungi of the Mediterranean and subtropical zones. echinulate or smooth-walled sporangiola develop on swollen denticles. Samson (1969) and Domsch et al. Antifungal Fluconazole Itraconazole Posaconazole MIC µg/mL Range MIC90 >64 0. Weitzman. but becoming rather dark grey and powdery with sporangiola development. (2003). with verticillate or solitary branches. rapidly growing colonies. 2000). However. they are only rarely isolated in temperate regions. RG-2 organism. (1980) preferred the name Cunninghamella elegans and Lunn and Shipton (1983) went further and reduced C. C. Colonies are very fast growing. clinical isolates grow at 40OC. antifungal susceptibility testing of individual strains is recommended. verrucose or short-echinulate.e. Vesicles subglobose to pyriform. 1984. 1979 and de Hoog et al.Descriptions of Medical Fungi 55 Cunninghamella bertholletiae Stadel Synonyms: Cunninghamella elegans Lendner Cunninghamella echinulata var. elegans (= C. or ellipsoidal (9-13 x 6-10 μm). Singh et al.125-8 >256 8->64 2 >256 >64 Very limited data. Sporangiola are globose (7-11 µm diameter). However. elegans. the terminal ones up to 40 µm and the lateral ones 10-30 µm in diameter. echinulata var. Many medical mycologists (McGinnis. The genus now contains seven species with C. bertholletiae the only known species to cause disease in man and animals which is often associated with trauma and immunosuppression. Once again. C. These sporangiosphores end in globose or pyriform-shaped vesicles from which several one-celled. straight. and Rippon. producing erect. Temperature: optimum 25 to 30OC: maximum up to 50OC. bertholletiae is currently the most acceptable name.003-1 >64 2 1 Antifungal Amphotericin B Flucytosine Voriconazole MIC µg/mL Range MIC90 0. bertholletiae) to a variety of Cunninghamella echinulata. echinulate sporangiola borne on swollen terminal or lateral globose to clavate fertile vesicles. hyaline singly but brownish in mass. 2003). . globose to ovoid. 1980. Sun et al. (1980). Domsch et al. Samson (1969). 56 Descriptions of Medical Fungi Cunninghamella bertholletiae Stadel 10 μm 10 μm Microscopic morphology of Cunninghamella bertholletiae showing simple sporangiophores forming a swollen. globose to ovoid sporangiola develop on swollen denticles. terminal vesicle around which single-celled. keys to taxa and additional information see McGinnis (1980). . de Hoog et al (2000) and Ellis (2005b). Weitzman (1984). For descriptions of species. Lunn and Shipton (1983). (2001) and WCH in-house data. however three ubiquitous species. germination is bipolar and some species may have a prominent hilum. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. C. pale brown. lunata. McGinnis (1980). For descriptions of species.06-1 Very limited data. Espinel-Ingroff et al.03-16 0. C. antifungal susceptibility testing of individual strains is recommended. The genus Curvularia contains some 35 species which are mostly subtropical and tropical plant parasites.03-32 0. pallescens and C. (1980). However. (2000). 20 µm Conidia of Curvularia lunata. RG-1 organisms. endocarditis. Rippon (1988) and de Hoog et al. peritonitis and disseminated infection have also been reported in immunosuppressed patients. brown to blackish brown with a black reverse. geniculata have been recovered from human infections. . cases of subcutaneous.Descriptions of Medical Fungi 57 Curvularia Boedijn Teleomorph: Cochliobolus Drechsler Colonies are fast growing. McGinnis and Pasarell (1998). sinusitis. Domsch et al. with three or more transverse septa (phragmoconidia) and are formed apically through a pore (poroconidia) in a sympodially elongating geniculate conidiophore similar to Drechslera. cylindrical or slightly curved phragmoconidia. principally from cases of mycotic keratitis. Key Features: dematiaceous hyphomycete producing sympodial. keys to taxa and additional information see Ellis (1971). with one of the central cells being larger and darker. with one of the central cells being larger and darker. suede-like to downy. Conidia are cylindrical or slightly curved. Conidia are pale brown. cylindrical to fusiform. chlamydospores and macroconidia of Cylindrocarpon lichenicola. smooth-walled conidia. suede-like or woolly. . in chains or in clumps. RG-2 organism if isolated from humans. Phialides are cylindrical to subulate. which are arranged in slimy masses. hyaline. and microconidia which are one-celled. (2000). intercalary or terminal. Domsch et al. spherical. Colonies are fast growing. which are usually clearly distinct from the macroconidia. 58 Descriptions of Medical Fungi Cylindrocarpon Wollenw. arranged in brush-like structures. with small collarettes producing hyaline. with a rounded apex and flat base. is widespread. keys to taxa and additional information see Booth (1966). hyaline or bright-coloured. The genus contains 35 species. (1980) and de Hoog et al. isolated mostly from soil and is recorded as an occasional human and animal pathogen. Cylindrocarpon differs from Fusarium by lacking an asymmetrical foot-cell on the macroconidia. macroconidia which are one to several septate. hyaline to brown. Two types of conidia may be produced. Conidiophores consist of simple or repeatedly verticillate phialides. Sporodochia may occasionally be present. Teleomorph: Nectria (Fries) Fr. 15 µm 15 µm Culture. Chlamydospores may be present or absent. For descriptions of species. formed singly. straight or curved. straight. Conidia are transversely septate (phragmoconidia). McGinnis (1980). McGinnis et al. McGinnis et al. Key Features: dematiaceous hyphomycete producing sympodial.Descriptions of Medical Fungi 59 Drechslera Ito Teleomorph: Pyrenophora Fries Colonies are fast growing. usually cylindrical or subcylindrical. (1986b). pale brown. Germinating is from any or all cells and the hilum is not protuberant. Curvularia and Exserohilum.25 0. . Rippon (1988) and de Hoog et al. with the septum delimiting the basal cell formed first during conidium maturation. suede-like to downy.06 Very limited data. antifungal susceptibility testing of individual strains is recommended. geniculate conidiophore. McGinnis and Pasarell (1998). (1986b) have reviewed the isolates from human and animal disease purported to be Drechslera or Helminthosporium and concluded that all pathogenic isolates examined actually belong to the genera Bipolaris or Exserohilum. transversely septate poroconidia. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. and are formed apically through a pore (poroconidia) on a sympodially elongating. cylindrical or subcylindrical. Ellis (1971 and 1976). For descriptions of species. Conidia are pale to dark brown. brown to blackish brown with a black reverse. Sivanesan (1987). Domsch et al. RG-1 organism. 20 µm Conidia of Drechslera. (2000). smooth-walled. Also see Descriptions for Bipolaris.25 0. keys to taxa and additional information see Luttrell (1978). (1980). darkly pigmented and have a verrucose external surface. (1995). 15 µm Conidia of Epicoccum purpurascens. Synonym: Epicoccum nigrum Link Colonies are fast growing. . (1980). determinant. 60 Descriptions of Medical Fungi Epicoccum purpurascens Ehrenb. large globose to pyriform. When sporulating numerous black sporodochia (aggregates of conidiophores) are visible. McGinnis (1980) and Samson et al. with a strong yellow to orange-brown diffusible pigment. Key Features: dematiaceous hyphomycete producing darkly pigmented. Conidia become multicellular (dictyoconidia). Conidia are globose to pyriform. i. Epicoccum purpurascens is a cosmopolitan saprophyte of world-wide distribution which is occasionally isolated as a contaminant from clinical specimens like skin. verrucose dictyoconidia on a sporodochium. keys to taxa and additional information see Ellis (1971). slightly pigmented conidiophores. RG-1 organism. ex Schlecht. nonspecialised.e. mostly l5-25 µm diameter with a funnel-shaped base and broad attachment scar. suede-like to downy. aleuric or rhexolytic dehiscence of conidia. Domsch et al. Conidia are formed singly on densely compacted. often seceding with a protuberant basal cell. For descriptions of species. 01-1 0. Epidermophyton floccosum is an anthropophilic dermatophyte with a world-wide distribution which often causes tinea pedis. Numerous chlamydospores are formed in older cultures. (2000). tinea cruris. RG-2 organism. 20 µm 15 µm Culture.125 Fernandez-Torres et al.Descriptions of Medical Fungi 61 Epidermophyton floccosum (Harz) Langeron et Milochevitch Colonies (SDA) are usually slow growing.01-8 0.5->64 >64 Terbinafine 0. greenish-brown or khaki-coloured with a suede-like surface. Rippon (1988) and de Hoog et al. keys to taxa and additional information see Rebell and Taplin (1970). (2006) and WCH in-house data.01-8 0. (1987). Older cultures may develop white pleomorphic tufts of mycelium.03-0.06 Voriconazole 0. Microscopic morphology shows characteristic smooth. microscopic morphology and clinical disease. Microconidia are not formed. floccosum.06-2 1 Amphotericin B 0. (2001) and Sabatelli et al. It is not known to invade hair in vivo and no specific growth requirements have been reported.125 Fluconazole 0. Antifungal MIC µg/mL Range MIC90 Range MIC90 Griseofulvin 0. with a flat periphery and submerged fringe of growth. tinea corporis and onychomycosis. Mackenzie et al. thin-walled macroconidia which are often produced in clusters growing directly from the hyphae. raised and folded in the centre. Antifungal MIC µg/mL . A deep yellowish-brown reverse pigment is usually present. For descriptions of species.25 Itraconazole 0. macroconidia and chlamydospores of E. Key Features: culture characteristics.5 0. Pfaller et al. Matsumoto et al. . With the development of mycelium. flask-shaped to cylindrical annellides are produced. Antifungal Itraconazole Voriconazole MIC µg/mL Range 0.03-2 0. ovoid to elliptical. 62 Descriptions of Medical Fungi Exophiala dermatitidis (Kano) de Hoog Synonym: Wangiella dermatitidis (Kano) McGinnis Colonies are slow growing. one-celled. Conidia are hyaline to pale brown.06-0. de Hoog et al.0-4.5 nd Limited data.03-2 0. E. Dixon and Polak-Wyss (1991). For descriptions of species.03-1 MIC90 0. Espinel-Ingroff et al. Cultures grow at 42OC. (1984). Nishimura and Miyaji (1983).5 0. 2. (2002a) and WCH in-house data (nd = not done). 10 µm Annellides and conidia of Exophiala dermatitidis. (2000).0 x 2. dermatitidis has been isolated from plant debris and soil and is a recognised causative agent of mycetoma and phaeohyphomycosis in humans. Espinel-Ingroff (2001). (1983). The initial yeast-like phase is referred to as the Phaeococcomyces exophialae synanamorph.5 MIC90 0. antifungal susceptibility testing of individual strains is recommended. Hohl et al. olivaceous grey with the development of aerial mycelium with age. round to obovoid. RG-2 organism.0 µm. smooth-walled and accumulate in slimy balls at the apices of the annellides or down their sides. budding yeast-like cells. McGinnis and Pasarell (1998).5-6. McGinnis (1980).25 Antifungal Amphotericin B Posaconazole MIC µg/mL Range 0. (2001). initially yeast-like and black. The yeast-like cells are hyaline and thin-walled when young becoming darkly pigmented (dematiaceous) and thick-walled when mature. which is characterised by unicellular. becoming suede-like. keys to taxa and additional information see de Hoog and Hermanides-Nijhof (1977). 06-2 MIC90 0. E.5 0. often becoming domeshaped and suede-like in texture. with regular tapering annellated zones. Numerous ellipsoidal. 2003. jeanselmei complex with less melanised conidiogenous cells. Annellated zones have the appearance of inconspicuous flat scars. 3. and E. inflated. A segregant genotype of the E. Conidia are formed on lateral pegs either arising apically or laterally at right or acute angles from essentially undifferentiated hyphae or from strongly inflated detached conidia. subglobose to broadly ellipsoidal cells (germinating cells) which give rise to short torulose hyphae that gradually change into unswollen hyphae. Domsch et al. becoming raised and developing tufts of aerial mycelium with age. antifungal susceptibility testing of individual strains is recommended. jeanselmei has long been recognised as heterogeneous (de Hoog 1977). yeast-like. Conidia are hyaline. (2001) and WCH in-house data. McGinnis and Padhye (1977). jeanselmei has a world-wide distribution and is a recognised causative agent of mycetoma and phaeohyphomycosis in humans.03-2 0. slightly darker than the supporting hyphae.2-2. Nucci et al. (2001). greenish-grey to black. Similar morphology to E. however large chlamydospore-like cells are present. RG-2 organism. No growth at 40OC. E. de Hoog (1977. (1987). the latter being flask or rocket-shaped. multicellular conidiophores are absent. Scattered amongst these yeast-like cells are larger. especially in young cultures. 1980). broadly ellipsoidal.Descriptions of Medical Fungi 63 Exophiala jeanselmei Complex Synonyms: Phialophora jeanselmei (Langeron) Emmons E. (1980). xenobiotica (Vitale and de Hoog.03-4 0.5 Antifungal Amphotericin B Posaconazole MIC µg/mL Range 0. xenobiotica Colonies are initially smooth. McGinnis and Pasarell (1998). smooth. Chlamydospores are absent. oligosperma Mature conidiogenous cells rocket-shaped. 2003. nishimurae E. . E. Recent molecular studies have redefined Exophiala jeanselmei and three additional species have been identified: E. oligosperma. jeanselmei E. oligosperma. Matsumoto et al. budding cells are usually present.5 Limited data. McGinnis (1978. thin-walled.5 MIC90 0. nishimurae. These species are morphologically very similar and can best be distinguished by genetic analysis. For descriptions of species.5 0. keys to taxa and additional information see de Hoog and Hermanides-Nijhof (1977). Reverse is olivaceous-black. mucoid and yeast-like. Espinel-Ingroff et al. 2006). Conidiogenous cells are predominantly annellidic and erect.4 x 1.2-4. 2002 . Mature conidiogenous cells remain concolorous with supporting hyphae and may be intercalary and lateral. (2000. and with inconspicuous basal scars. de Hoog et al. Antifungal Itraconazole Voriconazole MIC µg/mL Range 0. slightly tapering and imperceptibly annellate. 2006).25-0. Conidiogenous pegs are 1-3 µm long. 1985). Dixon and Polak-Wyss (1991) and de Hoog et al.2 µm. E. Cultures grow at 37OC but not at 40OC. Nishimura and Miyaji (1983). 64 Descriptions of Medical Fungi Exophiala jeanselmei/spinifera Complex 5 µm 15 µm 5 µm Annellides, conidia and conidiogenous pegs (annellides) on yeast-like cells and torulose hyphae of Exophiala jeanselmei. 10 µm Erect, multiseptate conidiophores that are darker than the supporting hyphae, with long annellated zones and conidia of Exophiala spinifera. Descriptions of Medical Fungi 65 Exophiala spinifera Complex Synonyms: Phialophora spinifera Nielsen & Conant Rhinocladiella spinifera (Nielsen & Conant) de Hoog Recent molecular studies have re-examined Exophiala spinifera and have recognised two species: E. spinifera and E. attenuata (Vitale and de Hoog, 2002). These two species are morphologically very similar and can best be distinguished by genetic analysis. Conidiogenous cells are predominately annellidic and erect, multicellular conidiophores that are darker than the supporting hyphae are present. No growth at 40OC. E. spinifera E. attenuata Annellated zones are long with clearly visible, frilled annellations. Annellated zones are inconspicuous and degenerate. Colonies are initially mucoid and yeast-like, black, becoming raised and developing tufts of aerial mycelium with age, finally becoming suede-like to downy in texture. Reverse is olivaceous-black. Conidiophores are simple or branched, erect or sub-erect, spine-like with rather thick brown pigmented walls. Conidia are formed in basipetal succession on lateral pegs either arising apically or laterally at right or acute angles from the spine-like conidiophores or from undifferentiated hyphae. Conidiogenous pegs are 1-3 µm long, slightly tapering and imperceptibly annellate. Conidia are one-celled, subhyaline, smooth, thin-walled, subglobose to ellipsoidal, 1.0-2.9 x 1.8-2.5 µm, and aggregate in clusters at the tip of each annellide. Toruloid hyphae and yeast-like cells with secondary conidia are typically present. No growth at 40OC. RG-2 organism. E. spinifera has a world-wide distribution and is a recognised causative agent of mycetoma and phaeohyphomycosis in humans. For descriptions of species, keys to taxa and additional information see de Hoog and Hermanides-Nijhof (1977), McGinnis and Padhye (1977), Domsch et al. (1980), McGinnis (1980), Nishimura and Miyaji (1983), de Hoog (1985), Matsumoto et al. (1987), Dixon and Polak-Wyss (1991) and de Hoog et al. (2000, 2003, 2006). MIC µg/mL Range MIC µg/mL Range MIC µg/mL Range Antifungal Amphotericin B Antifungal Itraconazole Antifungal Voriconazole 0.125-1 0.03-1 0.125-1 Very limited data, antifungal susceptibility testing of individual strains is recommended. McGinnis and Pasarell (1998), Espinel-Ingroff et al. (2001) and WCH in-house data. 66 Descriptions of Medical Fungi Exserohilum Leonard and Suggs Colonies are grey to blackish-brown, suede-like to floccose in texture and have an olivaceous black reverse. Conidia are straight, curved or slightly bent, ellipsoidal to fusiform and are formed apically through a pore (poroconidia) on a sympodially elongating geniculate conidiophore. Conidia have a strongly protruding, truncate hilum and the septum above the hilum is usually thickened and dark, with the end cells often paler than other cells, walls often finely roughed. Conidial germination is bipolar. The genus Exserohilum may be differentiated from the closely related genera Bipolaris and Dreschlera by forming conidia with a strongly protruding truncate hilum (i.e. exserted hilum). The hilum is defined as “a scar on a conidium at the point of attachment to the conidiophore”. In Drechslera species, the hilum does not protrude; in Bipolaris species the hilum protrudes only slightly. Several species of Exserohilum have been reported as agents of phaeohyphomycosis, notably E. rostratum (= E. halodes), E. mcginnisii and E. longirostratum. RG-1 organisms. Key Features: dematiaceous hyphomycete producing sympodial, transverse septate, ellipsoidal to fusiform conidia with a strongly protruding, truncate hilum. For descriptions of species, keys to taxa and additional information see Domsch et al. (1980), Alcorn (1983), Adam et al. (1986), McGinnis et al. (1986b), Rippon (1988), Burges et al. (1987), Dixon and Polak-Wyss (1991) and de Hoog et al. (2000). 20 µm 20 µm Conidiophores and conidia with distinctive hilum (arrow) of E. rostratum. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0.125-2 0.03-0.5 0.03-0.5 Very limited data, antifungal susceptibility testing of individual strains is recommended. McGinnis and Pasarell (1998) and WCH in-house data. Descriptions of Medical Fungi 67 Fonsecaea pedrosoi/monophora Complex Morphologically the genus Fonsecaea is defined by the presence of indistinct melanised conidiophores with blunt, scattered denticles bearing conidia singly or in short chains that eventually become branched. de Hoog et al. (2004) revised the genus on the basis of ribosomal DNA internal transcribed spacer (ITS) sequence data recognising two species; F. pedrosoi and F. monophora. The previously described species F. compacta was found to be a morphological variant of F. pedrosoi. Morphological F. pedrosoi and F. monophora are very similar and can best be distinguished by genetic analysis. F. monophora on average has slightly longer conidial chains and slightly shorter denticles than F. pedrosoi. All strains grow at 37OC but not at 40OC. Both species are recognised etiologic agents of chromoblastomycosis. RG-2 organism. Colonies are slow growing, flat to heaped and folded, suede-like to downy, olivaceous to black with black reverse. Conidiogenous cells pale olivaceous, arranged in loosely branched systems, with prominent denticles. Conidia pale olivaceous, clavate to ellipsoidal, in short chains, subhyaline, smooth and thin-walled, 3.5-5 x 1.5-2 µm. For descriptions of species, keys to taxa and additional information see McGinnis (1980), Dixon and Polak-Wyss (1991), de Hoog et al. (2000), de Hoog et al. (2004). 10 µm Conidiophores and conidia of Fonsecaea. Antifungal Itraconazole Voriconazole MIC µg/mL Range 0.03-1 0.06-1 MIC90 0.25 0.06 Antifungal Amphotericin B Posaconazole MIC µg/mL Range 0.03-2 0.06-1 MIC90 1 nd Limited data, antifungal susceptibility testing of individual strains is recommended. McGinnis and Pasarell (1998), Espinel-Ingroff et al. (2001), Espinel-Ingroff (2003) and WCH in-house data (nd = not done). Species of Fusarium typically produce both macro. Chlamydospores may be present or absent. Rippon (1988). Other species cause storage rot and are important mycotoxin producers. nature of the conidiogenous cell bearing microconidia. smaller than macroconidia. Cultures of F. For descriptions of species. Some are plant pathogens. Domsch et al. fusiform to sickle-shaped. Culture pigmentation on potato dextrose agar and/or potato sucrose agar after incubation for 10-14 days with daily exposure to light. and presence or absence of chlamydospores.to severalcelled. Microconidia are one. solani and F. causing root and stem rot. hyaline. McGinnis (1980). Identification of Fusarium species is often difficult due to the variability between isolates (e. moniliforme are recognised as being pathogenic to man and animals causing hyalohyphomycosis (especially in burn victims and bone marrow transplant patients). Colony growth diameters on potato dextrose agar and/or potato sucrose agar after incubation in the dark for 4 days at 25OC. oxysporum. mycotic keratitis and onychomycosis. pale or bright coloured (depending on the species) with or without a cottony aerial mycelium. pink. Several species. Macroconidia are hyaline. Samson et al.or two-celled.and microconidia from slender phialides. red or purple shades. (1995) and de Hoog et al. Most Fusarium species are soil fungi and have a world-wide distribution. straight or curved. fusiform to ovoid. 1.g. . two. vascular wilt or fruit rot. 2. oxysporum showing purple pigmentation and F. 3. The important characters used in the identification of Fusarium species are as follows. keys to taxa and additional information see Booth (1971 and 1977). Note: sporulation may need to be induced in some isolates and a good slide culture is essential. presence or absence of microconidia. pyriform. 68 Descriptions of Medical Fungi Fusarium Link ex Fries Colonies are usually fast growing. notably F. F. (2000). (1980). subglutinans showing pink pigmentation. in shape and size of conidia and colony colour) and because not all features required are always well developed (e. the absence of macroconidia in some isolates after subculture).g. shape and mode of formation of microconidia. mostly with an elongated apical cell and pedicellate basal cell. Burgess and Liddell (1983). The colour of the thallus varies from whitish to yellow. Microscopic morphology including shape of the macroconidia. 5 µm.25->16 1-2 Voriconazole 0. Cuenca-Estrella et al. single. Microconidia are abundant. becoming purple. pointed at the tip. Diekema et al. basal cells pedicellate. (2006) and WCH in-house data. (2006). solani the phialides are short and mostly non-septate. smooth or rough-walled. later arranged in densely branched clusters.5 cm in 4 days. 15 µm 15 µm Microconidia on short phialides and macroconidia of F. Conidiophores are short. 23-54 x 3-4.5->16 >8 Amphotericin B 0.3 . (2003).3. In contrast to F. slightly curved. mostly three septate. with discrete orange sporodochia present in some strains.5 µm. aerial mycelium white. Espinel-Ingroff (2001. RG-2 organism. straight or often curved. lateral monophialides in the aerial mycelium. hyaline. Chlamydospores are terminal or intercalary. . mostly non-septate. (2001). Macroconidia are fusiform. Espinel-Ingroff et al. 4. 2003). Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Itraconazole 0. 5-13 µm.Descriptions of Medical Fungi 69 Fusarium oxysporum Schlecht Colonies growing rapidly. antifungal susceptibility testing of individual strains is recommended. ellipsoidal to cylindrical. reverse hyaline to dark blue or dark purple.25->8 1-2 Posaconazole 1->8 4 Limited data. 5-12 x 2. Sabatelli et al. oxysporum. never in chains. 70 Descriptions of Medical Fungi Fusarium solani (Mart. (2006) and WCH in-house data. 28-42 x 4-6 µm. Microconidia are usually abundant.) Sacc.to 5. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Itraconazole 0. 2003). (2003). one. smooth to rough-walled. Colonies growing rapidly. often moderately curved. . Macroconidia are formed after 4-7 days from short multi-branched conidiophores which may form sporodochia. fusiform.5 cm in 4 days. antifungal susceptibility testing of individual strains is recommended. cylindrical to oval. 4. RG-2 organism. Diekema et al.to two-celled and formed from long lateral phialides. cylindrical. becoming bluish-brown when sporodochia are present. Sabatelli et al.25->16 4 Voriconazole 0. (2001). Espinel-Ingroff (2001. globose.25->16 >8 Amphotericin B 0. borne singly or in pairs on short lateral hyphal branches or intercalary. 6-10 µm.125->8 4 (>8) Posaconazole >8 >8 Limited data.septate). (2006). They are 3. aerial mycelium white to cream. macroconidia and chlamydospores of F. solani. with an indistinctly pedicellate foot cell and a short blunt apical cell. Cuenca-Estrella et al. 15 µm 15 µm 15 µm Microconidia on long phialides. 8-16 x 2-4.5 µm. Chlamydospores are hyaline.septate (usually 3. Espinel-Ingroff et al. 03->32 >32 Flucytosine 0. McGinnis (1980). which are quite variable in size may germinate at one end giving the appearance of a bud. Conidia may also develop sympodially and chlamydospores and endoconidia may also be present. keys to taxa and additional information see Gueho (1979). For descriptions of species. (2003). Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Fluconazole 0. as this name has often been used erroneously to describe any hyaline hyphomycete producing arthroconidia (McGinnis. Geotrichum species may be differentiated from each other using physiological and biochemical tests similar to those used for the identification of yeasts (Gueho. Barnett et al.125-16 4 Voriconazole 0. onecelled. (1995). 1988).06-1.Descriptions of Medical Fungi 71 Geotrichum Link Species of the genus Geotrichum typically produce chains of hyaline.25-32 8-32 Amphotericin B 0. However. (2005) and WCH in-house data. the latter develops into a septate mycelium. The need to exercise care when identifying species of Geotrichum must be stressed.125 Itraconazole 0. Kucukates et al. This characteristic distinguishes the genus Geotrichum from Trichosporon which usually does produce blastoconidia. Girmenia et al. antifungal susceptibility testing of individual strains is recommended. . Domsch et al. subglobose to cylindrical arthroconidia by the holoarthric fragmentation of undifferentiated hyphae.03-0.25 Limited data. 15 µm 15 µm Arthroconidium formation in G. candidum. (1980). 1979 and Buchta and Otcenasek. Kurtzman and Fell (1998) and de Hoog et al.5 0. Buchta and Otcenasek (1988). (2000). Hyphal elements are progressively compartmentalised by fragmentation of septa. The arthroconidia. 1980).0 0. Conidial secession is by the centripetal separation (schizolysis) of a so called double septum and concomitant rupture of the original outer hyphal wall layer. True blastoconidia production is not found in the genus. Samson et al. smooth. (1983). with terminal and intercalary conidiogenous cells which form long. s Slow. cutaneous and alimentary infections have also been noted. oral. but bronchial. Rectangular arthroconidia are also often present. cicatrized rachids on which conidia are borne. They are 6-12 x 3-6 µm in size and are released by the separation of a double septum. cylindrical to clavate. w Weak. fungemia and endocarditis have been reported in immunosuppressed patients. 7-10 x 2. .Negative. . . 72 Descriptions of Medical Fungi Geotrichum candidum Link Teleomorph: Galactomyces geotrichum (Butler & Petersen) Redhead & Malloch Colonies are fast growing. smooth. one-celled. branched and break up into chains of hyaline.1% Cycloheximide + Geotrichum candidum is an extremely common fungus with a world-wide distribution. Hyphae are profusely branched at acute angles.Negative. v Variable. whitish. white to cream. Hyphae are hyaline. Physiological Tests: + Positive.5-3. Blastoschizomyces capitis Colonies are moderately fast growing. Systemic infections including pulmonary. with a rounded apex and flat base.5 µm. v Variable. Pulmonary involvement is the most frequently reported form of the disease. Geotrichum capitatum (Diddens & Lodder) v. RG-1 organism. Arx Teleomorph: Dipodascus capitatis de Hoog et al. one-celled. and finely suede-like with no reverse pigment. Physiological Tests: + Positive. septate. vaginal. n No data Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + L-Sorbose v - L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v + - D-Glucitol + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine n Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0. flat. Conidia are hyaline. dry and finely suede-like with no reverse pigment. usually as a transient component of normal skin flora and sputum. w Weak. subglobose to cylindrical arthroconidia. s Slow.1% Cycloheximide + Geotrichum capitatum occurs quite commonly in humans. smooth. flat. RG-2 organism. Synonyms: Trichosporon capitatum. n No data Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + + v v L-Sorbose + + + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v + v v D-Glucitol + v v Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine n Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. The most characteristic feature of the genus is the distinctive erect. white at first. suede-like to downy in texture. one-celled hyaline to green. Gliocladium species have a world-wide distribution and are commonly isolated from a wide range of plant debris and soil. Onions et al. (1981). Colonies are fast growing. For descriptions of species. Although. 10 µm Conidiophore and conidia of Gliocladium. smooth-walled conidia in heads or columns. McGinnis (1980). becoming pale to dark green with sporulation. some penicillate conidiophores are always present. de Hoog et al. . (2000). sometimes pink to salmon. often densely penicillate conidiophores with phialides which bear slimy. Key Features: hyphomycete producing distinctive erect penicillate conidiophores with phialides bearing clusters of single-celled conidia.Descriptions of Medical Fungi 73 Gliocladium Corda The genus Gliocladium is often described as a counterpart of Penicillium with slimy conidia. keys to taxa and additional information see Domsch et al. Rippon (1988). Gliocladium species may also produce verticillate branching conidiophores which can be confused with Verticillium or Trichoderma. (1980). RG-1 organism. Conidia are hyaline. McGinnis (1980) and de Hoog et al. For descriptions of species. Key Features: dematiaceous hyphomycete producing erect synnemata with apical aggregates of single-celled conidia in slimy heads. one-celled. Ellis (1971). usually splaying out and bearing conidia at the apex. grey. subglobose to ovoid and are usually aggregated in slimy heads at the apex of the synnemata. Synnemata are darkly pigmented. 20 µm Synnemata and conidia of Graphium. erect and occur solitary or in clusters. RG-1 organism. . keys to taxa and additional information see Barron (1968). olivaceous brown or black. Colonies are effuse. (2000). Graphium eumorphum is one of the synanamorphs of Pseudallescheria boydii and is commonly found on woody plant material. 74 Descriptions of Medical Fungi Graphium Corda The genus Graphium is characterised by the formation of synnemata which consist of a more or less compact group of erect conidiophores that are cemented together. smooth. Other colony types are glabrous or verrucose. positive identification required conversion of the mould form to the yeast phase by growth at 37OC on enriched media. capsulatum is the common cause of histoplasmosis. suede-like to cottony with a pale yellow-brown reverse. Small. microconidia borne on short branches or directly on the sides of the hyphae may also be present. Colonies (SDA) at 25OC are slow growing. white or buff-brown. Chandler et al. WARNING: RG-3 organism. tuberculate macroconidia formed on short. starlings and bats. var. Environmental isolations of the fungus have been made from soil enriched with excreta from chicken. On brain heart infusion agar containing blood incubated at 37OC colonies are smooth. George and Penn (1986). moist. Rippon (1988) and de Hoog et al. depending on the clinical disease: var. 8-14 µm in diameter. white and yeast-like. numerous small round to oval budding yeast-like cells. keys to taxa and additional information see McGinnis (1980). 2-4 µm in diameter. and a red pigmented strain has been noted (Rippon. Histoplasma isolates may also resemble species of Sepedonium and Chrysosporium. duboisii is the African type and var. round to pyriform. (2000). Histoplasma capsulatum has a world wide distribution. however the Mississippi-Ohio River Valley in the USA is recognised as a major endemic region. Three varieties of Histoplasma capsulatum are recognised. single-celled. For descriptions of species. hyaline. Five percent of the cases have chronic progressive lung disease. Microscopic morphology shows the presence of characteristic large. farciminosum causes lymphangitis in horses. culture morphology and positive exoantigen test. (1980). Approximately 95% of cases of histoplasmosis are inapparent. Traditionally. tissue morphology. chronic cutaneous or systemic disease or an acute fulminating fatal systemic disease. Key Features: clinical history. subclinical or benign. rounded. undifferentiated conidiophores. Sporadic cases do occur in Australia. All stages of this disease may mimic tuberculosis. Cultures of Histoplasma capsulatum represent a severe biohazard to laboratory personnel and must be handled with extreme caution in an appropriate pathogen handling cabinet. Histoplasmosis is an intracellular mycotic infection of the reticuloendothelial system caused by the inhalation of the fungus. Microscopically.Descriptions of Medical Fungi 75 Histoplasma capsulatum Darling Histoplasma capsulatum exhibits thermal dimorphism growing in living tissue or in culture at 37OC as a budding yeast-like fungus and in soil or culture at temperatures below 30OC as a mould. 3-4 x 2-3 µm in size are observed. 1988). . however culture identification by exoantigen test is now the method of choice. (2005) and Sabatelli et al. rounded. Espinel-Ingroff et al. hyaline.03-2 0. (2006). (2001).03-2 0. capsulatum showing characteristic large. single-celled. Gonzales et al. .125-64 0. undifferentiated conidiophores.03-8 0. Espinel-Ingroff (2003). 76 Descriptions of Medical Fungi Histoplasma capsulatum Darling 20 µm Culture and microscopic morphology of the saprophytic or mycelial form of H.25 (2) 0. tuberculate macroconidia formed on short.5-1 16 0.06 (1) Antifungal Posaconazole Voriconazole MIC µg/mL Range MIC90 0. Antifungal Amphotericin B Fluconazole Itraconazole MIC µg/mL Range MIC90 0.25-1 0.25 (1) Limited data available. hyaline to pale brown and usually occur in aggregated masses. antifungal susceptibility testing of individual strains is recommended. 20 µm Culture and conidia of Hortaea werneckii. septate hyphal elements and numerous two-celled.03-0. (2000). Annellides may also arise from the hyphae. initially mucoid. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. Microscopically. For description of species. keys to taxa and additional information see Mok (1982). RG-1 organism. Most yeast-like cells also have prominent darkly-pigmented septa. cylindrical to spindle-shaped. compost.Descriptions of Medical Fungi 77 Hortaea werneckii (Horta) Nishimura & Miyaji Synonyms: Phaeoannellomyces werneckii (Horta) McGinnis & Schell Exophiala werneckii (Horta) v. colonies consist of brown to dark olivaceous.25 0. McGinnis and Pasarell (1998) and WCH in-house data.03-1 0. pale brown. two-celled yeast-like cells producing annelloconidia. (1985). . Arx Colonies are slow growing. Key Features: dematiaceous hyphomycete. However with age they develop abundant aerial mycelia and become dark olivaceous in colour.125 Very limited data. McGinnis (1980). Rippon (1988) and de Hoog et al. yeast-like and shiny black.03-0. Conidia are one to two-celled. cylindrical to spindle-shaped yeast-like cells that taper towards the ends to form an annellide. Hortaea werneckii is a common saprophytic fungus believed to occur in soil. McGinnis et al. humus and on wood in humid tropical and sub-tropical regions and is the causative agent of tinea nigra in humans. often aggregated. 78 Descriptions of Medical Fungi Lasiodiplodia theobromae (Pat. cylindrical. base truncate. RG-1 organism. Pycnidia are simple or compound. Key Features: coelomycete. 20-30 x 10-15 µm. It has also been associated with mycotic keratitis. . simple. sometimes septate. mature conidia oneseptate. often longitudinally striate. rarely branched cylindrical. Paraphyses when present are hyaline. reverse fuscous black to black. cylindrical to subobpyriform. Lasiodiplodia theobromae is a well known plant pathogen and it has been reported from about 500 host plants. (2000). simple. MIC µg/mL Range MIC µg/mL Range MIC µg/mL Range Antifungal Amphotericin B Antifungal Itraconazole Antifungal Voriconazole 0. For description of species. 10 µm Mature two-celled dark brown conidia with typical striations of L. & Curt. antifungal susceptibility testing of individual strains is recommended. thick-walled. Conidiophores are hyaline. up to 5 mm wide. sometimes septate. holoblastic. hyaline. subovoid to ellipsoide-oblong. arising from the inner layers of cells lining the pycnidial cavity.03 16 0. cinnamon to fawn. WCH in-house data only. theobromae. with pycnidia producing characteristic two-celled. Arx Synonym: Botryodiplodia theobromae Patouillard Colonies are greyish sepia to mouse grey to black. Conidia are initially unicellular. v. dark brown. granulose. ostiolate. fluffy with abundant aerial mycelium. keys to taxa and additional information see de Hoog et al. stromatic. striated conidia. lesions on nail and subcutaneous tissue. up to 50 µm long. frequently setose.) Griffon & Maublanc Teleomorph: Botryosphaeria rhodina (Berk. mainly confined to an area 40O north to 40O south of the equator.25 Very limited data. annellidic. Conidiogenous cells are hyaline. 5 0.06-32 0. Conidia are hyaline. Lecythophora contains 6 species. smooth and thin walled. with regular and sharp margin. with two species of medical interest. usually lateral or intercalary.F. either sessile or on small outgrowths.5 Very limited data. hyphae bearing one or several scattered inconspicuous collarettes. (2000). Chlamydospores may be present.H. keys to taxa and additional information see de Hoog (1983) and de Hoog et al. RG-1 organism. reverse pink.5-2. or from lateral cells which are sometimes arranged in dense groups. smooth.0-3. lateral cells flask-shaped or nearly cylindrical. smooth and thin walled. hyaline. antifungal susceptibility testing of individual strains is recommended. hyphae with small collarettes and conidia of Lecythophora hoffmannii.Descriptions of Medical Fungi 79 Lecythophora Nannfeldt Colonies are pink to salmon. later becoming blackish. moist. Beyma) W. broadly ellipsoidal. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0.125-0. Lecythophora hoffmannii (J. reniform or allantoid. . L hoffmannii and L.5 µm. produced in slimy heads. mutabilis. For description of species. 10 µm 10 µm Culture. pink to orange. Conidia are hyaline.5 x 1. McGinnis and Pasarell (1998). broadly ellipsoidal to cylindrical or allantoid.06-0. cylindrical. smooth. producing conidia laterally from small collarettes directly on the hyphae. Gams & McGinnis Teleomorph: Coniochaeta ligniaria (Grev.5 µm wide. Conidiogenous cells are poorly differentiated.) Cooke Colonies are flat. Collarettes are unpigmented. about 1. often mucoid or yeastlike. 3. Hyphae are narrow. colonies become dark brown to reddish-brown and have a brownish-black reverse.5 Very limited data. grisea can be distinguished from Madurella mycetomatis by the inability to grow at 37OC and to assimilate lactose. Colonies are slow growing. Chandler et al. antifungal susceptibility testing of individual strains is recommended. although hyphae of two widths have been described. . (1980). with two distinctive zones. Both M. folded with radial grooves and with a light brown to greyish surface mycelium. leathery. With age. grisea have been isolated from soil and are one of the major causative agents of mycetoma. For descriptions of species. Ferrada and Montemayer The genus Madurella is based on tissue morphology (mycetoma with black grains) and the formation of sterile cultures on mycological media. up to 1. Microscopically. Key Features: black grain mycetoma. 80 Descriptions of Medical Fungi Madurella grisea Mackinnon. mycetomatis and M. no diffusible brown pigment produced on culture and absence of conidia. (2001). Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. a hyaline to weakly pigmented central zone and a deeply pigmented periphery. dark.0 mm. Espinel-Ingroff et al. keys to taxa and additional information see McGinnis (1980). thin at 1-3 µm in width or broad at 3-5 µm in width. Rippon (1988) and de Hoog et al. cultures are sterile. no growth at 37OC. (2000). this fungus does not grow at 37OC.5 0. round to lobed. soft to firm.25 0. 100 µm Grains of Madurella grisea (tissue microcolonies) are black. grisea is 30OC. RG-2 organism. The optimum temperature for growth of M. M. 125 Voriconazole 0. (2000). 0. white to yellow to yellowish-brown.03 Itraconazole 0. Although most cultures are sterile. Chandler et al. mycetomatis. McGinnis and Pasarell (1998) and Espinel-Ingroff et al.0 mm in size. mycetomatis can be distinguished from Madurella grisea by growth at 37OC and its inability to assimilate sucrose. (1980). For descriptions of species. the first being flask-shaped phialides that bear rounded conidia. A brown diffusible pigment is characteristically produced in primary cultures. becoming brownish. Rippon (1988) and de Hoog et al. (2001). RG-2 organism Grains of Madurella mycetomatis (tissue microcolonies) are brown or black.03-0. round or lobed. MIC µg/mL Range MIC µg/mL Range MIC µg/mL Range Antifungal Amphotericin B Antifungal Antifungal 0. antifungal susceptibility testing of individual strains is recommended.Descriptions of Medical Fungi 81 Madurella mycetomatis (Laveran) Brumpt Colonies are slow growing. flat and leathery at first.6 Very limited data. growth at 37OC. with terminal cells expanded to 12-15 (30) µm in diameter. hard and brittle. two types of conidiation have been observed. The optimum temperature for growth of this mould is 37OC. M. composed of hyphae which are 2-5 µm in diameter. folded and heaped with age and with the formation of aerial mycelia. 20 µm Culture showing brown diffusible pigment and phialides of M. the second being simple or branched conidiophores bearing pyriform conidia (3-5 µm) with truncated bases. . Key Features: black grain mycetoma. diffusible brown pigment produced on culture and the occasional presence of phialides.5-1.03-0. keys to taxa and additional information see McGinnis (1980). Gueho et al. Guillot et al. yeast cells.125 (2) Very limited data available.03-4 4 (8) 0. sympodialis wide narrow wide wide narrow wide narrow SDA 40OC Cremophor EL Tween 80 Tween 40 Tween 20 Esculine Catalase + - + + + + + -. pachydermatis M. slooffiae M.125 (1) 0. normal flora.125 0. normal flora. pityriasis humans. With the exception of M. Buds M. normal flora. 2000). RG-2 organisms. glistening or dull. and with the margin being either entire or lobate (see photo). Nakamura et al. (2007). especially dogs Identification criteria for the differentiation of Malassezia species (de Hoog et. Seven species have now been recognised (Gueho et al. de Hoog et al. (2000). furfur M.w + + + + + + -. normal flora M. obtusa M. colonies are cream to yellowish. restricta M. Special growth conditions are needed for antifungal susceptibility testing. On such media. The most common method used is to overlay Sabouraud’s dextrose agar containing cycloheximide (actidione) with olive oil or alternatively to use a more specialised media like Dixon’s agar which contains glycerol mono-oleate.03-16 0. therefore in vitro growth must be stimulated by natural oils or other fatty substances. Malassezia are lipophilic yeasts. pachydermatis. (2004) and Miranda et al.03-16 0. keys to taxa and additional information see Guillot and Gueho (1995). restricta M. slooffiae M. .03-16 0.03-32 1 (8) 0. al. normal flora human and pig normal flora humans. pityriasis humans. smooth or lightly wrinkled. 1996). globosa M. oblong-ellipsoidal to cylindrical.w -.25 Antifungal Amphotericin B Voriconazole Posaconazole MIC µg/mL Range MIC90 0. 2000). (1996). obtusa M. Velegraki et al. Reproduction is by budding on a broad base and from the same site at one pole (unipolar). sympodialis Source humans.w + + w v + + + + v + + + For descriptions of species. furfur M. Antifungal Fluconazole Itraconazole Ketoconazole MIC µg/mL Range MIC90 0. (1996. pachydermatis animals. (2000). atopic dermatitis humans. Species M. globosa M. 82 Descriptions of Medical Fungi Malassezia Baillon Malassezia is characterised by globose.125->64 0.w + + +. Microscopic morphology shows typical hyaline. immitis/posadasii. Rippon (1988) and de Hoog et al. Malbranchea species are soil fungi of world-wide distribution which microscopically may resemble Coccidioides immitis/posadasii. alternate arthroconidia produced in terminal fertile portions of the hyphae. For description of the species. one-celled. . keys to taxa and additional information see Cooney and Emerson (1964).Descriptions of Medical Fungi 83 Malbranchea Saccardo Colonies are white to sulphur-yellow to ochre-brown in colour. with a reddish-brown reverse. McGinnis (1980). RG-1 organisms. (2000). Exoantigen tests are now the method of choice for culture identification of C. cylindrical. 20 µm Arthroconidia of Malbranchea. Key Features: hyphomycete producing alternate arthroconidia with disjunctor cells. suede-like in texture. These arthroconidia may be perceived as a yellow dust when released at maturity. Arthroconidia are released by lysis of the disjunctor cells. and often a reddish diffusible pigment. truncate. smooth-walled. (1980). keys to taxa and additional information see Rebell and Taplin (1970). 2. Microconidia are hyaline. 84 Descriptions of Medical Fungi Microsporum Gruby Teleomorph: Arthroderma Currey and Berkeley emend Weitzman et al.5 Fluconazole 0.01-4 0. It is essential to observe macroconidia when identifying species of Microsporum. (1986).125-2 1 Amphotericin B 0. Kane et al. (2006) and WCH in-house data. pyriform to clavate.or thick. usually being visible only as a brown discolouration.01-16 0. audouinii showing poor growth on rice grains.06 Voriconazole 0.06->64 64 Terbinafine 0.007-1 0. audouinii. with thin. Macroconidia are hyaline. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Griseofulvin 0. variable in form. Their shape. Sabatelli et al. canis and M. fusiform.03-8 1-2 Itraconazole 0. Microsporum species form both macro. Seventeen species of Microsporum have been described (Rippon.echinulate to verrucose cell walls. (b) M.25-0. canis often do not produce macroconidia and/or microconidia on primary isolation media and it is recommended that sub-cultures be made onto polished rice grains to stimulate sporulation.5 Fernandez-Torres et al. canis on rice grains showing good growth. Domsch et al. Strains of M. (1986). For descriptions of species. (1997) and de Hoog et al. multiseptate. The separation of this genus from Trichophyton is essentially based on the roughness of the macroconidial cell wall. Weitzman et al. yellow pigmentation and sporulation. Mackenzie et al. 1988) however only the more common species are included in these descriptions. McGinnis (1980). audouinii and it is surprising just how many laboratories have difficulty in differentiating between M.and microconidia on short conidiophores. ranging from 7-20 x 30-60 µm in size.5-3.5 x 4-7 µm in size and are not diagnostic for any one species. These non-sporulating strains of M. Vanbreusegham et al. single-celled. size and cell wall features are important characteristics for species identification. canis are often erroneously identified as M. Ajello (1977). . Rippon (1988). (2001). (2000). a b (a) M. although in practice this may sometimes be difficult to observe. spindle-shaped to obovate. (1978). Note: growth of some strains of M. whitish suede-like surface and a very pale yellow-brown reverse. Lactritmel Agar: Colonies are usually flat. Some strains may show no reverse pigment.Descriptions of Medical Fungi 85 Microsporum audouinii Gruby Colonies (SDA) are flat. Invaded hairs show an ectothrix infection and usually fluoresce a bright greenish-yellow under Wood’s ultra-violet light. Macroconidia and microconidia are only rarely produced. Vitamin Free Agar (Trichophyton Agar No. Cultures are flat. RG-2 organism. canis is bright yellow). Reverse can be yellow-brown to reddish-brown in colour. suede-like to downy. canis. spreading.1): Good growth indicating no special nutritional requirements. 10 µm Culture and a thick-walled intercalary chlamydospore of M. Once the cause of epidemics of tinea capitis in Europe and North America. most reports are in fact non-sporulating strains of M. Note: macroconidia and microconidia are only rarely produced. canis. canis but are usually longer. with a yellowbrown reverse. most cultures are sterile or produce only occasional thick-walled terminal or intercalary chlamydospores. white. and have a dense suede-like to downy surface. it is now becoming less frequent. audouinii is enhanced by the presence of thiamine (Trichophyton agar No. spreading. microconidia when present are pyriform to clavate in shape and are similar to those seen in other species of Microsporum. Hair Perforation Test: Negative after 28 days. Growth on Rice Grains: Very poor or absent. This is one of the features which distinguish M. inability to perforate hair in vitro. Only rarely found in Australasia. audouinii.4). Key Features: absence of conidia. . with a fine. audouinii is an anthropophilic fungus causing non-inflammatory infections of scalp and skin especially in children. Reverse Pigment on Potato Dextrose Agar: Salmon to pinkish-brown (M. greyish-white to light tan-white in colour. usually being visible only as a brown discolouration. M. When present macroconidia may resemble those of M. So called pectinate (comb-like) hyphae and racquet hyphae (a series of hyphal segments swollen at one end) may also be present. smoother and more irregularly fusiform in shape. suggestive of mouse fur in texture. poor or no growth on polished rice grains. Microscopic morphology as described above. audouinii from M. and culture characteristics. but non-pigmented strains may also occur. Key Features: distinctive macroconidia and culture characteristics. A few pyriform to clavate microconidia are also present. white. verrucose. with a yellow to pale yellow-brown reverse. Numerous clavate to pyriform microconidia are also present in this strain. 86 Descriptions of Medical Fungi Microsporum canis Bodin Teleomorph: Arthroderma otae (Hasegawa and Usui) McGinnis. spreading. . equinum are salmon to pinkish-brown). Colonies usually have a bright golden yellow to brownish yellow reverse pigment. Vitamin Free Agar (Trichophyton Agar No. Growth on Rice Grains: good growth of white aerial mycelium with production of yellow pigment. canis var. Macroconidia and/or microconidia are often not produced on primary isolation media and it is recommended that sub-cultures be made onto Lactritmel Agar and/or boiled polished rice grains to stimulate sporulation. Abundant growth and sporulation on polished rice grains and in vitro perforation of hair. Hair Perforation Test: Positive at 14 days. long. white to cream-coloured. canis. Macroconidia are typically spindle-shaped with 5-15 cells. Colonies (SDA) are flat. Microscopy reveals moderate numbers of thick-walled. 