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MIKOSIS SUPERFISIAL
DERMATOFITOSIS
MIKOSIS SUBKUTAN
Dr.Sofyan Lubis
Departemen Mikrobiologi
Fak.Kedokteran USU
2008
Pendahuluan
When fungi do pass the resistance barriers of
the human body and establish infections, the inf
ections are classified according to the tissue lev
els initially colonized
Superficial mycoses
Cutaneous mycoses (Dermatophytoses )
Subcutaneous mycoses
Systemic mycoses
Opportunistic mycoses
Levels of Invasion
Superficial Mycoses
There are a number of fungi capable of infecting
various superficial structure, including hair, nails,
stratum corneum of the skin, the cornea, and the
lining of the external ear canal
Epidemiology
Normal inhabitant of the superficial
epidermis and clusters around the
openings of hair follicles
Saprophytic on normal skin of trunk,
head, and neck
Sometime affecting more than 60% of
the population in some tropic
environments
Clinical features
The lesions are small hypopigmented or
hyperpigmented macules
Most common site : back, underarm,
upper arm, chest, neck
Most common in adolescent and young
adult males
Associated with increased sweating
http://www.mycology.adelaide.edu.au/Mycoses/Superficial/Malassezia_infections/index.html
Conidia of Phaeoannellomyces
werneckii
TINEA NIGRA
http://www.mycology.adelaide.edu.au/Mycoses/Superficial/Tinea_nigra/ind
Fungal keratitis
This is an infection on the surface of
cornea with usually follows an injury to
the eye.
The fungi involved are :
Fusarium solani,
Aspergillus fumigatus,
Candida albicans,
and several other genera of filamentous
fungi
canal
BLACK PIEDRA
Black Piedra
Micros.
Culture
Piedraia hortae
WHITE PIEDRA
Fungal infection of facial, axillary
or genital hair
Etiologic agent : Trichosporon
beigelii
Frequent in tropical and temperate
zones
White Piedra
Clin.findings
Microsc.
Culture
Treatment
White piedra
Black piedra
Cutaneous mycoses
Dermatophyosis
Cutaneous candidiasis
Dermatophytosis
Dermatophytosis (tinea or ringworm) is the
infection of keratinized structures, including
the nails, hair shafts, and stratum corneum
of the skin, by organisms of three genera of
fungi termed the dermatophytes :
Trichophyton
Epidermophyton keratophilic
Microsporum
DERMATOPHYTOSIS
(=Tinea = Ringworm)
Infection of the skin, hair or nails
caused by a group of keratinophilic
fungi, called dermatophytes:
Microsporum
: Hair, skin
Epidermophyton : Skin, nail
Trichophyton
: Hair, skin, nail
MICROSPORUM
(KUKUNO)
EPIDERMOPHYTON
(RAMBnO)
KULIT
KULIT
KULIT
RAMBUT
RAMBUT
KUKU
KUKU
II.
keratin.
Infection is transmitted by direct contact or
Dermatophytes ecology
Classified in to 3 categories
Geophilic : normally live in soil (e.g.,
M.gypseum)
Zoophilic : primarily parasitize the body
surfaces of animals but can transmitted to
humans (e.g., T.mentagrophytes, M.canis)
Arthropophilic : generally infect humans and
are transmitted between individuals
(e.g.,E.floccosum)
a. Trichophyton
b.Microsporum
canis
c.Epidermophyton
Epidermophyton floccosum
Microsporum
gypseum
Cutaneous Mycoses
Infections strictly confined to keratinized
epidermis (skin, hair, nails) are called
dermatophytoses - ringworm & tinea
39 species in the genera :
Trichophyton,
Microsporum,
Epidermophyton
Cutaneous Mycoses
http://www.mycology.adelaide.edu.au/Mycoses/Cutaneous/Dermatophytosis/index.html
Tinea Unguium
(dermatophyte onychomycosis)
usually caused by Trichophyton sp.
Tinea Barbae
Tinea Manuum
Trichophyton
Tinia unguium
Tinia Capitis
Tinea Corporis
Tinea capitis
Tinea corporis
Tinea capitis
Tinea capitis
Tinea barbae
Tinea cruris
SUBCUTANEOUS MYCOSES
Sporotrichosis
Chromoblastomycosis
Eumycotic mycetoma
Entomophthoramycosis
Phaeohyphomycosis
Rhinosporidiosis
Lobomycosis
SPOROTRICHOSIS
General features
Chronic inf. involving cutaneous,
subcutaneous and lymphatic tissue
Frequently encountered in
gardeners ,florists
May develop in otherwise healthy
individuals
Most common in Mexico, endemic in
Brasil
SPOROTRICHOSIS
Causative agent
Sporothrix schenkii
Natural habitat
: soil
Thermally dimorphic
Reservoir
Worldwide distribution
Soil, decaying vegetation
Transmission
Traumatic implantation
Inhalation ( ??? )
Occupational disease
Clinical
SPOROTRICHOSIS
Diagnosis
Samples: Aspiration fluid, pus, biopsy
1.Microscopic examination :
. Direct microscopic examination (KOH),
. Histopathological examination with
Gomori methenamine silver stain (GMS)
2.Culture
3.Serology :Yeast agglutination test
4.Sporotrichin skin test
Lab.diagnosis :
Direct microscopy
Poor sensitivity.
