4 superficial mycoses78

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  • Skin:Malasseziafurfur and ExophialawerneckiiHair: Trichosporonbeigelii and Piedraiahortae
  • Pityriasisversicolor/tineaversicolor
  • Trunk and upper arms (Shoulders & Arms) Damage: purely COSMETIC
  • Oral treatment: for more advance casesPapule: small circumscribed elevation Pustule: small inflammatory swelling containing pus
  • Seborrhoea- greasy condition of the scalp, face, sternal region and elsewhere due to overactivity of sebaceous glands (may result to alopecia, acne)genetic predisposition; emotional component
  • Intravenous infusions of lipid / lipid replacement therapy
  • Skin scrapings from patients with superficial lesionsblood indwelling catheter tips (fungaemia)
  • Skin scrapings : 10% KOH, glycerol and Parker ink solution
  • Superficial infection rarely requires culture, Culture is for systemic infection (blood & intravenous catheter tips)stimulated growht by natural oils or other fatty substances (OLIVE oil)Sabouraud's dextrose agar or Sheep blood agar containing cycloheximide (Acti-Dione) with olive oil INITIAL CLUE TO THIS PATHOGEN IS LACK OF GROWTH IN THE ABSENCE OF OIL
  • White discoloration of skin (for individuals with brown complexion; light brown discoloration for white/light complexion)
  • Often misdiagnosed as melanoma
  • common in Central and South America and South-East Asia (More in tropics and subtropics)epidemics in families: SHARING of combs and hairbrushes
  • shave or cut the hairs short (Not often acceptable)Sensitive: terbinafine (Dose: 250 mg a day for 6 weeks)
  • 4 superficial mycoses78

    1. 1. Superficial Mycoses<br />. . . . .<br />. . . .<br />
    2. 2. Superficial Mycoses andDermatophytosis<br />Predisposing factors:<br />humidity<br />Immunosuppression<br />Poor hygiene<br />Affects the epidermal area with strong affinity to keratin<br />
    3. 3. Superficial Mycoses<br />Causative agents:<br />Malasseziafurfur<br />Exophialawerneckii<br />Trichosporonbeigelii<br />Piedraiahortae<br />
    4. 4. Malasseziafurfur<br /><ul><li>lipophilic yeast
    5. 5. Found as a normal flora on the skin</li></ul>Diseases : <br /><ul><li>Pityriasisversicolor
    6. 6. Pityriasisfolliculitis
    7. 7. Seborrhoeic dermatitis; Dandruff
    8. 8. Systemic infection</li></li></ul><li>Major Clinical Manifestation:<br />Hyper- or hypopigmented of the skin.<br />Lesions are well-demarcated (white, pink or brownish)<br />Fawn-colored macules are the most common presentation <br /><ul><li>Trunk and upper arms
    9. 9. Rarely on neck and face</li></li></ul><li>
    10. 10.
    11. 11.
    12. 12. Pityriasisfolliculitis<br /><ul><li>follicular papules and pustules
    13. 13. back, chest and upper arms
    14. 14. sometimes the neck, seldom the face
    15. 15. Itchy and often appear after sun exposure</li></li></ul><li>Pityriasisfolliculitis<br />
    16. 16. Seborrhoeic dermatitis<br /><ul><li>changes in quantity and composition of sebum
    17. 17. increase in wax esters
    18. 18. shift from triglycerides to shorter fatty acid chains
    19. 19. increase in alkalinity of skin
    20. 20. external local factors such as occlusion</li></li></ul><li>Clinical manifestations: <br /><ul><li>erythema and scaling in areas with a rich supply of sebaceous glands
    21. 21. scalp, face, eyebrows, ears and upper trunk
    22. 22. Lesions are covered with greasy scales
    23. 23. Itching is common in the scalp</li></li></ul><li>13<br />
    24. 24. Systemic Infection (M. furfur)<br /><ul><li>common among infants as catheter acquired
    25. 25. Intravenous infusions of lipid
    26. 26. Pneumonia results from emboli from the infected IV catheter</li></li></ul><li>Laboratory Diagnosis<br />Clinical material/Specimen:<br />Skin scrapings <br />blood <br />indwelling catheter tips <br />
    27. 27. Laboratory Diagnosis<br />Direct Microscopy<br /><ul><li> 10% KOH (glycerol w/ Parker ink or Calcofluor white)
    28. 28. clusters of thick-walled round budding yeast-like cells
    29. 29. short angular hyphal forms
    30. 30. Yeast cells (3-7um)</li></li></ul><li>“Spaghetti and meatballs”<br />
    31. 31. “Spaghetti and meatballs”<br />
    32. 32. KOH w/ PI<br />GMS<br />
    33. 33. Culture<br /><ul><li>For systemic infection
    34. 34. Stimulate growth by natural oils or other fatty substances
    35. 35. Sabouraud's dextrose agar or Sheep blood agar containing Acti-Dione
