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Geotrichosis - An Opportunistic Mycosis of Humans And Animals
Mahendra Pal*, Sunita Sejra**, Anand Sejra**, Sihin Tesfaye***
*Department of Microbiology and Veterinary Public Health, Addis Ababa University, Faculty of
Veterinary Medicine , P.O. Box No. 34, Debre Zeit, Ethiopia.
** Department of Animal Husbandry, Government of Rajasthan, Tonk Road, Jaipur – 302015, India
***School of Veterinary Medicine, Wello University, P.O. Box No 1145, Desse, Ethiopia.
Corresponding author: palmahendra2@gmail.com
Rec.Date: Apr 19, 2013 03:21; Accept Date: May 02, 2013 08:14
Abstract
Geotrichosis, primarily caused by Geotrichum candidum, is an emerging opportunistic mycosis and is
reported from many countries of the world including India. The etiological agent is widely distributed in
environment and is recovered from the soil, air, water, silage, milk, vegetables, and fruits. In addition, G.
candidum can be isolated as part of the resident microflora in humans and animals. It can cause localized
as well systemic disease in humans and animals including birds. Geotrichosis affects mainly the patients
who are immunocompromised due to some underlying disease such as neoplasms, diabeties mellitus,
leucosis, renal transplant and HIV. The clinical diagnosis must be supported by laboratory tests.Direct
microscopic demonstration of pathogen in clinical specimens and its repeated isolation in pure and
luxuriant growth still remain the gold standard of diagnosis of geotrichosis in humans and animals. A
number of drugs such as gention violet, nystatin, miconazole, ketoconazole, amphotericin B and
voriconazole have been tried in the treatment of disease in humans as well as animals. The early diagnosis
and prompt therapy is highly imperative in immunocompromised patient to prevent the complications. The
application of Pal sunflower seed medium and Narayan stain for the study of yeasts including G.candium
in Microbiology and Public Health Laboratory is advised. It is emphasized that growing role of G.
candidum should be further studied in various clinical disorders of humans and animals.
Key words: Geotrichosis, Geotrichum candidum, Immunocompromised host, Opportunistic fungus,
Treatment
Introduction
Opportunistic mycoses are those diseases which exclusively occur in immunocompromised individuals
whose immune system is suppressed due to many factors. The examples of such opportunistic fungal
diseases are aspergillosis, fusariosis, geotichosis, pacilomycosis, rhodotoruliosis, trichosporonosis and
zygomycosis (Pal, 2007). Such infections are life threatening and are associated with high rates of
mortality. Among these infectious diseases, geotrichosis is a sporadic, infectious and opportunistic
mycotic disease of humans and animals, which is caused chiefly by Geotrichum candidum, filamentous
in man goes back to the year 1809 when Link isolated G. candidum from a patient (Pal, 2007). The
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infection due to G. candidum has been reported from India as well from other countries of the world
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yeast like fungus which occurs as a saprobe in the environment (Pal, 2007). The first record of the disease
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(Webster, 1959; Sheehy et al, 1976; Kantardies et al., 1998; Pal and Verma, 2003; Mahapatra, 2005; Pal,
2007; Lee et al., 2010 and Figueredo et al., 2011). In humans, G. candidum is mainly responsible to
respiratory diseases where as in animals,it mostly affects the skin, and the digestive tract (Dolensek et al.,
1977; Ruiz et al., 1980; Reppas and Snoeck, 1999; Pal et al., 2002; Pal and Verma, 2003; Pal, 2005; Lee
et al., 2010 and Figueredo et al., 2011). The present communication describes the growing significance of
geotrichosis as an emerging opportunistic mycotic disease of humans as well as animals.
Etiology
Geotrichosis is primarily caused by Geotrichum candidum which is a eukaryotic, aerobic, motile, Gram
positive, non-acid fast, and non-capsulated fungus. It is a filamentous mould that reproduces by
segmentation of the hyphae into arthrospores giving rise to a yeast-like bud.
It is sensitive to
o
cycloheximide and cannot grow at 40 C. Assimilation test is positive with glucose but negative with
lactose, galactose and maltose.
G. candidum belongs to class Hemiascomycetaeae, order
Saccharomycetales, Family Dipodascaceae (De Hoog and Smith, 2004). The genus Geotrichum contains
13 species of which G. candidum is one of the most spread species causing infections in humans and in a
wide variety of animals including birds (Rippon, 1988; Pal, 2007 and Figueredo et al., 2011). The fungus
has been recovered from fruits, vegetables, milk, milk products, cereals, plants,silage, textiles, soil,
sewage, water and air (Pal, 2007). It is also isolated as the part of the resident microflora in humans and
animals (Rayan et al., 1990; Pal, 2007 and Pottier et al., 2008).
