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Chapter 17 : Mixed Mycotic Infections

Author: David R. Soll1
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Affiliations: 1: Department of the Biological Sciences, University of Iowa, Iowa City, IA 52242
Content Type: Monograph
Publication Year: 2002

Category: Clinical Microbiology

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Abstract:

In considering the question of mixed mycotic infections, one is faced with a number of issues related to the specific pathogenic strategies that have developed in different species and related to the phylogenetic levels of unrelatedness. First, one must consider, where relevant, the issues of commensalism, opportunism, and infection. Second, one must consider exactly what is meant by mixed colonization, or mixed infection, as it relates to genetic relatedness. Mixing can occur between kingdoms (e.g., bacteria and fungi), between genera within a kingdom (e.g., . And spp.), between species within a genus (e.g., and ), between strains within a species, and between substrains within a strain, a result of microevolution. Each of these combinations is relevant since each involves combinations of genetically distinct organisms with potentially different phenotypes, even at the substrain level. In this context, colonizing populations can also contain mixed phenotypes that are quite stable but which may be the result of high-frequency phenotypic switching systems that involve epigenetic mechanisms rather than genetic change at the level of DNA sequence. The intention of this chapter is to consider all of the levels of genetic and phenotypic mixing.

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17

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Mixed Mycotic Infections
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Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
/content/10.1128/9781555817947.chap17.fig17-1
FIGURE 1

The levels of genetic relatedness (or unrelatedness) basic to mixed infections. In the scheme, mixing based on genetic differences (upper triangle) is separated from mixing due to epigenetic switching (lower triangle).

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FIGURE 1

The levels of genetic relatedness (or unrelatedness) basic to mixed infections. In the scheme, mixing based on genetic differences (upper triangle) is separated from mixing due to epigenetic switching (lower triangle).

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
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FIGURE 2

Primary culture from the vaginal canal in which the bacterial colony (B) alters the morphology of closely associated colonies by inducing hypha and pseudohypha formation. Altered portions of colonies (arrowheads) and an entirely altered colony (arrow) are indicated. The changes are not hereditary (Soll and Lockhart, unpublished observation).

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FIGURE 2

Primary culture from the vaginal canal in which the bacterial colony (B) alters the morphology of closely associated colonies by inducing hypha and pseudohypha formation. Altered portions of colonies (arrowheads) and an entirely altered colony (arrow) are indicated. The changes are not hereditary (Soll and Lockhart, unpublished observation).

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
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FIGURE 3

Dendrogram generated from the s computed for every pair in a set of test isolates that included identical, highly related, and unrelated isolates, originally analyzed by Pujol et al. ( ). This set of isolates has been separated into three clusters and outliers (strains not in clusters). The unrelated and highly related ranges of s are arbitrarily set between 0.57 and 0.80 and between 0.90 and 0.99, respectively ( ). Strains were fingerprinted by Southern blot analysis with the complex probe Ca3.

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Image of FIGURE 3
FIGURE 3

Dendrogram generated from the s computed for every pair in a set of test isolates that included identical, highly related, and unrelated isolates, originally analyzed by Pujol et al. ( ). This set of isolates has been separated into three clusters and outliers (strains not in clusters). The unrelated and highly related ranges of s are arbitrarily set between 0.57 and 0.80 and between 0.90 and 0.99, respectively ( ). Strains were fingerprinted by Southern blot analysis with the complex probe Ca3.

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
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FIGURE 4

Collections of clonal isolates, each from a primary sample from two patients (P2 and P3), were DNA fingerprinted with the complex probe Ca3 and incorporated into a mixed dendrogram that includes a more general collection of unrelated isolates. Note how the P2 and P3 collections cluster at very high s and exhibit microevolution in each case.

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Image of FIGURE 4
FIGURE 4

Collections of clonal isolates, each from a primary sample from two patients (P2 and P3), were DNA fingerprinted with the complex probe Ca3 and incorporated into a mixed dendrogram that includes a more general collection of unrelated isolates. Note how the P2 and P3 collections cluster at very high s and exhibit microevolution in each case.

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
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FIGURE 5

Surveillance of yeast colonization and drug regimen of a bone marrow transplant patient infected with two strains of in the blood and a variety of yeasts in other body locations. The origins of samples are indicated as follows: ur, urine; bl, blood; sk-b, skin blister; th, throat; st, stool. The major colony phenotypes were the following: sw, smooth white; ie, irregular edge; F, fuzzy; bh, bumpy halo. The names of the yeast colonies before identification and DNA fingerprinting are presented under “Major Colony Phenotype and Strain” (in parentheses) and with the identified species and strains. The identified species and strain, for example, C.alb-1, refer to species and strain number in order of isolation. Low-dosage (hatched bar) and maximum-dosage (solid bars) drug regimens are indicated. 5-FC, flucytosine. Modified from reference .

