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Superficial Mycoses Causative agents: Malasseziafurfur Exophialawerneckii Trichosporonbeigelii Piedraiahortae
Cutaneous mycoses (Dermatophytoses) fungal infections involving the dermis and its appendages  (hair follicles and nails)
[object Object]
Dermatophytosis – mycotic infection of the nails, hair, and/or stratum corneum of the skin caused by dermatophytes.
Generally called “Ringworms”  or
“Tineas” (Latin for ringworms),[object Object]
Dermatophytoses Severity depends on  	(1) strains or species of fungus involved (2) sensitivity of the host to a particular 	pathogenic fungus.   More severe reactions occur when a dermatophyte crosses non-host lines.
Major sources of ringworm infection Schools, military camps, prisons.  Warm damp areas (e.g., tropics, moisture accumulation in clothing and shoes).  Animals (e.g., dogs, cats, cattle, poultry, etc.).
Dermatophytes Geophilic species -  e.g., M. gypseum,   					               T. ajelloi Zoophilic species -  e.g., M. canis, 							      T. verrucosum Anthropophilic species -  e.g., M. audounii, 						     T. tonsurans)
a.   Microsporum 		- skin, hair (scalp)  		- children, rarely in adults 		- spontaneous remission b.   Epidermophyton 		- skin, nails c.   Trichophyton 		- hair (scalp), skin & nails 		- chronic
Tineas Skin: Tinea corporis	Tinea cruris Tinea manuum	Tinea pedis Tinea fascie		Tinea imbricata Hairy areas: Tinea capitis		Tinea barbae Nail: Tineaunguium/ onychomycosis
Tinea corporis Ringworm of the body (Generally restricted to stratum corneum of the smooth skin) Reddened, circular scaly patch with sharp delineated margins (may developing vesicles and postules) EA:  Trichophyton rubrum Trichophytonmentagrophytes
Tinea corporis
Tinea corporis – body ringworm
Tinea corporis MOT:  direct contact; fomites; 				autoinnoculation normally resolves itself in several months.    (T. rubrum – relapse) TX: topical agent containing tolnaftate, 	 ketoconazole, miconazole.
Tinea corporis vigorous treatment including cleaning of area to remove scales and  fungicidal topical applications of ammoniated mercury ointment, 3 % salicylic and sulfuric acid, or tincture of iodine for several weeks.  Widespread tinea corporis and more severe lesions: systemic griseofulvin treatment (about 6 weeks for effective treatment).
Tinea imbricata
Tinea cruris Ringworm of the groin  Almost exclusively in men  Lesion resemble tinea corporis Often starts on the scrotum and spread to the groin as dry, itchy lesions
Tinea cruris(“jock itch”)
Tinea cruris EA:  Trichophyton rubrum 		   Epidermophyton  floccosum(usually 		associated with epidemics)  MOT:   Sharing of linens, towels or 			clothes (Athletes, soldiers, ship 		crews) Predisposing factors: persistent perspiration, irritation of skin from clothes, or other pre-existing diseases.
Tinea cruris Diagnosis  KOH and Culture of dermatophyte from skin scrapings.  If lesion "weep", it is likely caused by a yeast, such as,  Candida albicans Treatment  Tolnaftate Area is sensitive
Tinea pedis Ringworm of the soles and interdigital areas men & women are equally affected More common in adults Peeling, maceration and fissuring of the skin to fluid-filled vesicles and bullae.
Tinea pedis
Tinea Pedis – Athlete’s Foot Infection
Tinea pedis All forms are pruritic EA:  T. rubrum(chronic infections)   E. floccosum(acute & spontaneously 				resolves)
Tinea manuum Ringworm of the palms and interdigits Common among patients with tinea pedis Symptoms generally resemble that of tinea pedis EA:  T. rubrum  & T. mentagrophytes   E. floccosum
Tinea manunm
Dermatophytid Reaction
Tinea barbae Ringworm of the bearded areas of the neck  postularfolliculitis Common among men who work with cattles EA:    T.  verrucosum  &               T.  mentagrophytes
Tinea barbae Kerions: boggy inflammation/spongy 		   swelling  Alopecia is also common in untreated 		    infections
Tinea barbae
Tinea fascie
Two forms of T. unguium: Leukonychiamycotica /superficial white onychomycosis - invasion of fungus restricted on patches or pits on surface of the toenail.  Invasive subungualdermatophytosis- lateral or distal edges first involved, followed by invasion of nail plates by dermatophytes.  Tinea unguium
Tinea unguium Most commonly caused by T. rubrum, then E. floccosumor otherTrichophyton spp.  Resistant to treatment   Rarely resolves spontaneously.