35-110 x 12-25 µm.1): Good growth indicating no special nutritional requirements. white suede-like to cottony colony with a bright yellow reverse. Lactritmel Agar: Flat. suede-like to downy. with a dense cottony surface which may show some radial grooves. multiseptate. thick-walled and often have a terminal knob. Culture of Microsporum canis. some of which show a terminal knob. audouinii and M. Reverse Pigment on Potato Dextrose Agar: Bright yellow (both M. Walls of macroconidia are slightly rough or echinulate especially at terminal knobs. et al. RG-2 organism. Lactritmel agar with sterile soil added is also an excellent medium for the stimulation of macroconidial development in M. spindleshaped macroconidia. Microscopy reveals numerous macroconidia and microconidia similar to those described above. Cultures are flat. Note: the dysgonic type colony of M. canis is a zoophilic dermatophyte of world-wide distribution and is a frequent cause of ringworm in humans. canis are usually produced by this variant when subcultured onto polished rice grains. yellow-brown thallus and macroconidia are usually absent. typical colonies and macroconidia of M. These dysgonic strains have a typically heaped and folded. Invaded hairs show an ectothrix infection and fluoresce a bright greenish-yellow under Wood’s ultra-violet light. M. Cats and dogs are the main sources of infection. Invades hair. canis are rare but may also occur. especially children.Descriptions of Medical Fungi 87 Microsporum canis Bodin 20 µm Typical spindle-shaped macroconidia of Microsporum canis. skin and rarely nails. Dysgonic strains of M. . However. canis is similar to that of Microsporum ferrugineum. distortum is a zoophilic fungus known to cause infections in cats. distortum. canis with distinctive distorted macroconidia. Microsporum canis var. dogs and other animals. 20 µm Culture and distorted macroconidia of M. distortum di Menna & Marples Supplementary description for Microsporum canis var. a dysgonic variant of M. RG-2 organism. . Australia and North America. canis . distortum. It is a rare cause of tinea capitis in New Zealand. Invaded hairs show an ectothrix infection and fluoresce a bright greenish-yellow under Wood’s ultraviolet light. Clinical disease is similar to M. canis var. 88 Descriptions of Medical Fungi Microsporum canis var. Abundant growth and sporulation on rice grains. spreading. broad. spreading. 2000). A buff to pinkish-buff to yellow-brown reverse pigment is produced. and poor growth on polished rice grains. Microscopic morphology as described above. suede-like to downy. Basionym: Microsporum equinum (Delacroix & Bodin) Gueguen Microsporum equinum is now considered to be a genotypic synonym of Microsporum canis (de Hoog et al. 1860 x 5-15 mm with rough thick walls and few septa. Cultures are flat. whitish suede-like surface and a very pale yellow-brown reverse. spindle-shaped. RG-2 organism. equinum from M. Growth on Rice Grains: Poor with minimal surface growth. 3-9 x 1. Invaded hairs show an ectothrix infection and fluoresce a bright greenishyellow under Wood’s ultraviolet light. suede-like. Key Features: macroconidial shape and size. Rarely infects man or other animal species. canis var. Reported from Australia. canis. usually with some radial furrows. inability to perforate hair in vitro. Macroconidia are small (especially when compared to those produced by M. however growth on urea agar usually stimulates the production of macroconidia. Hair Perforation Test: Negative after 28 days. 20 µm Culture and macroconidia of M. This is one of the features which distinguish M. Europe and North America.Descriptions of Medical Fungi 89 Microsporum canis var. but are rarely produced. Note: only a few strains produce conidia on primary isolation. canis var. Microconidia are pyriform to clavate in shape. Colonies are flat. canis is bright yellow). with a yellowbrown reverse. irregular. however we propose it be maintained as a variety of M. Vitamin Free Agar (Trichophyton Agar No. usually being visible only as a brown discolouration. . Microsporum equinum is a rare cause of ringworm of horses. canis due to phenotypic and epidemiologic differences. pale buff to pale salmon. Reverse Pigment on Potato Dextrose Agar: Salmon to pinkish-brown (M. with a fine.1): Good growth indicating no special nutritional requirements. equinum (Delacroix & Bodin) comb.5-3. nov. equinum.5 mm. canis). Lactritmel Agar: Colonies are usually flat. white. Key Features: distinctive macroconidial morphology and culture characteristics. Microscopic morphology as described above for the primary culture. RG-1 organism. cookei from M. Microsporum cookei is a geophilic fungus which has been isolated from hair of small mammals showing no clinical lesions. M. cookei and further tests are not necessary. cookei has a world-wide distribution. echinulate (rough) elliptical macroconidia with predominantly 5-6 septa but may be 2-8 septate. Lactritmel Agar: Flat. but produces hair perforations in vitro. McGinnis & Padhye Colonies (SDA) are flat. The thick walls and usually larger size of the macroconidia distinguish M. very thick-walled. Infection has been reported in rodents. The macroconidia are quite characteristic and diagnostic of M. Hair Perforation Test: Positive. pinkish-buff-coloured. suede-like colony with a deep magenta red reverse. Reverse pigment dark reddish brown. Moderate numbers of mainly slender clavate with some pyriform microconidia are present. Numerous large. buff-coloured. spreading. It is not known to invade hair in vivo. . Occasional spirals may be seen. buff to pale brown. Weitzman. with a slightly raised and folded centre and some radial grooves. Vitamin Free Agar (Trichophyton Agar No. suede-like to powdery colony with a deep redbrown reverse. 90 Descriptions of Medical Fungi Microsporum cookei Ajello Teleomorph: Arthroderma cajetani Ajello. 20 µm Culture and macroconidia of Microsporum cookei. dogs and rarely in humans. powdery to suede-like. gypseum.1): Good growth indicating no special nutritional requirements. Descriptions of Medical Fungi 91 Microsporum ferrugineum Ota Colonies (SDA) are slow growing, forming a waxy, glabrous, convoluted thallus with a cream to buff-coloured surface and no reverse pigment. Note: surface pigmentation may vary from cream to yellow to deep red and a flatter white form sometimes occurs. Cultures rapidly become downy and pleomorphic. Microconidia or macroconidia are not produced. However, irregular branching hyphae with prominent cross walls (“bamboo hyphae”) and chlamydospores are seen. The so-called “bamboo hyphae” is a characteristic of this species. RG-2 organism. Key Features: clinical history, culture characteristics and distinctive “bamboo” hyphae. 20 µm Culture and “bamboo hyphae” of Microsporum ferrugineum. Microsporum ferrugineum is an anthropophilic fungus causing epidemic juvenile tinea capitis in humans. The clinical features are similar to those of infections caused by M. audouinii. Invaded hairs show an ectothrix infection and fluoresce a greenish-yellow under Wood’s ultra-violet light. Reported from Asia (including China and Japan), USSR, Eastern Europe and Africa. 92 Descriptions of Medical Fungi Microsporum fulvum Uriburu Teleomorph: Arthroderma fulvum (Stockdale) Weitzman et al. Colonies (SDA) are fast growing, flat, suede-like, tawny-buff to pinkish-buff in colour and frequently have a fluffy white advancing edge. A dark red under surface is occasionally seen, otherwise it is colourless to yellow brown. Abundant thin-walled, elongate, ellipsoidal macroconidia are formed which closely resemble those of M. gypseum, except they are longer and more bullet-shaped (clavate) with 3 to 6 septa. Numerous spiral hyphae, which are often branched are seen. Numerous pyriform to clavate microconidia are also produced but these are not diagnostic. RG-1 organism. Key Features: macroconidial morphology and culture characteristics. 20 µm Culture and macroconidia of Microsporum fulvum. Microsporum fulvum is a geophilic fungus of world-wide distribution which may cause occasional infections in humans and animals. Clinical disease is similar to M. gypseum but less common. Invaded hairs show a sparse ectothrix infection but do not fluoresce under Wood’s ultra-violet light. Descriptions of Medical Fungi 93 Microsporum gallinae (Megnin) Grigorakis Colonies (SDA) are flat with a suede-like texture and are white in colour with a pinkish tinge. Some cultures show radial folding. An orange-pink “strawberry-coloured” reverse pigment is usually present. Macroconidia when present are usually five- to sixcelled, thin to thick-walled, slightly echinulate, cylindrical to clavate with narrow base and blunt tip, 15-60 x 6-10 µm. Microconidia are ovoidal to pyriform in shape. RG-2 organism. Key Features: macroconidial morphology, culture characteristics and clinical lesions in chickens. 20 µm Culture and macroconidia of Microsporum gallinae. Microsporum gallinae is a zoophilic fungus causing fowl favus in chickens and other fowl, affecting the comb and wattles producing “white comb” lesions. A rare cause of tinea in humans. Invaded hairs show a sparse ectothrix infection but do not fluoresce under Wood’s ultra-violet light. 94 Descriptions of Medical Fungi Microsporum gypseum (Bodin) Guiart & Grigorakis Teleomorphs: Arthroderma gypsea (Nannizzi) Weitzman et al. Arthroderma incurvatum (Stockdale) Weitzman et al. Colonies (SDA) are usually flat, spreading, suede-like to granular, with a deep cream to tawny-buff to pale cinnamon-coloured surface. Many cultures develop a central white downy umbo (dome) or a fluffy white tuft of mycelium and some also have a narrow white peripheral border. A yellow-brown pigment, often with a central darker brown spot, is usually produced on the reverse, however a reddish-brown reverse pigment may be present in some strains. Cultures produce abundant, symmetrical, ellipsoidal, thin-walled, verrucose, four- to six-celled macroconidia. The terminal or distal ends of most macroconidia are slightly rounded, while the proximal ends (point of attachment to hyphae) are truncate. Numerous clavate-shaped microconidia are also present, but these are not diagnostic. RG-1 organism. Key Features: distinctive macroconidia and culture characteristics. 20 µm Culture and macroconidia of Microsporum gypseum. Microsporum gypseum is a geophilic fungus with a world-wide distribution which may cause infections in animals and humans, particularly children and rural workers during warm humid weather. Usually produces a single inflammatory skin or scalp lesion. Invaded hairs show an ectothrix infection but do not fluoresce under Wood’s ultra-violet light. Invaded hairs may show a sparse ectothrix or endothrix infection but do not fluoresce under Wood’s ultra-violet light. and broad truncate bases. Many macroconidia are borne on conidiophores (stalks) which do not stain readily. finely echinulate (rough) walls. Cultures produce numerous small ovoid to pyriform macroconidia with one to three (mostly 2) cells. . cream to buff in colour with a suede-like to powdery surface texture. 20 µm Culture and macroconidia of Microsporum nanum. which distinguishes M.Descriptions of Medical Fungi 95 Microsporum nanum Fuentes Teleomorph: Arthroderma obtusum (Dawson and Gentles) Weitzman et al. Also present in soil of pig-yards. Young colonies have a brownish-orange pigment which deepens into a dark reddish-brown with age. Microsporum nanum is a geophilic and zoophilic fungus frequently causing chronic non-inflammatory lesions in pigs and a rare cause of tinea in humans. Occasional clavate microconidia are present. with relatively thin. RG-2 organism. nanum from some species of Chrysosporium. Colonies (SDA) are flat. Key Features: distinctive macroconidia and culture characteristics. The geographical distribution is world-wide. Infections in man are usually contacted directly from pig or fomites. Not known to invade hair in vivo. 20 µm Culture and microconidia of Microsporum persicolor. RG-2 organism. Microconidia are abundant. with a suede-like to granular texture and peripheral fringe. Microsporum persicolor is a zoophilic fungus often occurring as a saprophyte on voles and bats. white to pinkish in colour.to seven-celled. Australia. Macroconidia are thin-walled. 40-60 x 6-8 µm but are only rarely produced. A rare cause of tinea corporis in humans. four. Distribution: Africa. . Key Features: microscopic morphology and culture characteristics. Colonies (SDA) are generally flat. but produces hair perforations in vitro. Reverse pigmentation is orange to red. 96 Descriptions of Medical Fungi Microsporum persicolor (Sabouraud) Guiart & Grigorakis Teleomorph: Arthroderma persicolor (Stockdale) Weitzman et al. cigar-shaped. spherical to pyriform. Europe and North America. Australia. Cultures are fast growing. arising from rhizoids. downy. and the genus contains about 90 recognised species. wolfii showing a broadly zonate or lobed rosette-like surface appearance and sporangium. showing a sporangiophore. the Mortierellales (Cavalier-Smith 1998). McGinnis (1980). (2000). Sporangiophores are typically erect. RG-2 organism. pneumonia and systemic mycosis in New Zealand. 6-10 x 3-5 µm. delicate. keys to taxa and additional information see Domsch et al. rapid growth at 40OC (thermotolerant). with transparent walls and a conspicuous collarette is usually present following dehiscence of the sporangiospores. (1980). Columella are generally lacking and sporangiospores are single-celled. with a double membrane. Temperature: grows well at 40-42OC. often with a broadly zonate or lobed (rosette-like) surface appearance and no reverse pigment. maximum 48OC. Rippon (1988).Descriptions of Medical Fungi 97 Mortierella wolfii Mehrotra & Baijal The genus Mortierella has now been placed in a separate order. 6-20 µm wide at the base. Key Features: zygomycete. zygospores have not been observed. wide at the base. however Mortierella wolfii is probably the only pathogenic species being an important causal agent of bovine mycotic abortion. Sporangia are usually 15-48 µm in diameter. 80-250 µm in height. collarettes and sporangiospores. short-cylindrical. and acrotonous (terminal) branches. 20 µm 20 µm Culture of M. arising from rhizoids or bulbous swellings on the substrate hyphae and terminating with a compact cluster of short acrotonous (terminal) branches. Europe and USA. white to greyish white. Chlamydospores with or without blunt appendages (amoeba-like) may be present. and characteristic delicate acrotonous branching sporangia without columellae. Smith (1989) and de Hoog et al. . For descriptions of species. Rhizomucor and Rhizopus by the absence of stolons and rhizoids. grey or brownish. globose to ellipsoidal. A conspicuous collarette (remnants of the sporangial wall) is usually visible at the base of the columella after sporangiospore dispersal. white to yellow. antifungal susceptibility testing of individual strains is recommended. 2003). Chlamydospores and zygospores may also be present. Sun et al. and smooth-walled or finely ornamented. non-apophysate sporangia with pronounced columellae and conspicuous collarette at the base of the columella following sporangiospore dispersal. spherical. 20 µm 20 µm Sporangia. large.06-8 1 Voriconazole 8->64 >64 Very limited data. forming large (60-300 µm in diameter). Singh et al. Key Features: zygomycete. . cottony to fluffy.125-8 2 Flucytosine >256 >256 Posaconazole 0. Espinel-Ingroff (2001.03-4 1 Itraconazole 0. (2006) and WCH in-house data. simple or branched. (2005). (2003). columella with a conspicuous collarette (arrow) and sporangiospores of Mucor. becoming dark-grey. multispored sporangia. 98 Descriptions of Medical Fungi Mucor Micheli ex Staint-Amans The genus Mucor can be differentiated from Absidia. Colonies are very fast growing. Sporangiophores are erect. (2002). without apophyses and with well-developed subtending columellae. Sporangiospores are hyaline. globose to spherical. Sabatelli et al. terminal. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Fluconazole >64 >64 Amphotericin B 0. Dannaoui et al. with the development of sporangia. Scholer et al. RG-2 organism. (1983). Samson et al. Maximum temperature for growth of the reported pathogenic species of Mucor. Domsch et al. occasionally humans Questionable cutaneous infections only Humans and animals Questionable Humans and animals For descriptions of species. 1980). M.5 µm in diameter. amphibiorum M. erect and mostly unbranched. . with stellate projections. Mucor amphibiorum Schipper Colonies are greyish-brown. (2000). racemosus M. However. Onions et al. (1995). (1980). 2000). Goodman and Rinaldi 1991. Scholer et al. Sporangiospores are smooth-walled. (1981). 1969. Sporangiophores are hyaline. de Hoog et al. are spherical to slightly compressed. Schipper and Staplers (2003) and Ellis (2005b). M. rouxii). Columellae are subglobose to ellipsoidal or pyriform. up to 75 µm in diameter. Mucor amphibiorum is distinguished by poor ramification of the sporangiophores and by globose sporangiospores. Schipper 1978. Sporangia are dark-brown. indicus M. slightly aromatic and do not grow at 37OC (maximum temperature for growth is 36OC). principally amphibians Animals. spherical. Kwon-Chung and Bennett 1992. (OC) 36 36-40 30 42 32 36 Pathogenicity Animals. 1983.5-5. and 3. Species M. ramosissimus and M. Goodman and Rinaldi (1991). Ethanol and nitrate are not assimilated (Schipper 1978. indicus (M. and are slightly flattened with a diffluent membrane. Domsch et al. when formed by compatible mating types. de Hoog et al. many of which have widespread occurrence and are of considerable economic importance (Zycha et al. with small collarettes. 2000). up to 60 x 50 µm. up to 70 x 60 µm in diameter. circinelloides and similar species such as M. Hoog et al. hiemalis and M.Descriptions of Medical Fungi 99 Mucor Micheli ex Staint-Amans The genus Mucor contains about 50 recognised taxa. hiemalis M. racemosus have also been reported as infectious agents. rarely sympodially branched. although their inability to grow at temperatures above 32OC raises doubt as to their validity as human pathogens and their pathogenic role may be limited to cutaneous infections (Scholer et al. amphibiorum as the causative agents. Rippon (1988). 1983. circinelloides M. ramosissimus Max temp. Most infections reported list M. Zygospores. McGinnis (1980). only a few thermotolerant species are of medical importance and human infections are only rarely reported. keys to taxa and additional information see Schipper (1978). However. RG-1 organism. up to 40 µm high. 2000. 5-8 x 4. up to 100 µm in diameter and have equal to slightly unequal suspensor cells. 2000. 1983. lusitanicus. and being thiamine dependent (Schipper 1978. Sporangiophores are hyaline. Columellae are spherical to ellipsoidal and are up to 50 µm in diameter. Sporangiophores are hyaline to yellowish. and 4-5 µm in diameter. up to 75 µm in diameter. varying from 20-80 µm in diameter. Schipper and Staplers 2003). subglobose to ellipsoidal. RG-1 organism. chlamydospores and zygospores are absent. up to 40-50 µm in size and are often absent in smaller sporangia.5-6 µm in size. Sporangia are yellow to brown. . aromatic and have a maximum growth temperature of 42OC. Samson et al. and the occurrence of racket-shaped enlargements in the sporangiophores (Hesseltine and Ellis 1964. but not nitrate. Columellae are applanate (flattened). de Hoog et al. Sporangia are spherical. Colonies are floccose. spherical with stellate spines. especially in the light. Scholer et al. Sporangiospores are hyaline. spherical up to 100 µm in diameter. tapering towards the apex and are erect with repeated sympodial branching. Scholer et al. Mucor indicus Lendner Colonies are characteristically deep-yellow. Sporangiospores are faintly brown. circinelloides differs from other species of Mucor in its formation of short circinated (coiled). ellipsoidal. 100 Descriptions of Medical Fungi Mucor circinelloides v. restricted growth on any medium. griseo-cyanus and janssenii (Schipper 1978. Schipper and Staplers 2003). assimilating ethanol. Mucor ramosissimus Samutsevich Colonial growth is restricted. with diffluent membranes. de Hoog et al. extremely persistent sporangial walls. smooth-walled. subglobose to broadly ellipsoidal. globose or somewhat flattened. 1983). up to 80 µm in diameter and have very persistent sporangial walls. Zygospores are only produced in crosses of compatible mating types and are reddish-brown to dark-brown. Schipper 1976. 2000. Scholer et al. and 4. circinelloides is a common and variable species that includes 4 forms: circinelloides. 1983. short sporangiophores that repeatedly branch sympodially as many as 12 times. M. 1995.55 µm in size.5-7 x 3. pale greyish-brown and grow poorly at 37OC (maximum growth temperature 36-40OC). Tiegh M. Sporangiospores are smooth-walled. greyish and does not grow at 37OC (maximum temperature for growth is 36OC). Columellae are subglobose to pyriform. growth at over 40OC. Chlamydospores are produced in abundance. with stellate spines and unequal suspensor cells. often with truncate bases. branched sporangiophores bearing brown sporangia and its ability to assimilate ethanol and nitrate (Schipper 1976. with small sporangia often having a persistent sporangial wall. Sporangia are grey to black. slightly roughened. RG-1 organism. Mucor indicus differs from other species of Mucor by its characteristic deep-yellow colony colour. Zygospores when formed by crosses of compatible mating strains are black. erect or rarely circinate and repeatedly sympodially branched. Sporangiophores are hyaline and mostly sympodially branched with long branches erect and shorter branches becoming circinate (recurved). Mucor ramosissimus differs from other species of Mucor by its low. Oidia may be present in the substrate hyphae. de Hoog et al. Schipper and Staplers 2003). with long branches. Assimilation of ethanol is negative and that of nitrate is positive. smooth-walled. columellae that are applanate or absent in smaller sporangia (often resembling Mortierella species). Chlamydospores are generally absent. darkly pigmented arthroconidia. 3. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. flask-shaped phialides.to two-celled. 20 µm Microscopic morphology of the Scytalidium dimidiatum synanamorph of Nattrassia mangiferae showing chains of one. RG-2 organism. Nattrassia mangiferae (arthric synanamorph = Scytalidium dimidiatum) is a recognised agent of onychomycosis and superficial skin infections. (2000). isolates are sensitive to cycloheximide (actidione) which is commonly added to primary isolation media used for culturing skin scrapings.5-12 µm. hairy. produced by the holothallic fragmentation of undifferentiated hyphae. Espinel-Ingroff et al. Conidia are ovoid to ellipsoidal in shape. (2001) and WCH in-house data.5 Very limited data.Descriptions of Medical Fungi 101 Nattrassia mangiferae (H. Colourless (hyaline) mutants (=Scytalidium hyalinum) often occur.125-2 0. ostiolate pycnidia containing numerous hyaline. with a cream-coloured to deep ochraceous-yellow colony reverse. For descriptions of species. Frankel and Rippon (1989).5-5 x 6. Phialoconidia are at first one-celled and hyaline. & Syd) Sutton & Dyko Pycnidial synanamorph: Hendersonula toruloidea Nattras Arthroconidial synanamorph: Scytalidium dimidiatum (Penzig) Sutton & Dyko Scytalidium hyalinum Campbell & Mulder This coelomycete is characterised by the presence of black. or white to greyish. later becoming three-celled and brown.03-32 0. Pycnidia are only occasionally formed in older cultures. keys to taxa and additional information see McGinnis (1980). dark grey to blackish-brown. Syd. with the centre cell darker than the end cells. . Sutton and Dyko (1989) and de Hoog et al. Moore (1986). In culture the Scytalidium dimidiatum anamorph is typically present showing chains of one. Rippon (1988). Cultures are effuse.03-0. However.to two-celled. darkly pigmented arthroconidia. especially in tropical regions. antifungal susceptibility testing of individual strains is recommended. 03-2 0.5-4. Conidiophores are mostly cylindrical to acicular. Hyphae are brown with relatively thick walls. especially in poultry. subhyaline to pale brown. dry. Cooke) de Hoog Colonies are smooth to suede-like. cylindrical to clavate. sometimes poorly differentiated. with the apical cell wider than the basal cell. 102 Descriptions of Medical Fungi Ochroconis gallopava (W.03-0. Ochroconis gallopava is a well recognised species and has been reported as an avian pathogen. antifungal susceptibility testing of individual strains is recommended. tobacco-brown to brownish-black with a dark brown diffusible pigment.03-1 Very limited data. . McGinnis 1980 and de Hoog et al. tolerant to 40OC. bearing a few conidia at the tip. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. Espinel-Ingroff (2001) and WCH in-house data. smooth-walled to verrucose. RG-2 organism. A remnant of a denticle may also be seen at the conidial base. For descriptions of species. McGinnis and Pasarell (1998). 11-18 x 2. constricted at the septum. 1980.B.5 0. 2000. keys to taxa and additional information see Domsch et al. Conidia are two-celled.5 µm in size. Occasional human infections have also been reported. flat. Optimum growth at 35OC. conidiophores and conidia of Ochroconis gallopava. 10 µm 10 µm Hyphae. or two-celled. with a brownish reverse. white to yellowish. (1998) and de Hoog et al. Sigler et al. white. forming long chains. arthroconidial mould isolated from nails. However. (1994). RG-2 organism. Arthroconidia are cylindrical to broadly ellipsoidal. hyaline to subhyaline. rough-walled hyphae. 