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41. laboratory diagnosis of common fungal diseases

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41. laboratory diagnosis of common fungal diseases

  1. 1. LABORATORY DIAGNOSIS OF COMMON FUNGAL DISEASES Prof. Louella A. Dancel, RMT, MSc. University of Perpetual Help System DALTA 42 nd PAMET ANNUAL CONVENTION Manila Hotel – December 2,2006
  2. 2. Clinical specimens submitted for Fungal Isolation 2004-2006* Clinical specimen 2004 2005 2006 Total Respiratory 29 35 34 98 Body fluids 37 17 34 88 Tissues 9 0 23 32 Skin 1 0 0 1 Nails 29 31 20 80 Hair 0 1 0 1 CSF 8 5 8 21 Others 5 20 24 49 TOTAL 118 109 153 380
  3. 3. Fungal Isolates 2004-2006 * Isolate 2004 2005 2006 C.albicans 5.1% 13.8% 11.8% C.tropicalis 1.8% 3.7% 5.2% C.parapsilosis 5.1% 6.4% 3.9% C.glabrata 0.91% 0.91% 3.9% C.famata 1.8% 4.6% 2.0% Aspergillus spp. 0.91% 0% 0.65% Fusarium spp. 0% 0% 0.65%
  4. 4. Data from a Five-year review of Fungal Isolates at UPM-CPH <ul><li>Clinical specimens (n=545): </li></ul><ul><ul><li>Skin scrapings </li></ul></ul><ul><ul><li>Nail clippings/scrapings </li></ul></ul><ul><ul><li>Hair </li></ul></ul><ul><ul><li>Exudates </li></ul></ul><ul><ul><li>Biopsy materials </li></ul></ul>
  5. 5. Data from a Five-year review of Fungal Isolates at UPM-CPH <ul><li>Total clinical specimens tested – 545 </li></ul><ul><li>Results: </li></ul><ul><li>10.8%- (+) for both KOH & culture </li></ul><ul><li>59.1%- (-) for both KOH &culture </li></ul><ul><li>17.1% - (+)culture, (-) KOH </li></ul><ul><li>12.8% - (-) culture, (+) KOH </li></ul>
  6. 6. Data from a Five-year review of Fungal Isolates at UPM-CPH <ul><li>Fungal isolates : </li></ul><ul><li>Trichophyton mentagrophytes </li></ul><ul><li>Trichophyton rubrum </li></ul><ul><li>Trichophyton tonsurans </li></ul><ul><li>Trichophyton schoenlenii </li></ul><ul><li>Trichosporon spp. </li></ul>
  7. 7. Data from a Five-year review of Fungal Isolates at UPM-CPH <ul><li>Fungal isolates </li></ul><ul><li>Microsporum gypseum </li></ul><ul><li>Microsporum canis </li></ul><ul><li>Epidermophyton flocossum </li></ul><ul><li>Candida albicans </li></ul><ul><li>Exophiala werneckii </li></ul>
  8. 8. Data from a Five-year review of Fungal Isolates at UPM-CPH <ul><li>Fungal isolates from biopsy materials and exudates (31.2% positive): </li></ul><ul><li> Fonsecaea compactum </li></ul><ul><li>Phialophora verrucosa </li></ul><ul><li> Exophiala jeanselmei </li></ul><ul><li>Madurella grisea </li></ul>
  9. 9. Laboratory Methods for Diagnosis of Mycoses <ul><li>I. DIRECT EXAMINATION: </li></ul><ul><li>*10-30% KOH </li></ul><ul><li>*Calcofluor white stain </li></ul><ul><li>*Histological stains- H&E, PAS </li></ul><ul><li>*India Ink </li></ul><ul><li>*Wet mount </li></ul>
  10. 10. Laboratory Methods for Diagnosis of Mycoses <ul><li>II. Isolation & Culture </li></ul><ul><li>SDA </li></ul><ul><li>BHIA/BAP </li></ul><ul><li>Media with/without antibiotics </li></ul><ul><li>Macroscopic examination of culture </li></ul><ul><li>Microscopic examination using LPCB </li></ul>
