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SUPERFICIAL MYCOSES
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- 2. CLASSIFICATION OF FUNGALDISEASES • Mycoses • Infection caused by fungus • Types • Superficial mycoses • Strictly surf infection • Deep mycoses • Subcutaneous mycoses • By saprophytic fungi of soil/decaying vegetation • Introduced into s.c. tissue • Producing progressive local disease w tissue destruction & sinus formation • Systemic mycoses • By fungi of soil • Acquired by inhalation • Disseminate to bones, CNS, other organs
- 3. SUPERFICIAL MYCOSES SURFACE INFECTIONS Tinea/Pityriasis versicolor Tineanigra Piedra Black White CUTANEOUS INFECTIONS Dermatophytoses SURFACE INFECTIONS CUTANEOUS INFECTIONS Fungi live on dead layers of skin & its appendages Confined to cornified layer of skin & its appendages No inflammatory response As no contact w living tissue Inflammatory & allergic responses induced Due to fungi and their metabolic products
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- 5. CAUSATIVE FUNGUS: Pityrosporum orbiculare/Malasseziafurfur • Lipophilic yeast-like fungus • Forms normal skin flora • ∴ Most infections thought to be endogenous • CHARACTERISED BY MILD CHRONIC INFECTION OF STRATUM CORNEUM • COMMON SITES: Neck, Chest, Abdomen, Back, Upper arm • MANIFESTATION: Patchy discolouration of skin
- 6. LAB DIAGNOSIS • SPECIMEN •Skin scales • DIRECT MICROSCOPY • PROC – KOH preparation • RESULT – • Clusters of round yeast cells • Curved, non-branched, short hyphae • CULTURE (rarely necessary for diagnosis) • PROC – • SDA overlaid w layer of olive oil • Incubate at 37℃ for 5-7 days • COLONY MORPHO: Creamy colonies • LACTOPHENOL COTTON BLUE WET MOUNT OF COLONIES: • Budding yeast cells w no of bottle shaped cells
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- 8. CAUSATIVE AGENT –DERMATOPHYTES @ RINGWORM/TINEA (LATIN; TINEA = WORM) • Group of fungi infecting only superficial keratinized tissue (hair, nail, skin) • Breakdown & utilize keratin • Incapable of penetrating s.c. tissue GENUS IMP. SPECIES INFECTION OF Trichophyton More microconidia Few macroconidia H N S T. mentagrophytes T. rubrum T. schoenleinii T. tonsurans T. verrucosum T. violaceum Hair Nail Skin Microsporum Predominant macroconidia H S M. gypseum M. canis M. audouinii Hair Skin Epidermophyton Macroconidia N S E. floccosum Nail Skin
- 10. CLASSIFICATION ON THEBASIS OF NATURAL HABITAT & HOST PREFERENCES NATURAL HABITAT HOST PREFERENCES EXAMPLES Anthropophilic (Man) Man T. rubrum M. audouinii E. floccosum Zoophilic (Animals) Animals M. canis Geophilic Soil M. gypseum
- 11. CLINICAL CLASSIFICATION DEPENDINGON SITE INVOLVED CLINICAL TYPE SITE INVOLVED EXAMPLES Tinea pedis/athlete’s foot Foot Tinea cruris Groin Tinea corporis Non-hairy skin of body T. rubrum Tinea capitis Scalp Trichophyton (most spp) Microsporum (any spp) Tinea barbae/barber’s itch Bearded areas of face & neck Favus Hair follicles T. schoenleinii T. violaceum M. gypseum Hair infection Endothrix Fig. 66.10 Arthospore formation entirely within hair shaft T. schoenleinii T. tonsurans T. violaceum Ectothrix Fig. 66.10 Sheath of arthospores present on surface of hair shaft T. mentagrophytes T. rubrum Microsporum
- 12. LAB DIAGNOSIS (SPECIMEN, DIRECTMICROSCOPY, CULTURE) SPECIMEN • Skin, Nail, Hair DIRECT MICROSCOPY • PROC – Direct 10 % KOH mount • RESULT – Fungal hyphae seen
- 13. CULTURE • SDA, SDAw antibiotics • PROC – • Culture media incubated at 25-30℃ for 3 weeks • Identify dermatophytes based on • Colony morphology • Pigment production • Microconidia & Macroconidia • Lactophenol cotton blue prep from colony reveals microconidia & macroconidia • RESULT – • Colony morphology • White to creamy cottony growth • Pigment production • Microconidia & Macroconidia • Genus Trichophyton • More microconidia • Few macroconidia • Genus Microsporum • Predominant macroconidia • Genus Epidermophyton • Macroconidia
- 14. TREATMENT • DOC • Oralgriseofulvin • GENERALLY USED • Topical antifungal agents