    36. 36. Dixon's agar containing glycerol mono-oleate</li></ul>20<br />Laboratory Diagnosis<br />
    37. 37. Malasseziafurfur<br />Colonies of Malasseziafurfur on Dixon's agar. A specialized isolation medium containing glycerol-mono-oleate<br />
    38. 38. Laboratory Diagnosis<br />Microscopic apperances:<br /><ul><li>Broad-based buds
    39. 39. The collarettes of the phialides appear as distinct dark rings separation the mother & daughter cells
    40. 40. currently no commercially available Serology</li></li></ul><li>Management and Treatment:<br />topical agent: imidazole<br /><ul><li>Ketoconazole shampoo </li></ul>2. Oral treatment : ketoconazole<br /> : itraconazole<br />3. Alternative: zinc pyrithione shampoo<br />selenium sulfide lotion <br />propylene glycol 50% in water twice daily <br />
    41. 41. Helpful Features<br />White discoloration of skin or light brown discoloration <br /> Spaghetti and meatballs<br /> Oil and FA requirement<br />
    42. 42. Exophialawernekii<br /><ul><li>Phaeoannellomyces werneckii
    43. 43. Cladosporumwerneckii
    44. 44. common saprophytic fungus
    45. 45. soil, compost, humus and on wood</li></li></ul><li>Exophialawerneckii<br />Disease: Tineanigra<br /><ul><li>Chronic superficial fungal infection of the palms
    46. 46. brown to black macules (palmar and plantar and other surfaces of the skin)
    47. 47. Well-defined dark patch with irregular margin, 1-5 cm in diameter on palm; “stained appearance”</li></li></ul><li>Exophialawerneckii<br />Tineanigra<br /><ul><li>Lesions: non-inflammatory and non-scaling
    48. 48. Both tropics and temperate zones
    49. 49. Usually <20 y/o; > females (3:1)
    50. 50. Predisposing factor: excessive sweating</li></li></ul><li>
    51. 51.
    52. 52. Laboratory Diagnosis<br />Clinical Material: Skin scrapings<br />Direct Microscopy:<br /><ul><li>10% KOH and Parker ink; calcofluor white mounts.</li></ul>Culture:<br /><ul><li>Primary isolation media
    53. 53. Sabouraud's dextrose agar</li></li></ul><li><ul><li> pigmented brown to dark (dematiaceous)septatehyphal elements
    54. 54. 2-celled yeast cells </li></li></ul><li>Exophialawerneckii<br /><ul><li>Initially colonies are mucoid, yeast-like and shiny black. (young yeast)
    55. 55. Abundant aerial mycelia and become velvety, dark olivaceous in colour. (mature mould)</li></li></ul><li>Serology Not required for diagnosis<br />Management & Treatment:<br /><ul><li>Sulfur soap, SSA, azoles
    56. 56. Topical treatment
    57. 57. Whitfield's ointment (benzoic acid compound)
    58. 58. Imidazole agent twice a day for 3-4 weeks</li></ul>33<br />
    59. 59. Piedraiahortae<br /><ul><li>ascomycetous fungus
    60. 60. common in Central and South America and South-East Asia
    61. 61. Disease: Black piedra
    62. 62. Chronic fungal infection of the hair shaft
    63. 63. mostly affects young adults
    64. 64. epidemics in families</li></li></ul><li>Clinical Manifestations:<br /><ul><li>Does not penetrate the hair follicle
    65. 65. Scalp hair: rough, sandy
    66. 66. Infected hairs: hard black nodules on the shaft
    67. 67. Nodules: hard, fusiform, firmly attached to hair shaft</li></ul>PiedraiahortaeBlack piedra<br />
    68. 68. <ul><li>Clinical Manifestations:
    69. 69. Thick part: fungal cells cemented together
    70. 70. Thin part: hyphal elements</li></ul>PiedraiahortaeBlack piedra<br />
    71. 71. Black piedra<br />
    72. 72. Laboratory Diagnosis<br />Clinical Material: <br /><ul><li>hairs with hard black nodules </li></ul>1. Direct Microscopy: <br /><ul><li>10% KOH w/ Parker ink; calcofluor white
    73. 73. darkly pigmented nodules: hair shaft
    74. 74. Nodules: pigmented center containing asci</li></li></ul><li>Laboratory Diagnosis<br />2. Culture: <br />primary isolation media<br /><ul><li>Colonies are dark, brown-black
    75. 75. Take about 2-3 weeks to appear</li></li></ul><li>Management and Treament:<br /><ul><li>shave or cut the hairs short
    76. 76. Terbinafine
    77. 77. Dose: 250 mg a day for 6 weeks</li></li></ul><li>Trichosporonbeigelii<br /><ul><li>Worldwide, tropical or subtropical regions
    78. 78. More in temperate zones
    79. 79. Disease: White piedra
    80. 80. superficial cosmetic fungal infection of the hair shaft
    81. 81. Affects scalp, axilla, facial and genital hair</li></li></ul><li>TrichosporonbeigeliiWhite piedra<br /><ul><li>Clinical Manifestations:
    82. 82. common in young adults
    83. 83. Nodules: mucilaginous, white, follicles not affected
    84. 84. irregular, soft, white or light brown nodules firmly adhering to the hairs
    85. 85. 1.0 - 1.5 mm in length
    86. 86. no pathological changes are elicited</li></li></ul><li>White piedra<br />
    87. 87. Laboratory Diagnosis<br />1. Direct Microscopy: <br />10% KOH and Parker ink; calcofluorwhite <br />
    88. 88. Laboratory Diagnosis<br />2. Culture: <br /><ul><li>primary isolation media
    89. 89. white or yellowish to deep cream colored
    90. 90. smooth, wrinkled, velvety, dull colonies with a mycelial fringe.</li></li></ul><li>Trichosporonbeigelii<br /> Serological test in not Required<br />Management and Treatment:<br /><ul><li>Shave the hairs
    91. 91. Topical: imidazole agent</li></li></ul><li>Superficial Mycoses<br />Causative agents:<br />Malasseziafurfur<br />Exophialawerneckii<br />Trichosporonbeigelii<br />Piedraiahortae<br />
    92. 92.
    93. 93.
    94. 94. B. Dermatophytes(Cutaneous mycoses)<br />- fungal infections involving the dermis and its appendages<br /> (hair follicles and nails)<br />
    95. 95. <ul><li>Dermatophytosis - "ringworm" disease (mycotic infection) of the nails, hair, and/or stratum corneum of the skin caused by fungi called dermatophytes.
    96. 96. Dermatomycosis  - more general name for any skin disease caused by a fungus. </li></ul> - invasion of the cutaneous tissues by other fungi.<br />
    97. 97. THE SKIN PLANTS<br />Etiological agents are called dermatophytes - "skin plants".  Three important anamorphic genera, (i.e., Microsporum, Trichophyton, and Epidermophyton), are involved in ringworm. <br />Dermatophytes are keratinophilic - "keratin loving".  Keratin is a major protein found in horns, hooves, nails, hair, and skin. <br />- use keratin as a source of nitrogen<br />Ringworm - disease called ‘herpes' by the Greeks, and by the Romans ‘tinea' (which means small insect larvae). <br />
    98. 98. Infections by Dermatophytes<br />Severity of ringworm disease depends on (1) strains or species of fungus involved and (2) sensitivity of the host to a particular pathogenic fungus.  <br />More severe reactions occur when a dermatophyte crosses non-host lines (e.g., from an animal species to man). <br />
    99. 99. Dermatophytes<br />Common Causative agents:<br />a. Microsporum <br /> - hair, skin, rarely nails <br /> - children, rarely in adults<br /> - spontaneous remission <br />b. Trichophyton<br /> - hair, skin & nails<br /> - both children & adults<br /> - chronic. <br />c. Epidermophyton <br /> - skin, nails, rarely hair<br /> - adults, rarely children<br />
    100. 100. Among dermatophytes there appears to be a evolutionary transition from a saprophytic to a parasitic lifestyle. <br />Geophilic species - keratin-utilizing soil saprophytes (e.g., M. gypseum, T. ajelloi). <br />Zoophilic species - keratin-utilizing on hosts - living animals (e.g., M. canis, T. verrucosum). <br />Anthropophilic species -  keratin-utilizing on hosts - humans (e.g., M. audounii, T. tonsurans) <br />
    101. 101. Common Dermatomycoses<br />Diseases:<br />Hairy areas:<br />Tinea capitis Tinea barbae<br />Skin:<br />Tinea corpuris Tinea cruris <br />Tinea manum Tinea pedis<br />Tinea fascie Tinea imbricata<br />Nail:<br />Tinea ungium<br />
    102. 102. Microsporum species<br />Microsporum gypseum<br />Microsporum canis<br />
    103. 103. Microsporum species<br />Common features:<br />Colony:<br />Mycelium: white to buff<br />Underside: yellow to reddish brown<br />Microscopic<br />attached singly<br />thick walls & mature forms are echinulate (spiny)<br />Spindle-shaped macroconidia <br />Septate hyaline hyphae<br />
    104. 104. Microsporum gypseum complex <br />Teleomorphs are Arthroderma gypseum and A. incurvatum. <br />Produces abundant macroconidia brownish-yellow due to large numbers macroconidia.<br />  Surface of culture colony often is powdery in appearance. <br />Reverse of colony often appears ragged around edges. <br />Macroconidia usually have 4-6 septa or crosswalls, up to 40 µm long <br />Microconidia are smaller than in M. canis. <br />In lactophenol, water is extracted and can cause the macroconidia walls to collapse.  This is an artifact due to mounting media.  Macroconidia do not form on infected hair!<br />
    105. 105.