4-16 x 2-5 µm in size. (2000).Descriptions of Medical Fungi 103 Onychocola canadensis Sigler Teleomorph: Arachnomyces nodososetosus Sigler & Abbott Colonies grow slowly and are velvety to lanose. keys to taxa and additional information see Sigler and Congly (1990). 10 µm Culture and arthroconidia of Onychocola canadensis. it may sometimes be present in an abnormalappearing nail as an insignificant finding. For descriptions of species. one. Onychocola canadensis is an uncommon cause of distal and lateral subungual or white superficial onychomycosis. Gupta et al. brown. Older cultures may show broad. . Key Features: slow growing. not acting as a pathogen. in pairs. Paecilomyces species are common environmental moulds and are seldom associated with human infection. variotii (a) and P. variotii. smooth or rough. keys to taxa and additional information see Samson (1974). gradually tapering into a rather long and slender neck. marquandii and P. Rippon (1988) and de Hoog et al. and occur solitarily. but never green or blue-green as in Penicillium. 104 Descriptions of Medical Fungi Paecilomyces Bain Colonies are fast growing. (1981). yellow-brown. ovoid to fusoid conidia are produced in basipetal succession from the phialides. lilacinus (b) showing colony pigmentation. Phialides are swollen at their bases. lilacinus are emerging as causative agents of mycotic keratitis and of hyalohyphomycosis in the immunocompromised patient. green-gold. The genus Paecilomyces may be distinguished from the closely related genus Penicillium by having long slender divergent phialides and colonies that are never typically green. (2000). Domsch et al. (1980). lilac or tan. Long. gold. hyaline to dark. some species. Onions et al. Key Features: long slender divergent phialides and culture pigmentation. and in penicillate heads. dry chains of single-celled. McGinnis (1980). powdery or suede-like. However. For descriptions of species. a Cultures of P. P. b . P. as verticils. 25 (2) Limited data. Growth at 38OC. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Amphotericin B 2-16 8 Posaconazole 0.06-2 0. bearing branches with densely clustered phialides. yellow to purple and rough-walled. hyaline to purple in mass. (2001). Phialides are swollen at their bases. and WCH in-house data. 2003). smooth-walled to slightly roughened. 2. 10 µm 10 µm Note: Conidiophores.5-3. and are produced in divergent chains. RG-1 organism.0 x 2-2. (2005).5-16 16 Voriconazole 0. Conidia are ellipsoidal to fusiform. Chlamydospores are absent. vinaceous to violet-coloured. phialides and conidia of Paecilomyces lilacinus. suede-like to floccose. Espinel-Ingroff et al. and pigmented and rough-walled conidiophore stipes. Conidiophores are erect 400-600 µm in length.Descriptions of Medical Fungi 105 Paecilomyces lilacinus (Thom) Samson Colonies are fast growing. Gonzales et al. antifungal susceptibility testing of individual strains is recommended. Key Features: colony pigmentation. gradually tapering into a slender neck.5 (2) Itraconazole 0. Conidiophore stipes are 3-4 µm wide.2 µm. Espinel-Ingroff (2001. .06-4 0. absence of chlamydospores. phialides with swollen bases. rough-walled conidiophore (arrow). Phialides are cylindrical or ellipsoidal.03-0.03-8 0. smooth-walled. verticillately arranged branches bearing phialides. antifungal susceptibility testing of individual strains is recommended. tapering abruptly into a rather long and cylindrical neck. Espinel-Ingroff (2003) and WCH in-house data.06-1 1 Posaconazole 0. funiculose or tufted.5 Itraconazole 0. Chlamydospores are usually present.03-2 0. thick-walled to slightly verrucose. Key Features: yellow-brown colony pigmentation. ellipsoidal to fusiform. Conidia are subspherical. 4-8 µm in diameter. Espinel-Ingroff et al. (2001). and yellowbrown or sand-coloured.5 Voriconazole 0. phialides. 10 µm 5 µm 10 µm Conidiophores. 106 Descriptions of Medical Fungi Paecilomyces variotii Bain Colonies are fast growing. RG-2 organism. and presence of chlamydospores. subspherical to pyriform. conidia and terminal chlamydospores of P. variotii.5 0. brown. singly or in short chains. Conidiophores bearing dense. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Amphotericin B 0. hyaline to yellow. cylindrical phialides. . powdery to suede-like.5 Limited data. 3-5 x 2-4 µm and are produced in long divergent chains. On BHI blood agar at 37OC. Microscopically.03-4 0. tissue pathology. Rippon (1988) and de Hoog et al. Espinel-Ingroff (2001) and Sabatelli et al. numerous large. a variety of conidia may be seen. P.Descriptions of Medical Fungi 107 Paracoccidioides brasiliensis (Splendore) Almeida Colonies (SDA) at 25OC are slow growing and variable in morphology. none of these are characteristic of the species. Cultures of Paracoccidioides brasiliensis may represent a biohazard to laboratory personnel and should be handled with extreme caution in an appropriate pathogen handling cabinet. (2001). moist and glabrous and become wrinkled. including pyriform microconidia.125-64 0. Colonies may be flat. and most strains may grow for long periods of time without the production of conidia. WARNING: RG-3 Organism. keys to taxa and additional information see McGinnis (1980). (2000). 20-60 μm. Chandler et al. (2006) (na = not available). .25 na Antifungal Itraconazole Voriconazole MIC µg/mL Range MIC90 0.03-2 0. (1980). especially in methenamine silver stained tissue sections. Antifungal Amphotericin B Fluconazole MIC µg/mL Range MIC90 0. Single and multiple budding occurs. round. Espinel-Ingroff et al. suede-like or downy in texture. wrinkled and folded. For descriptions of species. narrow base budding yeast cells “steering wheels” of P. However. 20 µm 20 µm Multiple. brasiliensis is geographically restricted to areas of South and Central America (Rippon. Key Features: clinical history. the mycelium converts to the yeast phase and colonies are white to tan. 1988).03-1 0. folded and heaped. Microscopically. glabrous.06 na Limited data available. brasiliensis. narrow base budding yeast cells are present. chlamydospores and arthroconidia. white to brownish with a tan or brown reverse. culture identification with conversion to yeast phase at 37OC. the latter are thick-walled cells that form the classical “steering wheel” or “mickey mouse” structures that are diagnostic for this fungus. For identification. Microscopically. with the exception of P. consisting of a cylindrical basal part and a distinct neck. Microscopic mounts are best made using a cellotape flag or a slide culture preparation mounted in lactophenol cotton blue. sometimes white. two-stage branched (biverticillate-asymmetrical) or threeto more-staged branched. All cells between the metulae and the stipes of the conidiophores are referred to as branches. 108 Descriptions of Medical Fungi Penicillium Link: Fries Colonies are usually fast growing. (b) one-stage branched. or lanceolate (more or less with a narrow basal part tapering to a somewhat pointed apex). The branching pattern may be either simple (non-branched or monoverticillate). (a) simple. The penicillus may contain both branches and metulae (penultimate branches which bear a whorl of phialides). Conidia are in long dry chains. In Penicillium. flask-shaped phialides arranged in groups from branched metulae forming a penicillus. 1995). Key Features: hyphomycete. Conidiophores are hyaline. ellipsoidal. (c) two-stage branched. isolates are usually inoculated at three points on Czapek Dox agar and 2% Malt extract agar and incubated at 25OC. phialides metulae branches a b c d Morphological structures and types of conidiophore branching in Penicillium. marneffei which is an RG-3 organism. Most species sporulate within 7 days. cylindrical or fusiform. phialides may be produced singly in groups or from branched metulae. Phialides are usually flask-shaped. giving a brush-like appearance (a penicillus).. RG-1 organisms. hyaline or greenish. one-stage branched (biverticillate-symmetrical). in shades of green. . divergent or in columns. 1995). A drop of alcohol is usually needed to remove bubbles and excess conidia (see Samson et al. (d) three-stage branched (see Samson et al. smooth or rough-walled. mostly consisting of a dense felt of conidiophores. Sclerotia are produced by some species. chains of single-celled conidia are produced in basipetal succession from a specialised conidiogenous cell called a phialide. smooth or rough-walled. are globose. The term basocatenate is often used to describe such chains of conidia where the youngest conidium is at the basal or proximal end of the chain. For descriptions of species. keys to taxa and additional information see Raper and Thom (1949). (2000). Ramirez (1982). Simple conidiophore of P. McGinnis (1980).125-2 1-2 Posaconazole 0. Pitt (1979).. (2002).5-2 Voriconazole 0. Onions et al.03-2 0. (1981).5-2 Limited data. cyclopium showing two-stage branching. Correct identification is therefore important when studying possible Penicillium contamination of food. Human pathogenic species are rare. 20 µm 20 µm Conidiophores of P. Diekema et al. (2003). 1995 and Rippon. antifungal susceptibility testing of individual strains is recommended. Espinel-Ingroff (2003) and WCH in-house data. . but it should be pointed out that inhalation of conidia and volatiles may affect health. verrucosum var. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Amphotericin B 0.25-1 Itraconazole 0. however opportunistic infections leading to mycotic keratitis. cheresanum showing long chains of single-celled conidia.03-2 0. Domsch et al.Descriptions of Medical Fungi 109 Penicillium Link:Fries Many species of Penicillium are common contaminants on various substrates and are known as potential mycotoxin producers. 1988). otomycosis and endocarditis (following insertion of valve prosthesis) have been reported (see Samson et al. In some species odour and exudate production will help to recognise the taxa. Samson et al. Pfaller et al. (1995) and de Hoog et al.03->8 0. (1980). either packed within histiocytes or scattered through the tissue. WARNING: RG-3 organism. white with yellowishgreen conidial heads. P. phialides and conidia of Penicillium marneffei. large. with distinctive septa may be present. Tissue sections show small. smoothwalled and bear terminal verticils of 3-5 metulae. yeast cells are spherical to ellipsoidal. a giemsa stained touch smear showing typical septate yeast-like cells (arrow). marneffei exhibits thermal dimorphism and is endemic in Southeast Asia and the southern region of China. Numerous short hyphal elements are also present. Occasional. tan-coloured and yeast-like. each bearing 3-7 phialides. up to 8 µm long. 5 µm 15 µm 5 µm Colony. suede-like to downy. Conidia are globose to subglobose. glabrous. colonies are rough. On brain heart infusion (BHI) blood agar incubated at 37OC. 2-6 µm in diameter. elongated sausage-shaped cells. Cultures of Penicillium marneffei may represent a biohazard to laboratory personnel and should be handled with caution in an appropriate pathogen handling cabinet. Microscopically. 2 to 3 µm in diameter. . 3 µm in diameter. smooth-walled and are produced in basipetal succession from the phialides. Colonies become greyish-pink to brown with age and produce a diffusible brownish-red to wine-red pigment. and divide by fission rather than budding. 110 Descriptions of Medical Fungi Penicillium marneffei Segretain Colonies (SDA) at 25OC are fast growing. oval to elliptical yeast-like cells. Conidiophores are hyaline. Synonym: Phialophora parasiticum Ajello. arthritis. funnel-shaped collarettes. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. P. . acular to cylindrical slightly tapering towards the tip. 15-50 μm long. often in balls. suede-like with radial furrows.06-16 0. slender. with small. Phialides are brown. are hyaline. cylindrical to sausage-shaped. For descriptions of species and additional information see de Hoog et al. Gams et al. antifungal susceptibility testing of individual strains is recommended. RG-2 organism. initially whitish-grey becoming olivaceous-grey with age. mycetoma. 10 µm 20 µm Colony. parasiticum is a plant pathogen but it has also been reported from cases of subcutaneous infection. (2000).06-2 Very limited data. Hyphae hyaline. thin-walled. often proliferating.Descriptions of Medical Fungi 111 Phaeoacremonium parasiticum (Ajello et al. thick-walled. Conidia.06-32 0. later becoming brown and some becoming rough-walled. 2000). endocarditis and mycotic keratitis. phialides and conidia of Phaeoacremonium parasiticum. Gerog & Wang Cultures are usually slow growing. 3-6 x 1-2 μm. McGinnis and Pasarell (1998) and WCH in-house data. later inflating (de Hoog et al.) W. . thick-walled conidia formed on dark brown. and (2) brown. peg-like phialides on thin-walled hyphae.5-3. greyish-brown with a greybrown to olivaceous-black reverse.5 μm in size. formed on dark brown. (1) hyaline conidia. The genus Phialophora contains more than 40 species. tapering phialides with flaring collarettes. and are powdery to woolly or tufted. Two conidial types are produced. 2.5-2. verrucosa) or phaeohyphomycosis (P. which may be solitary. and (2) brown. thick-walled conidia which are spherical to sub-spherical. (1) hyaline conidia which are allantoid or cylindrical. often becoming brown with age. RG-2 organism. formed on inconspicuous. 3-6 x 1. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0.) Conant Colonies grow rapidly. 10 µm 10 µm Phialides of P. richardsiae). and usually aggregate in slimy heads at the apices of the phialides. antifungal susceptibility testing of individual strains is recommended. Phialophora richardsiae (Nannf.03-2 0. Phialophora richardsiae is a soft rot fungus of wood and is an uncommon cause of human infection. or in a brush-like arrangement. ovoid to cylindrical or allantoid. cases of subcutaneous phaeohyphomycosis have been reported.5 x 2-3 μm. members of the genus Phialophora produce clusters of single-celled conidia in basipetal succession from characteristic flask-shaped or cylindrical phialides which have distinctive collarettes. grey to olivaceous-black. McGinnis and Pasarell (1998) and WCH in-house data. 112 Descriptions of Medical Fungi Phialophora Medlar Colonies are usually slow growing. several species have been documented as causing either chromoblastomycosis (P.125-1 0. most are saprophytes commonly found in soil or on decaying wood. slender. smooth-walled. richardsiae producing 2 types of conidia. tapering phialides with flaring collarettes. peg-like phialides on thin-walled hyphae. However. Conidia are hyaline to olivaceous brown. However. slender. verrucosa and P.125-2 Very limited data. Microscopically. formed on inconspicuous. smoothwalled. and aggregate in slimy heads at the apices of the phialide. MIC µg/mL Antifungal Range MIC µg/mL Antifungal Range MIC µg/mL Range Antifungal Amphotericin B 0. Domsch et al. Conidia are ellipsoidal.0 x 1.03-4 Itraconazole 0. 20 µm 20 µm Phialides and conidia of Phialophora verrucosa.0-5. darkly pigmented collarettes. antifungal susceptibility testing of individual strains is recommended. suedelike and olivaceous to black in colour. and mycetoma. (2000). keys to taxa and additional information see Ellis (1971). mostly 3.03-0.5 Very limited data. McGinnis (1980) and de Hoog et al. initially dome-shaped. Phialides are flask-shaped or elliptical with distinctive funnel-shaped. (1980). RG-2 organism. For descriptions of species. Phialophora verrucosa is a well documented causative agent of chromoblastomycosis. McGinnis (1978). McGinnis and Pasarell (1998) and WCH in-house data. . hyaline.5-3.03-0. It produces characteristic flask-shaped phialides with distinctive funnel-shaped. later becoming flat.06 Voriconazole 0.Descriptions of Medical Fungi 113 Phialophora verrucosa Medlar Colonies (SDA) are slow growing. darkly pigmented collarettes.0 μm. Key Features: coelomycete. Rippon (1988). Samson et al. with over 2000 species having been described from soil. keys to taxa and additional information see Punithalingam (1979). membranous to leathery. (1995) and de Hoog et al. Conidia are produced in abundance within the pycnidia on narrow thread-like phialides. ostiolate pycnidia. one-celled. and as pathogens to plants and humans. as saprophytes on various plants. For descriptions of species. 114 Descriptions of Medical Fungi Phoma Saccardo Colonies are spreading. hyaline. . (2000). (1991). Sutton (1980). hyaline. Conidia are globose to cylindrical. and are usually extruded in slimy masses from the apical ostiole. which are hardly differentiated from the inner pycnidial wall cells. globose. greyish-brown. Montel et al. darkly pigmented. 20 µm Pycnidia of Phoma. powdery or suede-like and produce large. ostiolate pycnidia producing masses of slimy. RG-1 organism. single-celled conidia. McGinnis (1980). Members of the genus Phoma have a world-wide distribution and are ubiquitous in nature. Conidiophores are pale olive. apex obtuse. For descriptions of species. Key Features: dematiaceous hyphomycete with multi-celled conidia produced on small peg-like branches of the vegetative hyphae. with 1-2 loci of similar width in the conidiogenous cells. 2. suede-like to downy and black. base truncate and characteristically with part of the conidiogenous cell remaining attached as a small pedicel. sawn timber and ceiling plaster.5 µm. The genus Pithomyces contains about 15 species commonly found from a very wide range of plant material. with one or both median cells divided by longitudinal septa. smooth or verrucose. Ellis Colonies are fast growing. dark grey to black. echinulate to verrucose. Curtis) M.Descriptions of Medical Fungi 115 Pithomyces Berkeley and Broome Colonies are fast growing. pyriform. Domsch et al. slightly constricted at the septa. RG-1 organism. one species. also from air.5-10 x 2-3. Pithomyces chartarum is often involved with facial eczema of sheep. Conidiogenous cells integrated. 18-29 x 10-17 µm. Conidia are broadly elliptical. medium to dark brown. suede-like to downy and produce darkly pigmented. soil. oblong. However. & M. intercalary or terminal. broadly ellipsoidal. (1980) and Rippon (1988). Pithomyces chartarum (Berk. 3 (-4)-euseptate.B.A. . indeterminate. 15 µm Conidiophores and conidia of Pithomyces chartarum. and are commonly echinulate or verrucose. multicellular conidia formed on small peg-like branches of the vegetative hyphae. Conidia muriform. keys to taxa and additional information see Ellis (1971 and 1976). thick-walled. hay. wickerhamii and P. reproduction is by the development of large sporangia (theca) which contain from 2-20 or more small sporangiospores (endospores or autospores) which are asexually produced by nuclear division and cleavage of the cytoplasm (Kaplan. McGinnis. Mycelium and conidia are absent. moist. zopfii + + + + P. 1977. Growth at 37OC Glucose Trehalose L-propanol Acetate (pH5) Galactose Capsule P. Vegetative cells are globose to ovoid. Pore. 1988. The genus Prototheca contains four species which can be differentiated by assimilation tests and morphological criteria as outlined below. The API 20C yeast identification strip may be used for species identification.25 WCH in-house data only.25-0. No budding cells are present. moriformis + + + + 5 µm Thecae and autospores of Prototheca wickerhamii. wickerhamii + + + + P. and have a relatively thick and highly refractile wall. Key Features: achlorophyllous algae reproducing by sporangia (theca) and sporangiospores (autospores). stagnora + +/+/+ + P. Cultures are sensitive to cycloheximide (actidione) and optimal growth occurs at 25OC to 30OC. zopfii have been involved in human or animal infections. Rippon. 1980. So far only P. RG-1 organism. Colonies are smooth. hyaline. white to cream and yeast-like. . Antifungal Amphotericin B MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range Antifungal Posaconazole MIC µg/mL Range 0. 116 Descriptions of Medical Fungi Prototheca Kruger Prototheca species are achlorophyllous algae with phylogenetic affinities to the genus Chlorella. 1985).5 0. varying in size from approximately 8-20 µm.25 0. submerged mycelium. elongating sympodially during conidiogenesis. pimple-shaped conidium bearing denticles which have unpigmented scars. reverse pink to orange.5-10. consisting of a rather compact. locally with some powdery. R. mackenziei and R. straight. ellipsoidal. hyaline to pale brown. thick-walled. pale orange. keys to taxa and additional information see de Hoog (1977). (2000). unbranched. up to 250 µm high. brownish aerial mycelium.) de Hoog Colonies growing moderately rapidly. Conidiophores are erect. usually with an acuminate base and unpigmented scars. (1985) and de Hoog et al.Descriptions of Medical Fungi 117 Ramichloridium Stahel ex de Hoog Colonies are rapid growing. gradually becoming paler towards the apex. obovoidal or fusiform. For descriptions of species. 10 µm 20 µm Conidiophores showing sympodial development of conidia of R. schulzeri. . RG-1 organism. often with orange or yellow soluble pigments.0 x 34 µm. flat. apically with small denticles on which conidia are produced in sympodial succession. schulzeri. of variable length. farinose or velvety. reddishbrown. Conidia are subhyaline. Conidiophores are erect. smooth-walled or slightly rough-walled. however the genus contains two species of medical interest. brown or olivaceous-green. Conidia are one-celled. brown. smooth. with scattered. Ramichloridium contains about 25 species that are usually associated with forest litter and rotting wood. Ramichloridium schulzeri (Sacc. Rippon et al. 6. Rhinocladiella contains 6-8 species. Conidiophores are short. Conidia are hyaline. sub-erect.5-6.2 µm. For descriptions of species. Rhinocladiella atrovirens Nannfeldt Colonies are restricted. if present. spherical to subspherical. atrovirens and R.03-0. (1983) and de Hoog et al. conidia and budding yeast cells of Rhinocladiella atrovirens. velvety. Budding cells. grey to olivaceous-brown.0-4. Antifungal MIC µg/mL Range Antifungal MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range Amphotericin B 0. 4. keys to taxa and additional information see de Hoog (1977.5 x 1. lanose or nearly smooth.2-1. An annellidic Exophiala synanamorph may be present. 1983).7-5.5 µm. often slightly mucoid at the centre. 3. 3. antifungal susceptibility testing of individual strains is recommended. (2000). Conidiogenous cells are cylindrical. velvety or lanose.25 Itraconazole 0.03-0.6-2.3 x 1. Budding cells and an accompanying Exophiala state may be present. Germinating cells are inflated. denticulate rachis up to 15 µm long. brown. R.06 0. aquaspersa. broadly ellipsoidal. with two species of medical interest. Conidiogenous cells are intercalary or free. one-celled and smooth-walled. 118 Descriptions of Medical Fungi Rhinocladiella Nannfeldt Colonies are restricted. olivaceous. Espinel-Ingroff et al. cylindrical. conidiophores showing a terminal denticulate rachis. Conidiophores are slightly differentiated. RG-1 organism.0 µm. unpigmented conidial denticles. intercalary or free.7-2. Hyphae pale olivaceous. Schell et al.and smooth-walled. (2001) and WCH in-house data. in the apical part with conidium bearing denticles with unpigmented scars. with crowded. . flat or butt-shaped. short-cylindrical. thickwalled. usually branched.8 µm.03-0. 10 µm 10 µm 10 µm Culture. are hyaline. reverse dark olivaceous green to blackish. McGinnis and Pasarell (1998). thin. Conidia are hyaline to subhyaline. with truncate basal scars. thin-walled.5 Very limited data. 9-19 x 1. pale to dark brown. with no assimilation of sucrose and maximum temperature of growth is 54–58OC. disseminated and cutaneous types of infection. However. pusillus. miehei and R. the latter to a greater extent. Rhizomucor pusillus has a world-wide distribution and is commonly associated with compost heaps. a dirty grey culture colour and a partial growth requirement for thiamine.e. presence or absence of columellae and apophyses. Hoog et al. Domsch et al. pusillus and R. Ellis and Keane (1981). (1983). Rhizomucor pusillus (Lindt) Schipper Synonym: Mucor pusillus Lindt This species is a rare human pathogen. It has been reported from cases of pulmonary. the formation of numerous zygospores. Key Features: growth at 45OC. RG-1 organism. (1980). identification of most zygomycetes is based primarily on the morphology of the sporangia. 1999). keys to taxa and additional information see Cooney and Emerson (1964). Rhizopus and Absidia. pusillus have been reported as pathogens to humans and animals. globose to slightly compressed. R. Schipper (1978). (2000) is not thermophilic and is probably a degenerate culture of Mucor hiemalis (Voigt et al. as well as the arrangement of the sporangiophores and the presence or absence of rhizoids. arrangement and number of sporangiospores. all strains are homothallic forming numerous zygospores.Descriptions of Medical Fungi 119 Rhizomucor Lucet & Costantin The genus Rhizomucor is distinguished from Mucor by the presence of stolons and poorly developed rhizoids at the base of the sporangiophores and by the thermophilic nature of its 3 species: R. colour. Colony colour is a dirty grey rather than brown. i. Schipper and Staplers (2003) and Ellis (2005b). Growth is stimulated by thiamine. Rhizomucor variabilis as described by de Hoog et al. with columellae rarely larger than 30 µm in diameter. Scholer et al. It is more often associated with animal disease. up to 50 µm in diameter. (2000). Growth temperature tests can also be especially helpful in identifying and differentiating members of the genera Rhizomucor. with stellate warts and equal suspensor cells.. For descriptions of species. and sporangia have spiny walls. Remember. Rhizomucor miehei (Cooney and Emerson) Schipper Synonym: Mucor miehei Lindt This species has been reported as a rare cause of bovine mastitis (Scholer et al. are up to 50-60 µm in diameter. miehei. Rhizomucor pusillus is cosmopolitan and both R. shape. which are reddish-brown to blackish-brown. McGinnis (1980). . 