Learn fungal infections

1. Cutaneous Fungal Infection

2. Stratum corneum
Dermis
Subcutaneous tissue
Superficial
Fungal
Infection
Subcutaneous
Fungal
Infection
Deep
Fungal
Infection
THE SKIN

3. Fungal infections of the skin
1. Superficial mycoses
• invade stratum corneum, hair and nails
2. Subcutaneous mycoses
• invade the dermis or subcutaneous tissue
• due to implantation via injury
3. Systemic mycoses involving dermis or subcut.
tissue
• Deep (true pathogens)
• spread via blood or extension from nearby structures
• Opportunistic
• immunocompromised hosts

4. Fungi causing superficial mycoses
1. Dermatophytes
• Trichophyton
• Microsporum
• Epidermophyton
2. Yeasts
• Malassezia
• Candida
3. Moulds
• e.g. Scopulariopsis, Scytalidium, Fusarium, Aspergillus

5. Sources of fungi
• Endogenous
• fungi part of resident flora
• e.g. Candida, Malassezia
• Infection follows some change in host allowing fungus to
change from saprophyte to parasite
• Exogenous
• true pathogenic fungi
• external sources:
• Animals (zoophilic)
• Soil (geophilic)
• Other humans (anthrophilic)

7. Dermatophytoses
• Dermatophyte; a group of fungi capable of
infecting non viable keratinized cutaneous
structures including stratum corneum, nails,
and hair.

8. Dermatophytosis
Further specified according tissue involved;
• Epidermomycosis → epidermal
dermatophytosis
• Trichomycosis → dermatophytosis of hair and
hair follicles
• Onychomycosis →dermatophytosis of the
nails apparatus.

9. Dermatophyte infection
called ‘Tinea’ followed by appropriate body part (in Latin)
Tinea corporis body
Tinea pedis feet
Tinea cruris groin
Tinea capitis scalp
Tinea faciei face
Tinea unguium nail
Tinea manuum hand
Tinea barbae beard/moustache
Tinea incognito atypical dermatophyte infection altered
by use of steroids

10. Lab investigations
• Direct Microscopy
Skin: collect the scales
with no 15 scalpel
blade
Place on the microscope
slide > cover with a
cover slip.
Preparation of sample:
• KOH 5-20% solution is
applied at the edge of
coverslip.

11. Lab investigations
• Wood’s lamp

12. Lab investigations
• Fungal culture
- specimens collected from scaling skin
lesions, hair and nails – place into the culture
plate-culture on Sabauroud’s glucose medium.

13. Lab investigations
• Dermatopathology
- PAS ( Periodic acid-schiff ) stain to indentify
the fungal element.

14. Tinea Pedis
Tinea pedis : interdigital dry type .The
interdigital space between the toes shows
erythema and scaling
Tinea pedis: interdigital macerated
type

15. Tinea Pedis
Tinea pedis : moccasin type- fairly
sharply marginated erythema of the
plantar foot with mild keratoderma.
Tine pedis : moccasin type-well
demarcated erythema on the
dorsum of the foot.

16. Tinea Pedis
Tinea pedis: bulous type- presence of blister> ruptured and lead to
erosion

17. Tinea manuum
Erythema and scaling of the right hand
“The onehand, two-fet “ distribuition is typical of epidermal dermatophytosis of the
hands and feet.

18. Tinea cruris
Confluent, erythematous, scaling plaques o the medial thighs, inguinal folds, and
pubic area.
Raised margin and sharply marginated.

19. Tinea corporis
Sharply demarcated, erythematous plaques at the butock.

21. Tinea Facialis
Sharply marginated, erythematous, scaling, and crusted plaques with central
clearance on te face.

23. Tinea barbae
Scattered, discrete follicular pustules and papules in the moustache area,
easily mistaken for s.aureus folliculitis.

24. Tinea capitis
A large round, hyperkeratotic
plaque of alopecia due to breaking
off of the hair shafts.
A green fluorescence when examined
with a wood’s lamp.

25. Painful boggy, purulent inflammatory nodule on the scalp. The
lesion drain pus from multiple openings and there is retroauricular ,
tender lymphadenopathy.
KERION

27. Treatment
• Topical antifungal preparations
 Clotrimazole
 Miconazole
 Ketoconazole
 Econazole
 Imidazole
Allyamines
 Terbinafine
 Naftifine
Naphthionates
 tolnaftate

28. SYSTEMIC ANTIFUNGAL FOR TINEA CAPITIS
griseofulvin
adult: 250mg bd till hair
growth
child: 20-25mg/kg/day - 8-
10week
itraconazole
adult: 200mg od 4-6 weeks
child: 5mg/kg/day in divided
dose bd 4-6 week
fluconazole
adult : 150mg once a week 4-6
week
child: 5mg/kg/day 4-6week
terbinafine
adult: 250mg od 4weeks
child:
wt 10-20kg 62.5mg/day 2-4weeks
wt 20-40kg 125mg/day 2-4weeks
wt >40kg 250mg/day 2-4weeks

