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Cutaneous Fungal Infections

2009 Mark Tuttle


Superficial Skin Infection
Name Diagnosis/Labs Symptoms Pathogenesis Treatment
Tinea
versicol
or
Pseudohyphae
ND yeast
Caused by Malassezia species
Labs/Microscopy
- KOH ou!t "or de"i!iti#e dia$!osis
%de$rades e#erythi!$ but chiti!&
- '!ha!ced (ith Calcofluor !hite "ie
(hich bi!ds to cellulose/chiti!
- Lesio!s "luoresce yello(-$ree! i! #oo"$s
light
- )ee i*ture o" pseu"ohyphae an"
clusters of yeast
Culture
- +ro(s i! Sabourau" agar only if
containing lipi"
- Causes discolored ski!
(ithout i!"laatio!
- O#er$ro(th o" yeast i! lesio!s
Coplicatio!s
Preature i!"a!ts (ho are
$i#e! i!tralipid !utritio! by
i!"ected ,ro#iac catheters-
+et $e!erali.ed i!"ectio! (ith
septiceia/ p!euo!ia
012) patie!ts $et se#ere
"olliculitis a!d seborrheic
deratitis/ C3a produces
i!"laatio!
- Lipophillic yeast% #ill not
gro! in absence of lipi"
- Normal flora o" ski!/
especially oily ski!
- +ro(s O4L5 i! stratu
cor!eu
- 4ot a se#ere disease
- Kerati!olytic
%propyle!e $lycol&
- )ele!iu sul"ide
%da!dru""
shapoo&
- 0.ole
6sed "or se#ere
recurre!t
i!"ectio!s o"
u!k!o(! etiolo$y
Dermatophytosis &'ing!orm( ) *eratini+e" tissues
7- Trichophyton 8 icro/acro co!idiu
2- Microsporum 8 icro/acro co!idiu
9- Epidermophyton 8 Thallic - soliatary
- 2isti!$uished by details o" spores produced i! #itro- )pores
!ot produced i! #i#o- Teloorphs are possible/ too-
Labs/Microscopy
- KOH ou!t 8 reo#es e#erythi!$ e*cept chiti! i! cell (alls
)ee bra!chi!$ hyphae (ith septa :- arthrospores
- Sabourau" culture at ,-.C /01 !eeks is 2SS2NTIL
since many species
- 6se cyclohe*aide : a!tibacterial i! culture
- Outside; <i!$ o" i!"laatio!
- Middle; yceliu
- Ca! scratch a!d re-i!oculate
the iddle
0rthrospores
,ra!chi!$/ septate
hyphe
- True pathogens- 4ot !oral
"lora-
- 0!thropophilic species
usually !ot as se#ere as
.oophilic or $eophilic
=irule!ce "actors
- Proteinases
Kerati!ase/ elastase/
colla$e!ase
- Sulfite
<educes disul"ide bo!ds i!
kerati!
- Perhaps !itrite as
treate!t si!ce
!itrosylated
kerati! is to*ic to
"u!$i
Tinea pe"is
%0thlete>s ?oot&
- Trichophyton rubum
- Trichophyton mentagrophytes
#aria!t interdigitale
- Most o"te! bet(ee! @
th
a!d 3
th

toe
- Ca! be sypto-"ree carrier
- Picked up "ro i!"ected ski!
scales co!tai!i!$ arthrospores
- 0!thropophillic
Tinea cruris
%Aock itch&
- Trichophyton rubum
- Epidermophyton floccosum
KOH ou!t; see bra!chi!$ hyphae (ith
septa
Tinea corporis Caused by se#eral species that are
- Boophilic %e*- Microsporium canis&
- +eophilic 8 reCuires hi$h
dose/iu!ocop-
- 0!thropophilic 8 less coo!/ less
i!"la-
- <i!$(or o! body/ ars/
tru!k
- 1!cubatio! period is up to 9
(eeks
- 'specially susceptible (ith
ski! abrasion a!d perpetual
"ampness %=iet!a&
- Poor i!#asi#e!ess si!ce !o
$ro(th at 9DC a!d u!able to
access ?e i! deep tissues
- T0cell me"iate" immunity is
important &IDS get severe(
- 4atural a!ti"u!$al ski! "atty
acid
-
Dermatophytosis &'ing!orm( ) *eratini+e" tissues %Co!ti!ued& 2009 Mark Tuttle
Name Diagnosis/Labs Symptoms/ Pathogenesis Treatment
Tinea capitis 'ctothri*; +ro(s (ithi!/outside hair
- Microsporum cani/audouinii
- Most coo! be"ore puberty
'!dothri*; +ro(s (ithi! hair o!ly
- Trichophyton tonsurans %o!k&
- Co!ti!ues a"ter puberty
Labs
- ?luoresce i! Eood>s Li$ht
- Hair becoes i!"ected a!d breaks o"" lea#i!$
patches o" bald!ess
?a#us 8 coes out the e!d o" the hair "ollicle
- )carri!$ disease o" hair "ollicle- T. schoenleinii
Kerio!
- ,o$$y tuor associated (ith i!"laatory
respo!se to i!"ected hair "ollicles
I" reactions
- 1!"laatio! a!d blisteri!$ at distal sites (here
no infection is present
Liited areas; Topical a$e!ts
- Ti!acti!/ clotria.ole
- Ehit"ield oi!te!t
%,e!.oic : salicylic acids&
Lar$e areas; Oral therapy
- 0.oles/ +riseo"ul#i!/
allylai!es
'pideics
- F-irradiatio!/ $riseo"ul#i!/ a.ole
a!ti"u!$al
3nychomycosi
s
4ail i!"ectio!/ o"te! due to deratophytes- Hardest to treat a!d ay be i*ed (ith bacteria
4ycotic
*eratitis
?u!$al i!"ectio! o" the eye-

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