  11. 11. Laboratory Methods for Diagnosis of Mycoses <ul><li>III. Biochemical Tests: </li></ul><ul><li>* Rapid kits for yeasts </li></ul><ul><li>*Urea test </li></ul><ul><li>IV. Special Tests: </li></ul><ul><li>*In-vitro hair perforation test </li></ul><ul><li> *Germ tube test </li></ul><ul><li>*Chlamydoconidia formation test </li></ul>
  12. 12. Mycotic Infections <ul><li>Superficial </li></ul><ul><li>Cutaneous </li></ul><ul><li>Subcutaneous </li></ul><ul><li>Systemic </li></ul><ul><li>Opportunistic </li></ul><ul><li>*Mycotoxicosis </li></ul><ul><li>*Allergies </li></ul>
  13. 13. Superficial mycoses <ul><li>superficial cosmetic fungal infections of the skin or hair shaft </li></ul><ul><li>no living tissue is invaded </li></ul><ul><li>no cellular response from the host </li></ul><ul><li>no pathological changes </li></ul><ul><li>patients unaware of infection </li></ul>
  14. 14. Superficial mycoses <ul><li>Disease </li></ul><ul><li>SKIN </li></ul><ul><li>Pityriasis versicolor </li></ul><ul><li>Tinea nigra </li></ul><ul><li>Causative organisms </li></ul><ul><li>Malassezia furfur </li></ul><ul><li>Exophiala werneckii </li></ul>
  15. 15. Superficial mycoses <ul><li>Disease </li></ul><ul><li>HAIR </li></ul><ul><li>White piedra </li></ul><ul><li>Black piedra </li></ul><ul><li>Causative organisms </li></ul><ul><li>Trichosporon beigelii </li></ul><ul><li>Piedraia hortae </li></ul>
  16. 16. Pityriasis versicolor <ul><li>Lesion </li></ul><ul><ul><li>-An-an” </li></ul></ul><ul><ul><li>-Hyperpigmented or hypopigmented macular lesions </li></ul></ul>Superficial mycoses www.ethnomed.org
  17. 17. Pityriasis versicolor <ul><li>Lesion </li></ul><ul><ul><li>scale readily, giving a chalky branny appearance </li></ul></ul><ul><ul><li>occurs on the trunk, shoulders & arms, face and neck </li></ul></ul>Superficial mycoses Modified from www.columbia.edu
  18. 18. Pityriasis versicolor <ul><li>Lesion </li></ul><ul><ul><li>fluoresce pale greenish under Wood’s lamp </li></ul></ul><ul><li>Distribution </li></ul><ul><ul><li>worldwide </li></ul></ul><ul><ul><li>more common in tropical than temperate climates </li></ul></ul>Superficial mycoses
  19. 19. Pityriasis versicolor <ul><li>KOH of skin scrapings </li></ul><ul><li>clusters of budding yeast-like cells & short angular hyphal forms </li></ul><ul><li>“ spaghetti and meat balls” </li></ul>Superficial mycoses
  20. 20. Pityriasis versicolor <ul><li>PAS of skin scrapings </li></ul><ul><li>“ spaghetti and meat balls” </li></ul>Superficial mycoses
  21. 21. Pityriasis versicolor <ul><li>Culture of skin scrapings </li></ul><ul><ul><li>Not necessary </li></ul></ul><ul><ul><li>diagnostic microscopic features </li></ul></ul><ul><ul><li>SDA overlaid with peanut oil, olive oil </li></ul></ul>Superficial mycoses
  22. 22. Pityriasis versicolor <ul><li>Etiologic Agent </li></ul><ul><ul><li>Malassezia globosa </li></ul></ul><ul><ul><li>lipophilic yeast </li></ul></ul><ul><ul><li>part of skin normal flora </li></ul></ul>Superficial mycoses
