Medical Mycology Black Piedra and White Piedra.pptxDeborahAR1
Black piedra is a fungal infection of the hair shafts. It is also known as Trichomycosis nodosa. The fungal elements are attached to the hair shaft to form nodules along the hair shaft. It predominantly affects scalp hair, although involvement of the beard, mustache and pubic hairs is also known.
White Piedra is a superficial fungal infection of the hair caused by Trichosporon asahii. It is also known as trichomycosis nodosa or trichomycosis nodularis.
Cryptococcosis also called as Torulosis is a subacute or chronic fungal infection caused by Cryptococcus neoformans. It leads to compications such as fatal meningoencephalitis. It is an opportunistic infection in HIV-infected patients. The PPT discuss on the morphology of the fungus, pathogenesis, laboratory diagnosis and treatment.
Medical Mycology Black Piedra and White Piedra.pptxDeborahAR1
Black piedra is a fungal infection of the hair shafts. It is also known as Trichomycosis nodosa. The fungal elements are attached to the hair shaft to form nodules along the hair shaft. It predominantly affects scalp hair, although involvement of the beard, mustache and pubic hairs is also known.
White Piedra is a superficial fungal infection of the hair caused by Trichosporon asahii. It is also known as trichomycosis nodosa or trichomycosis nodularis.
Cryptococcosis also called as Torulosis is a subacute or chronic fungal infection caused by Cryptococcus neoformans. It leads to compications such as fatal meningoencephalitis. It is an opportunistic infection in HIV-infected patients. The PPT discuss on the morphology of the fungus, pathogenesis, laboratory diagnosis and treatment.
he culture media are classified in many different ways: Based on the physical state Liquid media Solid media Semisolid media Based on the presence or absence of oxygen Anaerobic media Aerobic media Based on nutritional factors Simple media Synthetic media Complex
and invade the genital ridges in the sixth week of
development. here they form primitive sex cords. in
the absence of tdf, medullary cords disappear and
get replaced by a vascular stroma (ovarian medulla).
cortical cords develop and surround one or more
primitive germ cells. the germ cells subsequently
develop into oogonia, while the surrounding epithelial
cells form the follicular cells. this differentiates
undifferentiated gonads into ovaries. stroma of ovary
develops from basal mesenchyme. granulosa and theca
cells develop from celomic epithelium.
development of genital ducts
development of genital duct system and the external
genitalia occurs under the influence of hormones
circulating in the fetus. sertoli cells in the fetal testes
produce a nonsteroidal substance known as müllerian
inhibiting substance (mis) that causes regression of
müllerian ducts. androgen from the fetal testes causes
masculinization of external genitalia. in the absence of
mis, müllerian ducts develop and mesonephric duct
system regresses. in the absence of androgen, external
genitalia differentiate into female phenotype. the
müllerian duct develops between the fifth and sixth
weeks lateral to intermediate cell mass and wolffian
duct. the müllerian duct has the following three parts:
•cranial vertical portion that opens into celomic
cavity. later it differentiates into fallopian tubes.
•horizontal part crosses the mesonephric duct.
•caudal vertical part that fuses with its partner
from opposite side. this fused part later differ
entiates into uterus, cervix, and upper one-third
of the vagina.
the dorsal celomic epithelium (which forms
müllerian duct) remains open at its site of origin and
ultimately forms the fimbriated ends of the fallopian
tubes. at their point of origin, each of the müllerian
ducts forms a solid bud. each bud penetrates the
mesenchyme lateral and parallel to the wolffian duct.
as the solid buds elongate, a lumen appears in the
cranial part, beginning at each celomic opening. the first time
Introduction to Mycology 2020 (2).pptxDawn Junkere
shows the different fungal infections human can be exposed to. how medical treatment can be carried out to treat
use of antofungals. the different parts of the fungus
Subspecialty of dermatology and pathology focused on performing and interpreting tests on human tissue samples to provide scientific data and consultative opinions to referring clinicians
Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes characterized by circumscribed depigmented macules and patches that result from a progressive loss of functional melanocytes that are selectively destroyed.
