MYCOSES


  MAJID MOHIUDDIN
SUPERFICIAL MYCOSES
• 1. Pityriasis (Tinea) versicolor (Malassezia
  furfur)
• 2. Tinea Nigra – Hortaea/Exophiala werneckii
• 3. White Piedia – Trichosporon
• 4. Black piedra – Piedraia
SUPERFICIAL   CAUSITIVE             CLINICAL          DIAGNOSIS     TREATMENT
MYCOSES       ORGANISMS             SYNDROME
(TYPE)

1. TINEA      Malassezia furfur     Small hypo       Skin         Topical azoles
VERSICOLOR    (Yeast like fungus)   (or) hyper        scraping      Selenium
(PITYRIASIS   represent             pigmented         Direct       sulfide shampoo
                                                                    Imidazole
VERSICOLOR)   phialoconidia         macules           observation
                                                                    ointments
                                    Chronic, mild,   Exposure     Miconazole &
                                     infection of     of Wood’s     clotrimazole
                                    stratum           lamp.         shampoo
                                    corneum                         Hot soak bath
SUPERFICIAL      CAUSITIVE               CLINICAL           DIAGNOSIS      TREATMENT
MYCOSES          ORGANISMS               SYNDROME
(TYPE)

2. TINEA NIGRA   Hortaea werneckii/     Irregular         Microscopic   Whitfield’s
                 exophiala werneckii                       examination    ointment,
                                         pigmented
Superficial                              macules            of skin        miconazole
                 Black fungus
                                                            scraping       nitrate in a cream
Phaeophypho      Cladosporium            No scaling
                                                            culture       base
mycosis                                  (or) invasion of                  Imidazole &
                 (branched, septate
                 hyphae, arthroconidia   hair follicles                    triazole
                 & elongate budding      Non                              Sulfur
                 cells)                  contagious                        ointments
                                                                           Tincture of
                                                                           iodine
                                                                           terbinafine
SUPERFICIAL   CAUSITIVE             CLINICAL          DIAGNOSIS        TREATMENT
MYCOSES       ORGANISMS             SYNDROME
(TYPE)

3. WHITE      Trichosporon:         Hairs of the     Culture in      Topical azoles
PIEDRA        T. inkin, T.asahii,   groin & axillae   mycological      Improve
              T.beigelii,           White to         media            hygiene
                                                                       Shaving of
              T.mucoides            brown welling     without
                                                      cycloheximide.
                                                                       infected hairs
                                    along the air
              Dolipore septum       strand.
              hyphae

              Or budding yeast
              like cells
SUPERFICIAL   CAUSITIVE         CLINICAL        DIAGNOSIS     TREATMENT
MYCOSES       ORGANISMS         SYNDROME
(TYPE)

4. BLACK      ASCOMYCETES – Small, dark        Branch       Hair cut
PIEDRA        Piedraia hortae or nodules –      pigmented     Proper and
              hortai             surround the   hyphae        regular washing.
                                 hair shafts    Culture
                                 scalp         Begin as
                                                yeast like
                                                colony then
                                                hyphae
CUTANEOUS MYCOSES
CUTANEOUS   CAUSITIVE         CLINICAL     DIAGNOSIS      TREATMENT
MYCOSES     ORGANISMS         SYNDROME


DERMATO-    TRICHOPHYTON      Ectothrix   Direct        Tropical Azoles
PHYTOSES    EPIDERMOPHYTON    Endothrix   microscopic    (micronazole,
            MICROSPORUM       Favic       Skin, hair    clotrimazole,
                                                          econazole, etc)
                              patterns     /nail sample
            Macro and micro                               Terbinafine and
                                           Culture on    haloprogin
            conidia                        scrappings     Whitfield
            Arthroconidia
                                                          ointment
                                                          (benzoic &
                                                          salicyclic acids)
                                                          optical agent.
DERMATOPHYTOS CAUSITIVE                CLINICAL
IS            ORGANISMS                SYNDROME
TINEA CAPITIS      Trichophyton        Small scalling
(Scalp ringworm)   Microsporium        patches to entire
                                       scalp
                                       Scalp, eyebrows
                                       & eyelashes
TINEA BARBAE                           Beard

TINEA CORPORIS     E. floccosum        Annular rings
(Ring worm)        Trichophyton        with scaly centers
                   Microsporium
TINEA CRURIS       Epidermophyton      Moist groin area
(Jock itch)        T. rubrum
TINEA PEDIS        T.rubrum/mentagrop Toes then nails
(Athlete’s foot)   hytes              becomes yellow
                   E.fluccosum        and brittles
TINEA UNGUIUM      T. rubrum           Nails thickned,
(Onychomycosis)                        discolored &
                                       brittle
SUBCUTANEOUS MYCOSES
• Main
  Lymphocutaneous sporotrichosis
  Chromoblastomycosis
  Eumycotic mycetoma
  Subcutaneous zygomycosis
  Subcutaneous phaeohyphomycosis