29. SYSTEMIC ANTIFUNGAL FOR TINEA CORPORIS,
/CRURIS/FACIALIS/BARBAE/MANUUM
Griseofulvin
adult :500mg OD or BD 2-4 weeks,
child: 10-20mg/kg od 2-6weeks
Terbinafine
Adult:250mg OD for 2 weeks , child
wt 10-20kg 62.5mg/day 2-4weeks
wt 20-40kg 125mg/day
wt >40kg 250mg/day 2-4weeks
Itraconazole
200mg OD for 1-2 weeks,
child 3-5mg/kg od 1week
fluconazole
adult : 150mg once a week 2-4week
child: 6mg/kg once a week 2-4week

30. SYSTEMIC ANTIFUNGAL FOR TINEA PEDIS
griseofulvin
1000mg od 4-8weeks
child: 10-20mg/kg od 4-8weeks
Itraconazole
200mg bd for 1 week then 200mg od
2 weeks
child: 3-5mg/kg per day for 2 weeks
Terbinafine
250mg OD for 2 week
child
wt 10-20kg 62.5mg/day 2-4weeks
wt 20-40kg 125mg/day 2-4weeks
wt >40kg 250mg/day 2-4weeks

31. Pityriasis versicolor
Tinea versicolor
• A chronic asymptomatics scaling
epidermomycosis associated with superficial
overgrowth of the hyphal form of Malassezia
furfur.
• Characterized by well-demarcated scaling
patches with variable pigmentation.
• Occurring most commonly on the trunk.

32. etiology
• M.furfur ( Pityrosporum ovale, P.orbiculare)
Round yeast and elongated pseudohyphal forms, so-called “spaghetti and meatballs”

33. • Age of onset: young adult
- Less common when sebum production is
reduced or absent.
• Predisposing factors:
- High temperature/relative humidity,oily skin,
hyperhidrosis, hereditary factors, and
immunodeficiency.

34. Pityriasis versicolor
Multiple, small-to-medium sized, well-
demarcated hypopigmented macules on the
back.

35. Lab examination
• Direct microscopic
examination
• Wood’s lamp
-Blue-green fluorescence of
the scales.
• Dermatopathology:
- Budding yeast and hypals
form in the most superficial
layers of the stratum
corneum, seen best with
PAS stain.

36. diagnosis
• Clinical findings
• Confirmed by positive KOH preparation
findings.

37. treatment
• Topical agents
- Selenium sulphide 2·5% (SELSUN) apply daily for
1week for 10-15min,
- ketoconazole 2% shampoo
- miconazole, clotrimazole, ketoconazole, econazole
cream bd for 2 weeks
- terbinafine 1% solution bd 1week
• Systemic therapy
- Itraconazole 200 mg/day for 7 days
- fluconazole 400mg stat, repeat in 1 week

38. A subtype of onychomycosis caused by the dermatophyte group of fungi.
Classification of the anatomic patterns of onychomycosis:
1) Distal & Lateral Subungual Onychomycosis (DLSO)
-T. rubrum
2) Superficial White Onychomycosis (SWO)
-T. mentagrophytes
3) Proximal Subungual Onychomycosis (PSO)
- T. rubrum,T megnenii, T. schoenleinii
4) Total Dystrophic Onychomycosis (TDO)
NAIL ONYCOMYCOSIS

39. Patterns of nail infection (onychomycosis)
Distal & lateral subungual
Superficial white
Proximal subungual
Total dystrophic

40. AETIOLOGIC FACTORS:
-Wearing of occlusive footwear
-overcrowding
-communal bathing areas
TRANSMISSION
-transmitted from one to another by fomite or direct contact, commonly
within family members.

41.  Topical agents
- clotrimazole cream/lotion la
bd
TREATMENT (Adults)
Systemic antifungal
Itraconazole
200mg bd for 1 week per month
(pulse dosing)
2 months (fingernails),
3 months (toenails) -once a year
Terbinafine 250mg daily – 6 weeks
(fingernails), 12 weeks (toenails)

42.  Majority of infections caused by Candida albicans
 Predisposing factors – diabetes, cancer, HIV infection,
broad-spectrum antibiotic or corticosteroid therapy
 Affects skin and mucous membranes of mouth and
vagina
 Clinical features – oropharyngeal candidiasis,
vulvovaginal candidiasis, candida intertrigo, candidal
paronychia, chronic mucocutaneous candidiasis

43. Oral candidiasis
Candida intertrigo
Candidal paronychia

44.  Direct microscopic examination
 Budding yeasts with hyphae or pseudohyphae
 Culture
 Rapidly growing, smooth, soft, shiny, and cream in
colour

45.  Mild cutaneous candidiasis
 Topical Miconazole 2%, Clotrimazole 1%, Tioconazole 1%
cream
 Extensive cutaneous candidiasis
 Itraconazole 200mg OD for 1 week or Fluconazole 100mg OD
for 1 week
 Oral candidiasis
 Nystatin suspension 500,000 units QID for 2 weeks
 Flucanazole 100mg OD for 1-2 weeks

46. THANK YOU