Androgenetic alopecia (AGA), also referred to as male-pattern hair loss or common baldness in men and as female-pattern hair loss in women is the most common hair loss disorder
Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous units
Acne can present as noninflammatory lesions, inflammatory lesions, or a mixture of both,
affecting mostly the FACE but also the back and chest.
There are several dermatoses that occur during pregnancy or immediately postpartum, in particular polymorphic eruption of pregnancy, pemphigoid gestationis, and atopic eruption of pregnancy. Pruritus due to intrahepatic cholestasis of pregnancy leads to nonspecific skin lesions, including excoriations due to scratching.
Impetigo herpetiformis simply represents pustular psoriasis occurring during pregnancy, and this may be related to the relative hypocalcemia of pregnancy. Lastly, there are physiologic changes that occur during pregnancy.
ABNORMAL REDNESS of the skin resulting from dilation of blood vessels that is Blanch on pressure or Diascopy
Erythema Multiforme, Stevens Johnson Syndrome, and Toxic Epidermal Necrolysis
Figurate Erythemas
Urticaria is characterized by WEALS (hives) or ANGIOEDEMA (swellings, in 10%) or both (in 40%). There are several types of urticaria
Spontaneous urticaria
Acute spontaneous urticaria Spontaneous wheals and/or angioedema <6 />6 wk
Urticarias induced by physical agents
dermographic urticaria Eliciting factor: mechanical shearing forces (wheals arising after 1–5 min)
Cold contact urticaria Eliciting factor: cold objects/air/fluids/wind
Solar urticaria Eliciting factor: UV and/or visible light
Delayed pressure urticaria Eliciting factor: vertical pressure (wheals arising with a 3–12 h latency)
Heat contact urticaria Eliciting factor: localized heat Hot water bottle Hot drink
Vibratory urticaria/angioedema Eliciting factor: vibratory forces, e.g. pneumatic hammer/Jack hammer
Other inducible urticarias
Contact urticaria Elicitation by contact with urticariogenic substance
Aquagenic urticaria Eliciting factor: water
Cholinergic urticaria Elicitation by increase of body core temperature due to physical exercises, spicy food, stress
Exercise-induced anaphylaxis/urticaria Eliciting factor: physical exercise
The major forms of dermatitis include
Atopic,
Contact
Seborrheic,
Asteatotic (xerotic),
Stasis,
Disseminated Eczema (Autosensitization)
Nummular. (Discoid)
Pompholyx
The major forms of dermatitis include
Atopic,
Contact
Seborrheic,
Asteatotic (xerotic),
Stasis,
Disseminated Eczema (Autosensitization)
Nummular. (Discoid)
Pompholyx
Insects Bites & Stings: can be divided into 2 groups venomous insect such as a bee or wasp, which uses this as a defense mechanism by injecting toxic and painful venom through its stinger.
Non-venomous insect bites pierce the skin to feed on blood. This usually results in intense itching.
Papular Urticaria:
common disorder manifested by chronic or recurrent papules caused by a HYPERSENSITIVITY REACTION to the bites of mosquitoes, fleas, bedbugs, and other insects
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
4. • Historically it was thought that fungi were plants that did not need
photosynthesis.
• But now fungi are classified in their own kingdom, separate from
plants and animals because:
1- The cell walls of plants are made of cellulose whereas the walls of fungal cells are
made of chitin
2- Plants require only simple inorganic compounds such as carbon dioxide and water
to grow. Fungi require a diet of complex organic molecules to thrive.
• Fungi are parasites or saprophytes i.e. they live off living or dead
organic matter.
5. • Growing fungi have branched filaments called
hyphae, which make up the mycelium (like branches
are part of a tree). Hyphae are threadlike filaments
made up of fungal cells, whereas mycelium is the
mass of hyphae that forms the fungal body. Some
fungi are compartmented by cross-walls (called
septae).