• Additional
  Lobomycosis
  Rhinosporidiosis
SUBCUTANEOUS      CAUSITIVE             CLINICAL         DIAGNOSIS      TREATMENT
MYCOSES           ORGANISMS             SYNDROME

1.                Sporothrix            Skin by truma   Culture of     Oral
LYMPHOCUTANEOUS   schenckii –           Small nodule    pus / tissue   potassium
SPOROTRICHOSIS    thermophilic          – ulcerate       Immunologi    iodide
                  dimorphic             Then            cally –        Itraconazole,
                  Mold – narrow,        discharge pus    exoantigen     terbinafine
                  hyaline, septate –                     test           /potassium
                  condiophores                                          iodide
                  Yeast – spherical,                                    Fluconazole
                  oval (or) elongated                                   Local
                                                                        application of
                                                                        heat
SUBCUTANEOUS     CAUSITIVE                   CLINICAL          DIAGNOSIS       TREATMENT
MYCOSES          ORGANISMS                   SYNDROME
2.              Pigmented                    Legs & arms/     Histopathol     antifungal
CHROMOBLASTOMYC septated                     shoulds, neck,    ogic findings   theraphy
    OSIS        (dematiaceous)               truck, face,      of chestnut     Itraconazole &
(Chromomycosis) fungi                        ears.             brown,          terbinafine
                                             Chronic,         musiform
                 Fonsecaea,                  pruritic,         cells.          Posaconazole
                 Cladosporium,               progressive,                      with
                 Exophiala,                  resistant to                      flucytosine
                 Cladophialophora            treat.
                 Rhinocladiella              Verrucous
                 Phialophora                 lesions to flat
                                             plagues
                 Form muriform cells         Cauliflower
                 (Sclerotic bodies, Medlar
                 bodies)
                                             like growth
SUBCUTANEOUS   CAUSITIVE           CLINICAL        DIAGNOSIS       TREATMENT
MYCOSES        ORGANISMS           SYNDROME

3.             Phaeoacremonium     Foot &          Grains can    Amphotericin B,
EUMYCOTIC                          hand/back        be mounted     Kitoconazole,
   MYCETOMA    Curvularia,         shoulders &      Microscopic   itraconazole
               Fusarium            chest wall also.                Antifungal
               Madurella,          Small,                         Theraphy
               Exophiala,          painless,
               Pyrenochaeta,       subcutaneous
               Leptosphaeria       nodule/plague -
               Scedosporium spp.   increase slowly
                                   & enlarge -
               Septate             disfigured
               Chlamydoconidia
SUBCUTANEOUS        CAUSITIVE            CLINICAL           DIAGNOSIS      TREATMENT
MYCOSES             ORGANISMS            SYNDROME
4.                  a)Conidiobolus      Chronic           Require       Itraconazole
SUBCUTANEOUS        coronatus            a)Rhinofacial     biopsy for     Oral
    ZYGOMYCOSIS     b)Basidiobolus      area - swelling    diagnosis      potassium
(Entomophthoromyc   ranarum              of the upperlips   Can culture   iodide
    osis)
                    Facial area in      & face -                          alternatively
                    adults               painless                          Facial
                    Proximal limbs in   b)Disk,                          reconstruction
                    children             shaped,                           surgery in case
                    respectively         rubbary                           of C.coronatus
                                         movable
                    Mucoraceaous        masses –
                    Zygomycetes,         shoulders,
                    sparse hyphae,       pelvis, lips &
                    fragmented,          thighs.
                    septae
SUBCUTANEOUS          CAUSITIVE              CLINICAL        DIAGNOSIS         TREATMENT
MYCOSES               ORGANISMS              SYNDROME