1983) and is similar in most respects to R. especially bovine abortion. All 3 of these species are potential human and animal pathogens and were originally classified in the genus Mucor. tauricus. antifungal susceptibility testing of individual strains is recommended. maximum 55-60OC. Sporangiospores are hyaline. globose to subglobose.25 Itraconazole 0. Zygospores are rough-walled. RG-2 organism. (2003). branching sporangiophores with a septum below the sporangium. pusillus. (2005) and WCH inhouse data. often with a collarette. Chlamydospores are absent. reddish brown to black. 15 µm 20 µm Sporangiophores. smooth-walled.25 Flucytosine >256 Posaconazole 0. poorly developed stolons and rhizoids. low growing (2-3 mm high). . growth at 45OC (thermophilic). grey to greyish brown-coloured mycelium and by the development of typical sympodially branched. Sporangia are globose (40-60 µm in diameter). Singh et al. Dannaoui et al. collumellae and primitive rhizoids of R. Key Features: zygomycete. darkcoloured sporangia without apophyses and smooth-walled globose to subglobose sporangiospores. always with a septum below the sporangium. There is positive assimilation of sucrose and no thiamine dependence. Temperature growth range: minimum 20-27OC. Antifungal MIC µg/mL Range Antifungal MIC µg/mL Range Fluconazole >64 Amphotericin B 0.06-0.06-0. occasionally oval (3-5 µm). each possessing an oval or pear-shaped columella (20-30 µm). 45-65 mm in diameter and may be produced throughout the aerial hyphae in matings between compatible isolates.03-0. and are often mixed with crystalline remnants of the sporangial wall.25 Voriconazole 2-16 Very limited data. 120 Descriptions of Medical Fungi Rhizomucor pusillus (Lindt) Schipper This thermophilic zygomycete is readily recognizable by its characteristic compact. hyaline to yellow-brown sporangiophores (8-15 μm in diameter). optimum 35-55OC. and smaller sporangia up to 100 µm in diameter and grows at both 40 and 45OC. The ‘oryzae’ group has been reduced to a single species that is able to grow at 40OC but not at 45OC. hyaline to brown and striate in many species. (2002). stolonifer. homothallicus. 3 excellent revisions with easy to use keys have been produced by Schipper (1984). R. antifungal susceptibility testing of individual strains is recommended. Sabatelli et al. (2003). microsporus var. singly or in groups from nodes directly above the rhizoids. azygosporus. however. and apophysate.03-4 2 Itraconazole 0. Rhizopus oryzae is an important human pathogen. one-celled. generally globose sporangia. although with a maximum growth temperature of only 32OC its pathogenicity is thus questionable. 2003). . Basically. and has sporangia not exceeding 240 µm in diameter. The G-C values of the 3 groups have been defined by Frye and Reinhardt (1993). There is no doubt that R. columellate. numerous attempts have been made to clarify the species concepts of the genus Rhizopus. multispored. arrhizus are synonymous. microsporus var. microsporus is a well-recognised pathogen of humans and animals. microsporus var. The latter has been unconvincingly implicated in human infection (Ferry and Abedi 1983). 1986) and Schipper and Stalpers (2003). Espinel-Ingroff (2001. Sporangiospores are globose to ovoid. rhizopodiformis. microsporus with the later subdivided into 3 varieties. (2006) and WCH in-house data. Dannaoui et al. 3 groups have been recognised: the ‘stolonifer’ group. schipperae and R. Colonies are fast growing and cover an agar surface with a dense cottony growth that is at first white becoming grey or yellowish brown with sporulation.Descriptions of Medical Fungi 121 Rhizopus Ehrenberg ex Corda. namely R. 36OC and 45OC are characteristic for each of the groups.25-8 4 Flucytosine >256 >256 Posaconazole 0. The ‘microsporus’ group has simple rhizoids. After spore release the apophyses and columella often collapse to form an umbrellalike structure. In the past. The ‘stolonifer’ group has sporangia up to 275 µm in diameter and grows at 30OC. Sun et al. Singh et al. arrhizus is commonly used in the medical literature.03-8 2 Voriconazole 4->64 >64 Very limited data. This group contains 4 species: R. oryzae and R. the formation of sporangiophores. Ellis (1985. sexualis and R. but has a maximum growth temperature of 36OC. the ‘oryzae’ group and the ‘microsporus’ group. The taxonomic treatment of Schipper and Stalpers (2003) will be used in this book. Species in this group include R. (2005). and temperature growth studies at 30OC. the synonym R. the contentious issue being which species name to use. Recently. microsporus. oligosporus and R. R. R. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Fluconazole >64 >64 Amphotericin B 0. The genus Rhizopus is characterised by the presence of stolons and pigmented rhizoids. All are thermophilic and R. There is good growth at 45OC with a maximum of 46-48OC. Schipper and Stalpers (1984. with coarse conical projections. up to 100 µm in diameter. Kwon-Chung and Bennett (1992). . keys to taxa and additional information. RG-2 organism. microsporus is a rare cause of human infection (Kerr et al. 2003). microsporus var. Previously. spherical. Azygospores are pale to dark-brown. Sporangiophores are brownish. are dark red–brown. Sporangiophores are brownish. Rhizopus azygosporus Yuan & Jong Rhizopus azygosporus is closely related to R. Good microsporus R. spherical. Onions et al. quite equal in size. a solid fermented soybean food from Indonesia (Yuan and Jong 1984). 1988. Sporangia are greyish-black. microsporus (Yuan and Jong 1984) and has been reported as the causative agent of 3 fatal cases of gastrointestinal infection in premature babies (Woodward et al. Samson et al. Schipper (1984). 1996). Species Growth at 45OC R. (1981). up to 400 µm high and 10 µm wide. microsporus var. Rippon (1988). There is good growth at 45OC. with stellate projections and unequal suspensor cells. McGinnis (1980). (2000) and Ellis (2005b). which has been isolated from tempeh. formed by crosses of compatible mating strains. Columellae are subglobose to globose to conical. but most are smaller and are produced in pairs. Columellae are subglobose to globose. spherical to subglobose. Sporangiospores are angular to broadly ellipsoidal to lemon-shaped. up to 9 µm diameter or more. Restricted oligosporus R. Kwon-Chung and Bennett. 30–70 µm in diameter. 1992. up to 80 µm in diameter. with a maximum of 46–48OC. see Domsch et al. this fungus was only known from its type culture. (1995). schipperae Good Growth Main species characteristics at 50OC No Abundant azygospores No Sporangiospores angular to ellipsoidal and distinctly striate. Zygospores. microsporus Rhizopus microsporus var. 1986). RG-2 organism. 1992). Ellis (1985. Sporangiospores are ovoid to ellipsoidal 4-5 to 6-7 µm in diameter with faint striations. heterogeneous Good Sporangiospores globose rarely over 5 µm in diameter minutely spinulose No Abundant chlamydospores and restricted sporulation For descriptions of species. azygosporus Good R. 122 Descriptions of Medical Fungi Rhizopus Ehrenberg ex Corda. Good rhizopodiformis R. Sporangia are greyish-black. up to 350 µm high and 6-14 µm wide. Colonies are pale brownish-grey producing simple rhizoids. Differentiation of pathogenic Rhizopus microsporus group isolates. spherical and 50-100 µm in diameter. Schipper et al. microsporus var. Hoog et al. Scholer et al. up to 5-6 µm in diameter and are distinctly striate. (1980). up to 5–6 µm diam No Sporangiospores globose. producing pale-brown simple rhizoids. All strains produce abundant azygospores in unmated isolates as a species characteristic. Rhizopus microsporus var. Colonies are whitish to grey-black. (1983). Columellae are pyriform comprising 80% of the sporangium. There is good growth at 45OC with a maximum of 50–52OC. oligosporus is a rare cause of human zygomycosis (Tintelnot and Nitsche 1989). Chlamydospores are abundant. columellae. up to 300 µm high and 15 µm wide. hyaline. Sporangiospores are subglobose to globose. accounting for between 10% and 15% of reported human cases (Scholer et al. almost smooth. 7-35 µm in diameter. when formed by crosses of compatible mating strains. microsporus var. RG-2 organism. Sporangia are bluish to greyish-black. spherical. spherical and up to 100 µm in diameter. with stellate projections and unequal suspensor cells. spherical. Colonies are dark greyish-brown. oligosporus (Saito) Schipper & Stalpers Rhizopus microsporus var. Sporangia are black. . 1983. oligosporus. ellipsoidal or cylindrical. Sporangiospores are subglobose to globose. 30 µm Sporangia showing sporangiophores. quite equal in size. up to 10 mm high with simple rhizoids. are reddish-brown. up to 100 µm in diameter. sporangiospores and rhizoids of R. with larger spores often irregular in shape. RG-2 organism. single or in chains. Rhizoids are subhyaline and simple. up to 100 µm in diameter. rhizopodiformis is the second most frequently isolated zygomycete. up to 9 µm in diameter. Colonies are pale yellowish-brown to grey and sporulation is often poor. with 1-3 produced together. with 1-4 produced together. Kwon-Chung and Bennett 1992). Zygospores.Descriptions of Medical Fungi 123 Rhizopus microsporus var. Sporangiophores are brownish. Rhizopus microsporus var. Sporangiophores are brownish. Columellae are subglobose to somewhat conical. up to 500 µm high and 8 µm wide. Zygospores are not known. rhizopodiformis (Cohn) Schipper & Stalpers Rhizopus microsporus var. up to 6 µm in diameter and minutely spinulose. There is growth at 45OC with a maximum of 46–48OC. spherical. sporangiophores and rhizoids of R. Sporangiophores up to 1500 µm in length and 18 µm in width. powdery in appearance. Sporangia are globose.oryzae. about 5-8 mm high. good growth at 40OC. with some tendency to collapse. up to 130 µm in height and soon collapsing to an umbrella-like form after spore release. Colonies are very fast growing. 124 Descriptions of Medical Fungi Rhizopus oryzae Went & Prinsen Geerligs Synonym: Rhizopus arrhizus Fischer Rhizopus oryzae is the most common causative agent of zygomycosis. smooth-walled. and nearly 90% of the rhinocerebral form of infection. white cottony at first becoming brownish grey to blackish-grey depending on the amount of sporulation. subglobose to ellipsoidal. up to 175 µm in diameter and many spored. subglobose or oval. sporangia. No growth at 45OC. with ridges on the surface. arising from stolons opposite rhizoids usually in groups of 3 or more. RG-2 organism 20 µm 100 µm Culture. non-septate. simple or branched. Columellae and apophysis together are globose. . accounting for some 60% of the reported culture positive cases. greyish black. and up to 8 µm in length. often with a flattened base. Sporangiospores are angular. The distinctive difference between the two is the assimilation of inositol. Kurtzman and Fell (1988) and de Hoog et al. Rippon (1988). The basidiomycetous nature of yeasts is usually indicated by a positive urease test. Kreger-Van Rij (1984). . urine and faeces. Barnett et al. For descriptions of species. the inability to assimilate inositol and the absence of fermentation. mucilaginosa is a known cause of fungal peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). lungs. (2000). Culture of Rhodotorula mucilaginosa. Rhodotorula mucilaginosa is a common airborne contaminant of skin. The genus Cryptococcus is similar to Rhodotorula both in production of carotenoid pigments and the presence of capsulated blastoconidia. This is usually due to saprophytic colonisation of catheters or dialysis machinery and removal of the source of contamination usually leads to clearing of the symptoms. which is positive in Cryptococcus.Descriptions of Medical Fungi 125 Rhodotorula Harrison The genus Rhodotorula is characterised by the combination of red or yellow cultures due to the presence of carotenoid pigments. (1983). R. keys to taxa and additional information see McGinnis (1980). Common saprophyte however cases of fungemia have been reported. antifungal susceptibility testing of individual strains is recommended. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + v L-Sorbose v + + v + v + v L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v v v v v v v v D-Glucitol v v + v v v + v Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0.25 Itraconazole 0.5-1 Flucytosine 0. Mucoid to pasty to slightly tough. w Weak.1% Cycloheximide v Key Features: germ tube negative yeast and sugar assimilation pattern. . Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Budding blastoconidia only. v Variable.Negative. 2. .3-5.25 Very limited data. Physiological Tests: + Positive. smooth to wrinkled. MIC µg/mL Range MIC µg/mL Range Antifungal Antifungal Fluconazole >64 Amphotericin B 0. India Ink Preparation: Small capsules present. highly glossy to semi-glossy. WCH in-house data only.0 x 4.06 Voriconazole 1-4 Caspofungin 0.06-0. RG-1 organism.0 µm. No pseudohyphae are formed. 126 Descriptions of Medical Fungi Rhodotorula glutinis (Fresenius) Harrison Culture: Colonies (SDA) are coral red to salmon-coloured or slightly orange. yeast-like colonies. Microscopy: Ovoidal to globose or more elongate budding yeast-like cells or blastoconidia.0-10.03-0. RG-1 organism. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Fluconazole 0. Espinel-Ingroff et al. No pseudohyphae are formed. 2. moist to mucoid.Negative.5-6.25-4 2 Caspofungin 16 >16 Very limited data.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern. Physiological Tests: + Positive.Descriptions of Medical Fungi 127 Rhodotorula mucilaginosa (Jorgensen) Harrison Synonym: Rhodotorula rubra (Demme) Lodder. yeast-like colonies.5 x 6. v Variable.5-14.25 Voriconazole 0. usually smooth.0 µm. . rugose or corrugated. Espinel-Ingroff (2003). antifungal susceptibility testing of individual strains is recommended. India Ink Preparation: Negative .5->64 >64 Amphotericin B 0.5 Itraconazole 0.No capsules present. sometimes reticulate.25-4 2 Flucytosine 0.03-0. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Budding blastoconidia only. . Microscopy: Spherical to elongate budding yeast-like cells or blastoconidia. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + v L-Sorbose v + v v + + v + L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine v v v v v v v v v v D-Glucitol v v + v v + + Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 40OC 0. Culture: Colonies (SDA) are coral pink. w Weak.25 0. (2001).03-1 0. Common saprophyte however cases of peritonitis and fungemia have been reported. (2006) and WCH in-house data. Cuenca-Estrella et al. Cuenca-Estrella et al. smooth. keys to taxa and additional information see McGinnis (1980). Kreger-Van Rij (1984). . 3. Pseudohyphae can be formed. v Variable.25 0. cerevisiae.25 Voriconazole 0. (2000).Negative. with a smooth wall. antifungal susceptibility testing of individual strains is recommended.0 µm. Lactose and nitrate are not utilised. Ascospores are globose to ellipsoidal. . The species S. India Ink Preparation: Negative .03-4 0. Dalmau Plate Culture on Cornmeal and Tween 80 Agar: Usually budding blastoconidia only.03-0. For descriptions of species.0 x 4.0-10. usually one to four per ascus.No capsules present. Kurtzman and Fell (1988) and de Hoog et al. but never true hyphae.5 0. Common food and environmental saprophyte. is the most important representative. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 0.125-16 8 Amphotericin B 0. s Slow Germ Tube Fermentation Glucose Galactose Sucrose Maltose Lactose Trehalose Assimilation Glucose Galactose + v + v + v L-Sorbose + + + v + v - L-Arabinose D-Arabinose D-Ribose L-Rhamnose D-Glucosamine - D-Glucitol v v v Sucrose Maltose Cellobiose Trehalose Lactose Melibiose Raffinose Melezitose Soluble Starch D-Xylose α-M-D-glucoside D-Gluconate DL-Lactate myo-Inositol 2-K-D-gluconate D-Glucuronate N-A-D-glucosamine - Glycerol Erythritol Ribitol Galactitol D-Mannitol Nitrate Urease Growth at 37OC 0. (2001). however pseudohyphae may be formed rarely. commonly known as Baker’s yeast. RG-1 organism.125 Caspofungin 1 1 Very limited data.06-2 1 Itraconazole 0. Microscopy: Large globose to ellipsoidal budding yeast-like cells or blastoconidia. Espinel-Ingroff (2003). Physiological Tests: + Positive. Barnett et al. Espinel-Ingroff et al.1% Cycloheximide - Key Features: germ tube negative yeast and sugar assimilation pattern.06-0. (2006) and WCH in-house data. glabrous yeast-like colonies. (1983). Rippon (1988). w Weak. Culture: Colonies (SDA) are white to cream. 128 Descriptions of Medical Fungi Saccharomyces cerevisiae Meyen ex Hansen The genus Saccharomyces is characterised by strong fermentation of at least glucose and the presence of rather large globose to ellipsoidal cells with multilateral budding.5-21.5 Flucytosine 0. Sporangia are typically flask-shaped with a distinct spherical venter and long-neck. de Hoog et al. Sun et al. The agar block method to induce sporulation of Saksenaea vasiformis and Apophysomyces elegans. Sporangiospores are small. arising singly or in pairs from dichotomously branched.25 Voriconazole 0. Goldschmied-Reouven et al. Key Features: zygomycete. Sporulation may be stimulated by the use of nutrient deficient media.5-4 Very limited data.Descriptions of Medical Fungi 129 Saksenaea vasiformis Saksena The genus Saksenaea is characterised by the formation of flask-shaped sporangia with columellae and simple. poor sporulation. (1976). Czapek Dox agar.015-0. white with no reverse pigment made up of broad. 1997) that is most often associated with cutaneous or subcutaneous lesions after trauma. RG-2 organism. Pritchard et al. failure to sporulate on primary isolation media. non-septate hyphae typical of a zygomycetous fungus. Colonies are fast growing. (1986). Ellis and Ajello (1982). (2000) and Ellis (2005b). Laboratory identification of this fungus may be difficult or delayed because of the mould’s failure to sporulate on the primary isolation media or on subsequent subculture onto potato dextrose agar.015-0. or by using the agar block method described by Ellis and Ajello (1982). Saksenaea vasiformis is the only known species and appears to have a world-wide distribution in association with soil. A small block of agar is cut from a well established culture grown on PDA and is placed in the centre of petri dish containing 1% agar in distilled water. For descriptions of species. It is an emerging human pathogen (Holland. Ellis and Hesseltine (1966).125-2 Itraconazole 0. keys to taxa and additional information see Saksena (1953). 1-2 x 3-4 µm. Collumellae are prominent and dome-shaped. and are discharged through the neck following the dissolution of an apical mucilaginous plug. darkly pigmented rhizoids. . darkly pigmented rhizoids. (1989). Padhye and Ajello (1988). unique flask-shaped sporangia. Ellis and Kaminski (1985). (1988). Antifungal MIC µg/mL Range Antifungal MIC µg/mL Range Fluconazole >64 Amphotericin B 0. Ajello et al. Ellis and Kaminski (1985) and Padhye and Ajello (1988). like cornmeal-glucose-sucrose-yeast extract agar. Padhye et al. oblong. antifungal susceptibility testing of individual strains is recommended. After 21 days at 26OC look for sporangium formation at the periphery of the petri dish. downy. (2002) and WCH in-house data.3 Flucytosine >256 Posaconazole 0. . 130 Descriptions of Medical Fungi Saksenaea vasiformis Saksena 15 µm Sporangium of Saksenaea vasiformis. The vast majority of infections are mycetomas. McGinnis et al. it is presumptive to use the teleomorph name to describe this fungus without seeing cleistothecia (ascocarps). Campbell and Smith (1982). RG-2 organism. spherical. obovoid or sub-cylindrical conidia. apiospermum and S. the remainder include infections of the eye. Erect synnemata (a Graphium synanamorph) may be present in some isolates. however as all species of Pseudallescheria have Scedosporium anamorphs. internal organs and more commonly the lungs. rounded above with truncate bases are observed. 2005). greyish-white. S. ear. smooth-walled. subhyaline.9 µm in size. max 45OC. Until the taxonomy of Pseudallescheria is resolved. pale-brown. Numerous single-celled. For descriptions of species. aurantiacum appear to be common soil fungi capable of causing a spectrum of diseases similar in terms of variety and severity to those caused by Aspergillus collectively referred to as Pseudallescheriasis.Descriptions of Medical Fungi 131 Scedosporium apiospermum/aurantiacum Complex Recent genetic studies have shown Scedosporium apiospermum to be a species complex and two species of medical importance have now been recognised: S. Ascocarp formation may be stimulated on cornmeal agar or other nutrient deficient media. however it should be noted that many isolates may fail to produce cleistothecia. (1980). 4-9 x 610 mm. Domsch et al. When crushed cleistothecia release numerous. producing slimy heads of one-celled . apiospermum and S. are mostly submerged in the agar and are composed of irregularly interwoven brown hyphae. All isolates produce a light yellow diffusible pigment on PDA after a few days incubation. 5-14 x 2-5 um. Scedosporium apiospermum (Saccardo) Castellani and Chalmers Colonies are fast growing. Conidia are borne singly or in small groups on elongate. central nervous system. Conidiogenous cells and conidia are similar in shape and size to S. (1982). Conidiogenous cells arising from undifferentiated hyphae are cylindrical to slightly flask-shaped. . 4-5 x 7. although the annellations (ringlike scars left at the apex of an annellide after conidial secession) are extremely difficult to see. Rippon (1988). RG-2 organism. de Hoog et al. it is recommended that laboratories use the anamorphic name Scedosporium apiospermum when describing this fungus. keys to taxa and additional information see McGinnis (1980). Optimum temperature for growth is 30-37OC. Cleistothecia (non-ostiolate ascocarps) are yellow-brown to black. apiospermum. The teleomorph is currently referred to as Pseudallescheria boydii. Optimum temperature for growth 37-40OC. Conidial development can be described as annellidic. (2000) and Gilgado et al. ellipsoidal ascospores. (2005). simple or branched conidiophores or laterally on hyphae. faintly brown. Scedosporium aurantiacum Gilgado et al. A Graphium synanamorph may also be present. aurantiacum (Gilgado et al. broadly clavate to ovoid conidia. and the two can best be distinguished by genetic analysis. but the teleomorph is unknown. suede-like to downy with a greyish-black reverse. . McGinnis and Pasarell (1998). 132 Descriptions of Medical Fungi Scedosporium apiospermum (Saccardo) Castellani and Chalmers 20 µm Culture and a cleistothecium of Pseudallescheria boydii. MIC90s from the Australian Scedosporium Study. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Itraconazole 0.06-4 2 Amphotericin B 1-16 16 Voriconazole 0. (2001) and Cuenca-Estrella et al.03-1 0. Espinel-Ingroff (2001. 20 µm Conidiophores (annellides) and conidia of Scedosporium apiospermum.5 Posaconazole 0.5-2 1 Good data available. Espinel-Ingroff et al. (2006). 2003). 125-1 16 0. . aurantiacum. apiospermum (left) and S.Descriptions of Medical Fungi 133 Scedosporium aurantiacum Gilgado et al.25-2 1 Amphotericin B Voriconazole 0.03-0.5 0. Australian Scedosporium Study. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 2-16 0.25 Posaconazole Good data available. Culture reverse (PDA) of S.5 Itraconazole 0. 20 µm Conidiophores (annellides) and conidia of Scedosporium aurantiacum. aurantiacum (right) showing the production of a light yellow diffusible pigment that is typical of S. (2006). 2003). Conidia are borne in small groups on distinctive basally swollen. Gueho and de Hoog (1991) and de Hoog et al. RG-2 organism. For descriptions of species.3 µm). spreading. (2001). olive-grey to black and have a suede-like to downy surface texture. Conidia are single-celled. keys to taxa and additional information see Malloch and Salkin (1984). Espinel-Ingroff et al.4 x 5. flat. 2-5 x 3-13 µm (average 3. ovoid to pyriform.5-32 >8 Posaconazole >8 >8 Good data available. Wilson et al. Key Features: dematiaceous hyphomycete with initial black pasty colony. 20 µm Conidiophores (annellides) and conidia of Scedosporium prolificans. hyaline to pale-brown. Rippon (1988). Sabatelli et al. Cuenca-Estrella et al. Salkin et al. which occur singly or in clusters along the vegetative hyphae. and have smooth thin walls. . (2006) and the Australian Scedosporium Study. flask-shaped annellides. (1990). basally swollen (inflated) annellides and no growth on media containing cycloheximide (actidione). MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Itraconazole 1-32 >8 Amphotericin B 1-16 >8 Voriconazole 0. McGinnis and Pasarell (1998). (1988). Espinel-Ingroff (2001. 134 Descriptions of Medical Fungi Scedosporium prolificans (Hennebert & Desai) Gueho & de Hoog Synonym: Scedosporium inflatum Malloch & Salkin Colonies are rapid growing. (2000). For descriptions of species. and a pronounced odour should be suspected of being S. Basidia bear 4 basidiospores on erect sterigmata. elongate with lateral scar at lower end. (2000).. 6-7 x 2-3 µm. rapidly growing. commune are monokaryotic and therefore do not show clamp connections. kidney-shaped. Hyphae are hyaline. Fruit bodies are sessile. Basidiospores hyaline. keys to taxa and additional information see McGinnis (1980). (1995) and de Hoog et al. . Rippon (1988). Although some isolates may take up to 12 weeks to form fruiting bodies. woolly. susceptibility to cycloheximide. lobed with split gills on the lower side.Descriptions of Medical Fungi 135 Schizophyllum commune Fries Colonies on 2% malt extract agar are spreading. wide and have clamp connections (although many primary clinical isolates are monokaryotic and will therefore not produce clamp connections). therefore any white. 