Host
Disease has been diagnosed in man, cattle, chicken, dog, goat, gorilla, horse, mouse, ocelot, penguin, pig,
red flamingo, snake, and tortoise (Bendove and Ashe, 1952; Spanoghe et al., 1976; Jacobson, 1980, Ruiz
et al., 1980; Rayan et al., 1990; Chahota et al., 2003; Pal et al., 2002; Pal, 2007; Lee et al., 2011 and
Figueredo et al., 2011).
Transmission
Transmission of disease occurs by inhalation of infectious fungal cells through the respiratory tract from
the saprobic environment. Ingestion of organisms in contaminated foods may also produce infection (Pal,
2007). Rarely, the fungus may enter the susceptible host following traumatic injury. In this context, Hrdy
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received a splinter injury to the metacarpophalangeal joint while cleaning a box to package graphs.
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and co-workers (1995) reported traumatic joint infection in a person due to G. candidum. The patient had
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Disseminated geotrichosis is recorded in two dogs following multiple bite wounds from a wild raccoon
(Rhyan et al., 1990).
Clinical spectrum
Man
The affected person exhibits signs of intermittent fever, dullness, reduced appetite, mucopurulent sputum,
hemoptysis, increased pulse rate, persistent pain in the abdomen, indigestion and decreased body weight
(Pal, 2007). The infection of the skin, conjunctiva, oral cavity, respiratory tract, gastrointestinal tract,
brain and joint can occur. Oral geotrichosis shows three clinical forms: pseudomembraneous, hyperplastic
and palatine (Boniafaz et al., 2010). In mouth, there are white patches which clinically simulate to thrush
(oral candidiasis). Patients with involvement of lungs show fever, asthma or cough with sputum which is
sometime blood stained and is often gelatinous. The pulmonary form resembles to tuberculosis or chronic
Klebiesella pneumonia. The abdominal pain, diarrhoea, blood and mucus in the stool are observed in
gastrointestinal infection. Dissemination may occur in immunocompromised patients. Disease is fatal
when disseminated (Pal, 2007).
Animals
In animals, clinical signs include dermatitis, mastitis, abortion, gastritis, enteritis, diarrhea, stomatitis,
respiratory distress, fever, anorexia, besides pulmonary and renal disorders. Dissemination of infection is
observed in dogs (Rayan et al., 1990). The fungus has been identified in the oral ulcers of a dog (Pal,
2005).Generalized disease in dog is manifested with signs of fever, coughing, poor appetite, progressive
difficulty in breathing, excessive intake of water, jaundice and vomiting.Very recently, Lee and coinvestigators (2010) diagnosed intestinal geotrichosis in a 4-year-old male German shepherd from
Taiwan. The dog had a three month history of chronic watery diarrhoea, and also showed dehydration,
emaciation and weight loss. Tonsillitis is recorded in a weaned pig by Lee and others in 2011. Alopecia,
desquamation, and puritus localized mainly on the head and neck were frequently observed in equine
affected with cutaneous geotrichosis (Figueredo et al., 2011).
Epidemiology
disease are the main predisposing conditions (Kwon-Chung and Bennett, 1992., Ng et al., 1994; Vergese
and Ravichandran, 2003 and Pal, 2007). The disease is recorded in both sex and in all age groups. Most
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The leukemia, diabetes mellitus, malignant disease, HIV/AIDS, organ transplantation, and Hodgkin’s
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Geotrichosis is an infectious, non-contagious, opportunistic mycotic disease of worldwide distribution.