5.                   Numerous &             Solitary        Culture          Itraconazole,
SUBCUTANEOUS         diverse                inflammatory     Identification   with or
    PHAEOHYPHOMY Black molds in             cyst.            of pattern of     without
    COSIS            culture                Feet & legs     sporulation       flucytosine
(Superficial,
                     Yeast like in tissue.  although other                     Posaconazole
    subcutaneous or
    deeply invasive  Branced septate –      body sites                         Voriconazole
    or disseminated) budding yeast like     Lessions                          Terbinafine
                                            grows slowly
                      Exophiala jeanselmei, and expand
                      Alternaria,           Firm &
                      Curvularia,           painless
                      Phaeoacremonium,
                      Bipolaris spp.
SYSTEMIC MYCOSES DUE TO
       DIMORPHIC FUNGI
• 1. Blastomycosis
• 2. Histoplasmosis
• 3. Coccidiodomycoses
• 4. Paracoccidiodomycosis
(Blastomyces dermatitidis, Coccidioides immitis &
  C.posadasii, Histoplasma capsulatum var.
  capsulatum & H. Capsulatum var duboisii,
  Paracoccidioides brasiliensis & Penicillium
  marneffei).
Restricted geographically to specific area.
SYSTEMIC MYCOSES   CAUSITIVE               CLINICAL          DIAGNOSIS      TREATMENT
                   ORGANISMS               SYNDROME

1. BLASTOMYCES     BLASTOMYCOSIS           Present as       Suptum,pus    Itraconazole
    DERMATITIDIS   Molds in culture -      pulmonary         , exudates,    Ketoconazole
                   Branced septate         disease (or)      Urine &        Serious cases
                   Yeast like in tissue.   extra             biopsis from   amphotericin
                   – single budding        pulmonary         lessions.      B.
                   yeast like              disseminated      Microscopic
                                           disease           examination
                   Older culture may       Asymptomati      Culture
                   produce                 c /present as a   Seriologic
                   chlamydospores          mild flu like     test
                                           illness.
SYSTEMIC MYCOSES   CAUSITIVE             CLINICAL         DIAGNOSIS         TREATMENT
                   ORGANISMS             SYNDROME

2.COCCIDIOIDOMY    Coccidioides          Asymptomati     Suptum,          Itraconazole
   COSIS           immitis &             c pulmonary      exudates          Serious cases
                   C.posadasii           disease          from              amphotericin
                   Molds hyphae –        Vally           cutaneous         B.
                   arthroconidia –       fever/SanJoaqu   lession, spinal   Azoles,
                   endosporulating       in vally         fluid, blood,     fluconazole
                   spherule in tissue.   fever/desert     Urine &
                                         rheumatism       Tissue
                                                          biopsis.
                                                          Microscopic
                                                          examination
                                                          Culture
                                                          Seriologic
                                                          test
SYSTEMIC MYCOSES    CAUSITIVE            CLINICAL        DIAGNOSIS       TREATMENT
                    ORGANISMS            SYNDROME

3.HISTOPLASMOSIS Histocapsulatum         Conidia        Suptum,        Itraconazole
                 var Capsulatum, H.      develops into   scrapings       In
                 capsulatum var          yeast cells –   from            disseminated
                 duboisii                engulfed by     superficial     disease,
                 Molds in culture -      alvelor         lesions, bone   treatment with
                 hyaline septate -       macrophages     marrow,         amphotericin
                 conidiophore            Initial        aspirates &     B.
                 Yeast like in tissue.   inflammatory    buffy coat
                 – intracelluar          reaction        blood cells,
                 budding yeast like      because         blood films &
                                         granulomatous   biopsis from
                                         Mediastinal    lessions.
                                         fibrosis        Microscopic
                                                         examination
                                                         Culture
                                                         Seriologic
                                                         test
SYSTEMIC MYCOSES    CAUSITIVE            CLINICAL       DIAGNOSIS      TREATMENT
                    ORGANISMS            SYNDROME

4.PARACOCCIDIOID Paracoccidioides        Present as    Suptum,       Itraconazole
    OMYCOSIS     brasiliensis            pulmonary      exudates &     Ketoconazole
                 Molds in culture -      disease (or)   biopsis from   &
                 Branced septate         extra          lessions.      Trimethoprim-
                 Yeast like in tissue.   pulmonary      Microscopic   sulfamethoxaz
                 – multiply budding      disseminated   examination    ole
                 yeast like              disease.       Culture       Serious cases
                                                        Seriologic    amphotericin
                    Older culture may                   test           B.
                    produce
                    chlamydospores
                    and conidia

