Microbiology /Parasitology

Superficial and Cutaneous Mycoses

11 January 08

SUPERFICIAL MYCOSES
● Pityriasis versicolor
● Keratomycosis TINEA NIGRA
● Tinea nigra ● Etio: Exophiala werneckii (pigmented) – produce melanin
● Black piedra (impart brown to black color)
● White piedra ● Frequent in tropical areas
● Clinical findings: Brownish maculae on palms, fingers, face
PITYRIASIS VERSICOLOR ● Micr.
● Superficial chronic infection of Stratum corneum o Septate hyphae and yeast cells (brown in color)
● Etio: Malassezia furfur (Pityrosporum orbiculare) (Lipophilic ● Culture:
yeast: Commensal of N skin) o Black colonies
● (+) accumulation of sebum and skin oils –proliferates during ● Treatm.:
times of poor hygiene o Topical salicylic acid, tincture of iodine
● Clinical findings: Manifest early on:
o Irregular patches of hypo/ hyperpigmentation: noticeable BLACK PIEDRA
on exposure to sunlight ● Fungal infection of the scalp hair
o Intermittent areas of scaling with variegated hues ● Etio: Piedraia hortae
o Light yelloew and dark brown maybe observed as ● Frequent in tropical areas
infection progresses ● Clinical findings: Discrete, hard, dark brown to black nodules
o Folliculitis (+) in severe cases – infection extends into on the hair
hair shafts and sebaceous glands ● Micr.
o Most commonly involved: skin of chest, back, arms o Septate pigmented hyphae, and asci; unicellular and
o Condition: chronic; irritation and inflammation absent; fusiform ascospores with polar filament(s)
mild pruritus ● Culture:
● Diagnosis: o Brown to black colonies
o Direct observation of skin ● Treatm.:
o Wood’s lamp – yellow fluorescence o Topical salicylic acid, azole creams
o Microscope:
 tight clusters of spherical yeast cells admixed with WHITE PIEDRA
hyphal fragments (spaghetti and meatballs) ● Fungal infection of scalp, facial, axillary or genital hair
o Culture: ● Trichosporon beigelii
 Sabouraud’s dextrose agar ● Frequent in tropical and temperate zones
 Yeast-like colonies ● Clinical findings:
 Creamy consistency after 2 – 4 days o Soft, white to yellowish nodules loosely attached to the
 Incubation at 35 C hair
o Microscopically: o Occur as a sleeve or collarette around the hair shaft
 1x2 to 2x4 um broadly budding yeast cells observed o Micr.: Intertwined septate hyphae, blasto- and
 Bottle-shaped with a colarette-like thickening seen arthroconidia
at the junction of the mother and daughter cells o Culture: Soft, creamy colonies
o Systemic infection (parenteral lipid solution) o Treatm.: Shaving, azoles
o Micr.: Short hyphae, yeast cells
o Culture: Yeast (suppl.: olive oil) CUTANEOUS MYCOSES
DERMATOPHYTOSIS (=Tinea = Ringworm)
● Treatm.
● Infection of the skin, hair or nails caused by a group of
o Topical selenium sulfide keratinophilic fungi, called dermatophytes
o Oral ketaconazole
o Microsporum Hair, skin
o Oral itraconazole
o Epidermophyton Skin, nail
KERATOMYCOSIS (Mycotic keratitis) o Trichophyton Hair, skin, nail
● Posttraumatic / postsurgical corneal inf.
● Etio: Saprophytic fungi (Aspergillus, Fusarium, Alternaria, GENUS SPECIES
Candida), Histoplasma capsulatum Epidermophyton E. floccosum
● Clinical findings: Corneal ulcer Microsporum M. canis
● Micr.: Hyphae in corneal scrapings M. gypseum
● Treatm.: Trichophyton T. mentagrophytes
o Surgery (keratoplasty) T. rubrum
o Topical pimaricin T. tonsurans
o Nystatin
o Amphotericin B ● Digest keratin by their keratinases
● Resistant to cycloheximide