Tinea unguium
Tinea Unguium
Tinea capitis Ringworm of the scalp, eyebrows and eyelashes  Fungus grows into hair follicle and hair shaft  Caused by species of Microsporumand 						Trichophyton.
Tinea capitis Wood's lamp Subculture any strands of hair that fluoresce
Tinea capitis
Tinea capitis Ectothrix infection - fragmentation of 	mycelium into conidia around the hair 	shaft or just beneath the cuticle.
Tinea capitis Caused by M. audouinii, M. canis, M. ferrugineum, T. mentagrophytes, T. verrucosum and T. megninii.
Tinea capitis “gray patch T. capitis"  ectothrix disease common in children usually not associated with inflammation.
Tinea capitis Endothrix infection - arthroconidia 	formation within the hair shaft.   ,[object Object],[object Object],[object Object]
Tinea favosa (favus) ringworm infection of the scalp (crusty hair)  Characterized by the occurrence of dense masses of mycelium and epithelial debris, which forms yellowish, cup-shaped crusts.
Tinea favosa (favus) Leads to scarring and alopecia “mousy odor” Caused by T. schoenleinii
Diagnosis of Dermatophytoses Note the symptoms.  Note the kind of tissue attacked  Observe proper collection of the specimen Keep specimen dry during transport  Microscopic examination of slides of skin scrapings, nail scrapings, and hair. 
Methods: 1.    Direct Microscopy Not sensitive Useful in more severe conditions KOH (10% & 20%)
2.    Culture Observe type of colonies Pigment production: one pigment on the surface of the colony, and another pigment other than black, on the reverse
Emmon’s modification of SabouraudDextrose Agar (SDA); orSDA with 4% glucose incorporate chloramphenicol  or gentamicin and cycloheximide thiamine will enhance growth of dermatophytes esp. Trichophytonverrucosum  (Nutritional Studies) Dermatophyte Test medium (DTM)   screening medium (w/ phenol red)
Microsporum species Microsporumgypseum Microsporumcanis
Microsporum species Common features: Colony: Mycelium: white to buff Underside: yellow to reddish brown
Microsporumgypseum Colonies are at first white and downy, later become flat and granular with white sterile hyphae at the center Surface  pigment is tan to cinnamon –pink to brown Reverse is tan to orange-brown or modified cinnamon-pink on PDA
Microsporumgypseum Macronidia: Ellipsoidal to fusiform  with 	thick, rough walls Microconidia: Sessile and solitary Wood’s lamp: Dull-green yellow
Microsporum canis Macroconidia: Spindle shaped with asymmetrical beaked apex and thick rough walls Microconidia:  Clavate or pyriform
MicrosporumcanisTeleomorph: Arthrodermaotae ,[object Object]
Colonies: Yellow pigment on reverse ,[object Object]
Epidermophyton species Epidermophyton floccosum ,[object Object],[object Object]
Epidermophyton floccosum Microscopic: attached in multiples (2 – 4/group) Macroconidia = moderately thick , smooth walls (beaver tails) or paddle-like Clubbed-shaped, 2 – 5  cell macroconidia Septate,hyalinehyphae
Epidermophyton floccosum Microscopic:
Trichophyton species Presence of macroconidia in cultures varies and may not help in identification of cultures.  Most common species include:  Trichophyton mentagrophytes T. rubrum T. tonsurans T. verrucosum T. violaceum T. schoenleinii T. ajelloi(rare infects humans).