• Arthrospores are made up of fragments of the
hyphae, breaking off at the septae.
• Asexual spores (conidia) form on conidiophores. The
sexual reproductive phase of many fungi is unknown;
these are ‘fungi imperfecta’ and include those which
infect humans.
6. FORMS OF HYPHAE;
1. Septate hyphae: In most fungi, hyphae are divided
into cells by internal cross-walls for example
“Aspergillus”.
2. Coenocytic hyphae (non-septate hyphae): meaning
their hyphae are not partitioned by septa.
3. Pseudo hyphae: They are the result of incomplete
budding where the cells remain attached after
division, and Yeast can form pseudohyphae.
7.
8. • Yeasts form a subtype of
fungus characterized by
clusters of round or oval cells.
• These bud out similar cells
from their surface to divide
and propagate. In some
circumstances they form a
chain of cells called a
pseudomycelium.
12. THE ORGANISMS ARE TRANSMITTED BY EITHER;
1. Direct contact with infected host (human or
animal).
2. Indirect contact with infected exfoliated skin or
hair in combs, hair brushes, clothing, furniture,
theatre seats, caps, bed linens, towels, hotel rugs,
and locker room floors.
13. • According to their appearance by microscopy and in
culture or method of reproduction.
BY THE METHOD OF REPRODUCTION:
1. Sexual
2. Asexual.
14. Classification of Fungal
Infections (mycoses)
I. SUPERFICIAL MYCOSES
a) Non-inflammatory
b) Inflammatory
II. SUBCUTANEOUS MYCOSES
III. SYSTEMIC MYCOSES
15.
16. • These affect the outer layers of the skin, the nails and hair.
• The main groups of fungi causing
superficial fungal infections are:
1. Yeasts
i. Candida
ii. Malassezia
2. Dermatophytes (ringworm/tinea)
3. Other Moulds e.g.
i. Aspergillus spp.
ii. Fusarium spp.
17. Infections limited to the outermost layers of the skin
and hair:
1. Pityriasis versicolor
2. Candidiasis
3. Tinea nigra
4. Black piedra
5. White piedra
18. • Infections that extend deeper into the epidermis, as well as hair and nail
and caused by dermatophytes.
• They colonize the keratin and inflammation is caused by host response to
metabolic by-products:
1. Tinea capitis (head)
2. Tinea faciei (face)
3. Tinea barbae (beard)
4. Tinea corporis (body)
5. Tinea manus (hand)
6. Tinea cruris (groin)
7. Tinea pedis (foot)
8. Tinea unguium (nail)
19. THE MAIN 3 GENERA OF DERMATOPHYTES ARE:
1. Trichophyton (abbreviated as "T")
2. Epidermophyton (“E")
3. Microsporum (“M")
20. 1. Anthropophilic dermatophytes are restricted to human hosts and produce a mild, chronic
inflammation e.g.
T. rubrum ▪ M. audouinii
T. interdigitale ▪ T. violaceum
T. tonsurans ▪ T. schoenleinii
2. Zoophilic organisms are found primarily in animals and cause marked inflammatory reactions in
humans who have contact with infected cats, dogs, cattle, horses, birds, or other animals e.g.
M. canis (originating from dogs and cats)
T. equinum (originating from horses)
T. verrucosum (originating from cattle)
3. Geophilic species are usually recovered from the soil but occasionally infect humans and animals.
They cause a marked inflammatory reaction, which limits the spread of the infection and may lead
to a spontaneous cure but may also leave scars e.g.
M. gypseum
M. fulvum
21.
22. • These involve the deeper layers of the skin (the dermis,
subcutaneous tissue, muscle & fascia and even bone).
• The causative organisms normally live in the soil living on
rotting vegetation. They can get pricked into the skin as a
result of an injury but usually stay localized at the site of
implantation.
• Deeper skin infections include:
1. Mycetoma
2. Chromoblastomycosis
3. Sporotrichosis
23.