Elyu, Brim & Virns 1 of 4

 Microbiology/Parasitology – Superficial and Cutaneous Mycoses by Dra Bunyi Page 2 of 4

● Classified into three groups depending on their usual habitat ● Typical annular lesions on the skin of the SMOOTH parts of
o ANTROPOPHILIC the skin
 Trichophyton rubrum... ● Acquired from cats and dogs
o GEOPHILIC ● Spreading, hemorrhagic border caused by:
o T. rubrum
 Microsporum gypseum...
o ZOOPHILIC o T. mentagrophytes
o T. tonsurans
 Microsporum canis: cats and dogs ● T. rubrum
 Microsporum nanum: swine o Well suited to survive on the surface of the skin à
 Trichophyton verrucosum: horse and swine… chronic infection (lifetime)
● Pathogenesis and Immunity o Mannnans better able to suppress CMI reactions à
o Contact and trauma evade host response à survival
o Moisture o Survive off human body as spores in desquamated skin
o Crowded living conditions scales
o Cellular immunodeficiency à(chronic inf.)
o Re-infection is possible (but, larger inoculum is needed, TINEA BARBAE
the course is shorter ) Ringworm of the bearded area
● Clinical Classification ● Common among farm workers
o Infection is named according to the anatomic location ● T. mentagrophytes
involved: ● Lesions tend to be inflammatory
a. Tinea barbae ● Can spread during shaving
b. Tinea corporis ● Fungal folliculitis
c. Tinea capitis
d. Tinea cruris (Jock itch) TINEA CRURIS (jock itch)
e. Tinea pedis (Athlete’s foot) ● Ringworm of the groin, perineum, and perianal areas
f. Tinea manuum ● E. floccosum
g. Tinea unguium ● Circinate and serpiginous with inflammatory, vesicular,
● Clinical manifestations enlarging margins
o Skin: Circular, dry, erythematous, scaly, itchy lesions ● May reach epidemic proportions in athletes, soldiers, ship
o Hair: Typical lesions,”kerion”, scarring, “alopecia” crews
● Shared towels, linen, clothing
o Nail: Thickened, deformed, friable, discolored nails,
● Perspire freely or obese
subungual debris accumulation
o Favus (Tinea favosa) TINEA PEDIS
● Athlete’s Foot – most common fungal infection among
TINEA CAPITIS adolescents – T. rubrum
● Ringworm of the scalp ● T. mentagrophytes, T. rubrum, E. flocossum
● Peak in the early school years (M.canis) ● Occurs in 3 main forms:
● Direct contact: infected child; variety of families o Moccasin
● Asymptomatic carrier state; persistence
● This is most likely caused by trichophyton tonsurans in the  Mild to severe scaling à soles
US o Interdigital
● Microsporum audinii has been prominent cause of children’s  Peeling and cracking in the toe webs (4th web)
fungal disease  Itchy, burning or painful
● Gray-patch ringworm o Vesicular
o communicable ectothrix infection  Sudden appearance of itchy or painful blisters
o M. audorum/canis (instep, heel, or ball of the foot)
● Inflammatory ectothrix infection ● Keratin : soles of feet, palms of hands – vulnerable
o T. mentagrophytes ● Capability of T. rubrum to survive as spores in desquamated
o animal origin skin scales – vulnerable bath towels, locker room floors, etc.
● Black-dot ringworm
o endothrix infection TINEA UNGUIUM
o infected degenerate hair breaks off at the skin surface ● Involvement of nails by dermatophyte fungi
producing black dot ● T. mentagrophytes, T. rubrum, E. flocossum
o T. tonsurans ● Onychomycosis
● Fungating exophytic masses o Nail infections caused by nondermatophytic fungi
o Kerions o Aspergillus spp., C. albicans, Geotricum spp., etc.
o T. tonsurans ● Begin at the lateral or distal edge of the nail plate à
o Favus infections paronychial inflammation
 T. schoenleini ● Progresses à nail becomes thickened and brittle with
 T. violaceum accumulation of subungal keratinized debris
● Nail plate separates from the nail bed à split and crumble
TINEA CORPORIS ● Nail may thicken, become elevated and distorted
● May occur in a single nail (great toe nail)
● Usually lasts a lifetime, rarely healing spontaneously
 Microbiology/Parasitology – Superficial and Cutaneous Mycoses by Dra Bunyi Page 3 of 4