Mycoses

  • 1.
    MYCOSES MAJIDMOHIUDDIN
  • 2.
    SUPERFICIAL MYCOSES • 1.Pityriasis (Tinea) versicolor (Malassezia furfur) • 2. Tinea Nigra – Hortaea/Exophiala werneckii • 3. White Piedia – Trichosporon • 4. Black piedra – Piedraia
  • 3.
    SUPERFICIAL CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME (TYPE) 1. TINEA Malassezia furfur Small hypo Skin Topical azoles VERSICOLOR (Yeast like fungus) (or) hyper scraping Selenium (PITYRIASIS represent pigmented Direct sulfide shampoo Imidazole VERSICOLOR) phialoconidia macules observation ointments Chronic, mild, Exposure Miconazole & infection of of Wood’s clotrimazole stratum lamp. shampoo corneum Hot soak bath
  • 4.
    SUPERFICIAL CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME (TYPE) 2. TINEA NIGRA Hortaea werneckii/ Irregular Microscopic Whitfield’s exophiala werneckii examination ointment, pigmented Superficial macules of skin miconazole Black fungus scraping nitrate in a cream Phaeophypho Cladosporium No scaling culture base mycosis (or) invasion of Imidazole & (branched, septate hyphae, arthroconidia hair follicles triazole & elongate budding Non Sulfur cells) contagious ointments Tincture of iodine terbinafine
  • 5.
    SUPERFICIAL CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME (TYPE) 3. WHITE Trichosporon: Hairs of the Culture in Topical azoles PIEDRA T. inkin, T.asahii, groin & axillae mycological Improve T.beigelii, White to media hygiene Shaving of T.mucoides brown welling without cycloheximide. infected hairs along the air Dolipore septum strand. hyphae Or budding yeast like cells
  • 6.
    SUPERFICIAL CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME (TYPE) 4. BLACK ASCOMYCETES – Small, dark Branch Hair cut PIEDRA Piedraia hortae or nodules – pigmented Proper and hortai surround the hyphae regular washing. hair shafts Culture scalp Begin as yeast like colony then hyphae
  • 7.
    CUTANEOUS MYCOSES CUTANEOUS CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME DERMATO- TRICHOPHYTON Ectothrix Direct Tropical Azoles PHYTOSES EPIDERMOPHYTON Endothrix microscopic (micronazole, MICROSPORUM Favic Skin, hair clotrimazole, econazole, etc) patterns /nail sample Macro and micro Terbinafine and Culture on haloprogin conidia scrappings Whitfield Arthroconidia ointment (benzoic & salicyclic acids) optical agent.
  • 8.
    DERMATOPHYTOS CAUSITIVE CLINICAL IS ORGANISMS SYNDROME TINEA CAPITIS Trichophyton Small scalling (Scalp ringworm) Microsporium patches to entire scalp Scalp, eyebrows & eyelashes TINEA BARBAE Beard TINEA CORPORIS E. floccosum Annular rings (Ring worm) Trichophyton with scaly centers Microsporium TINEA CRURIS Epidermophyton Moist groin area (Jock itch) T. rubrum TINEA PEDIS T.rubrum/mentagrop Toes then nails (Athlete’s foot) hytes becomes yellow E.fluccosum and brittles TINEA UNGUIUM T. rubrum Nails thickned, (Onychomycosis) discolored & brittle
  • 9.
    SUBCUTANEOUS MYCOSES • Main Lymphocutaneous sporotrichosis Chromoblastomycosis Eumycotic mycetoma Subcutaneous zygomycosis Subcutaneous phaeohyphomycosis • Additional Lobomycosis Rhinosporidiosis
  • 10.
    SUBCUTANEOUS CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME 1. Sporothrix Skin by truma Culture of  Oral LYMPHOCUTANEOUS schenckii – Small nodule pus / tissue potassium SPOROTRICHOSIS thermophilic – ulcerate Immunologi iodide dimorphic Then cally – Itraconazole, Mold – narrow, discharge pus exoantigen terbinafine hyaline, septate – test /potassium condiophores iodide Yeast – spherical, Fluconazole oval (or) elongated Local application of heat
  • 11.
    SUBCUTANEOUS CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME 2. Pigmented Legs & arms/ Histopathol  antifungal CHROMOBLASTOMYC septated shoulds, neck, ogic findings theraphy OSIS (dematiaceous) truck, face, of chestnut Itraconazole & (Chromomycosis) fungi ears. brown, terbinafine Chronic, musiform Fonsecaea, pruritic, cells. Posaconazole Cladosporium, progressive, with Exophiala, resistant to flucytosine Cladophialophora treat. Rhinocladiella Verrucous Phialophora lesions to flat plagues Form muriform cells Cauliflower (Sclerotic bodies, Medlar bodies) like growth
  • 12.