1995). RG-1 organism. Sigler et al. Note: many clinical isolates of S. soon forming macroscopically visible fruiting bodies. whitish to pale greyish-brown. and is an occasional human pathogen. allergic bronchopulmonary mycosis and as a contaminant from respiratory specimens. commune (Sigler et al. smooth-walled. sterile isolate showing good growth at 37OC with tolerance to benomyl. principally associated with sinusitis. Shizophyllum is a common bracket fungus on rotten wood. Basidiocarps of Schizophyllum commune on malt extract agar. antifungal susceptibility testing of individual strains is recommended. usually truncate. For descriptions of species. Samson et al. Conidia are globose to pyriform. RG-2 for species isolated from humans. cream. smooth to rough. In Scopulariopsis. . grey. (2000). McGinnis and Pasarell (1998) and WCH in-house data. black. buff to brown. conidia often shaped like light globes. and hyaline to brown in colour. however a few. Microscopic morphology shows chains of single-celled conidia produced in basipetal succession from by a specialised conidiogenous cell called an annellide. in groups. 10 µm Conidiophores (annellides) and conidia of Scopulariopsis brevicaulis. keys to taxa and additional information see Morton and Smith (1963). in particular S. basocatenate arising from annellides. the term basocatenate can be used to describe such chains of conidia where the youngest conidium is at the basal end of the chain. with a rounded distal portion. Domsch et al. brevicaulis. but are predominantly light brown. (1980). or organised into a distinct penicillus. annellides may be solitary. Most members of the genus Scopulariopsis are soil fungi. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 2-16 32 2-8 Very limited data. have been reported as causative agents of onychomycosis and hyalohyphomycosis. varying in colour from white. 136 Descriptions of Medical Fungi Scopulariopsis Bain Colonies are fast growing. Once again. Key Features: hyphomycete. (1995) and de Hoog et al. McGinnis (1980). Rippon (1988). becoming fluffy with age.Descriptions of Medical Fungi 137 Sepedonium Link ex Greville Colonies are moderately fast growing. suede-like to downy. smooth to verrucose and usually with a thick wall. globose. resembling Histoplasma capsulatum. Therefore. . Conidiophores are hyaline and non-specialised. globose to ovoid. or in clusters. solitary. Key Features: hyphomycete. terminal macroconidia from non-specialised conidiophores. For descriptions of species. positive identification of the latter. 7 to 17 µm. one-celled. hyaline to amber. RG-1 organism. usually white to golden yellow. requires conversion of the mould form to the yeast phase by growth at 37OC on enriched media or by exoantigen test. Conidia are terminal. producing large. resembling short branches of the vegetative hyphae. one-celled. verrucose. thick-walled. keys to taxa and additional information see McGinnis (1980) and Rippon (1988). 15 µm Conidia of Sepedonium. The microscopic morphology of Sepedonium isolates resembles that of Histoplasma capsulatum. one-celled and smooth-walled. Conidia are formed in clusters on tiny denticles by sympodial proliferation at the apex of the conidiophore. Sporotrichosis is primarily a chronic mycotic infection of the cutaneous or subcutaneous tissues and adjacent lymphatics characterised by nodular lesions which may suppurate and ulcerate. lungs or genitourinary tract. . Rippon (1988) and de Hoog et al. and the infection may also occasionally involve the central nervous system. bone and muscle is not infrequent. de Hoog et al. darkly-pigmented. For descriptions of species. On brain heart infusion agar containing blood at 37OC. Key Features: hyphomycete characterised by thermal dimorphism and clusters of ovoid. (1980). hyaline. Conidia are ovoid or elongated. Some strains may produce short aerial hyphae and pigmentation may vary from white to cream to black. or very rarely. colonies are glabrous. As the culture ages. conidia are subsequently formed singly along the sides of both conidiophores and undifferentiated hyphae. RG-2 organism. solitary. Sporothrix schenckii is a dimorphic fungus and has a world-wide distribution. In some isolates. Conidiophores arise at right angles from thin septate hyphae and are usually solitary. It is commonly found in soil and on decaying vegetation and is a well known pathogen of humans and animals. 3-6 x 2-3 µm. one-celled. white to greyish-yellow and yeast-like consisting of spherical or oval budding yeast cells. Domsch et al. Infections are caused by the traumatic implantation of the fungus into the skin. moist and glabrous. Secondary spread to articular surfaces. (2000). 10 µm Periodic Acid-Schiff (PAS) stained tissue section showing budding yeast-like cells of S. particularly in tropical and temperate regions. (1985). are slow growing. denticulate conidia produced sympodially on short conidiophores. their arrangement often suggestive of a flower. keys to taxa and additional information see McGinnis (1980). with a wrinkled and folded surface. 138 Descriptions of Medical Fungi Sporothrix schenckii Hektoen & Perkins Colonies (SDA) at 25OC. obovate to angular conidia may also be observed along the hyphae. thick-walled. schenckii. erect and tapered toward the apex. by inhalation into the lungs. 10 µm Conidiophores and conidia of Sporothrix schenckii on SDA at 25OC. McGinnis et al. (nd = not done).5 (4) Flucytosine 4->64 >64 Posaconazole 0. Espinel-Ingroff et al.Descriptions of Medical Fungi 139 Sporothrix schenckii Hektoen & Perkins 10 µm Culture on SDA at 25OC and budding yeast cells in BHI at 37OC.25->8 nd Limited data.125-4 2 Caspofungin 1->8 nd Voriconazole 0.06->16 >16 Itraconazole 0. MIC µg/mL Range MIC90 MIC µg/mL Range MIC90 Antifungal Antifungal Fluconazole 32->64 >64 Amphotericin B 0. (2001).03->16 0. Espinel-Ingroff (2003). antifungal susceptibility testing of individual strains is recommended. Gonzales et al. (2005) and Alvarado-Ramirez and Torres-Rodriguez (2007). . (2001).125->16 4 (16) Anidulafungin 0. 140 Descriptions of Medical Fungi Stemphylium Wallroth Colonies are rapid growing. terminal. RG-1 organism. Rippon (1988) and de Hoog et al. dictyoconidia from the swollen end of a percurrent conidiophore. For descriptions of species. Stemphylium should not be confused with Ulocladium which produces similar dictyoconidia from a sympodial conidiophore. Note: the conidiophore proliferates percurrently through the scar where the terminal conidium (poroconidium) was formed. Key Features: dematiaceous hyphomycete producing darkly pigmented. solitary. brown to olivaceous-black or greyish and suede-like to floccose. Conidia are pale to mid-brown. oblong. (2000). rounded at the ends. ellipsoidal. darkly pigmented. . Microscopically. 20 µm Conidiophores and conidia of Stemphylium. keys to taxa and additional information see Ellis (1971 and 1976). obclavate or subspherical and are smooth or in part verrucose. not from a percurrent conidiogenous cell as in Stemphylium. multicellular conidia (dictyoconidia) are formed on a distinctive conidiophore with a darker terminal swelling. if the isolate is not looked at carefully. (2000) and Ellis (2005b). merosporangia and merospores of S. merosporangia are thin-walled. It can also be a difficult laboratory aerial contaminant. keys to taxa and additional information see Domsch et al. McGinnis (1980). It is found mainly from soil and dung in tropical and subtropical regions. often producing adventitious rhizoids. At maturity. cottony to fluffy. The main stalk and branches form terminal. The sporangiophore and merosporangia of Syncephalastrum species may also be mistaken for an Aspergillus species. Key Features: zygomycete producing sympodially branching sporangiophores with terminal vesicles bearing merosporangia. Onions et al. white to light grey. Hoog et al. . (1981). globose to ovoid vesicles which bear finger-like merosporangia directly over their entire surface. (1995). becoming dark grey with the development of sporangia. racemosum. Syncephalastrum racemosum is the type species of the genus and a potential human pathogen. well-documented cases are lacking. Optimum growth temperature 20-40OC. stolon-like. however. Samson et al. Rippon (1988). and show sympodial branching (racemose branching) producing curved lateral branches. Sporangiophores are erect. 30 µm 10 µm Terminal vesicle. RG-2 organism. smooth-walled sporangiospores (merospores). Sporangiospores are arranged in a single row within the merosporangia. Colonies are very fast growing. (1980).Descriptions of Medical Fungi 141 Syncephalastrum Schröter The genus Syncephalastrum is characterised by the formation of cylindrical merosporangia on a terminal swelling of the sporangiophore. For descriptions of species. evanescent and contain 5-10(18) globose to ovoid. Antifungal Amphotericin B MIC µg/mL Range Antifungal Itraconazole MIC µg/mL Range Antifungal Voriconazole MIC µg/mL Range 0. irregularly verticillate. Conidiophores are repeatedly branched.5-2 2-16 0. Trichoderma is an RG-1 organism. often irregularly bent. 142 Descriptions of Medical Fungi Trichoderma Persoon ex Grey Colonies are fast growing. Gliocladium (with strongly convergent phialides) and Verticillium (with straight and moderately divergent phialides) are closely related genera. antifungal susceptibility testing of individual strains is recommended. bearing clusters of divergent. Espinel-Ingroff (2001) and WCH in-house data. Conidia are mostly green. (2000). sometimes hyaline. flask-shaped phialides. McGinnis (1980).25-2 Very limited data. For descriptions of species. Rippon (1988). often only in small areas or in concentric ring-like zones on the agar surface. with smooth or rough walls and are formed in slimy conidial heads (gloiospora) clustered at the tips of the phialides. 20 µm Phialides and conidia of Trichoderma harzianum. flask-shaped phialides. keys to taxa and additional information see Domsch et al. Samson et al. Trichoderma is a very common genus especially in soil and decaying wood. later developing yellowish-green to deep green compact tufts. (1995). Key Features: hyphomycete with repeatedly branched conidiophores bearing clusters of divergent. at first white and downy. (1980). . de Hoog et al. concentricum. Macroconidia are mostly borne laterally directly on the hyphae or on short pedicels. pyriform to clavate or of irregular shape and range from 2-3 x 2-4 mm in size. keys to taxa and additional information see Rebell and Taplin (1970).06->64 32 Terbinafine 0. The descriptions and species concepts provided in this publication are based on traditional morphological criteria which may not correspond to molecular identification results. In practice. T. The media in this scheme are Littman Oxgall agar.e. The presence of microconidia distinguishes this genus from Epidermophyton and the smooth-walled. . devised by the late Geraldine Kaminski. equinum. rubrum. terrestre and to a lesser extent T. and 2. T. verrucosum. comprising 6 different media to help identify and differentiate the various species and strains of Trichophyton. (2001). interdigitale. Sabatelli et al. interdigitale.007-8 0. T. Lactritmel agar.25-0. T. Trichophyton agar No. 1% Peptone agar. (2000). Those species that usually produce microconidia. 1.5-1 Itraconazole 0. The Mycology Unit at the Adelaide Women’s and Children’s Hospital uses a dermatophyte identification scheme. Santos and Hamdan (2006). macroconidia may or may not be present i. T. violaceum. Antifungal MIC µg/mL Range MIC90 Antifungal MIC µg/mL Range MIC90 Griseofulvin 0. Rippon (1988).or thick-walled.and microconidia. Twenty species have been recognised.5 Fluconazole 0. tonsurans. Macroconidia are few or absent in many species. tonsurans. schoenleinii and T. and are thin.Descriptions of Medical Fungi 143 Trichophyton Malmsten The genus Trichophyton is characterised by the development of both smooth-walled macro. 2006). T. For description of species. T. Note: species concepts in dermatophytes are currently in a state of flux.25 Fernandez-Torres et al. However. it must be stressed that no one single test is infallible.06-4 1-2 Amphotericin B 0. (2006). clavate to fusiform. T. two groups may be recognised on direct microscopy: 1. Chlamydospores or other hyphal structures may be present. T.e. (1997) and de Hoog et al. Microconidia are spherical. Recent molecular studies have shown that many species appear to be clonal and that there is little correlation between “genetic” and “phenotypic” species (Graser et al. especially isolates of T. Domsch et al. mentagrophytes. erinacei. dermatophyte species are very variable organisms and many characteristics either overlap or are inconsistent.01-16 0.06 Voriconazole 0. and range from 4-8 x 8-50 mm in size. and hydrolysis of urea (see appendix for details). which may produce conidia on some media. T. Kane et al. T. Vanbreusegham et al. rubrum. T. Basically.01-8 0. verrucosum. T. mentagrophytes and T. i. the laboratories which consistently identify these fungi correctly do more work and use additional media and/or confirmatory tests.03-16 0. Sabouraud’s agar with 5% NaCl. mostly sessile macroconidia separate it from Microsporum. (1980). (1978). but microscopy is generally non-diagnostic. Many laboratories seem to have difficulty in distinguishing between species of Trichophyton. Those species that usually do not produce conidia. however only the more common species are included in these descriptions. soudanense. Ajello (1972). McGinnis (1980). but when present are ovate to pyriform in shape. macroconidial morphology. with a blackish-purple submerged fringe and reverse. Key Features: culture characteristics. powdery. and multiseptate with up to 9 or 10 septa. elongate. . Microconidia are usually absent. Not known to invade hair in vivo. smooth. Trichophyton ajelloi is a geophilic fungus with a world-wide distribution which may occur as a saprophytic contaminant on humans and animals. 29-65 x 5-10 µm. RG-1 organism. Macroconidia are numerous. cigar-shaped. but produces hair perforations in vitro. Infections in man and animals doubtful. urease positive and good growth on Sabouraud’s 5% salt agar. 20 µm Culture and macroconidia of Trichophyton ajelloi. 144 Descriptions of Medical Fungi Trichophyton ajelloi (Vanbreuseghem) Ajello Teleomorph: Arthroderma uncinatum Dawson and Gentles Colonies are usually flat. cream to tan to orange-tan in colour. thickwalled. septate hyphae which may have “antler” tips resembling T. smooth thin-walled macroconidia with 2-3 septa have been reported on specialised media like lactritmel agar. although this does not occur in all strains. Note: hyphal segments may artificially resemble macroconidia. Hair Perforation Test: Negative at 28 days. suede-like. blue-grey. small.Descriptions of Medical Fungi 145 Trichophyton concentricum Blanchard Teleomorph: Arthroderma benhamiae Ajello & Chang. clinical disease. Distribution is restricted to the Pacific Islands of Oceania. schoenleinii. 1% Peptone Agar: Flat. irregular. Microconidia and macroconidia are not usually produced. heaped and folded. often segmented. RG-2 organism. and T4 = T1 + thiamine. slender. stunted. Lactritmel Agar: Colonies tend to be flatter. raised and folded. however occasional clavate to pyriform microconidia may be present. glabrous colonies with no reverse pigment. It is not known to invade hair. suede to glabrous colonies with no reverse or diffusible pigment. Chlamydospores are often present in older cultures. . bean pod agar and hay infusion agar. often deeply folded into the agar which may produce splitting of the medium in some cultures. white. mostly white to cream-coloured. dull-white. Sabouraud’s Dextrose Agar with 5% NaCl: Small. cream to buff. Colonies (SDA) are slow growing. Hydrolysis of Urea: Negative after 7 days Vitamin Free Agar (Trichophyton Agar No. geographical distribution and culture characteristics. Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: Small. Key Features: hyphomycete (dermatophyte). Microscopic morphology is similar to that described above. concentricum from T. The slight enhancement of growth in the presence of thiamine helps to distinguish T. heaped and folded. glabrous becoming suede-like. Cultures consist of broad. T3 = T1 + thiamine and inositol. Infections among Europeans are rare.1): Growth occurs on vitamin free agar (T1) but is usually slightly better on media containing thiamine i. although some isolates will produce occasional clavate to pyriform microconidia. schoenleinii. South East Asia and Central and South America. muchbranched. almost glabrous with a yellow-brown reverse pigment. Reverse is buff to yellow-brown to brown in colour. Trichophyton concentricum is an anthropophilic fungus which causes chronic widespread non-inflammatory tinea corporis known as tinea imbricata because of the concentric rings of scaling it produces.e. Note: occasional. but sometimes orange-brown-coloured. suede-like colony with a pale yellow-brown reverse. concentricum showing the formation of typical “balloon-shaped” chlamydospores. concentricum on mycobiotic agar showing a typical slow growing. 146 Descriptions of Medical Fungi Trichophyton concentricum Blanchard 20 µm T. heaped and folded. . Note: microconidia and macroconidia are usually not produced. Microscopic morphology of T. glabrous to suede like colony. and are similar to T. Macroconidia are only rarely produced. Fig. RG-2 organism. mentagrophytes. culture characteristics. slow growing dark brown colony with a few submerged brown hyphae. Hydrolysis of Urea: Positive in 4-5 days. . Microscopically. T5 = vitamin free + nicotinic acid agar. 1. 1% Peptone Agar: Flat white to cream. Sabouraud’s Dextrose Agar with 5% NaCl: An extremely stunted. 2). white to buff in colour. but when present are clavate. nicotinic acid requirement and clinical lesions in horses. 2. suede-like surface with raised white downy centre and pale yellow reverse. 1) for growth except those from Australia and New Zealand. Occasional nodular organs may be present and the microconidia often undergo a transformation to produce abundant chlamydospores in old cultures. white to cream-coloured. Fig. abundant microconidia which may be clavate to pyriform and sessile or spherical and stalked are formed laterally along the hyphae. T1 = vitamin free agar. and deep brownish red reverse. smooth. Cultures usually have a deep-yellow submerged fringe and reverse which later becomes dark red in the centre. Nutritional Tests on Trichophyton Agars: Most strains require nicotinic acid (Fig. Hair Perforation Test: Negative. but some may develop gentle folds or radial grooves.Descriptions of Medical Fungi 147 Trichophyton equinum (Matruchot & Dassonville) Gedoelst Teleomorph: Arthroderma vanbreuseghemii Takashio Colonies (SDA) are usually flat. Key Features: microscopic morphology. Lactritmel Agar: Flat spreading. which are autotrophic (Fig. thin-walled and of variable size. suede-like to downy in texture. Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: Compact. raised velvety white surface with yellowish reverse and diffusing yellow pigment. but positive for the autotrophicum strains. powdery to granular surface with a central downy papilla. Microscopic morphology as described above for the primary culture. It has a world-wide distribution except for the autotrophicum strain which is restricted to Australia and New Zealand. 148 Descriptions of Medical Fungi Trichophyton equinum (Matruchot & Dassonville) Gedoelst Trichophyton equinum is a zoophilic fungus causing ringworm in horses and rare infections in humans. equinum. 20 µm Culture. microconidia. Invaded hairs show an ectothrix infection but do not fluoresce under Wood’s ultra-violet light. . macroconidia and nodular organs of T. flat. suede-like to powdery colony with pale yellow reverse. downy colony with yellowish-green diffusible pigment. RG-2 organism. Numerous large slender clavate microconidia. mentagrophytes. powdery. Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: White.Descriptions of Medical Fungi 149 Trichophyton erinacei (Smith & Marples) Quaife Teleomorph: Arthroderma benhamiae Ajello & Chang. Positive “in vitro” hair perforation test. clavate. Vitamin Free Agar (Trichophyton Agar No.1): Good growth indicating no special nutritional requirements. Colonies are white suede-like to powdery with no reverse pigment. Macroconidia are smooth-walled. and may have terminal appendages. Colonies (SDA) are white. Invaded hairs show an ectothrix infection but do not fluoresce under Wood’s ultra-violet light. 1% Peptone Agar: White. The distribution of this fungus is New Zealand and Europe. Hair Perforation Test: Positive Trichophyton erinacei is a zoophilic fungus associated with hedgehogs and the epidermal mites which they often harbour. Hydrolysis of Urea: Negative at 7 days. Human infections occur most frequently on the exposed parts of the body. Macroconidia are much shorter than those seen in T. two. . Numerous large clavate microconidia are borne on the sides of hyphae.to six-celled. sometimes downy to fluffy with a brilliant lemon yellow reverse. Sabouraud’s Dextrose Agar with 5% NaCl: White folded suede-like to powdery colony with no reverse pigment. Lactritmel Agar: White suede-like to powdery colony with brilliant yellow reverse. but tinea of the scalp and nails can also occur. variable in size. microconidia and macroconidia of Trichophyton erinacei. and (d) its negative hydrolysis of urea. 20 µm Culture. (c) its lack of reverse pigment on Sabouraud’s salt agar. (b) its brilliant lemon yellow reverse pigment on plain Sabouraud’s agar and Lactritmel agar. microscopic morphology. Trichophyton erinacei is generally distinguished from T. 150 Descriptions of Medical Fungi Trichophyton erinacei (Smith & Marples) Quaife Key Features: culture characteristics. thin-walled clavate macroconidia. mentagrophytes by (a) its microscopic morphology showing numerous large slender clavate microconidia borne on the sides of hyphae and its smooth. . geographical distributions and negative urease test. multiseptate macroconidia are also present in some cultures. Occasional slender. Reverse pale pinkish-brown. Lactritmel Agar: Macroscopic and microscopic features as described for the primary culture. mentagrophytes has a characteristic granular appearance. interdigitale and T. rubrum and T. mentagrophytes unlike T.1 agars. microscopic morphology and in vitro perforation of human hair. Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: raised white downy colony with no reverse pigment. 1% Peptone Agar: Flat. Trichophyton interdigitale can be distinguished from T. flat cream powdery surface with central downy tuft. white to cream. a positive hair perforation test and the production of a yellow-brown to pinkish-brown reverse pigment on pigment stimulation media like lactritmel and Trichophyton No.1): Good growth indicating no special nutritional requirements. rubrum. Vitamin Free Agar (Trichophyton Agar No. particularly the vesicular type. Numerous subspherical to pyriform microconidia. Hydrolysis of Urea: Positive within 5 days. RG-2 organism. often becoming a darker red-brown with age. occasional spiral hyphae and spherical chlamydospores are present. smooth-walled. white to cream in colour with a powdery to suede-like surface and yellowish and pinkish brown reverse pigment. the latter being more abundant in older cultures. (c) a positive urease test (within 7 days). grow very well on this medium and usually produce a distinctive dark reddish-brown reverse pigment). Distribution is world-wide. Key Features: culture characteristics. tinea corporis. Sabouraud’s Dextrose Agar with 5% NaCl: Heaped and folded. Trichophyton interdigitale is an anthropophilic fungus which is a common cause of tinea pedis. Hair Perforation Test: Positive. It is not known to invade hair in vivo but produces hair perforations in vitro. mentagrophytes by (a) its culture characteristics and microscopic morphology on Sabouraud’s dextrose agar and/or lactritmel agar. interdigitale has a suede-like to downy surface whereas T. No reverse pigment. buff-coloured suedelike surface with a dark reddish-brown submerged fringe and brown reverse.Descriptions of Medical Fungi 151 Trichophyton interdigitale Priestley Teleomorph: Arthroderma vanbreuseghemii Takashio Colonies (SDA) are usually flat. (b) its growth and colony morphology on Sabouraud’s salt agar (colonies of T. and (d) on 1% peptone agar T. clavate. . and sometimes superficial nail plate invasion. suede-like surface with raised white downy centre. chlamydospores and spiral hyphae in Trichophyton interdigitale. macroconidia. 152 Descriptions of Medical Fungi Trichophyton interdigitale Priestley 20 µm 20 µm Culture. microconidia. . colonies are often glabrous with minimal surface mycelium. . interdigitale var. 20 µm Culture and “nodular organs” T.Descriptions of Medical Fungi 153 Trichophyton interdigitale var. It has a world-wide distribution. RG-2 organism. On primary isolation. may produce subspherical to pyriform microconidia similar to those of T. interdigitale var. a dysgonic variant of T. interdigitale with distinctive bright yellow to apricot-coloured colonies with a suede-like to powdery surface and a bright yellow-brown to orange reverse. especially with subculture. but produces hair perforations in vitro. interdigitale. Microscopically characteristic “nodular organs” are observed in the vegetative hyphae. Usually. nodulare Supplementary description for Trichophyton interdigitale var. T. nodulare. no conidia are seen but some isolates. It is not known to invade hair in vivo. nodulare. nodulare is an unusual cause of tinea pedis. Kerion of the scalp and beard may occur. microscopic morphology and clinical disease with known animal contacts. guinea-pigs.1): Good growth indicating no special nutritional requirements. Reverse pigmentation is yellow-brown to pinkish-brown to red-brown. horses. Hair Perforation Test: Positive within 14 days. mentagrophytes with a world-wide distribution and a wide range of animal hosts including mice. Produces inflammatory skin or scalp lesions in humans. Microconidia are hyaline. Some cultures develop a raised central tuft or pleomorphic downy areas. Hydrolysis of Urea: Positive within 7 days (usually 3 to 5 days). particularly in rural workers. smooth-walled. cream-coloured. 