24. • May result from breathing in the spores of fungi, which
normally live in the soil or rotting vegetation or as
opportunistic disease in immune compromised
individuals.
A. Inhaled fungal infection (By True pathogens)
• Although uncommon, some may infect healthy
individuals. The result is most often a mild infection and
long lasting resistance to further attack, but occasionally
these infections are more serious and chronic (especially
in the immune suppressed). The organisms causing
systemic fungal infections include:
1. Histoplasmosis
2. Coccidioidomycosis (North and South America).
B. Opportunistic infections
• Other systemic mycoses only infect those who are already
sick or with an immunodeficiency disorder i.e. they are
‘opportunists’. Repeated infection may occur. Risks for
systemic mycoses include:
1. Serious illness and debility
2. Cancer or leukemia
3. Diabetes mellitus
4. Transplant
5. Massive doses of antibiotics
6. Parenteral nutrition
7. Drug addiction
8. Infection with human immunodeficiency virus (HIV)
• Opportunistic fungal infections include:
1. Aspergillosis (found everywhere)
2. Zygomycosis
3. Cryptococcosis (where there are pigeon droppings)
4. Trichosporon beigelii
5. Pseudallescheria boydii
25.
26.
27. • It is a common, long-term (chronic) superficial
fungal infection of the skin.
• Affected skin change color and become either
lighter or darker than surrounding skin.
28. • Common in adolescent and young adult males.
Malassezia requires oil to grow, accounting for the
increased incidence in adolescents and preference for
sebum-rich areas of the skin.
• Its occurrence before puberty or after age 65 years is
uncommon.
• A member of normal human cutaneous flora, and it is
found in 18% of infants and 90-100% of adults and it is
NOT CONTAGIOUS.
29. • Worldwide distribution but prevalence reported to
be as high as 50% in the humid, hot environment
and as low as 1.1% in the colder temperatures.
• The condition is more noticeable during the
summer months.
30. • The causative fungus is Malassezia furfur (previously known as
Pityrosporon orbiculare and Pityrosporon ovale).
• In patients with clinical disease, the organism is found in both the
yeast stage and the filamentous (mycelial/hyphae) form.
• Factors that lead to the conversion to the parasitic, mycelial
morphologic form include;
1. Genetic predisposition
2. Oily skin (yeast is lipophilic)
3. Excessive sweating
4. Warm, humid environments
5. Immuno-suppression
6. Malnutrition
7. Pregnancy
8. Cushing disease
31. • The reason why this organism causes PVC in some
individuals while remains as normal flora in others is not
entirely known.
• Several factors, such as the organism's nutritional
requirements and the host's immune response to the
organism, are significant.
• Lymphocyte function on stimulation with the organism
has been shown to be impaired in patients who are
affected.
32. • Decreased pigmentation may be secondary
to the inhibitory effects of dicarboxylic acids
on melanocytes (these acids result from
metabolism of surface lipids by the yeast).
• Sun exposure may make PVC more
apparent. Decreased tanning, due to the
ability of the fungus to filter sunlight.
• The yeasts induce enlarged melanosomes
within melanocytes in the brown type of
PVC.
33. • Pityriasis versicolor is usually
asymptomatic, but in some people it
is mildly itchy.
• Numerous, well-marginated, finely
scaly, oval-to-round macules.
• Demonstration of this associated
scale may require scratching or
stretching the skin surface.
34. • Scattered over the trunk,
shoulders and/or the chest,
the proximal extremities
with occasional extension
to the lower part of the
abdomen and the neck.
• Less frequently, lesions are
seen on the face (especially
in children), scalp.
35.
36.
37.
38. • The macules tend to coalesce, forming large irregularly shaped patches.
39. • As the name versicolor implies, the color of each lesion varies
from almost , pink (mildly inflamed), tan to dark brown
40.
41.
42.
43. • An INVERSE form also exists affecting the flexural regions
antecubital fossae, sub-mammary region and groin.
44.