Trichophytonmentagrophytes Most common dermatophyte on humans and animals.  Microconidia:  en grappe
Macroconidia:  when present, are cigar-			shaped.  Spiral hyphae Trichophytonmentagrophytes
Colony: Texture: deep, cottony; white and downy; pale yellow to tan reverse Trichophytonmentagrophytes
Trichophytonmentagrophytes
Trichophytonrubrum Resistant and persistent  Microconidium:  clavate or "teardrop" 	shape with a broad attachment point 	of the hyphae. ,[object Object],[object Object]
Colony:  fluffy white with Port burgundy wine 	or venous blood underside. When 	intensely pigmented in culture the 	color is reminiscent  Trichophytonrubrum
Trichophytontonsurans Anthropophilic; third most common cause 	of tinea capitis Macroconidia: Short blunt , irregular clubs 	with moderately thick, smooth walls Microconidia: Truncate of varying shapes; 	typically numerous Hyphae are hyaline, septate and often with 	terminal swellings
Trichophytontonsurans Colony: Usually flat and off-white to yellow 	initially with a powdery texture; wrinkled Reverse on SDA is yellow-brown to reddish brown Growth is enhanced by thiamine and inositol.
Trichophytonverrucosum Associated with cattle ("barn itch")  Causes severe infections in humans on the scalp and beard.
Trichophytonverrucosum Colony: no pigment to yellow on reverse.  On unenriched media  ,[object Object],On thiamine-enriched media,  ,[object Object],[object Object]
Trichophytonschoenleinii Endothrix infection of hair.
Trichophytonschoenleinii Colony: waxy to suede-like; off white in 		color.  ,[object Object],No conidia (micro- or macro-) even on enriched media .
6 cutaneus myco
6 cutaneus myco
6 cutaneus myco

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6 cutaneus myco

  • 1. Superficial Mycoses Causative agents: Malasseziafurfur Exophialawerneckii Trichosporonbeigelii Piedraiahortae
  • 2. Cutaneous mycoses (Dermatophytoses) fungal infections involving the dermis and its appendages (hair follicles and nails)
  • 3.
  • 4. Dermatophytosis – mycotic infection of the nails, hair, and/or stratum corneum of the skin caused by dermatophytes.
  • 6.
  • 7. Dermatophytoses Severity depends on (1) strains or species of fungus involved (2) sensitivity of the host to a particular pathogenic fungus.  More severe reactions occur when a dermatophyte crosses non-host lines.
  • 8. Major sources of ringworm infection Schools, military camps, prisons. Warm damp areas (e.g., tropics, moisture accumulation in clothing and shoes).  Animals (e.g., dogs, cats, cattle, poultry, etc.).
  • 9. Dermatophytes Geophilic species - e.g., M. gypseum, T. ajelloi Zoophilic species - e.g., M. canis, T. verrucosum Anthropophilic species -  e.g., M. audounii, T. tonsurans)
  • 10. a. Microsporum - skin, hair (scalp) - children, rarely in adults - spontaneous remission b. Epidermophyton - skin, nails c. Trichophyton - hair (scalp), skin & nails - chronic
  • 11. Tineas Skin: Tinea corporis Tinea cruris Tinea manuum Tinea pedis Tinea fascie Tinea imbricata Hairy areas: Tinea capitis Tinea barbae Nail: Tineaunguium/ onychomycosis
  • 12. Tinea corporis Ringworm of the body (Generally restricted to stratum corneum of the smooth skin) Reddened, circular scaly patch with sharp delineated margins (may developing vesicles and postules) EA: Trichophyton rubrum Trichophytonmentagrophytes
  • 14. Tinea corporis – body ringworm
  • 15. Tinea corporis MOT: direct contact; fomites; autoinnoculation normally resolves itself in several months. (T. rubrum – relapse) TX: topical agent containing tolnaftate, ketoconazole, miconazole.
  • 16. Tinea corporis vigorous treatment including cleaning of area to remove scales and fungicidal topical applications of ammoniated mercury ointment, 3 % salicylic and sulfuric acid, or tincture of iodine for several weeks. Widespread tinea corporis and more severe lesions: systemic griseofulvin treatment (about 6 weeks for effective treatment).
  • 18. Tinea cruris Ringworm of the groin Almost exclusively in men Lesion resemble tinea corporis Often starts on the scrotum and spread to the groin as dry, itchy lesions
  • 20. Tinea cruris EA: Trichophyton rubrum Epidermophyton floccosum(usually associated with epidemics) MOT: Sharing of linens, towels or clothes (Athletes, soldiers, ship crews) Predisposing factors: persistent perspiration, irritation of skin from clothes, or other pre-existing diseases.