1% Peptone Agar: Flat. Sabouraud’s Dextrose Agar with 5% NaCl: Cultures are heaped and folded. Numerous single-celled microconidia are formed. Colonies (SDA) are generally flat. suede-like to downy colony. Lactritmel Agar: Cultures are flat. Reverse pigmentation is usually a yellow-brown to reddish-brown colour. with a suede-like surface texture and characteristically have a very dark reddish-brown submerged peripheral fringe and reverse pigmentation. with a powdery to granular surface. Key Features: culture characteristics. clavate. mentagrophytes is the zoophilic form of T. (b) its microscopic morphology of more spherical microconidia and generally greater numbers of macroconidia and (c) a yellow to brown diffusible pigment is often seen on Littman Oxgall agar. buff to brown in colour. cats. with predominantly spherical microconidia. interdigitale by (a) its granular appearance on 1% Peptone agar. often forming in dense clusters and varying numbers of spherical chlamydospores. Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: Raised greyish-white. multiseptate macroconidia. spiral hyphae and smooth. multi-celled macroconidia may also be present. however occasional clavate to pyriform forms may occur. and are predominantly spherical to subspherical in shape. Some cultures show central folding or develop raised central tufts or pleomorphic suede-like to downy areas. T. Vitamin Free Agar (Trichophyton Agar No. . Varying numbers of spherical chlamydospores. Some cultures may show a diffusible yellow to brown pigment. often in dense clusters. Invaded hairs show an ectothrix infection but do not fluoresce under Wood’s ultra-violet light. Microscopic morphology similar to that described above. with a powdery to suedelike surface. clavate-shaped. white to cream in colour. and have a reddish-brown reverse pigmentation. thin-walled. RG-2 organism. spiral hyphae and smooth. sheep and rabbits. thin-walled. mentagrophytes can be distinguished from T. cream-coloured. with a powdery to granular surface. powdery to granular colony with no reverse pigment. white to cream in colour. kangaroos. T. Cultures are flat. 154 Descriptions of Medical Fungi Trichophyton mentagrophytes (Robin) Blanchard Teleomorph: Arthroderma simii Stockdale et al. chlamydospores and spiral hyphae in Trichophyton mentagrophytes. macroconidia. . microconidia.Descriptions of Medical Fungi 155 Trichophyton mentagrophytes (Robin) Blanchard 20 µm 20 µm 20 µm Cultures. Key Features: culture characteristics. dome-like bluish-grey. clavate macroconidia are present. No submerged fringe. mentagrophytes). suede-like in texture with a pale yellow-brown to pinkish brown reverse. are borne laterally along the sides of hyphae. greyish-white. greyish-white. No diffusible or reverse pigment should be present. A characteristic pungent “mousy” odour may be present. Lactritmel Agar: Flat. multiseptate.e. Raised white suede-like to downy colony with no reverse Hydrolysis of Urea: Positive within 7 days (usually very rapid 2-3 days). white to cream. usually within 2 to 3 days. quinckeanum (Zopf) MacLeod & Muende Colonies (SDA) are flat or slightly raised and folded. and some subspherical forms are present. but with no distinctive dark reddish-brown submerged fringe and reverse pigment as seen in T. Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: Raised. Hair Perforation Test: Positive in 7 to 10 days. suede-like colony with either no reverse pigment or a pale yellow-brown reverse. clavate macroconidia may be present. white to cream. raised. . mentagrophytes var. clavate macroconidia. Vitamin Free Agar (Trichophyton Agar No. bluish-grey suede-like colony with a narrow flat. contact with mice. odour and rapid urease test. no special nutritional requirements. 1% Peptone Agar: pigment. (b) microscopic morphology showing numerous slender clavate with some pyriform microconidia and moderate numbers of smooth thin-walled.1): Flat. suede-like colony with a narrow flat. quinckeanum may be distinguished from T.e. white to cream. With age the microconidia become broader and pyriform. (c) a rapid urease test. suede-like border. T. suede-like border and no diffusible or reverse pigment). Numerous slender clavate to pyriform (depending on age of sub-culture) microconidia and occasional to moderate numbers of smooth. and on Sabouraud’s salt agar (typically heaped and folded white suede-like colony. Sabouraud’s Dextrose Agar with 5% NaCl: Heaped up and much folded white suede-like colony with very pale yellow-brown reverse. thin-walled. Numerous microconidia. i. Occasional to moderate numbers of smooth-walled. mentagrophytes by (a) its characteristic culture appearance on Littman Oxgall agar (i. and (d) cultures often have a characteristic pungent “mousy” odour. predominantly slender clavate when young. suede-like to powdery colony with either no reverse pigment or a pale yellow-brown to pinkish-brown reverse. RG-2 organism. microscopic morphology. dome-like. 156 Descriptions of Medical Fungi Trichophyton mentagrophytes var. The geographical distribution of this dermatophyte is difficult to establish. saucer-shaped crusted lesions up to 1 cm in diameter called scutula. microconidia quinckeanum. yellow. quinckeanum causes “mouse favus” on mice. . and macroconidia of T. It is often associated with mice plagues in the Australian Wheat Belt. but very occasional hairs from experimental lesions in guinea pigs may show a pale yellow fluorescence. but it is probably world-wide.Descriptions of Medical Fungi 157 Trichophyton mentagrophytes var. Infected human hairs do not fluoresce under Wood’s ultra-violet light. Invaded hairs are rarely seen but they may show either ectothrix or endothrix infection. 20 µm Culture. mentagrophytes var. quinckeanum (Zopf) MacLeod & Muende Trichophyton mentagrophytes var. and this is seen as thick. These will need to be subcultured onto media like Lactritmel agar or potato dextrose agar which stimulate pigmentation and sporulation. suede-like to downy. rubrum represents the parent strain of T. especially to those countries with returning troops or to those receiving refugees. Granulomatous lesions may sometimes occur. cigar-shaped macroconidia. white to cream. Trichophyton rubrum typical downy strain Colonies (SDA) are flat to slightly raised. Note: on primary isolation some cultures may lack reverse pigmentation and fail to produce microconidia. However. Culture of Trichophyton rubrum downy strain. 158 Descriptions of Medical Fungi Trichophyton rubrum (Castellani) Semon Many strains and varieties of T. The macroconidia may or may not have terminal appendages. It should be stressed that intermediate strains between the two types do occur and that many culture and morphological characteristics overlap. where it has often been described as a new species. RG-2 organism. rubrum downy type and T. If sporulation still fails subculture the fungus onto Trichophyton Agar No. Macroconidia are usually absent. however closterospore-like projections may be present in some mounts. . Microscopically. the granular type is characterised by the production of moderate to abundant numbers of clavate to pyriform microconidia and moderate to abundant numbers of thin-walled. Microscopically. the latter evolved by establishing a niche in feet (tinea pedis) when the former was imported into Europe and North America at the beginning of the 20th century. The granular strain of T. the downy type is characterised by the production of scanty to moderate numbers of slender clavate microconidia and no macroconidia. It frequently causes chronic infections of skin and nails. Most cultures show scanty to moderate numbers of slender clavate to pyriform microconidia.1. since the Vietnam War. it has been spread throughout the world. For practical purposes we will distinguish two types: T. rubrum granular type. with a yellow-brown to wine-red reverse. Trichophyton rubrum granular strain is a frequent cause of tinea corporis in South East Asia and in Aborigines living in the Northern Territory of Australia. rubrum downy type. rubrum have been described and opinion differs between mycologists as to the exact validity of many of these. Some cultures may have showed a faint greenish-yellow diffusible pigment. downy colonies with a deep wine-red reverse pigment. white to cream. 1% Peptone Agar: Flat. No reverse pigment produced. suede-like to downy with a deep wine-red reverse pigment. white to cream. Colonies are flat. Vitamin Free Agar (Trichophyton Agar No. downy colony often with a raised centre. greyish-white.1): Good growth indicating no special vitamin requirements. Hydrolysis of Urea: Negative at 7 days. Sabouraud’s Dextrose Agar with 5% NaCl: Very stunted. white downy colony with a pale yellow-brown reverse pigment. 20 µm Typical slender clavate microconidia of Trichophyton rubrum downy type.Descriptions of Medical Fungi 159 Trichophyton rubrum (Castellani) Semon Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: Raised. . microscopic morphology and failure to perforate hair “in vitro”. suede-like to downy colony with no reverse pigment. white. Key Features: culture characteristics. cultures show the typical downy type morphology of pyriform to slender clavate microconidia. Lactritmel Agar: Flat. Microscopically. Hair Perforation Test: Negative at 28 days. 1): Good growth indicating no special nutritional requirements. Key Features: culture characteristics and microscopic morphology. Numerous broad clavate to pyriform microconidia and moderate numbers of smooth. 160 Descriptions of Medical Fungi Trichophyton rubrum granular type Colonies (SDA) are flat to slightly raised. glabrous to suede-like colony with no reverse pigment. most cultures have numerous clavate to pyriform microconidia and moderate numbers of smooth. . Reverse is a brownishyellow colour. Hair Perforation Test: Positive. suede-like colonies with some radial folding and a greenish-yellow diffusible pigment. Lactritmel Agar: Flat. thin-walled multiseptate. white to cream. Older cultures may show numerous chlamydospores with few clavate to pyriform microconidia. slender cylindrical macroconidia. suede-like with a pinkish-red reverse. slender cylindrical macroconidia are present. greyish. white to cream. glabrous. Sabouraud’s Dextrose Agar with 5% NaCl: A very stunted. thin-walled. Microscopically. later developing a dark red central spot. A few chlamydospores may be present in older cultures. suede-like to granular colonies with a pinkish to wine-red reverse. cream thallus. Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: Raised. white to rose pink. Hydrolysis of Urea: Positive at 7 days Vitamin Free Agar (Trichophyton Agar No. White to cream suede-like colonies with a pinkish-red to wine-red reverse. 1% Peptone Agar: Flat. heaped and folded. Culture of Trichophyton rubrum granular strain. .Descriptions of Medical Fungi 161 Trichophyton rubrum granular type 20 µm 20 µm Macroconidia and microconidia of Trichophyton rubrum granular type. . Favus is a chronic. Invaded hairs remain intact and fluoresce a pale greenish yellow under Wood’s ultra-violet light. Cultures are difficult to maintain in their typical convoluted form. however numerous chlamydospores may be present in older cultures. and rapidly become flat and downy. Favus was once common in Eurasia and North Africa. No macroconidia and microconidia are seen in routine cultures. However. The thallus is cream-coloured to yellow to orange brown. waxy or suede-like with a deeply folded honeycomb-like thallus and some sub-surface growth. 162 Descriptions of Medical Fungi Trichophyton schoenleinii (Lebert) Langeron & Milochevitch Colonies (SDA) are slow growing. No reverse pigmentation is present. Trichophyton schoenleinii is an anthropophilic fungus causing favus in humans. RG-2 organism Key Features: clinical history. culture characteristics and microscopic morphology showing favic chandeliers. scarring form of tinea capitis characterised by saucer-shaped crusted lesions or scutula and permanent hair loss. however its incidence is now in decline. 20 µm Culture and “favic chandeliers” of Trichophyton schoenleinii. characteristic antler “nail head” hyphae also known as “favic chandeliers” may be observed. A few distorted clavate microconidia may be formed by some isolates when grown on polished rice grains. Trichophyton soudanense is an anthropophilic fungus which is a frequent cause of tinea capitis in Africa. The surface mycelium and reverse pigment are characteristically a deep apricot-orange in colour. Often there is a broad fringe of submerged growth. 2007). RG-2 organism. soudanense appears to be genetically related to Trichophyton rubrum and T. culture characteristics and microscopic morphology showing reflexive hyphal branching and endothrix invasion of hair. Pyriform microconidia may occasionally be present and numerous chlamydospores are often found in older cultures. . Distribution is mainly in Africa with imported cases now reported from Europe. suede-like surface. a thin halo of clearing usually appears in the milk solids around the colony edge at 7-10 days. 20 µm Culture and “reflexive” hyphal branching in Trichophyton soudanense. Microscopically. Australia and USA. Invaded hairs show an endothrix infection but do not fluoresce under Wood’s ultra-violet light. violaceum (Graser et al. On BCPmilk solids agar. Brazil. Key Features: clinical history. T.Descriptions of Medical Fungi 163 Trichophyton soudanense Joyeux. the hyphae often show reflexive or right-angle branching. however we have maintained the current description until the taxonomy is clarified. Colonies (SDA) are slow-growing with a flat to folded. racquet mycelium and antler hyphae may also be present. . hyphal spirals. It is not known to invade hair in vivo. RG-1 organism. Chlamydospores. Reverse pigmentation is usually yellowish-brown although some variants have a deep rose-red reverse. 20 µm Culture and macroconidia of Trichophyton terrestre. but produces hair perforations in vitro. and are two. smooth and thin-walled. No growth at 37OC. clavate or pedicellate.to six-celled. Key Features: culture characteristics and microscopic morphology. Trichophyton terrestre is a geophilic fungus of world-wide distribution which may occur as a saprophytic contaminant on humans and animals. Macroconidia are clavate to cylindrical with rounded ends. mentagrophytes. usually exhibiting transition forms to more or less abundant lateral macroconidia. Tsao and Plunkett Arthroderma quadrifidum Dawson and Gentles Colonies (SDA) are usually flat to downy with a suede-like to granular texture resembling T. buff to yellow. 164 Descriptions of Medical Fungi Trichophyton terrestre Durie and Frey Teleomorphs: Arthroderma insingulare Padhye and Carmichael Arthroderma lenticulare Pore. The surface colour may range from white to cream. or greenish-yellow. Microconidia are large. are borne at right angles to the hyphae. to dark-brown. sometimes greyish. The colour may vary from pale-buff to yellow. Trichophyton tonsurans is an anthropophilic fungus with a world wide distribution which causes inflammatory or chronic non-inflammatory finely scaling lesions of skin. 1% Peptone Agar: Flat. Numerous swollen giant forms of microconidia and chlamydospores are produced in older cultures. . The reverse colour varies from yellow-brown to reddish-brown to deep mahogany. endothrix invasion of hairs and partial thiamine requirement. No reverse pigment. T1 = vitamin free agar. Lactritmel Agar: Macroscopic and microscopic features as described above for the primary culture. thin-walled. irregular. It is a common cause of tinea capitis in the Australian Aborigine and African Americans. Hyphae are relatively broad. Numerous characteristic microconidia varying in size and shape from long clavate to broad pyriform. suede-like folded surface with no reverse pigment. (the sulfureum form which resembles Epidermophyton floccosum). white to cream suede-like surface with raised centre. much branched with numerous septa. Sabouraud’s Dextrose Agar with 5% NaCl: Very stunted slow growing colony with dark brown surface and reverse. irregular. T4 Key Features: microscopic morphology. T1 Hair Perforation Test: Positive within 14 days. They may be suedelike to powdery. Invaded hairs show an endothrix infection and do not fluoresce under Wood’s ultra-violet light. flat with a raised centre or folded. clavate macroconidia may be present on some cultures. culture characteristics. RG-2 organism. nails and scalp. Very occasional smooth. Hydrolysis of Urea: positive at 5 days Nutritional Tests on Trichophyton Agars: results demonstrate a partial requirement for thiamine. Kaminski’s Dermatophyte Identification Scheme Littman Oxgall Agar: Restricted colony with cream.Descriptions of Medical Fungi 165 Trichophyton tonsurans Malmsten Colonies (SDA) show considerable variation in texture and colour. which often remain unstained by lactophenol cotton blue. T4 = vitamin free + thiamine agar. often with radial grooves. hyphae. 166 Descriptions of Medical Fungi Trichophyton tonsurans Malmsten 20 µm Colonies. microconidia and macroconidia of Trichophyton tonsurans. . . All strains produce typical chains of chlamydospores. Key Features: culture characteristics and requirements for thiamine and inositol.Descriptions of Medical Fungi 167 Trichophyton verrucosum Bodin Teleomorph: Arthroderma benhamiae Ajello & Chang. The tips of some hyphae are broad and club-shaped. and occasionally divided. clinical lesions and history. Colonies (SDA) are slow growing. Chlamydospores are often in chains. Also when grown at 25OC on milk solids glucose agar a halo of peripheral clearing of milk solids occurs within 7 days. giving the so-called “antler” effect. minimal submerged growth on T1 + inositol (T2). but when present have a characteristic tail or string-bean shape. Invaded hairs show an ectothrix infection and fluorescence under Wood’s ultraviolet light has been noted in cattle but not in humans. Confirmatory Tests: Growth at 37OC: unlike other dermatophytes growth is enhanced at 37OC Nutritional Requirements: all strains require thiamine and approximately 80% require thiamine and inositol.5% yeast extract and incubated at 30OC. white to cream-coloured. occasional strains produce clavate to pyriform microconidia borne singly along the hyphae. large ectothrix invasion of hair. Infections in humans result from direct contact with cattle or infected fomites and are usually highly inflammatory involving the scalp. on Sabouraud’s’ dextrose agar containing 0. Reverse pigment may vary from non-pigmented to yellow. a raised centre. Macroconidia are only rarely produced. Geographic distribution is world-wide. There is no growth on casein vitamin free agar (T1). good growth on T1 + inositol and thiamine (T3) and good growth on T1 + thiamine only (T4). grown from a very small inoculum. Microscopic examination of young 4 to 5 day old colonies. button or disc-shaped. skin). nails. with a suede-like to velvety surface. especially when grown on BCP milk solids glucose agar at 37OC. and flat periphery with some submerged growth. irregular hyphae with many terminal and intercalary chlamydospores are present. small. often referred to as “chains of pearls”. The number of vesicles produced is greater from primary inoculations of skin scrapings or hairs. RG-2 organism. Broad. show characteristic terminal vesicles (not chlamydospores) at the tips of hyphae. Trichophyton verrucosum is a zoophilic fungus causing ringworm in cattle. When grown on thiamine-enriched media. beard or exposed areas of the body (ie. terminal vesicles at the tips of hyphae in young colonies and chains of chlamydospores. . 168 Descriptions of Medical Fungi Trichophyton verrucosum Bodin 20 µm 20 µm 20 µm 30 µm Trichophyton verrucosum showing clavate to pyriform microconidia. characteristic rat tail or string bean-shaped macroconidia. No conidia are usually seen. producing the so-called “black dot” tinea capitis. Distribution is world-wide. Invaded hairs show an endothrix infection and do not fluoresce under Wood’s ultra-violet light. 4). beard and scalp. tortuous. although occasional pyriform microconidia have been observed on enriched media. There is minimal growth on casein vitamin-free agar (Trichophyton Agar No. Hyphae are relatively broad. . partial thiamine requirement and endothrix hair invasion. glabrous or waxy. Trichophyton violaceum is an anthropophilic fungus causing inflammatory or chronic non-inflammatory finely scaling lesions of skin. violaceum has a partial nutrient requirement for thiamine. gourvillii. Cultures often become pleomorphic. especially in older cultures. and other species that may produce purple pigmented colonies. 20 µm Culture and chlamydospores of Trichophyton violaceum. rubrum. heaped and folded and a deep violet in colour. Key Features: culture characteristics. much branched and distorted. The partial requirement for thiamine separates this organism from T. whereas older hyphae stain poorly and show small central fat globules and granules. Numerous chlamydospores are usually present. particularly in the Near East. T. RG-2 organism. forming white sectors and occasional non-pigmented strains may occur.Descriptions of Medical Fungi 169 Trichophyton violaceum Sabouraud apud Bodin Colonies (SDA) are very slow growing. 1). and slightly better growth on vitamin-free agar plus thiamine (Trichophyton Agar No. Eastern Europe. Young hyphae usually stain well in lactophenol cotton blue. USSR and North Africa. Nutritional Requirements: T. nails. the genus has undergone major revision (Gueho et al. Trichosporon species are a minor component of normal skin flora. thallus not meristematic Arthroconidia elongate. 2. Infections in non-immunosuppressed patients include endophthalmitis after surgical extraction of cataracts. and previously described infections reported in the literature under this name could in fact be due to any one of the species listed below. cutaneum T. keys to taxa and additional information see Kurtzman and Fell (1988). organ transplantation. and are widely distributed in nature. Following recent molecular studies. Disseminated infections are often fulminate and widespread. asteroides . asahii T. Disseminated infections are most frequently caused by T. (2000). They are regularly associated with the soft nodules of white piedra. endocarditis usually following insertion of prosthetic cardiac valves. Rodriguez-Tudela et al. 3. growth with L-arabinose Colony with very slow growth. de Hoog et al. 2000. solid tumours and AIDS. or thallus meristematic 2 3 T. Some blastoconidia are also seen. 1. with lesions occurring in the liver. In particular. 4. For descriptions of species. asahii and have been associated with leukaemia. Rodriguez-Tudela et al. asteroides 5 T. 6. ovoides 6 T. thallus consisting of clumps of meristematic cells (sarcinae) Colonies and microscopy otherwise Appressoria present in slide cultures Appressoria absent in slide cultures Arthroconidia barrel-shaped. multiple myeloma. 170 Descriptions of Medical Fungi Trichosporon Behrend The genus Trichosporon is characterised by the development of hyaline. Key to medically important species (de Hoog et al. de Hoog et al. which develop radial furrows and irregular folds. lymphoma. (2005). peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). aplastic anaemia. lungs and gastrointestinal tract. and have been involved in a variety of opportunistic infections in the immunosuppressed patient. spleen. Growth with melibiose No growth with melibiose Tolerant to cycloheximide Not tolerant to cycloheximide Growth with myo-inositol. mucoides T. 2005) and 6 species of medical importance are described below. inkin 4 T. (1992). The colonies are usually raised and have a waxy appearance. and intravenous drug abuse. the name Trichosporon beigelii is now obsolete. no growth with L-arabinose No growth with myo-inositol. Gueho et al. 1992. 5. 2000). septate hyphae that fragment into oval or rectangular arthroconidia. suede-like to farinose with radial furrows and irregular folds. . v Variable.Descriptions of Medical Fungi 171 Trichosporon asahii Akagi ex Sugita et al.25 Anidulafungin >8 >8 MIC data for T.25-16 8. (2002).5 Flucytosine 2-128 16 Posaconazole 0. Arthroconidia are barrel-shaped. RG-2 organism.0 Amphotericin B 0. antifungal susceptibility testing of individual strains is recommended.0 Caspofungin >8 >8 Voriconazole 0.25-16 8. Growth at 37OC. Colonies (SDA) are white to cream-coloured. Appressoria absent. Antifungal . hyphae and arthroconidia of Trichosporon asahii. powdery. (2005) and WCH in-house data. Budding cells and lateral conidia are absent. s Slow Glucose Galactose L-Sorbose + + v v + + + + Melibiose Raffinose Melezitose Soluble Starch D-Xylose L-Arabinose D-Arabinose D-Ribose v v v + + + L-Rhamnose D-Glucosamine N-A-D-glucosamine + + + v + v v D-Glucitol v + + v v + + α-M-D-glucoside D-Gluconate DL-Lactate Sucrose Maltose Cellobiose Trehalose Lactose Glycerol Erythritol Ribitol Galactitol D-Mannitol myo-Inositol Nitrate 2-K-D-gluconate D-Glucuronate 20 µm Culture. especially from invasive infections.0 Itraconazole 0. asahii. MIC µg/mL MIC µg/mL Antifungal Range MIC90 Range MIC90 Fluconazole 0. Therefore. Assimilation Tests: + Positive. w Weak. (2005). Most common species.03-16 0. Rodriguez-Tudela et al. Antifungal susceptibility may vary between species and resistant strains have been reported.03-16 0.Negative. Paphitou et al.06-16 1. Metin et al. Espinel-Ingroff (2003). This species assimilates L-arabinose but not melibiose. cerebriform. The meristematic form is punctiform. cerebriform. white.Negative. Growth at 37OC is variable. s Slow Glucose Galactose L-Sorbose + + v + + + + + Melibiose Raffinose Melezitose Soluble Starch D-Xylose L-Arabinose D-Arabinose D-Ribose + + + + + + L-Rhamnose D-Glucosamine N-A-D-glucosamine + v + + + v v D-Glucitol v + + + + + α-M-D-glucoside D-Gluconate DL-Lactate Sucrose Maltose Cellobiose Trehalose Lactose Glycerol Erythritol Ribitol Galactitol D-Mannitol myo-Inositol Nitrate 2-K-D-gluconate D-Glucuronate Trichosporon cutaneum (de Beurmann et al. brownish and consists of hyphae which swell and become multiseptate which may fall apart into smaller packets. No growth at 37OC. Growth at 37OC. Assimilation Tests: + Positive.Negative. glabrous. This species assimilates myo-inositol but not melibiose. . Budding cells and lateral conidia absent. RG-2 organism. w Weak. RG-2 organism. Sarcinae present on media with high sugar-content. This species assimilates melibiose. with radial furrows and irregular folds. often cracking the media. with radial furrows and irregular folds.) Ota Colonies (SDA) are cream-coloured. s Slow Glucose Galactose L-Sorbose + + v + + + + + Melibiose Raffinose Melezitose Soluble Starch D-Xylose L-Arabinose D-Arabinose D-Ribose + + + + + + v + L-Rhamnose D-Glucosamine N-A-D-glucosamine + v + + + + + D-Glucitol + + + + + + + α-M-D-glucoside D-Gluconate DL-Lactate Sucrose Maltose Cellobiose Trehalose Lactose Glycerol Erythritol Ribitol Galactitol D-Mannitol myo-Inositol Nitrate 2-K-D-gluconate D-Glucuronate Trichosporon inkin (Oho ex Ota) do Carmo-Sousa & van Uden Colonies (SDA) are restricted. hyphae developing in older cultures. . v Variable. . This species assimilates L-arabinose but not myo-inositol. dry. RG-2 organism.1% cycloheximide. Usually associated with white piedra on pubic hairs. Assimilation Tests: + Positive. Uncommon species usually associated with superficial infections. Arthroconidia are long cylindrical. Appressoria absent. 