  23. 23. Pityriasis versicolor <ul><li>Treatment </li></ul><ul><ul><li>keratinolytic agents applied locally </li></ul></ul><ul><ul><li>Mild fungicides </li></ul></ul><ul><ul><li>Miconazole </li></ul></ul><ul><ul><li>Selenium sulfide (1%) shampoo </li></ul></ul>Superficial mycoses
  24. 24. Tinea nigra <ul><li>Lesion </li></ul><ul><ul><li>Gray to black well-demarcated macular lesions </li></ul></ul><ul><ul><li>most frequently occurring on the palms of the hand </li></ul></ul><ul><ul><li>non-inflammatory & non-scaling lesions </li></ul></ul>Superficial mycoses 11th.blogspot.com
  25. 25. Tinea nigra <ul><li>Distribution </li></ul><ul><ul><li>world-wide </li></ul></ul><ul><ul><li>more common in tropical regions of Central & South America, Africa, Southeast Asia & Australia </li></ul></ul>Superficial mycoses
  26. 26. Tinea nigra <ul><li>KOH </li></ul><ul><ul><li>pigmented brown to dark olivaceous (dematiaceous) septate hyphal elements & 2-celled yeast cells </li></ul></ul>Superficial mycoses
  27. 27. Tinea nigra <ul><li>Etiologic agent </li></ul><ul><ul><li>Exophiala werneckii </li></ul></ul><ul><ul><li>saprophyte found in soil, compost, humus & wood in humid tropical & sub-tropical regions </li></ul></ul>Superficial mycoses
  28. 28. Tinea nigra <ul><li>Culture on SDA </li></ul><ul><ul><li>initially mucoid, yeast-like & shiny black </li></ul></ul><ul><ul><li>with age: aerial mycelia & dark olive color </li></ul></ul>Superficial mycoses
  29. 29. Tinea nigra <ul><li>Lactophenol cotton blue (LPCB) of culture on SDA </li></ul><ul><ul><li>2-celled, pale brown yeast cells </li></ul></ul><ul><ul><li>darkly pigmented septa (annelides) </li></ul></ul><ul><ul><li>one cell cylindrical, the other cell is spindle-shaped </li></ul></ul><ul><ul><li>occur in aggregated masses </li></ul></ul>Superficial mycoses
  30. 30. Tinea nigra <ul><li>Treatment </li></ul><ul><ul><li>keratinolytic agents (Whitfield’s ointment) </li></ul></ul><ul><ul><li>tincture of iodine, 2% salicylic acid, 3% sulfur </li></ul></ul><ul><ul><li>miconazole nitrate, imidazoles, triazoles </li></ul></ul>Superficial mycoses
  31. 31. Tinea nigra <ul><li>Prevention </li></ul><ul><ul><li>avoid exposure to sources, contaminated material </li></ul></ul>Superficial mycoses
  32. 32. Piedra <ul><li>Fungus infection of the hair shaft </li></ul><ul><li>presence of firm, irregular nodules </li></ul><ul><li>Nodules - fungal elements cemented together along the hair shaft </li></ul><ul><li>Multiple infections of the same strand </li></ul>Superficial mycoses
  33. 33. Piedra <ul><li>Two varieties </li></ul><ul><ul><li>White piedra </li></ul></ul><ul><ul><li>Black piedra </li></ul></ul>Superficial mycoses
  34. 34. Black piedra <ul><li>Lesion </li></ul><ul><ul><li>discrete, hard, gritty, brown to black concretions / nodules </li></ul></ul><ul><ul><li>infection of hair </li></ul></ul><ul><ul><ul><li>scalp hair -common </li></ul></ul></ul><ul><ul><ul><li>beard, moustache - less common </li></ul></ul></ul><ul><ul><ul><li>axilla & groin hairs - rare </li></ul></ul></ul>Superficial mycoses www.doctorfungus.org
  35. 35. Black piedra - distribution Superficial mycoses
