3/2/2012

Superficial Fungal Infections: Dermatophytes Part 1

Glenn D. Roberts, PhD Division of Clinical Microbiology Department of Laboratory Medicine & Pathology Mayo Clinic Rochester, Minnesota

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Disclosures
None

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Selection of Clinical Specimens

Normal Host
Hair Skin Nails

Immunocompromised host
Potentially any source

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

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Microbiology
Trichophyton
Characterized by macroconidia that are elongated, pencil to cigar-shaped, smooth-walled, multiseptate, and thin-walled In general, microconidia predominate in most cultures
They may be arranged in clusters, produced singly along hyphae, or hardly sporulate at all

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Genus Trichophyton

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Microbiology
Epidermophyton
Produces only large, multiseptate, smooth-walled, and club-shaped macroconidia

Microsporum
Characterized by large, multiseptate, rough-walled, and spindle-shaped macroconidia

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

3/2/2012

Genus Epidermophyton

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Genus Microsporum

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Common Dermatophytes Found in North America

Trichophyton rubrum T mentagrophytes T tonsurans T verrucosum Microsporum canis M audouinii Epidermophyton floccosum

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

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Pathogenesis
Dermatophytes are keratinophilic Trichophyton infects the hair, skin, and nails Microsporum infects the hair and skin Epidermophyton infects the skin and nails Dermatophyte infections are seen most commonly in the immunocompetent patient

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Ecology
Dermatophytes: 3 major groups denoting where they are present in nature
Geophilic: found exclusively in soil Zoophilic: infect living animals including humans Anthropophilic: infect only humans

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Ecology
Geophilic
Microsporum gypseum

Zoophilic
Microsporum canis Trichophyton mentagrophytes Trichophyton verrucosum

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

3/2/2012

Ecology
Anthropophilic
Trichophyton mentagrophytes Trichophyton rubrum Trichophyton tonsurans Epidermophyton floccosum

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Direct Microscopic Examination

Septate hyaline hyphae Arthroconidia

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

KOH Preparation

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

3/2/2012

KOH Preparation

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Common Clinical Presentations

Tinea pedis: infection of the feet
Primarily involving the soles and toe webs, seen in areas between the third and fifth toes

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Tinea Pedis

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

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Severe Tinea Pedis

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Common Clinical Presentation

Tinea cruris: infection of the groin
Including the perineum and perianal region

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Tinea Cruris

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

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Common Clinical Presentation

Tinea corporis: infection of the smooth skin of the trunk and extremities
Exclusive of the face, foot, groin, hands, or scalp area

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Tinea Corporis

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Common Clinical Presentation

Tinea capitis: infection of the scalp, eyebrows, and eyelashes

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

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Tinea Capitis

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Common Clinical Presentation

Onychomycosis: nails and surrounding tissues may be infected by a number of fungi including Aspergillus, Fusarium, and others

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Onychomycosis

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

3/2/2012

Microbiology
Tinea pedis
Trichophyton rubrum Trichophyton mentagrophytes Epidermophyton floccosum

Tinea cruris
Epidermophyton floccosum Trichophyton rubrum Trichophyton mentagrophytes
Superficial Fungal Infections: Dermatophytes Part 1
2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Microbiology
Tinea corporis
Trichophyton rubrum Trichophyton mentagrophytes Microsporum canis

Tinea capitis
Trichophyton tonsurans Microsporum canis Microsporum audouini Trichophyton violaceum
Superficial Fungal Infections: Dermatophytes Part 1
2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Epidermophyton floccosum
Microscopic Identification From Mycosel or Cornmeal Agars

Large, smooth-walled, clubshaped conidia arranged singly or in clusters of 2 or 3

Colony khaki colored with white areas

Epidermophyton floccosum

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

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Microscopic Morphologic Features

Epidermophyton floccosum
Hyphae are hyaline, septate, and contain numerous chlamydoconidia Macroconidia are blunt, club-shaped, smooth-walled, multicelled
Attached singly or in groups of 2 or 3

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Epidermophyton floccosum

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Epidermophyton floccosum

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

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Cultural Features
Epidermophyton floccosum
Colonies are pale olive-green or khaki; some may be white in color; most are folded and velvety White sterile hyphae cover the colonies after 2 to 3 weeks of incubation

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

Epidermophyton floccosum

Superficial Fungal Infections: Dermatophytes Part 1

2012 Mayo Foundation for Medical Education and Research. All rights reserved.

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