MYCOLOGY

ELIZABETH P. QUILES, M.D., FPASMAP DEPARTMENT OF MICROBIOLOGY OUR LADY OF FATIMA UNIVERSITY COLLEGE OF MEDICINE

SUPERFICIAL MYCOSES
Do not elicit cellular response colonize only non-living tissues No pathology generally cause no discomfort to the patient more of cosmetic problem

Skin infections: - limited to the outer most layer of the stratum corneum Hair infections: - only the cuticle

INFECTIONS: A. SKIN 1. Pityriasis versicolor 2. Tinea nigra B. HAIR 1. Black piedra 2. White piedra

PITYRIASIS VERSICOLOR
Chronic, mild, usually asymptomatic infection of the stratum corneum Etiology : Malassezia furfur (Pityrosporum orbiculare) Characteristics: - lipophilic - found in areas rich in sebaceous glands - part of the normal flora of the skin

Produce azelaic acid inhibit synthesis of melanin in keratinocytes lesional hypopigmentation Increase turn over of stratum corneum 8 days (Normal= 15 days)

Predisposing factors: 1. corticosteroids 2. tropics 3. genetic predisposition 4. poor nutritional state 5. excessive sweating 6. chronic infections

Lesions: - involves the upper torso, arms & abdomen - hypo- or hyperpigmented macular lesions - scaly dry, chalky appearance - rarely papular - may involve hair folicles folliculitis

DDx: 1. Pityriasis alba - common in children - usually found in the cheeks - due to excessive exposure to the sun - not due to fungi - hypopigmented with welldefined borders & non-scaling - commonly associated with atopy

2. Vitiligo 3. Chloasma 4. Tinia ciricinata 5. Seborrheic dermatitis 6. Pityriasis rosea 7. erythrasma

Diagnosis: - Specimen skin scrapings 1. microscopic spaghetti & meatballs appearance 2. Woods lamp golden yellow fluorescence 3. Culture

TREATMENT : 1. keratolytic agents Whitfields ointment or salicylic acid 2. 25% sodium thiosulfate + 1% salicylic acid 3. miconazole 4. selenite disulfide

TINEA NIGRA

Etiology: Exophiala wernickii Characteristics: - dimorphic - produce melanin brown to black color - initially grows as yeast with many cells in various stages of cell division twocelled oval structures - older colonies hyphae mycelia & conidia

Lesions: - asymptomatic - well-demarcated brown to black non-scaly macular lesions peripheral extension - deeper pigmentation at the advancing borders - often seen in the palms & soles

Diagnosis: - microscopic darkly pigmented yeastlike cells & hyphal fragments two-celled yeasts (annelioconidia)

DDx: 1. malignant melanoma 2. junctional nevus 3. pigmentation of Addisons disease 4. contact dermatitis 5. chemical staining

BLACK PIEDRA
Etilogy: Piedraia hortae Lesion: - hard nodules along the infected hair shaft - nodules have hard carbonaceous consistency & house asci DDx: nits of pediculosis & abnormal hair growth

WHITE PIEDRA
Etiology: Trichosporon beigelii Affects the hairs of the scalp, mustache & beard Characterized by cream-colored soft pasty growths along the infected hair shafts Growths occur as sleeve or collarette around the hair shaft DDx: trichomycosis axillaris & nits

TREATMENT

Skin infections: - keratolytic agents - selenium disulfide (hyposulfite or thiosulfate) - salicylic acid - antifungal agents miconazole Hair infections: - shaving or cropping the infected hairs - proper hygiene

DISEASE Pityriasis versicolor

ORGANISM Malassezia furfur

TISSUE Skin

CLINICAL FEATURES Hyper- or hypopigmented macular lesions, scaly Chalky, branny appearance Upper torso of the body Well-demarcated gray to black macular lesions Palms & soles Hard, gritty, brown to black concretions along the hair shaft Soft, white to creamy yellow granules sleevelike collarette along the hair shaft

Tinea Nigra Exophiala wernickii

Skin

Black piedra Piedraia hortae Hair

White piedra Trichosporon beigelii

Hair

CUTANEOUS MYCOSES (DERMATOPHYTOSIS)

Involve the skin, hair & nails Restricted to keratinized layers of integument & its appendages Keratinophilic fungi Have the ability to use keratin as substrate Clinical manifestations Tinea or ringworm due to serpentine or annular lesions they produce

3 Genera: 1. Microsporum - produce both micro- & macroconidia - predominantly macroconidia (rough-walled) - infects the skin & hair

2. Trichophyton - produce both micro- & macroconidia - predominantly microconidia (smooth-walled) - infects the skin, hair & nails

3. Epidermophyton - produce only macroconidia (smooth-walled) - infects the skin & nails

CLASSIFICATION (accg to source): 1. GEOPHILIC soil 2. ZOOPHILIC domestic & wild animals & birds 3. ARTHROPOPHILIC humans & their habitats Importance diagnostic & prognostic

Anthropophilic dermatophytes cause chronic infections & difficult to treat Geophilic & zoophilic dermatophytes cause inflammatory lesions but respond well to therapy & occasionally heal spontaneously