  36. 36. Black piedra <ul><li>Etiologic agent </li></ul><ul><ul><li>Piedraia hortae </li></ul></ul><ul><ul><li>source of infection </li></ul></ul>Superficial mycoses
  37. 37. Black piedra - lab diagnosis <ul><li>Direct microscopy </li></ul><ul><ul><li>specimen - hair with nodules </li></ul></ul><ul><ul><li>25% NaOH or KOH </li></ul></ul><ul><ul><li>dark septate hyphae </li></ul></ul>Superficial mycoses
  38. 38. Black piedra - lab diagnosis <ul><li>Direct microscopy </li></ul><ul><ul><li>round to oval asci; hyaline, curved to fusiform ascospores </li></ul></ul>Superficial mycoses
  39. 39. Black piedra - lab diagnosis <ul><li>Isolation – medium </li></ul><ul><ul><li>SDA with chloramphenicol </li></ul></ul><ul><ul><li>SDA  cycloheximide </li></ul></ul>Superficial mycoses
  40. 40. Black piedra - lab diagnosis <ul><li>Isolation </li></ul><ul><li>-growth very slow </li></ul><ul><ul><li>-dark brown to black </li></ul></ul><ul><ul><li>-greenish brown, short aerial mycelium </li></ul></ul>Superficial mycoses Heaped center Flat periphery
  41. 41. White piedra <ul><li>Infection of hair shaft </li></ul><ul><ul><li>face, axilla, genitals - common </li></ul></ul><ul><ul><li>scalp, eyebrows, eyelashes - less common </li></ul></ul>Superficial mycoses
  42. 42. White piedra <ul><li>Infection of hair shaft </li></ul><ul><ul><li>less common </li></ul></ul>Superficial mycoses scalp eyebrow eyelashes
  43. 43. White piedra <ul><li>Nodule </li></ul><ul><li>Soft, white, yellowish, beige or greenish nodule </li></ul><ul><li>Discrete </li></ul><ul><li>more often coalescent, forming an irregular transparent sheath </li></ul>Superficial mycoses
  44. 44. White piedra <ul><li>Distribution </li></ul><ul><ul><li>common in S. America & Asia </li></ul></ul><ul><ul><li>sporadic in N. America & Europe </li></ul></ul><ul><li>Etiologic agent </li></ul><ul><ul><li>Trichosporon beigelii or T. cutaneum </li></ul></ul>Superficial mycoses
  45. 45. White piedra <ul><li>Ecology </li></ul><ul><ul><li>soil, stagnant water </li></ul></ul><ul><ul><li>decaying fruit </li></ul></ul><ul><ul><li>spoiled food </li></ul></ul><ul><ul><li>sputum & body surfaces </li></ul></ul><ul><ul><li>horses </li></ul></ul>Superficial mycoses
  46. 46. White piedra - lab diagnosis <ul><li>Microscopic direct examination </li></ul><ul><ul><li>specimen - hair with nodules </li></ul></ul><ul><ul><li>10% KOH or 25% NaOH + 5% glycerin </li></ul></ul><ul><ul><li>hyaline septate hyphae </li></ul></ul><ul><ul><li>oval or rectangular arthroconidia </li></ul></ul><ul><ul><li>occasional blastoconidia </li></ul></ul>Superficial mycoses
  47. 47. White piedra - lab diagnosis <ul><li>Isolation </li></ul><ul><li>medium - SDA with chloramphenicol without cycloheximide </li></ul><ul><li>growth/culture </li></ul><ul><ul><li>rapid </li></ul></ul><ul><ul><li>cream-colored, soft </li></ul></ul><ul><ul><li>membranous, wrinkled radial furrows, irregular folding </li></ul></ul>Superficial mycoses
  48. 48. White piedra - lab diagnosis <ul><li>Isolation </li></ul><ul><li>microscopic exam of culture </li></ul><ul><ul><li>hyaline hyphae </li></ul></ul><ul><ul><li>arthroconidia </li></ul></ul><ul><ul><li>blastoconidia </li></ul></ul>Superficial mycoses