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10.1128/9781555817947/fig17-5.gif
Image of FIGURE 5
FIGURE 5

Surveillance of yeast colonization and drug regimen of a bone marrow transplant patient infected with two strains of in the blood and a variety of yeasts in other body locations. The origins of samples are indicated as follows: ur, urine; bl, blood; sk-b, skin blister; th, throat; st, stool. The major colony phenotypes were the following: sw, smooth white; ie, irregular edge; F, fuzzy; bh, bumpy halo. The names of the yeast colonies before identification and DNA fingerprinting are presented under “Major Colony Phenotype and Strain” (in parentheses) and with the identified species and strains. The identified species and strain, for example, C.alb-1, refer to species and strain number in order of isolation. Low-dosage (hatched bar) and maximum-dosage (solid bars) drug regimens are indicated. 5-FC, flucytosine. Modified from reference .

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
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FIGURE 6

The basic bud-hypha transition in (A) A budding cell in which the mother and daughter cell have in turn budded and are separating; (B) a cell forming a germ tube. Note the bud scars on the mother cell.

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Image of FIGURE 6
FIGURE 6

The basic bud-hypha transition in (A) A budding cell in which the mother and daughter cell have in turn budded and are separating; (B) a cell forming a germ tube. Note the bud scars on the mother cell.

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
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FIGURE 7

Colony morphologies in the switching system in 3153A. (A) Original smooth; (B) star; (C) ring; (D) wrinkle; (E) mottled; (F) hat; (G) fuzzy; (H) revertant smooth. Reprinted from reference with permission.

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10.1128/9781555817947/fig17-7.gif
Image of FIGURE 7
FIGURE 7

Colony morphologies in the switching system in 3153A. (A) Original smooth; (B) star; (C) ring; (D) wrinkle; (E) mottled; (F) hat; (G) fuzzy; (H) revertant smooth. Reprinted from reference with permission.

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
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FIGURE 8

Isolates from sequential episodes of recurrent vaginal candidiasis caused by a single strain. (A) The original large-colony phenotype in episode 1. (B) The small- and medium-sized-colony phenotype in episode 2. DNA fingerprinting with probe Ca3 demonstrated that all colonies represented the same strain. Plating experiments demonstrated that smalland medium-sized-colony phenotype cells switched back to the large- colony phenotype. Reprinted from reference .

10.1128/9781555817947/fig17-8_thmb.gif
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Image of FIGURE 8
FIGURE 8

Isolates from sequential episodes of recurrent vaginal candidiasis caused by a single strain. (A) The original large-colony phenotype in episode 1. (B) The small- and medium-sized-colony phenotype in episode 2. DNA fingerprinting with probe Ca3 demonstrated that all colonies represented the same strain. Plating experiments demonstrated that smalland medium-sized-colony phenotype cells switched back to the large- colony phenotype. Reprinted from reference .

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
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Tables

Mixed Mycotic Infections
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Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
/content/10.1128/9781555817947.chap17.tab17-1
TABLE 1

Summary of carriage of spp. in 17 body locations of 52 healthy young women

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10.1128/9781555817947/tab17-1.gif
Generic image for table
TABLE 1

Summary of carriage of spp. in 17 body locations of 52 healthy young women

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
/content/10.1128/9781555817947.chap17.tab17-2
TABLE 2

Proportions of posthysterectomy patients carrying bacteria and yeast

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10.1128/9781555817947/tab17-2.gif
Generic image for table
TABLE 2

Proportions of posthysterectomy patients carrying bacteria and yeast

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
/content/10.1128/9781555817947.chap17.tab17-3
TABLE 3

Species and intensities of carriage in healthy individuals over 70 years of age

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10.1128/9781555817947/tab17-3.gif
Generic image for table
TABLE 3

Species and intensities of carriage in healthy individuals over 70 years of age

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17
/content/10.1128/9781555817947.chap17.tab17-4
TABLE 4

Microevolution in commensal and pathogenic populations revealed by C1 fingerprinting of

10.1128/9781555817947/tab17-4_thmb.gif
10.1128/9781555817947/tab17-4.gif
Generic image for table
TABLE 4

Microevolution in commensal and pathogenic populations revealed by C1 fingerprinting of

Citation: Soll D. 2002. Mixed Mycotic Infections, p 335-356. In Brogden K, Guthmiller J (ed), Polymicrobial Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817947.ch17

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