    106. 106. Microsporum gypseum<br />
    107. 107. Microsporum canis<br />Teleomorph is an ascomycete called Arthroderma otae. <br />Macroconidia are abundant, thick-walled with many septa, up to 15.  Macroconidia are often hooked or curved at ends. <br />Microconidia are small and clavate<br /> (club-shaped).<br />
    108. 108. Microsporum canisTeleomorph: Arthroderma otae<br />
    109. 109.
    110. 110. Dermatophytosis of the skin<br />Clinical Manifestations: <br />“ringworm”<br />Papules to pustules with clear center and active borders (peripheral pustules and scaling), itchy,circinate and serpiginous with inflammatory, vesicular, enlarging margins<br />Differential Diagnosis:<br />Psoriasis: dry and circinate borders<br />Ezcema: no clear center<br />
    111. 111. Tinea or “ringworm”: basic lesion<br />
    112. 112. Dermatophytosis (skin and nail)<br />Tinea fascie (face)<br />Tinea imbricata (subtype of Tinea corpuris, concentric layers of lesions)<br />Tinea cruris (inguinal area)<br />Tinea pedis (interdigits of the feet)<br />Tinea manum (interdigits of the hand)<br />Tinea ungium (fingernails)<br />
    113. 113. Tinea fascies<br />
    114. 114. Tinea corporis<br />
    115. 115. Tinea manum (hand)<br />
    116. 116. Tinea pedis (feet)<br />
    117. 117. Tinea imbricata<br />
    118. 118. Tinea unguium<br />
    119. 119. Epidermophyton species<br />Epidermophyton floccosum<br />
    120. 120. Epidermophyton floccosum<br />Only one pathogenic species in this genus. <br />Tinea unguium and tinea cruris are often caused by this fungus. <br />/<br />
    121. 121. Epidermophyton floccosum<br />Colony:<br />Mycelium: yellow – green, “khaki”; suede, gentle folds; slow grower<br />Underside: green to brown<br />
    122. 122. Epidermophyton floccosum<br />Microscopic:<br />attached in multiples (2 – 4/group)<br />moderately thick , smooth walls (beaver tails)<br />Clubbed-shaped, 2 – 5 cell macroconidia<br />Septate,hyaline hyphae<br />Chlamydoconidia<br />Typically present particularly in older culture.<br />
    123. 123. Dermatophytes<br />
    124. 124. Epidermophyton floccosum<br />Areas affected: skin and nails<br />Disease: Tinea cruris or “jock itch”<br />Often start on the scrotum and spread to the groin as dry, itchy lesions<br />Source of infection:<br />Sharing of linens, towels or clothes<br />Athletes, soldiers, ship crews<br />
    125. 125. Tinea cruris (groin) – jock itch<br />
    126. 126. Trichophyton species<br />Trichophyton tonsurans<br />Trichophyton mentagrophytes<br />Trichophyton rubrum<br />Trichophyton concentrum<br />
    127. 127. Trichophyton species <br />The word "trichophyton" literally means "hair plant". <br />Presence of macroconidia in cultures varies and may not help in identification of cultures. <br />Most common species include: <br />Trichophyton mentagrophytes<br />T. rubrum<br />T. tonsurans<br />T. verrucosum<br />T. violaceum<br />T. schoenleinii<br />T. ajelloi (rare infects humans). <br />
    128. 128. ON SKIN: Scrapings from skin and nails cannot distinguish species in this genus. <br />ON HAIR:  Pattern of infection can help distinguish etiologic or causal agent. <br />For Microsporum species - infections on hair lead to a mosaic pattern of arthrospores. <br />For Trichophyton species - infections on hair follow one of the 4 patterns. <br />