  49. 49. White piedra - lab diagnosis <ul><li>Physiological studies </li></ul><ul><ul><li>does not ferment carbohydrates </li></ul></ul><ul><ul><li>assimilate dextrose, lactose, D-xylose, inositol </li></ul></ul><ul><ul><li>negative KNO 3 assimilation </li></ul></ul><ul><ul><li>urease positive </li></ul></ul><ul><ul><li>arbutin is split </li></ul></ul>Superficial mycoses
  50. 50. Piedra - Treatment <ul><li>Shaving or cutting infected hair </li></ul><ul><li>Topical fungicides </li></ul><ul><ul><li>1:200 bichloride of mercury </li></ul></ul><ul><ul><li>benzoic acid & salicylic acid combinations </li></ul></ul><ul><ul><li>3% sulfur ointment </li></ul></ul><ul><ul><li>2% formalin </li></ul></ul>Superficial mycoses
  51. 51. Cutaneous mycoses <ul><li>No living tissue </li></ul><ul><li>Host Rxn to fungus </li></ul>skin hair nails keratinase
  52. 52. Cutaneous mycoses <ul><li>Disease </li></ul><ul><li>Dermatophytosis </li></ul><ul><li>Causative organisms </li></ul><ul><li>Dermatophytes </li></ul><ul><li>Microsporum </li></ul><ul><li>Trichophyton </li></ul><ul><li>Epidermophyton </li></ul>ringworm
  53. 53. Cutaneous mycoses <ul><li>Disease </li></ul><ul><li>Candidiasis of skin, mucous membranes & nails </li></ul><ul><li>Causative organisms </li></ul><ul><li>Candia albicans & related species </li></ul><ul><li>dermatomycosis </li></ul><ul><li>Soil fungi (Scytalidium, Fusarium, etc.) </li></ul><ul><li>Systemic fungi ( Histoplasma, etc) </li></ul>
  54. 54. <ul><li>Ecological Groups of </li></ul><ul><li>Dermatophytes </li></ul>
  55. 55. Geophilic <ul><li>inhabit soil where they decompose keratinaceous debris </li></ul><ul><li>Dead animals </li></ul>
  56. 56. Zoophilic <ul><li>parasitic on animals </li></ul>www.saanendoah.com www.kolumbus.fi
  57. 57. Anthropophilic fungi <ul><li>primarily parasitic to man </li></ul><ul><li>man as exclusive host </li></ul><ul><li>for maintenance & dissemination of species </li></ul>
  58. 58. Anthropophilic fungi <ul><li>Anthropophilic fungi: </li></ul><ul><ul><li>Examples: </li></ul></ul><ul><ul><ul><li>M. audonii </li></ul></ul></ul><ul><ul><ul><li>T. rubrum </li></ul></ul></ul><ul><ul><ul><li>T. schoenleinii </li></ul></ul></ul><ul><ul><ul><li>T. tonsurans </li></ul></ul></ul><ul><ul><ul><li>T. violaceum </li></ul></ul></ul>
  59. 59. Classification of Dermatophytes
  60. 60. Microsporum Macroconidia Rough walled Microconida present
  61. 61. Trichophyton Macroconidia Smooth walled Microconidia present
  62. 62. Epidermophyton Chlamydoconidia Macroconidia Smooth walled Microconidia none
  63. 63. <ul><li>Clinical Manifestations of Dermatophytes </li></ul>
  64. 65. Tinea capitis www.emedicinehealth.com <ul><li>Scalp, eyebrow, eyelashes </li></ul><ul><li>Microsporum & Trichophyton </li></ul>
  65. 66. Tinea capitis <ul><li>Endothrix </li></ul><ul><li>Ectothrix </li></ul>
  66. 67. Tinea favosa <ul><li>Scutulum </li></ul><ul><li>Mass of mycelia & epithelial debris </li></ul><ul><li>Cup shaped crusts </li></ul>www.mf.uni-lj.si