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clinical infections are reported in individuals who are immunocompromised. The disease can causes oral,
pharyngeal, bronchial and intestinal disorders. It can also result in systemic infection particularly in
immunosuppressed individuals.The fatal infections occur in immunocompromised patients who develop
systemic disease. The prognosis of disease is poor with a mortality rate ranging from 50 to 90 %. The
fungus Geotrichum candidum, the main etiological agent of disease, is a commensal in humans and part
of the normal flora of the skin, mouth and gastrointestinal tract (Pal, 2007 and Pottier et al., 2008). The
organism is isolated from 29 % of human faecal samples and from 18 % to 31 % of more than 2000
specimens of sputum, faeces, urine and vaginal discharges (Rippon, 1988 and Bonifaz et al., 2010). The
prevalence of up to 2.5 % has been reported in patients with bronchomycosis (Reeves, 1941). Geotrichum
candidum is also occasionally isolated from the healthy tissues of animals (Rosa et al., 2003). The fungus
can invade the lung, heart, liver, spleen, bone marrow and lymph nodes (Pal, 2007). Mahapatra (2005)
recorded co-infection of Geotrichum and Cryptosporidium in an AIDS patient. A case of G. candidum
infection in a HIV patient was diagnosed by Pal (2007) who isolated the fungus from oral lesions on Pal
sunflower seed medium and studied its morphology in Narayan stain. He also demonstrated the agent in
the impression smear of oral scrapings by Periodic Acid Schiff (PAS) technique. Among domestic
animals, cases of geotrichosis are encountered in dogs, horses, and cattle ( Pal et al.,2002; Pal and
Verma,2003; Pal,2005, Lee et al., 2010,Figueredo et al,2011).Most of cutaneous G.candidum infections
in horses were described during spring ;and adults were more affected than the young animals. The
lesions were mainly localized on the head and neck regions. Cutaneous geotrichosis should be included in
the differential diagnosis of the skin infections of equines and laboratory tests are required to confirm the
clinical diagnosis of disease ( Figueredo et al.,2011).Further studies are required to study the
epidemiology of geotrichosis as it is emerging as an opportunistic mycosis in humans.
Diagnosis
The clinical signs are not suggestive of the disease and hence the clinical diagnosis should be confirmed
by direct demonstration of the fungus in the clinical material submitted to the laboratory. The specimen
should be treated with 10-15% potassium hydroxide solution to detect the organism which appears as
branched, septate hyphae and cylindrical, barrel- shaped conidia. The fungus can be easily isolated from
clinical samples on Pal’s sunflower seed medium (Pal, 1997), and Sabouraud dextrose agar with
chloramphenicol at 30˚C. The cycloheximide (actidione) should not be incorporated in the medium as it
sweet odor (Pal, 2007). The detailed morphology of the fungal isolates can be studied in Narayan stain
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based on growth characteristics and morphology. The colony appears as white to cream colored with
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inhibits the growth of G. candidum (Kwon-Chung and Bennett, 1992). The identification of fungus is
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developed by Pal (2004). The new stain contains 0.5 ml of 3 % aqueous solution of methylene blue, 4.0 ml
of glycerin and 6.0 ml of dimethyl sulfoxide (DMSO). Culture in Narayan stain shows chains of smooth,
septate hyphae with arthroconidia. Histopathological examination of tissues can indicate the presence of
fungus when stained by Gomori methanamine silver (GMS) technique. FAT is also useful to detect the
fungal pathogen in tissue sections (Pal, 2007). In humans, the thoracic radiograph may show multiple
modular pulmonary densities. The enteroedoscopy of colon in intestinal geotrichosis in a dog reveals
edema, erythema and loss of usual fine vascular pattern, with granularity of the mucosa of the descending
column (Lee et al., 2010). The cutaneous, oral, pulmonary and systemic geotrichosis should be
differentiated from dermatophytosis, thrush, tuberculosis, and colitis, respectively. The role of cytology
and histopathology in the diagnosis of geotrichosis should be further studied.
Chemotherapy
Treatment with gentian violet, chrorexidine, miconazole, nystatin and ketoconazole has shown good
response in cutaneous, bronchopulmonary, intestinal and joint geotrichosis (Dolensek et al., 1977; Sidhu et
al., 1993; Pal, 2007 and Lee et al., 2010). Recently, Sfakianakis and co-workers (2007) reported the
efficacy of amphotericin B and voriconazole in humans suffering with invasive cutaneous Geotrichum
infection. However, the prognosis of disease is often grave in disseminated form. Attempts should be
made to develop safe, cheap and potent drugs which can help in the management of geotrichosis.
Control
Control of geotrichosis can be achieved by making early diagnosis and instituting prompt treatment in
immunocompromised patients, avoiding direct contact of traumatized skin with environmental materials,
proper washing of fruits and vegetables before consumption, use of face mask in dusty places to prevent
the entry of fungal aerosol and avoiding drinking raw or unpasteurized milk (Pal, 2007). In dairy animals,
the injury to teat/s with the soil contaminated objects should be avoided and the rules of udder hygiene
should be followed during milking.
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