45. • Sometimes the patches start scaly and brown, and
then resolve through a non-scaly and white stage.
47. • SKIN SCRAPING: then it is examined under a
microscope.
• DIRECT MICROSCOPY: Skin scrapings taken from
patients with PVC stain rapidly when mounted in 10%
KOH, glycerol and Parker ink solution and show
characteristic clusters of thick-walled round, budding
yeast-like cells and short angular hyphal forms up to
8um in diameter (SPAGHETTI AND MEATBALLS
APPEARANCE). These microscopic features are
diagnostic for Malassezia furfur and culture
preparations are usually not necessary.
48.
49. • CULTURE: is only necessary in cases of
suspected fungaemia. M. furfur is a
lipophilic yeast, therefore in vitro growth
must be stimulated by natural oils or other
fatty substances.
• The most common method used is to
overlay Sabouraud's dextrose agar
containing cycloheximide (actidione) with
olive oil or alternatively to use a more
specialized media like Dixon's agar which
contains glycerol mono-oleate (a suitable
substrate for growth).
50. • Biopsies are usually not
performed, as KOH examination
of associated scale is typically
diagnostic.
• This section shoes;
1. Hyperkeratosis without
parakeratosis
2. Few inflammatory cells in the
epidermis
3. Numerous yeast & plump hyphae
(Spaghetti and meatballs)
54. TOPICAL TREATMENT
1. Azole creams and lotions; Clotrimazole,
Ketoconazole, Miconazole
2. Dandruff shampoos Ketoconazole (1% or 2%) or
2.5% selenium sulfide twice weekly for 2 to 4
weeks; the preparation is left on the skin for 10–15
minutes before rinsing. Over-the-counter dandruff
shampoo contain heavy metals e.g. Zinc, Mercury,
Copper e.t.c. inhibition of growth of any fungi by
reacting in their biosynthetic pathways. Treatment
of all the skin from the neck down to the knees,
even if only a small area is clinically involved.
3. Allylamine
4. Nystatin
5. Salicylic acid
6. Sodium thiosulphate solution
7. Ciclopirox cream/solution
8. 50% propylene glycol in water
55. SYSTEMIC TREATMENT
• If the rash is extensive, oral antifungal medications may be needed they are;
1. Fluconazole (300 mg once weekly for 2 weeks)
2. Itraconazole (200 mg daily for 5-7 days)
3. Ketoconazole (200 mg 5 days-5 weeks),
• Vigorous exercise an hour after taking the medication may help sweat it onto
the skin surface, where it can effectively eradicate the fungus. Avoid bathing
for a few hours.
56. • Though it is easily treated, pigment changes may last for months
after treatment.
• Because this rash has a high recurrence rate, medication may be
needed periodically to prevent recurrence. The rate of recurrence
of pityriasis versicolor is very high, especially in hot humid climates
so avoid heat in hot weather.
• Patients at high risk for recurrence may be helped by using
ketoconazole shampoo once weekly as a body cleanser. Another
preventative measure is once-monthly dosing of oral ketoconazole
(400 mg), fluconazole (300 mg) or itraconazole (400 mg).
57.
58.
59. • It is due to infection by the fungus,
Hortaea werneckii.
• Occurs as a result of inoculation
from a contamination source such
as soil sewage, wood, or compost
subsequent to trauma in the
affected area.
Note the 2 celled yeast forms
60. • Typically occur in tropical climates such as Central and
South America, Africa, Asia and, occasionally, in the
southeastern US.
61. • No predispositions have been identified.
• Typically, the incubation period is 10- to 15-day.
• A pigmentary change in the skin results from the
accumulation of a melanin-like substance in the
fungus.
62. • Asymptomatic brown-to-black sharply
marginated macule or patch, resembling
silver nitrate or India ink stains.
• The surface may appear mottled, velvety or
have mild scale.
• The lesions are typically solitary, although
may be multiple.
• Although most frequently seen on the
palms, tinea nigra can also appear on the
soles, neck and trunk.
63.