  67. 68. Tinea corporis <ul><li>Non-hairy skin </li></ul><ul><li>Rings with scaly centers </li></ul><ul><li>Rxn vs fungus </li></ul>www.cut.ee/
  68. 69. Tinea corporis <ul><li>E. floccosum </li></ul><ul><li>Trichophyton </li></ul><ul><li>Microsporum </li></ul>
  69. 70. Tinea imbricata Cutaneous <ul><li>Concentric rings </li></ul><ul><li>Trichophyton concentricum </li></ul>
  70. 71. Tinea barbae <ul><li>Bearded areas of face & neck </li></ul>Cutaneous www.merck.com www.emedicine.com
  71. 72. Tinea cruris Cutaneous www.dermnetnz.org <ul><li>Jock itch </li></ul><ul><li>Moist groin area </li></ul><ul><li>E. floccosum, T. rubrum </li></ul>
  72. 73. Tinea pedis Cutaneous www.doctorfungus.org dermatologie.free.fr <ul><li>Athlete’s foot </li></ul><ul><li>Toe webs & soles, even nails </li></ul><ul><li>Id reaction, circulating fungal antigens </li></ul>
  73. 74. Tinea manuum <ul><li>Interdigital areas & palmar surfaces </li></ul>Cutaneous www.dermnetnz.org
  74. 75. Tinea unguium Cutaneous www.dermnetnz.org <ul><li>Invasion of nail plate by dermatophytes </li></ul><ul><li>Thickened, discolored & brittle </li></ul><ul><li>Onychomycosis- non dermatophyte </li></ul><ul><li>Yeast etc. </li></ul>
  75. 76. Laboratory diagnosis
  76. 77. Skin scraping specimen Wipe with water www.doctorfungus.org scalpel Paper / envelope active edge
  77. 78. Direct Examination <ul><li>Wet mount </li></ul><ul><li>KOH </li></ul><ul><ul><li>10% to 30% </li></ul></ul><ul><ul><li>with Parker Superquink blue-black ink </li></ul></ul><ul><ul><li>gentle warming </li></ul></ul>KOH parker
  78. 79. KOH of skin scrapings Cutaneous Septate hypha
  79. 80. KOH of skin scrapings Cutaneous arthrospores septate hypha
  80. 81. Ectothrix invasion of hair <ul><li>Hair invasion </li></ul><ul><li>formation of arthroconidia on the outside of hair shaft </li></ul><ul><li>cuticle of hair is destroyed </li></ul>Cutaneous
  81. 82. Ectothrix invasion of hair <ul><li>Hair invasion by a dermatophyte </li></ul><ul><ul><li>Microsporum canis </li></ul></ul><ul><ul><li>M. gypseum </li></ul></ul><ul><ul><li>Trichophyton equinum </li></ul></ul><ul><ul><li>T. verrucosum </li></ul></ul>Cutaneous
  82. 83. Ectothrix invasion of hair <ul><li>Wood’s UV light </li></ul><ul><li>infected hairs fluoresce </li></ul><ul><li>bright greenish yellow under </li></ul>Cutaneous
  83. 84. Endothrix invasion of hair <ul><li>formation of arthroconidia within hair shaft </li></ul><ul><li>cuticle of hair remains intact </li></ul><ul><li>do not fluoresce under Wood’s UV light </li></ul>Cutaneous
  84. 85. Endothrix invasion of hair <ul><li>ALL AGENTS ARE ANTHROPOPHILIC </li></ul><ul><li>Trichophyton tonsurans, </li></ul><ul><li>T. violaceum </li></ul>Cutaneous
  85. 86. Culture: <ul><li>Selective media </li></ul><ul><ul><li>SDA with chloramphenicol & cycloheximide (Mycosel or Mycobiotic agar) </li></ul></ul><ul><ul><li>Dermatophyte test medium </li></ul></ul><ul><li>Non-selective medium </li></ul><ul><ul><li>Sabouraud’s dextrose agar </li></ul></ul>