CLASSIFICATION ACCORDING TO ECOLOGICAL NICHE

ANTHROPOPHILIC DERMATOPHYTES M. audouinii M. mentagrophytes T. rubrum T. tonsurans T. violaceum E. floccosum ZOOPHILIC DERMATOPHYTES M. canis M. equinum M. gallinae T. equinum T. mentagrophytes GEOPHILIC DERMATOPHYTES M. cookei T. gypseum M. fulvum M. nanum

INFECTIONS
Tinea Tinea Tinea Tinea Tinea

pedis feet capitis scalp manus hands unguium nails corporis body

Other infections are given special names: - Favus (T. schoenleinii) - Tokelau (T. concentricum) Fungal elements in infected hairs may appear as endothrix infection or ectothrix infection

TINEA CORPORIS
Also known as tinea circinata Ringworm of the body outside the body folds, palms & soles Lesions are circular, erythematous with elevated papular borders & scaly With central clearing Usually appear first on sweaty areas

DDx: 1. nummular eczema moist with vesicles & crusting 2. plaque psoriasis thicker, silvery white scales 3. Hansens disease patchy anesthesia & non-scaly 4. granuloma annulare no-scaly & not erythematous

TINEA CRURIS (JOCK ITCH)

Affects the body folds integluteal fold, axillae & genitocrural fold More common in males than females Annular plaques in the genitocrural fold upper inner thighs, lower abdomen or buttocks The genitals are spared DDx: allergic contact dermatitis, seborrheic dermatitis, psoriasis

TINEA PEDIS (ATHLETES FOOT)

Most common type Usually involves the 3rd & 4th toe web 4th & 5th toes may also be affected Varied clinical presentation maceration of the interdigital space Associated with hyperhidrosis

Types: 1. Hyperkeratotic type present with chronic scaling, with fissuring over the sole, heal & sides of the foot moccasin configuration 2. Vesiculobullous type vesicles on toes & soles DDx: dyshidrotic eczema, contact dermatitis, psoriasis

TINEA CAPITIS
Common in children Fungi invade the hair cortex endothrix infection hair breakage broken hair stubs on a scaly patch black dot capitis or alopecia Ectothrix infection not much hair breakage highly inflammatory nodular, boggy erythematous swelling kerion

DDx: 1. alopecia areata bald spot smooth & non-scaly 2. seborrheic dermatitis 3. psoriasis alopecia is not common & scales are thicker 4. Trichotillomania neurotic compulsive hair pulling; broken stubs of hair at varying lengths

TINEA BARBAE
Dermatophytosis of the beard area Lesions are red, dry & scaly Usually highly inflammatory Similar to folliculosis DDx: sycosis barbae due to Staphylococcus

TINEA UNGUIUM
Also known as onychomycosis Causes accumulation of hyperkeratotic material under the nail, deformities & white discoloration of the nail plate with separation or lifting from the nail bed Toenails are commonly affected

TINEA FACIEI
Dermatophytosis of nonbearded areas of the face Lesions annular patch or plaque Papules & pustules may be present (acquired from household pets) DDx: allergic contact dermatitis, seborrheic dermatitis & discoid lupus erythematosus

TINEA MANUUM
Affects the interdigits, dorsa & palm of one or both hands Dry, hyperkeratotic scaling, fissuring with or without vesicles on the palms Annular lesions in the dorsa Occasionally hyperkeratosis of one palm may be associated with the same lesion on both soles two feet-one hand syndrome

TINEA IMBRICATA (TOKELAU)

Etiology: T. concentricum Common in the Pacific Islands Lesions: - concentric rings of red & scaly plaques Commonly located on the widespread of the trunk

EPIDEMIOLOGY

Tinea capitis is more common in children Tinea pedis is more common in adults Tinea capitis, pedis & cruris are more common in males Tinea unguium of the hand is more common in women Tinea unguium of the feet is more common in males

Microscopic Characteristics of Common Fungi

M. Furfur E. Wernickii M. Canis Spaghetti & meatballs Two-celled yeast (annelioconidia) Spindle-shaped, thick, rough-walled macroconidia (5-15 cells), w/ terminal knob & spiny tips Blunt terminal ends, thin, rough-walled conidia En grappe microconidia w/ coiled hyphae Teardrop or enthyrse microconidia; no macroconidia Antler nail-head hyphae or favic chandelier; no micro- or macroconidia Smooth, thin-walled macroconidia in clusters

M. Gypseum T. Mentagrophytes T. Rubrum T. Scheoenleinii E. floccosum

Macroconidia of Microsporum canis

Macroconidia of M. gypseum

Macroconidia of Epidermophyton floccosum

Micro and Macroconidia of Trichophyton mentagrophytes

rosette pattern of conidia in Sporothrix schenckii

TINEA CORPORIS

TINEA CORPORIS

TINEA UNGUIUM

TINEA PEDIS

TINEA PEDIS

TINEA FACIEI

TINEA CRURIS