  • 21. Tinea cruris Diagnosis KOH and Culture of dermatophyte from skin scrapings. If lesion "weep", it is likely caused by a yeast, such as,  Candida albicans Treatment Tolnaftate Area is sensitive
  • 22. Tinea pedis Ringworm of the soles and interdigital areas men & women are equally affected More common in adults Peeling, maceration and fissuring of the skin to fluid-filled vesicles and bullae.
  • 24. Tinea Pedis – Athlete’s Foot Infection
  • 25. Tinea pedis All forms are pruritic EA: T. rubrum(chronic infections) E. floccosum(acute & spontaneously resolves)
  • 26. Tinea manuum Ringworm of the palms and interdigits Common among patients with tinea pedis Symptoms generally resemble that of tinea pedis EA: T. rubrum & T. mentagrophytes E. floccosum
  • 29. Tinea barbae Ringworm of the bearded areas of the neck postularfolliculitis Common among men who work with cattles EA: T. verrucosum & T. mentagrophytes
  • 30. Tinea barbae Kerions: boggy inflammation/spongy swelling Alopecia is also common in untreated infections
  • 33. Two forms of T. unguium: Leukonychiamycotica /superficial white onychomycosis - invasion of fungus restricted on patches or pits on surface of the toenail. Invasive subungualdermatophytosis- lateral or distal edges first involved, followed by invasion of nail plates by dermatophytes. Tinea unguium
  • 34. Tinea unguium Most commonly caused by T. rubrum, then E. floccosumor otherTrichophyton spp. Resistant to treatment Rarely resolves spontaneously.
  • 37. Tinea capitis Ringworm of the scalp, eyebrows and eyelashes Fungus grows into hair follicle and hair shaft Caused by species of Microsporumand Trichophyton.
  • 38. Tinea capitis Wood's lamp Subculture any strands of hair that fluoresce
  • 40. Tinea capitis Ectothrix infection - fragmentation of mycelium into conidia around the hair shaft or just beneath the cuticle.
  • 41. Tinea capitis Caused by M. audouinii, M. canis, M. ferrugineum, T. mentagrophytes, T. verrucosum and T. megninii.
  • 42. Tinea capitis “gray patch T. capitis"  ectothrix disease common in children usually not associated with inflammation.
  • 43.
  • 44. Tinea favosa (favus) ringworm infection of the scalp (crusty hair) Characterized by the occurrence of dense masses of mycelium and epithelial debris, which forms yellowish, cup-shaped crusts.
  • 45. Tinea favosa (favus) Leads to scarring and alopecia “mousy odor” Caused by T. schoenleinii
  • 46. Diagnosis of Dermatophytoses Note the symptoms. Note the kind of tissue attacked Observe proper collection of the specimen Keep specimen dry during transport Microscopic examination of slides of skin scrapings, nail scrapings, and hair. 
  • 47. Methods: 1. Direct Microscopy Not sensitive Useful in more severe conditions KOH (10% & 20%)
  • 48. 2. Culture Observe type of colonies Pigment production: one pigment on the surface of the colony, and another pigment other than black, on the reverse
  • 49. Emmon’s modification of SabouraudDextrose Agar (SDA); orSDA with 4% glucose incorporate chloramphenicol or gentamicin and cycloheximide thiamine will enhance growth of dermatophytes esp. Trichophytonverrucosum (Nutritional Studies) Dermatophyte Test medium (DTM) screening medium (w/ phenol red)
  • 51. Microsporum species Common features: Colony: Mycelium: white to buff Underside: yellow to reddish brown
  • 52. Microsporumgypseum Colonies are at first white and downy, later become flat and granular with white sterile hyphae at the center Surface pigment is tan to cinnamon –pink to brown Reverse is tan to orange-brown or modified cinnamon-pink on PDA
  • 53.
  • 54. Microsporumgypseum Macronidia: Ellipsoidal to fusiform with thick, rough walls Microconidia: Sessile and solitary Wood’s lamp: Dull-green yellow
  • 55. Microsporum canis Macroconidia: Spindle shaped with asymmetrical beaked apex and thick rough walls Microconidia: Clavate or pyriform
  • 56.
  • 57.
  • 58.
  • 59. Epidermophyton floccosum Microscopic: attached in multiples (2 – 4/group) Macroconidia = moderately thick , smooth walls (beaver tails) or paddle-like Clubbed-shaped, 2 – 5 cell macroconidia Septate,hyalinehyphae
  • 61. Trichophyton species Presence of macroconidia in cultures varies and may not help in identification of cultures. Most common species include: Trichophyton mentagrophytes T. rubrum T. tonsurans T. verrucosum T. violaceum T. schoenleinii T. ajelloi(rare infects humans).