  86. 87. Culture: <ul><li>Incubation </li></ul><ul><li>Room temperature </li></ul><ul><li>At least 2 weeks </li></ul>
  87. 88. Identification <ul><li>Gross color & texture </li></ul><ul><li>Microscopic characteristics </li></ul><ul><li>Confirm / compare with </li></ul><ul><ul><li>Written descriptions </li></ul></ul><ul><ul><li>Drawings </li></ul></ul><ul><ul><li>photographs </li></ul></ul>
  88. 89. Mycology
  89. 90. Microsporum canis <ul><li>Zoophilic </li></ul><ul><ul><li>cats and dogs </li></ul></ul><ul><li>Invades </li></ul><ul><ul><li>Hair </li></ul></ul><ul><ul><li>skin </li></ul></ul><ul><ul><li>rarely nails </li></ul></ul><ul><li>distribution </li></ul><ul><ul><li>worldwide </li></ul></ul>Cutaneous netti.nic.fi www.vet.ohio-state.edu
  90. 91. Microsporum canis <ul><li>lab diagnosis – culture </li></ul><ul><li>white cottony growth </li></ul>Cutaneous <ul><li>golden yellow reverse colony </li></ul>www2.provlab.ab.ca
  91. 92. Microsporum canis <ul><li>microscopic: </li></ul><ul><ul><li>spindle shaped, one end pointed, other end blunt </li></ul></ul><ul><ul><li>thick walled verrucose macroconidia </li></ul></ul><ul><ul><li>6 to 12 cells </li></ul></ul>Cutaneous www.doctorfungus.org
  92. 93. Microsporum gypseum <ul><ul><li>geophilic </li></ul></ul><ul><ul><li>usually produces a single inflammatory skin or scalp lesion </li></ul></ul><ul><li>distribution </li></ul><ul><ul><li>worldwide </li></ul></ul>Cutaneous
  93. 94. Microsporum gypseum <ul><li>lab diagnosis - culture </li></ul><ul><li>flat, spreading suede-like to granular </li></ul><ul><li>cinnamon growth </li></ul><ul><li>yellow brown pigment on reverse of colony </li></ul>Cutaneous www.ukneqasmicro.org.uk
  94. 95. Microsporum gypseum <ul><li>microscopic: </li></ul><ul><li>symmetrical ellipsoidal </li></ul><ul><li>thin walled verrucose macroconidia </li></ul><ul><li>distal end slightly rounded, proximal (point of attachment) is blunt </li></ul><ul><li>4 to 6 cells </li></ul>Cutaneous vtpb-www.cvm.tamu.edu www.medmicro.wisc.edu
  95. 96. Trichophyton mentagrophytes <ul><ul><li>zoophilic: mice, cats, horses, sheep, rabbits </li></ul></ul><ul><ul><li>inflammatory skin or scalp lesions in humans </li></ul></ul><ul><ul><li>ectothrix </li></ul></ul><ul><li>distribution </li></ul><ul><ul><li>worldwide </li></ul></ul>Cutaneous
  96. 97. Trichophyton mentagrophytes <ul><li>lab diagnosis - culture </li></ul><ul><li>flat, white to cream color; powdery to granular surface </li></ul>Cutaneous danival.org
  97. 98. Trichophyton mentagrophytes Cutaneous Microscopic <ul><li>spherical microconidia </li></ul><ul><li>forming dense clusters, “en-grappe” </li></ul>vtpb-www.cvm.tamu.edu
  98. 99. Trichophyton mentagrophytes <ul><li>spiral hyphae </li></ul>Cutaneous <ul><li>smooth thin-walled clavate multiseptate macroconidia </li></ul>Microscopic www.vet.ohio-state.edu vtpb-www.cvm.tamu.edu
  99. 100. Trichophyton mentagrophytes <ul><li>lab diagnosis </li></ul>Cutaneous www2.provlab.ab.ca <ul><li>positive urease production </li></ul><ul><li>positive for in-vitro hair perforation </li></ul>www2.provlab.ab.ca