    SUBCUTANEOUS CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME 3. Phaeoacremonium Foot & Grains can Amphotericin B, EUMYCOTIC hand/back be mounted Kitoconazole, MYCETOMA Curvularia, shoulders & Microscopic itraconazole Fusarium chest wall also. Antifungal Madurella, Small, Theraphy Exophiala, painless, Pyrenochaeta, subcutaneous Leptosphaeria nodule/plague - Scedosporium spp. increase slowly & enlarge - Septate disfigured Chlamydoconidia
  • 13.
    SUBCUTANEOUS CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME 4. a)Conidiobolus Chronic Require Itraconazole SUBCUTANEOUS coronatus a)Rhinofacial biopsy for Oral ZYGOMYCOSIS b)Basidiobolus area - swelling diagnosis potassium (Entomophthoromyc ranarum of the upperlips Can culture iodide osis) Facial area in & face - alternatively adults painless Facial Proximal limbs in b)Disk, reconstruction children shaped, surgery in case respectively rubbary of C.coronatus movable Mucoraceaous masses – Zygomycetes, shoulders, sparse hyphae, pelvis, lips & fragmented, thighs. septae
  • 14.
    SUBCUTANEOUS CAUSITIVE CLINICAL DIAGNOSIS TREATMENT MYCOSES ORGANISMS SYNDROME 5. Numerous & Solitary Culture Itraconazole, SUBCUTANEOUS diverse inflammatory Identification with or PHAEOHYPHOMY Black molds in cyst. of pattern of without COSIS culture Feet & legs sporulation flucytosine (Superficial, Yeast like in tissue. although other Posaconazole subcutaneous or deeply invasive Branced septate – body sites Voriconazole or disseminated) budding yeast like Lessions Terbinafine grows slowly Exophiala jeanselmei, and expand Alternaria, Firm & Curvularia, painless Phaeoacremonium, Bipolaris spp.
  • 15.
    SYSTEMIC MYCOSES DUETO DIMORPHIC FUNGI • 1. Blastomycosis • 2. Histoplasmosis • 3. Coccidiodomycoses • 4. Paracoccidiodomycosis (Blastomyces dermatitidis, Coccidioides immitis & C.posadasii, Histoplasma capsulatum var. capsulatum & H. Capsulatum var duboisii, Paracoccidioides brasiliensis & Penicillium marneffei). Restricted geographically to specific area.
  • 16.
    SYSTEMIC MYCOSES CAUSITIVE CLINICAL DIAGNOSIS TREATMENT ORGANISMS SYNDROME 1. BLASTOMYCES BLASTOMYCOSIS Present as Suptum,pus Itraconazole DERMATITIDIS Molds in culture - pulmonary , exudates, Ketoconazole Branced septate disease (or) Urine & Serious cases Yeast like in tissue. extra biopsis from amphotericin – single budding pulmonary lessions. B. yeast like disseminated Microscopic disease examination Older culture may Asymptomati Culture produce c /present as a Seriologic chlamydospores mild flu like test illness.
  • 17.
    SYSTEMIC MYCOSES CAUSITIVE CLINICAL DIAGNOSIS TREATMENT ORGANISMS SYNDROME 2.COCCIDIOIDOMY Coccidioides Asymptomati Suptum, Itraconazole COSIS immitis & c pulmonary exudates Serious cases C.posadasii disease from amphotericin Molds hyphae – Vally cutaneous B. arthroconidia – fever/SanJoaqu lession, spinal Azoles, endosporulating in vally fluid, blood, fluconazole spherule in tissue. fever/desert Urine & rheumatism Tissue biopsis. Microscopic examination Culture Seriologic test
  • 18.
    SYSTEMIC MYCOSES CAUSITIVE CLINICAL DIAGNOSIS TREATMENT ORGANISMS SYNDROME 3.HISTOPLASMOSIS Histocapsulatum Conidia Suptum, Itraconazole var Capsulatum, H. develops into scrapings In capsulatum var yeast cells – from disseminated duboisii engulfed by superficial disease, Molds in culture - alvelor lesions, bone treatment with hyaline septate - macrophages marrow, amphotericin conidiophore Initial aspirates & B. Yeast like in tissue. inflammatory buffy coat – intracelluar reaction blood cells, budding yeast like because blood films & granulomatous biopsis from Mediastinal lessions. fibrosis Microscopic examination Culture Seriologic test
  • 19.
    SYSTEMIC MYCOSES CAUSITIVE CLINICAL DIAGNOSIS TREATMENT ORGANISMS SYNDROME 4.PARACOCCIDIOID Paracoccidioides Present as Suptum, Itraconazole OMYCOSIS brasiliensis pulmonary exudates & Ketoconazole Molds in culture - disease (or) biopsis from & Branced septate extra lessions. Trimethoprim- Yeast like in tissue. pulmonary Microscopic sulfamethoxaz – multiply budding disseminated examination ole yeast like disease. Culture Serious cases Seriologic amphotericin Older culture may test B. produce chlamydospores and conidia