  • 62. Trichophytonmentagrophytes Most common dermatophyte on humans and animals. Microconidia: en grappe
  • 63. Macroconidia: when present, are cigar- shaped. Spiral hyphae Trichophytonmentagrophytes
  • 64. Colony: Texture: deep, cottony; white and downy; pale yellow to tan reverse Trichophytonmentagrophytes
  • 66.
  • 67. Colony: fluffy white with Port burgundy wine or venous blood underside. When intensely pigmented in culture the color is reminiscent Trichophytonrubrum
  • 68.
  • 69. Trichophytontonsurans Anthropophilic; third most common cause of tinea capitis Macroconidia: Short blunt , irregular clubs with moderately thick, smooth walls Microconidia: Truncate of varying shapes; typically numerous Hyphae are hyaline, septate and often with terminal swellings
  • 70.
  • 71. Trichophytontonsurans Colony: Usually flat and off-white to yellow initially with a powdery texture; wrinkled Reverse on SDA is yellow-brown to reddish brown Growth is enhanced by thiamine and inositol.
  • 72.
  • 73. Trichophytonverrucosum Associated with cattle ("barn itch") Causes severe infections in humans on the scalp and beard.
  • 74.
  • 76.

Editor's Notes

  1. Dermatophytes ("skin plants“). Tinea: char. by advancing , serpiginous nature of the lesion
  2. dermatophyte crosses non-host lines (e.g., from an animal species to man).Dermatophytes are NOT inhibited by CYCLOHEXIMIDE
  3. Evolutionary transition from a saprophytic to a parasitic lifestyle. Some have strict association with….Geophilic species – “earth-loving” (e.g., M. gypseum, T. ajelloi)Zoophilic species - keratin-utilizing on living animal host (e.g., M. canis, T. verrucosum)Anthropophilic species -  keratin-utilizing on humans hosts (e.g., M. audounii, T. tonsurans)
  4. Microsporum -skin, hair (scalp), rarely nails Epidermophyton - adults, rarely childrenTrichophyton - both children & adults - chronic
  5. Tinea unguium (onychomycosis) Tineas or “ringworms”
  6. Fomites: rugs and carpets (fomites). T.metagrophytes (w/ red pigment (colony); urease production in 3 - 5 days; V-shape penetration on hair-baiting test)T. rubrum (intense red pigment is more enhanced by culture on PFA or CMA w/ 1% DEXTROSE; no urease; grows outside hair shaft w/o penetration.)
  7. Fomites: rugs and carpets (fomites). T.metagrophytes (w/ red pigment (colony); urease production in 3 - 5 days; V-shape penetration on hair-baiting test)T. rubrum (intense red pigment is more enhanced by culture on PFA or CMA w/ 1% DEXTROSE; no urease; grows outside hair shaft w/o penetration.)
  8. Tinea imbricata -subtype of Tinea corporis, concentric layers of lesions
  9. Ringworm of the groin (“jock itch”) Infection seen on scrotum and inner thigh, the penis is usually not infected.
  10. Epidermophyton floccosum(usually associated with epidemics because resistant arthroconidia in skin scales can survive for years on rugs, shower stalls, locker room floors *Predisposing factors: persistent perspiration, high humidity, irritation of skin from clothes, such as tight fitting underwear or athletic supporters or other pre-existing diseases, such as diabetes and obesity.
  11. Diagnosis If lesion "weep", it is likely caused by a yeast, such as,  Candida albicans, and not by a  dermatophyte, especially if infections are seen in a woman.
  12. “Athlete’s foot”
  13. “barber’s itch” – Tinea barbae
  14. “barber’s itch” – Tinea barbaeKerions: boggy inflammation- due to deep infection of hair follicles
  15. KOH (10% & 20%)May be added with DMSO(to increase penetration of stain into tissues)
  16. DTM: contains phenol red (dermatophytes produce alkaline metabolites resulting to change in the color from yellow to reddish- orange or red)
  17. Macronidia: Ellipsoidal to fussiform (cucumber shape) with thick, rough walls
  18. Epidermophytonfloccosum:Only one pathogenic specie in this genus.