 In vitro hair perforation test

DERMATOPHYTOSIS (in general)  Special amino acid and vitamin requirements
● Transmission  Urea hydrolysis
o Close human contact  Growth on BCP-milk solids-glucose medium
o Sharing clothes, combs, brushes, towels, bedsheets...  Growth on polished grains
(Indirect)  Temperature tolerance and enhancement
o Animal-to-human contact (Zoophilic)
If microscopic morphology is not distinct, perform:
● Diagnosis Urease, Hair baiting test
o Clinical Urease Hair baiting test
 Appearance T. mentagrophytes Convert urease to red Invade shaft within 7-10
color within 1-2 days days à conical shaped
 Wood lamp (UV, 365 nm) holes
o Lab T. rubrum (hindi ko n mabasa.. Non-invasive
 Direct microscopic examination sorry)
− (10-25% KOH)
− Ectothrix/endothrix/favic hair ● Laboratory Presentation
 Culture
Colony Pigment
− Mycobiotic agar M. canis Cotton or wooly Lemon-yellow around
− Sabouraud dextrose agar growing periphery or
underside of the
● Microscopic features colony
Genus Microsporum M. gypseum Sugary, granular Cinnamon brown to
surface buff
 Macroconidia
T. mentagrophytes granular Less intense than T.
− (+) multicelled with thick rough walls rubrum
 Microconidia Microconidia Cluster in grapelike
− (+) in small numbers masses (en grappe);
− Unevenly dispersed spiral hyphae may
also be seen
− Generally oval or elliptical T. rubrum Burgundy-red
− NO distinguishing morphologic features Microconidia Tear shaped; irregular
o M. canis size; distributed on
either side of the
 Barrel or spindle shaped hyphal strands (bird
 Macroconidia on the fence
− Multicelled appearance)
− Pointed and slightly turned to one side at the tip Macroconidia Uncommon, if (+)
o M. gypseum pencil shaped; thin
smooth walls
 Macroconidia T. tonsurans Flat, granular, rugose Buff to tan brown
− More numerous than M. canis with folds radiating
− Less barrel shaped with rounded tips outward from center
− Features not always clear-cut Microconidia Elongated, club
shaped or large
Genus Trichophyton balloon shaped forms;
 Macroconidia admixed with the
− Typically absent or present only in small smaller oval or tear
numbers shaped microconidia
− Elongated and pencil-shaped Macroconidia NEVER seen
Genus Microconidia ABSENT
− Muticelled Epidermophyton
− Thin, smooth walls Macroconidia Club shaped; (+) 3 – 5
 Microconidia cells; thin smooth
− Small, regular sized walls; cluster in groups
of 3 or 4;
− abundant chlamydochonidia
 typically present in
● Identification older cultures
o Colony characteristics E. flocossum Suede appearance, Khaki or green yellow
o Microscopic morphology gentle folds
Macroconidium___Microconidium
Microsporum fusiform (+) ● Treatment
Epidermophyton clavate (-) o Azole derivatives
Trichophyton (few)cylindrical/ (+)  Interfere with the cyP450 dependent enzyme
clavate/fusiform single, systems at the demethylation step from lanosterol to
in clusters ergosterol à defective cell membrane with altered
permeability characteristics
o Physiological tests o Hair infection
Microbiology/Parasitology – Superficial and Cutaneous Mycoses by Dra Bunyi Page 4 of 4

 Griseofulvin
− Interferes with the mitotic spindle and
cytoplasmic microtubules
o Foot infections
 Acute phase
− Soak in KMnO4 1:5000 until acute inflammation
subsides then apply antifungal
 Chronic phase
− A.M. : powder
− P.M. : cream
o Topical
 Miconazole
 Clotrimazole
 Econazole
 Terbinafine
o Oral
 Griseofulvin
 Ketaconazole
 Itraconazole
 Terbinafine