    129. 129. Ectothrix - more or less parallel rows of arthrospores produced on surface of hair. <br />1.  Small-spored ectothrix (arthrospores are < 5 mm in diameter) - caused by T. mentagrophytes or T. rubrum (rare).  Spores are about the same size as those    produced by Aspergillus. <br />2.  Large-spored ectothrix (arthrospores are 5- 10 mm in diameter) - caused by T. verrucosum. <br />Endothrix - growth inside hair shaft only!<br />3.  "Black-dot" endothrix (hair stubs filled with arthrospores) - caused by T. tonsurans or T. violaceum. <br /> 4.  "Favus hair" endothrix (honeycomb pattern of damage seen on surface of hair shaft) - caused by T. schoenleinii. <br />
    130. 130. Trichophyton species<br />Common Features:<br />Colony:<br />Mycelia: Cream, buff to brown, granular to wrinkled<br />Underside: differ (brown to red)<br />Microscopic feature<br />Microconidia; oval- pyriform<br />attached singly, some in clusters<br />have smooth walls <br />Hyaline septate hyphae <br />Areas affected: hair, skin and nails<br />
    131. 131.
    132. 132.
    133. 133.
    134. 134. Trichophyton rubrum- spores spherical/elongate <br />
    135. 135. Ectothrix (Trichophyton rubrum)<br />
    136. 136. Trichophyton mentagrophytes<br />Growth rate: moderate <br />Texture: deep, cottony <br />Thallus color: white <br />Reverse: pale yellow to tan <br />
    137. 137. Trichophyton mentagrophytes- spores are pyriform<br />
    138. 138. round microconidia in grape-like clusters <br />(“ën grappe”) <br />spiral hyphae <br />
    139. 139. Endothrix<br />
    140. 140. Other Biochemical Tests for T. mentagrophytes<br />Urease: positive <br />Vitamin requirement: none<br />Hair perforation: positive <br />
    141. 141. Tinea capitis (head, hair)<br />Clinical Manifestations:<br />Bald patches, moist, itchy, scaly<br />Papules to pustules<br />Friable hair<br />Differential Dx:<br />Alopecia: no scaling<br />Psoriasis: no loss of hair; silvery scaling<br />Seborrheic dermatitis: diffuse hair loss;<br /> 6-8 months old; pustular<br />Other hairy areas:Tinea barbei (beard)<br />
    142. 142. Tinea capitis<br />
    143. 143. Differential Diagnoses:Alopecia areata<br />
    144. 144. Differential Diagnoses:Psoriasis<br />
    145. 145. Differential Diagnoses:Seborrheic keratosis<br />
    146. 146. Tinea barbei<br />
    147. 147. Other Forms Superficial Mycoses<br />Keratomycosis<br />Onychomycosis<br />Cutaneous candidiasis<br />
    148. 148. ..mycology-katKERATOMYCOSIS.ppt<br />
    149. 149. ..myco reports-anieonychomycosis.ppt<br />
    150. 150. ..myco reports-aniecandida.ppt<br />
    151. 151. ..myco reports-mimimimi- myco report slide.ppt<br />
    152. 152. ..mycology-katSUBCUTANEOUS MYCOSES chromomycosis.ppt<br />
    153. 153. ..myco reports-mimiPhaeohyphomycosis.ppt<br />
    154. 154. mycoSystemic mycosesSystemic mycoses - Introduction.ppt<br />
    155. 155. mycoSystemic mycosesParacoccidioides brasiliensis.ppt<br />mycoSystemic mycosesHistoplasma capsulatum.ppt<br />mycoSystemic mycosesCryptococcus neoformans.ppt<br />mycoSystemic mycosesCoccidioides immitis.ppt<br />mycoSystemic mycosesBlastomyces dermatitidis.ppt<br />
    156. 156. mycoSystemic mycoses8. Anti-fungal Therapy.ppt<br />
    157. 157. mycomycology-katANTIFUNGAL SUSCEPTIBILITY TESTING.ppt<br />
    158. 158. mycomyco reports-anieDetermination of MICs of Aminocandin for Candida spp.ppt<br />

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