172 Descriptions of Medical Fungi Trichosporon asteroides (Rischin) Ota Colonies (SDA) are restricted. Uncommon species usually associated with superficial infections. without marginal zone. cream-coloured. Budding cells abundant in primary cultures. Arthroconidia are cylindrical to ellipsoidal. v Variable. Appressoria present in slide cultures. Appressoria absent. Arthroconidia are elongate and hyphae are often present. finely cerebriform with a granular covering. Budding cells and lateral conidia are absent. w Weak. not tolerant to 0. Appressoria absent. w Weak. This species assimilates melibiose and is tolerant to 0. like white piedra. Appressoria present in slide cultures. . Common species associated with superficial infections.1% cycloheximide. Uncommon species usually associated with superficial infections. v Variable. Growth at 37OC. . terminal or lateral blastoconidia often present. Broadly clavate.1% cycloheximide. Growth at 37OC is variable. white. white.Descriptions of Medical Fungi 173 Trichosporon inkin (Oho ex Ota) do Carmo-Sousa & van Uden Assimilation Tests: + Positive. cerebriform. . w Weak. heaped and folded. white piedra and onychomycosis. Budding cells present in primary cultures. RG-2 organism. This species does not assimilate melibiose. w Weak. Arthroconidia are barrel-shaped. becoming thick-walled with age. v Variable. Assimilation Tests: + Positive. folded at the centre. Smith Colonies (SDA) are moist and glabrous. RG-2 organism.Negative. Budding cells and lateral conidia absent. s Slow Glucose Galactose L-Sorbose + + + + + + + + Melibiose Raffinose Melezitose Soluble Starch D-Xylose L-Arabinose D-Arabinose D-Ribose + + + + + + + + L-Rhamnose D-Glucosamine N-A-D-glucosamine + + + + + + + + D-Glucitol + + + + + + + α-M-D-glucoside D-Gluconate DL-Lactate Sucrose Maltose Cellobiose Trehalose Lactose Glycerol Erythritol Ribitol Galactitol D-Mannitol myo-Inositol Nitrate 2-K-D-gluconate D-Glucuronate Trichosporon ovoides Behrend Colonies (SDA) are restricted. but tolerates 0.Negative. v Variable. with a flat marginal zone. Arthroconidia are cylindrical. s Slow Glucose Galactose L-Sorbose + + v + + + v + Melibiose Raffinose Melezitose Soluble Starch D-Xylose L-Arabinose D-Arabinose D-Ribose v v + + v v + L-Rhamnose D-Glucosamine N-A-D-glucosamine + v + v + + D-Glucitol v + + + + + + α-M-D-glucoside D-Gluconate DL-Lactate Sucrose Maltose Cellobiose Trehalose Lactose Glycerol Erythritol Ribitol Galactitol D-Mannitol myo-Inositol Nitrate 2-K-D-gluconate D-Glucuronate . granular. s Slow Glucose Galactose L-Sorbose + v v + + + + + Melibiose Raffinose Melezitose Soluble Starch D-Xylose L-Arabinose D-Arabinose D-Ribose + + + v v + L-Rhamnose D-Glucosamine N-A-D-glucosamine v + v + v D-Glucitol + + + + + + α-M-D-glucoside D-Gluconate DL-Lactate Sucrose Maltose Cellobiose Trehalose Lactose Glycerol Erythritol Ribitol Galactitol D-Mannitol myo-Inositol Nitrate 2-K-D-gluconate D-Glucuronate Trichosporon mucoides Gueho & M.Th.Negative. Assimilation Tests: + Positive. unbranched. often septate near the base. (1980). nanum will perforate hair in vitro. It is occasionally isolated as a saprophyte in the clinical laboratory. retrogressive conidial development. more or less rough-walled. Finally. Domsch et al. Rippon (1988) and Samson et al. sometimes on stalks. For descriptions of species. RG-1 organism. suede-like to powdery. (1995). Trichothecium roseum should not be confused with Microsporum nanum. Colonies of the latter may be pinkish-buff in colour and also produce ovoid to pear-shaped.e. pink or orange with age. Key Features: hyphomycete. Note: conidia are not produced in basipetal chains as in T. Conidia are two-celled ellipsoidal to pyriform. Note: the conidiophore is progressively shortened with the formation of each conidium i. bearing basipetal zig-zag (alternating) chains of conidia at the apex. 174 Descriptions of Medical Fungi Trichothecium roseum (Persoon) Link ex Gray Colonies are moderately fast growing. M. flat. Trichothecium roseum has a world-wide distribution and is often isolated from decaying plant substrates. initially white but becoming rosy. nanum usually produces a red-brown reverse pigment and the two-celled macroconidia are sessile and formed singly. soil. The conidiophores are indistinguishable from the vegetative hyphae until the first conidium is produced. basipetal zig-zag chains of two-celled conidia showing retrogressive development where the conidiophore becomes progressively shorter. However. roseum demonstrating retrogressive conidial development. keys to taxa and additional information see McGinnis (1980). mostly two-celled macroconidia with thin. and food-stuffs (especially flour products). They are erect. . on undifferentiated conidiophores which do not undergo further change or produce secondary conidia. roseum. smooth to delicately roughened and thick-walled. hyaline. 20 µm Conidiophores of T. M. verrucose walls. seeds of corn. with an obliquely truncate basal scar. RG1 organism. Conidia are typically obovoid (narrowest at the base). Bipolaris. Exserohilum. Domsch et al. Rippon (1988).25 Very limited data.06->16 Flucytosine >128 Voriconazole 0. multi-celled conidia (dictyoconidia) are formed through a pore (poroconidia) by a sympodially elongating geniculate conidiophore. all being saprophytes. Antifungal MIC µg/mL Range Antifungal MIC µg/mL Range Fluconazole 8->64 Amphotericin B 1->16 Itraconazole 0. Alternaria. 10 µm Conidia of Ulocladium. (1995) and de Hoog et al. numerous. brown to olivaceous-black or greyish and suede-like to floccose. Samson et al. Dreschlera and Curvularia. Seven species have been described. For descriptions of species. Antifungal susceptibility testing of individual strains is recommended. .Descriptions of Medical Fungi 175 Ulocladium Preuss Colonies are rapid growing. usually solitary. (2000). (2000) and WCH in-house data. Species of Ulocladium should not be confused with other poroconidial genera such as Stemphylium. Microscopically. (1980). dark brown and often rough-walled. Pujol et al. keys to taxa and additional information see Ellis (1970 and 1976). 5-12 x 3-4 µm. This genus is very similar to Rhinocladiella. greyish-brown to blackish-brown. They are smooth-walled. due to the sympodial development of the conidia. (2000). up to 250 µm long and 2-4 µm wide. 176 Descriptions of Medical Fungi Veronaea botryosa Ciferri & Montemartini Colonies grow rapidly and are suede-like to downy. Conidia are pale brown. RG-1 organism. keys to taxa and additional information see Ellis (1971) and de Hoog et al. two-celled. smooth-walled or slightly verrucose. pale to medium olivaceous-brown. cylindrical with a truncated base. 10 µm Conidiophores and conidia of Veronaea botryosa. occasionally branched and are usually geniculate. straight or flexuose. Conidiophores are erect. . however the conidia are typically twocelled. Occasional skin infections have been reported from humans. For descriptions of species. green or yellow with a colourless. verticillate branched conidiophores bearing whorls of awl-shaped. (2000). and are usually borne in slimy heads (glioconidia). (1980). de Hoog et al. phialides and conidia of Verticillium. RG-1 organism. red. It has been reported as a rare agent of mycotic keratitis. McGinnis (1980). Key Features: hyphomycete. white to pale yellow in colour. Samson et al. verticillately branched over most of their length. becoming pinkish brown. yellow or reddish brown reverse. Members of this genus are often isolated from the environment. Conidia are hyaline or brightly coloured. For descriptions of species. Rippon (1988). 20 µm Conidiophores. mostly one-celled. keys to taxa and additional information see Domsch et al.Descriptions of Medical Fungi 177 Verticillium Nees ex Link Colonies are fast growing. (1995). . bearing whorls of slender awl-shaped divergent phialides. Conidiophores are usually well differentiated and erect. divergent phialides. suede-like to downy. 1984. mix well with a sterilised loop. . and cover with a coverslip.. 1984. squash the preparation with the butt of the inoculation needle and then blot off the excess fluid. remove a small portion of the specimen with an inoculation needle and mount in a drop of KOH on a clean microscope slide. nails and other clinical specimens for fungal elements.1% . a fluorescence microscope with the correct ultraviolet filters is required (Hageage and Harrington. For the direct microscopic examination of skin scrapings. Potassium hydroxide 10 g Coral Azole E Black (0. hairs. 1984). Best brands to use are “Pelikan” or “Talons” Indian Ink.. Place a drop of Indian Ink on the specimen. For the direct microscopic examination of CSF for Cryptococcus species. This as a very sensitive method.100mg in 100ml) 10 mL Glycerol 10 mL Distilled water 80 mL Using sterile technique. Cover with a coverslip. Indian Ink Mounts. 10 g 10 mL 80 mL Potassium Hydroxide (KOH) with Chlorazol Black. Potassium hydroxide Glycerine Distilled water Solution B: Calcofluor white reagent. 178 Descriptions of Medical Fungi MICROSCOPY STAINS & TECHNIQUES Calcofluor White with 10% KOH.5 g Evans blue 0. Note: Parker Quink ink is no longer available. nails and other clinical specimens for fungal elements. Hollander et al.02 g Distilled water 50 mL Mix one drop of each solution on the centre of a clean microscope slide. Monheit et al. however. For the direct microscopic examination of skin scrapings. Solution A: Potassium hydroxide reagent. hairs. Place the specimen in the solution and cover with a coverslip. Calcofluor white 0. Descriptions of Medical Fungi 179 MICROSCOPY STAINS & TECHNIQUES Lactophenol Cotton Blue (LPCB). Remove and apply a drop of 95% alcohol to the flag. Using clear 2cm wide cellotape and a wooden applicator stick (orange stick) make a small cellotape flag (2 x 2 cm). An excellent technique for the rapid mounting of sporulating fungi because it keeps more of the reproductive structures intact. 3. Cover with a coverslip. Using sterile technique. remove a small portion of the colony with an inoculation needle and mount in a drop of Lactophenol Cotton Blue on a clean microscope slide. cover with a coverslip.05 g Phenol Crystals (C6H5O4) 20 g Glycerol 40 mL Lactic acid (CH3CHOH COOH) 20 mL Distilled water 20 mL This stain is prepared over two days. 1. squash the preparation with the butt of the inoculation needle and then blot off the excess fluid. add another drop of stain. . 3. 4. Using sterile technique. Cellotape Flag Preparations. Add the glycerol. Filter the Cotton Blue and distilled water solution into the phenol/glycerol/ lactic acid solution. Cotton Blue (Aniline Blue) 0. remove the applicator stick and discard. Place on magnetic stirrer until the phenol is dissolved. On the first day. this acts as a wetting agent and also dissolves the adhesive glue holding the flag to the applicator stick. Mix and store at room temperature. For the staining and microscopic identification of fungi. 1. Direct Microscopic Mounts or Squash Preparations. gently press and mop up any excess stain. Leave overnight to eliminate insoluble dye. 2. wearing gloves add the phenol crystals to the lactic acid in a glass beaker. dissolve the Cotton Blue in the distilled water. 2. On the second day. Place the flag onto a small drop of Lactophenol cotton blue on a clean glass slide. 4. gently press the sticky side of the flag onto the surface of the culture. 8. Riddel’s simple method of slide culturing (Mycologia 42:265. 1950) permits fungi to be studied virtually in situ with as little disturbance as possible. Flip the block up onto the surface of the agar plate. potato dextrose is recommended. A simple modification of this method using a single agar plate is described below. some fastidious fungi may require harsher media to induce sporulation like Cornmeal agar or Czapek Dox agar. Apply a drop of 95% alcohol as a wetting agent. Using a sterile blade cut out an agar block (7 x 7 mm) small enough to fit under a coverslip. Incubate the plate at 26OC until growth and sporulation have occurred. 10. 1. . 6. When sealing with nail polish use a coat of clear polish followed by one coat of red-coloured polish. Place a flamed coverslip centrally upon the agar block. Make at least 2 slides per culture. 5. 2. however. 7. The slide can be left overnight to dry and later sealed with fingernail polish. Simple agar block method. Gently lower the coverslip onto a small drop of Lactophenol cotton blue on a clean glass slide. 9. 180 Descriptions of Medical Fungi MICROSCOPY STAINS & TECHNIQUES Slide Culture Preparations. inoculated on four sides with cover slip on top. In order to accurately identify many fungi it is essential to observe the precise arrangement of the conidiophores and the way in which spores are produced (conidial ontogeny). 3. Inoculate the four sides of the agar block with spores or mycelial fragments of the fungus to be grown. One plate of nutrient agar. Remove the cover slip from the agar block. 4. 5 g Bacto Agar to each 500 mL reagent bottle. Solution B: Glucose 40 g Distilled water Dissolve and autoclave at 10 psi/8minutes. 200 mL 1000 mL 80 g 2 mL . 2. Autoclave 110OC for 20 minutes. Grind seeds of Guizotia abyssinica as finely as possible with an electric mixer and add to 1000 mL distilled water in a stainless steel jug. Guizotia abyssinica (niger seed) 50 g Glucose 1g KH2PO4 (potassium dihydrogen 1g Creatinine 1g orthophosphate) Bacto Agar (BD 214010) 15 g Distilled water 1000 mL Penicillin G (20 units/mL) 1 mL Gentamicin (40 mg/mL) 1 mL 1. 5. Solution C: Bacto Agar (BD 214010) 30 g Distilled water 800 mL Soak for 15 minutes in 3 litre flask. Mix gently and pour into 90 mm plastic petri dishes. 4.6. 6. for selective isolation of Cryptococcus neoformans and C. Aseptically dispense for slopes (7 mL amounts into 30 mL disposable bottles). Check pH is 6. add solution A and B to solution C.6% solution in alcohol) Dissolve in 2 litre flask and autoclave 10 psi/15 minutes.5. Bromcresol Purple Milk Solids Glucose Agar (BCP-MS-G). 1977).6. If required: Cool to room temperature and adjust pH to 5. Solution A: Distilled water Skim milk powder (Carnation Brand) Bromcresol (or bromocresol) purple (1. pass through filter paper and adjust volume to 1000 mL. Boil for 30 minutes. Dispense into 500 mL bottles. gattii. Caution: Do not substitute casein for skim milk. autoclave at 15 psi/15 minutes To make media. Cool to 48OC and add 0.5 mL Gentamicin to each 500 mL of Bird Seed Agar. Adjust final pH to 6. 3. 1987). for the differentiation of Trichophyton species (Kane et al. Add 7. 7.5 mL Penicillin G and 0.Descriptions of Medical Fungi 181 SPECIALISED CULTURE MEDIA Bird Seed Agar (Staib. Add remaining ingredients except Bacto Agar to filtrate and dissolve. To prepare medium (1 litre for plates): Solution A 980 mL Solution B 20 mL Bacto Agar (BD 214010) 20 g O Autoclave to 121 C for 15 minutes. Add to the water. 2. 1994).1 g Distilled water 980 mL 1. 182 Descriptions of Medical Fungi SPECIALISED CULTURE MEDIA CDBT (Creatinine dextrose bromothymol blue thymine agar).22 µm filter. Solution B (Aqueous Bromothymol Blue): Bromothymol blue 0. Autoclave to 121 C for 15 minutes. Filter sterilise solution using 0. Dissolve ingredients in small beaker and adjust pH to 5. Solution B (Aqueous Bromothymol Blue): Bromothymol blue 0. 64 mL CGB (L-Canavanine glycine bromothymol blue agar). Dissolve the Bromothymol Blue in the NaOH 2. Dispense in plates. neoformans and Cryptococcus neoformans var. Dissolve the Bromothymol Blue in the NaOH 2. Dissolve ingredients in small beaker and adjust pH to 5. Solution A: Creatinine 1g Dextrose 0.01N NaOH Distilled water 36 mL 1. grubii (Irokanulo et al. Add to the water. Solution A: for differentiation of Cryptococcus neoformans and Cryptococcus gattii (Kwon-Chung et al. 3.01N NaOH Distilled water 36 mL 1. Store in refrigerator. 1982).5 g KH2PO4 1g MgSO47H2O 0. To prepare medium (1 litre for plates): Distilled water 980 mL Solution B 20 mL Bacto Agar (BD 214010) 20 g O 1.4 g 0. Store in refrigerator. Glycine Univar 10 g KH2PO4 1g MgSO4 1g Thiamine HCl 1 mg L-canavanine sulphate 30 mg Distilled water 100 mL 1.6 2. 64 mL . cool to 48OC. for differentiation of Cryptococcus neoformans var.5 g Thymine 0.6 2. cool to 48OC and pour plates.4 g 0. For plates add 100 mL of the filtered solution A and mix. Cornmeal Glucose Sucrose Yeast Extract Agar. Autoclave for 10 minutes at 120OC. and non-sporulating moulds. especially Aspergillus. 2.5 mL Oleic acid 0. then slope on racks. 2. Mix dry ingredients into 100 mL H2O. 2.5 mL Bacto Agar 3g Distilled water 250 mL 1. Bring remaining water to boil. Dispense for slopes. . Autoclave for 10 minutes at 120OC. boil remaining water. Add boiling water to mixture and bring to boil. for zygomycete sporulation Cornmeal agar (Oxoid CM 0103) 17 g Dextrose (Glucose) 2g Sucrose 3g Yeast extract 1g Distilled water 1000 mL 1. boil remaining water. for primary isolation and cultivation of Malassezia species. Dixon’s Agar (modified).5 g Glycerol 0. add to soaking ingredients and bring to the boil again. Autoclave at 121OC for 10 minutes.5 g Ox-bile Desiccated (Oxoid L50) 5g Tween 40 2. Soak ingredients in a little of the water. Cornmeal agar (Oxoid CM 0103) 8.5 g Distilled water 500 mL 1. remove and slope or pour for plates as required. Mix dry ingredients into 100 mL H2O. Penicillium. Autoclave at 121OC for 10 minutes and then slope. Dispense for slopes as required. stirring continuously. 4. Add boiling water to mixture and bring to boil. Bring remaining water to boil. 3. 4. 3. remove and slope. for routine cultivation and identification of fungi.4 g Distilled water 1000 mL 1. 4. 2. Malt extract (Oxoid L39) 9g Bacto Tryptone 1. Dispense for slopes (7 mL amounts into 30 mL disposable bottles. Soak the ingredients in small amount of water. for routine cultivation of fungi. 3. add to the soaking ingredients and bring to the boil again constantly stirring. Czapek Dox Agar (Oxoid CM97) 45.Descriptions of Medical Fungi 183 SPECIALISED CULTURE MEDIA Cornmeal Agar. 3. Czapek Dox Agar. Skimmed milk powder 7g (use only Dutch Jug skimmed milk powder) Honey 10 g Cornmeal agar (Oxoid CM 0103) 17 g Chloramphenicol 1 x 250 capsule Distilled water 1000 mL 1. and with it wash out honey from beaker. 5. 2. Littman Oxgall Agar (US Biological L3025) 27. 2. 3. Add to other ingredients and boil. Weigh skimmed milk into stainless steel jug. remove and slope. On removal from autoclave allow to stand 5 minutes then shake and slope on racks. Incubate at room temperature.5 g Distilled water 500 mL 1. 4. 4. Place 10-20 short pieces of hair in 5 mL water in vial. mentagrophytes produce marked localised areas of pitting and marked erosion whereas those of T. Inoculate with small fragments of the test fungus. Individual hairs are removed at intervals up to 4 weeks and examined microscopically in lactophenol cotton blue. Autoclave for 10 minutes at 115OC. Soak agar in 100 mL of water in stainless steel jug. Autoclave for 10 minutes at 121OC. mixing milk into smooth paste. 184 Descriptions of Medical Fungi SPECIALISED CULTURE MEDIA Hair Perforation Test. 2. Weigh other ingredients into skimmed milk and allow to soak. Blonde pre-pubital hair cut into short pieces (1 cm) 10-20 hairs Distilled water 5 mL 1. for the production of pigment by Trichophyton species. Boil remaining 400mL in a separate jug. 3. stirring constantly. 4. . 3. Slowly add some water. Continue adding small quantities of water until powder is dissolved (about 150 mL). 7. 5. Isolates of T. Autoclave hair at 121OC for 10 minutes and store in sterile container. Lactritmel Agar. Boil remaining water. for the differentiation of Trichophyton species. Dispense for slopes. for the differentiation of Trichophyton species. Dispense for slopes (7 mL). Note: Do not filter or adjust pH in any way Littman Oxgall Agar. 6. rubrum do not. When water has boiled add to soaking agar and reboil. remove and slope or pour for plates as required. add this to soaking ingredients and bring to boil again. Add to soaking agar. canis. Boil remaining water. for routine cultivation and identification of fungi. Rice Grain Slopes.5 with NaOH. Potato Dextrose Agar. Remove and slope or pour for plates as required. 2. 3. Boil remaining water. 1% Peptone Agar. Autoclave for 10 minutes at 121OC. 4. stirring constantly. Dispense for slopes as required. Autoclave at 121OC for 10 minutes. . 2. Dispense for slopes (7 mL). bring to the boil.Descriptions of Medical Fungi 185 SPECIALISED CULTURE MEDIA Malt Extract Agar. 2. Bring to boil. add to soaking ingredients. 3. Place ~ 1/2 teaspoon rice grains into wide neck 20 mL glass vials. 3. for routine cultivation and identification of fungi. Soak agar in small quantity of solution. Add 8 mL distilled water to each vial. stirring constantly. Lid. to induce sporulation and for differentiation of M. Potato Dextrose Agar (Oxoid CM139) 39 g Distilled water 1000 mL 1. Polished rice grains Distilled water 1. Tryptone Peptone (BD 211705) 5g Bacto Agar (BD 214010) 10 g Distilled water 500 mL 1. 3. Dissolve malt extract in a plastic beaker and pH the solution to pH 6. 4. 4. 4. Soak potato dextrose agar in small amount of the water in a stainless steel jug. Bring remaining solution to the boil. then slope on racks ensuring rice grains are evenly distributed. audouinii and M. Dispense for slopes as required. 2. 5. Oxoid Malt Extract (L39) 20 g Bacto Agar (BD 214010) 20 g Distilled water 1000 mL 1. Autoclave racks at 121OC for 15 minutes. then slope on racks. stirring constantly. Soak agar and peptone in about 50 mL of water. Autoclave at 121OC for 15 minutes. for the differentiation of Trichophyton species. or pour for plates as required. Sabouraud Dextrose Agar (Oxoid CM41) Sodium Chloride NaCl (Univar 465) Distilled water 1. Gentamicin and Yeast Extract. 4. in 100 mL water. except Gentamicin. Sabouraud Dextrose Agar with 5% Salt. Sabouraud Dextrose Agar (Oxoid CM41) 65 g Cycloheximide (Actidione) 0.56 mL Distilled water 1000 mL See above method for Sabouraud Dextrose Agar with Cycloheximide. Sabouraud Dextrose Agar (Oxoid CM41) 65 g Chloramphenicol 1 x 250 capsule Gentamicin (40mg/mL) 0. 2. add to soaking ingredients. 5. and bring to boil to dissolve. 186 Descriptions of Medical Fungi SPECIALISED CULTURE MEDIA Sabouraud Dextrose Agar with Cycloheximide. Chloramphenicol.56 mL Yeast extract 5g Distilled water 1000 mL 1. Mix well. for the primary isolation and cultivation of dermatophytes. 32. Dispense for slopes (7 mL). 2. Soak ingredients in approximately 100 mL water. Bring remaining water to boil. 4. for primary isolation and routine culture of yeasts and moulds. 3. Chloramphenicol.5 g 25 g 500 mL . Soak all ingredients. Boil remaining water. for the differentiation of Trichophyton species. Autoclave at 121OC for 10 minutes. Remove and slope. Gentamicin and Yeast Extract. Dispense for slopes as required. Autoclave at 118OC for 10 minutes. 3. Sabouraud Dextrose Agar with Chloramphenicol and Gentamicin.5 g Chloramphenicol 1 x 250 capsule Gentamicin (40mg/mL) 0. stirring well to prevent from charring. then slope on racks. Add the Gentamicin. add to soaking ingredients. Urease Agar Slopes with 0. 3. label and store in the fridge. When cool. 4.0 grams of agar to 100 mL of distilled water in a 250 mL pyrex bottle.5% Glucose. Dispense for slopes. stirring constantly. When cool add 90 mL of the Urease broth with glucose and the 10 mL of 40% urea solution to agar and dispense in 3 mL aliquots and slope on racks.8 g Distilled water 200 mL 1. Dispense in 5 X 90 mL amounts. for the stimulation of sporulation in Apophysomyces and Saksenaea isolates. for the differentiation of Trichophyton species. Add agar to water in stainless steel jug. allow to soak. Method to make slopes: 40% Urea Solution (Oxoid SR 20) 10 mL Bacto Agar (BD 214010) 3g Distilled water 100 mL 1.1). 4. Bring to boil to dissolve. Autoclave at 121OC for 15 minutes and place in 50OC water bath. Urea. Trichophyton Agar No. 3. Once boiled remove immediately to avoid discolouration. allow to soak. 2. 3. remove and slope. 3. Autoclave at 118OC for 10 minutes. Dispense for slopes. Add the Urea broth base and glucose to the distilled water in a 500mL beaker. Add 3. Bacto Agar (BD 214010) 15 g Distilled water 1000 mL 1. Autoclave at 118OC for 10 minutes. 2. Urease glucose broth base: for the differentiation of Urease producing organisms. broth base (Oxoid CM71) 0. remove and slope. 1 (BD 287710) 11.Descriptions of Medical Fungi 187 SPECIALISED CULTURE MEDIA Tap Water Agar. 2. Autoclave at 115OC for 20 mins. 5. Vitamin Free Agar (Trichophyton Agar No.9 g Glucose 5g Distilled water 450 mL 1. 2. Add agar to water in stainless steel jug. . W. 73: 203-266. 1977. E. Petersen et al. University Park Press. Mycopathologia. Booth. J. E. M. Mycoses. Can. 40:1137-1173.T. Genetic concepts in Drechslera. D.M. Payne and D. 575. 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