64.
65. • The shape of the lesion varies, and they may appear
ovoid, round, or irregular.
• The lesion slowly grows over weeks to months.
• The size may range from a few millimeters to
several centimeters in diameter, depending on the
duration.
• It may have darker pigmentation of the advancing
border as compared to the center.
• While the disease tends to be chronic, recurrence
after effective treatment is infrequent except in the
case of re-exposure.
66.
67. • KOH EXAMINATION reveals highly
branched and septate pigmented
hyphae.
• BIOPSY specimens have similar findings
observed within the stratum corneum.
• CULTURES of H. werneckiifirst appear
as pasty, green-black colonies with a
yeast-like appearance, and then change
after approximately 2 weeks to a fuzzy,
dematiaceous (dark in color) mold.
68.
69. 1. Acral melanocytic nevi.
2. Fixed drug eruption.
3. Postinflammatory hyperpigmentation.
4. Staining from chemicals, pigments and dyes.
5. Melanoma.
70. 1. Topical keratolytic agents such as Whitfield’s ointment
(typically 6% benzoic acid plus 3% salicylic acid)
2. Topical azole
3. Topical Allylamine
• Several weeks of therapy may be required to prevent
recurrence of disease.
• Systemic therapy is generally not indicated.
71.
72.
73. • It is a superficial non-inflammatory nodular fungal
infection confined to hair shafts.
• “Piedra” means “stone”, reflecting the fungal
elements’ adherence to one another to form
nodules along the hair shaft, the surrounding skin is
healthy.
• Favored climate; tropical areas.
• There are 2 types Black Piedra & White Piedra.
74.
75.
76.
77.
78.
79.
80.
81. BLACK PIEDRA WHITE PIEDRA
CAUSATIVE FUNGI Piedraia hortae
Trichosporon beigelii (6
pathogens)
PATHOGENESIS
• Infection usually begins
under the cuticle of the
hair shaft and extends
outward.
• Hair breakage may occur
as a result of shaft rupture
at the site of the nodules.
• As the nodules enlarge,
they can even envelope
the hair shaft.
• Infection also begins
beneath the cuticle and
grows through the hair
shaft, causing weakening
and breakage of the hair.
82. CLINICALLY BLACK PIEDRA WHITE PIEDRA
NODULE COLOR
Brown to black
along the hair shaft.
Generally white but may also be red, green or
light brown in color.
NODULE FIRMNESS Hard Soft
NODULE ADHERENCE TO
THE HAIR SHAFT Firm Loose
TYPICAL ANATOMIC
LOCATION
Face, axillae and
pubic region
(occasionally scalp)
Scalp and face (occasionally pubic region its
incidence has increased since the start of the
HIV pandemic)
SYSTEMIC INFECTION Non
In immunosuppressed patients, T. beigelii can
cause TRICHOSPORONOSIS, a serious with
fungemia, fever, pulmonary infiltrates, skin
lesions (papulovesicular and purpuric, often
with central necrosis) and renal disease.
83. INVESTIGATIONS BLACK PIEDRA WHITE PIEDRA
KOH EXAMINATION
“crush preparation”
• Dematiaceous hyphae
• Organized cluster of asci, each of
which contains eight ascospores
(sexual phase of P. hortae-the only
sexual phase detected that is
pathological to human)
• Non-dematiaceous
hyphae
• Blastoconidia and
arthroconidia
(representing the
asexual state)
CULTURE ON
SABOURAUD’S AGAR
• Very slow-growing
• Dark green to dark brown–black
colonies with a velvety texture
(asexual phase)
• Grows rapidly
• Moist, cream-colored,
yeast-like colonies
• Cycloheximide inhibits
growth.
86. 1. Clip affected hairs.
2. Wash affected hairs with antifungal shampoo 2%
ketoconazole shampoo or selenium sulfide.
3. Topical imidazole cream.
4. Oral terbinafine may also be used for black piedra.
5. Oral itraconazole may also be used for white
piedra.