  100. 101. Trichophyton rubrum <ul><li>anthropophilic </li></ul><ul><ul><li>chronic infections of the skin, nails, rarely scalp </li></ul></ul><ul><ul><li>ectothrix or endothrix hair infection </li></ul></ul><ul><li>distribution </li></ul><ul><ul><li>worldwide </li></ul></ul>Cutaneous
  101. 102. Trichophyton rubrum <ul><li>lab diagnosis – culture </li></ul><ul><li>white, suede-like to downy </li></ul><ul><li>wine red pigment on reverse side </li></ul>Cutaneous www.pfizer.ch www4.medfak.lu.se
  102. 103. Trichophyton rubrum <ul><li>lab diagnosis </li></ul><ul><ul><li>scanty to moderate numbers of slender clavate to pyriform microconidia </li></ul></ul><ul><ul><li>arranged “en-thyrse” </li></ul></ul>Cutaneous www2.provlab.ab.ca
  103. 104. Trichophyton concentricum Cutaneous <ul><li>Anthropophilic </li></ul><ul><li>chronic non-inflammatory tinea corporis </li></ul><ul><li>tinea imbricata – concentric scaling of skin </li></ul><ul><li>Not invade hair </li></ul>
  104. 105. Trichophyton concentricum Cutaneous <ul><li>Distribution </li></ul><ul><ul><li>Pacific Islands of Oceania </li></ul></ul><ul><ul><li>Southeast Asia </li></ul></ul><ul><ul><li>Central and South America </li></ul></ul>
  105. 106. Trichophyton concentricum Cutaneous <ul><li>Lab diagnosis </li></ul><ul><li>Slow growing deeply folded thallus </li></ul><ul><li>Cream to orange brown in color </li></ul><ul><li>Reverse buff to brown </li></ul>
  106. 107. Trichophyton concentricum Cutaneous <ul><li>Microscopic – </li></ul><ul><li>“ antler tips” hyphae, </li></ul><ul><li>chlamydoconidia </li></ul>
  107. 108. Trichophyton schoenleinii Cutaneous <ul><li>Anthropophilic </li></ul><ul><li>Cause favus </li></ul><ul><li>Chronic scarring form of tinea capitis </li></ul><ul><li>Saucer shaped crusted lesions or scutula </li></ul><ul><li>Permanent hair loss </li></ul>
  108. 109. Trichophyton schoenleinii Cutaneous <ul><li>Lab diagnosis </li></ul><ul><li>Culture </li></ul><ul><li>Waxy or glabrous </li></ul><ul><li>Deeply folded honeycomb-like thallus with sub-surface growth </li></ul>
  109. 110. Trichophyton schoenleinii Cutaneous <ul><li>Lab diagnosis </li></ul><ul><li>Microscopic </li></ul><ul><ul><li>Favic chandeliers </li></ul></ul><ul><ul><li>No macroconidia </li></ul></ul><ul><ul><li>No microconidia </li></ul></ul>
  110. 111. Epidermophyton floccosum <ul><li>anthrophophilic </li></ul><ul><li>does not invade hair in vivo </li></ul><ul><li>distribution </li></ul><ul><ul><li>worldwide </li></ul></ul>Cutaneous
  111. 112. Epidermophyton floccosum <ul><li>Culture </li></ul><ul><li>greenish-brown or “khaki” colored </li></ul><ul><li>suede-like surface </li></ul><ul><li>raised & folded center, with flat periphery </li></ul><ul><li>yellowish brown reverse pigment </li></ul>Cutaneous
  112. 113. Epidermophyton floccosum <ul><li>Microscopic </li></ul><ul><li>smooth thin-walled macroconidia often in clusters growing directly from hyphae </li></ul><ul><li>no microconidia </li></ul><ul><li>numerous chlamydoconidia </li></ul>Cutaneous botit.botany.wisc.edu www.fns.uniba.sk

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