Sparse yeast cells, asteroid body
Culture
Good yield and grows on most media
Room temp for isolation & (37oC is slower:yeast
form)
Identification
A white to grey mold becoming moist
Hyaline hyphae, mixed hyaline/dematiaceous conidia
Need in vitro conversion to yeast
SPOROTRICHOSIS
Treatment
Spontaneous healing is possible.
Cutaneous inf.: Potassium iodide (KJ)
(Topical/oral)
Disseminated inf.: Amphotericin
Sporothrix schenckii
Sporothrix schenckii
Sporothrix schenckii
Laboratory diagnosis
Direct
examination
Sporothrix schenckii
Laboratory diagnosis
Culture
Conversion
of mycelial
phase to yeast phase
Sporothrix schenckii
Mycelial form
Conidia forming
a rosette-like
Sporothrix schenckii
Yeast form
Round,
oval and
fusiform budding
yeast cells of
various sizes 2-3 x
3-10 m
Cigar-bodied
Sporothrix schenckii
Sporotrichosis
Subcutaneous,
pulmonary sporotrichosis
Scattered worldwide
Cutaneous
sporotrichosis
Sporotrichosis
CHROMOBLASTOMYCOSIS
General features
Reservoir and transmission
Traumatic implantation from decaying vegetation, but
chronicity dictates that it is uncommon in developed
countries.
Chromoblastomycosis
Classified by presence of fungal tissue form &
clinical presentation, not etiologic agent
Etiologic agents: - any dematiaceous fungi, e.g.
Cladosporium verrucosa
Fonsecaea compacta,
Fonsecaea pedrosoi,
Phialophora carrionii
Rhinocladiella aquaspersa.
Chromoblastomycosis :
Pigmented (dematiaceous) fungi in soil
Arrangement and shape of the spores
vary from one genus to other
Tissue form is SCLEROTIC BODY
Dematiaceous thick walled yeast cell
Non budding, but multiplane septation
Chromoblastomycosis
Phialophora verrucosa
CHROMOBLASTOMYCOSIS
Lab. Diagnosis
Direct microscopy
Sclerotic bodies (usually easily seen)
Occasional hyphae
Culture
Will grow on most media (some are
cycloheximide resistant )
Slow growing (4-6 wks)
Dark velvety colonies (similar)
Contamination can be a problem
Chromoblastomycosis :
Identification
Sclerotic cells are identical for all etiologic
agents
No dimorphism in vitro
Complex and variable conidiation
Fonsecae, phialophora, rhinocladiella, cladosporia
Chromoblastomycosis
CHROMOBLASTOMYCOSIS
TREATMENT
Surgery
Antifungal therapy (susceptibility
varies depending on the genus)
Amphotericin B
Flucytosine
Ketoconazole
Heat
MYCETOMA
(=Maduromycosis=Madura foot)
Common in tropical climates
Posttraumatic chronic inf. of
subcutaneous tissue
Causative agents
o Saprophytic fungi (Eumycetoma)
o Actinomyces (Actinomycetoma)
MYCETOMA
Eumycetoma
Actinomycetoma
Dark grains
White-yellow grains
Madurella mycetomatis
Leptospharia senegalensis
Exophiala jeanselmei
Actinomadula madurae
Nocardia brasiliensis
Pale grains
Streptomyces somaliensis
Fusarium sp.
Acremonium sp.
Scedosporium
apiospermum
Red-pink grains
Yellow-brown grains
Actinomycetoma pelletieri
MYCETOMA
Clinical findings
Variable incubation period.
Swelling hard and painless
Local spread to contiguous tissue
Eventual sinus formation and drainage
Location of lesions linked to exposure
Male to female is 3:1
Therapy is poor for eumycotic but slightly better for
actinomycotic.
SYMPTOMS
swelling
suppurating abscesses
granulomas
Sinuses
MYCETOMA
Diagnosis
Clinical findings are nonspecific
Identification of the infecting
fungus is difficult
Criteria used for identification:
Characteristics of the granule,
Colony morphology, and
Physiological tests
Diagnosis..
Recover granules : black, red, white
Squash prep. microscopy
2-6um
= fungal,
<0.5 um = actinomycetes
EUMYCETOMA
Treatment
Surgery
Antifungal therapy
Amphotericin B
Flucytosine
Topical nystatin
Topical potassium iodide
(choice of treatment varies
according to the infecting fungus)
Mycetoma
Mycetoma
Mycetoma
Mycetoma
Phaeohyphomycosis
Caused by a number of dematiaceous
(brown-pigmented) fungi where the tissue
morphology of the causative organism is
mycelial
Sclerotic bodies ( - )
NB: Chromoblastomycosis : sclerotic
bodies (+).
Causative agents :
Exophiala, Phialophora, Wangiella,
Bipolaris, Exserohilum, Cladophialophora ,
Phaeoannellomyces, Aureobasidium, Clad
osporium, Curvularia and Alternaria
Clinical forms of
Phaeohyphomycosis
Clinical forms range from:
localized superficial infections of the
stratum corneum (tinea nigra)
to subcutaneous cysts
phaeohyphomycotic
cyst
to invasion of the brain.
Rhinosporidiosis
Chronic infection
In divers
Polypoid masses at nasal mucosa,
conjunctiva, genitalia and rectum
Rhinosporidiosis
Chronic infection of nasal
and other mucosal
surfaces
Rhinosporidium seeberi
It is a protozoan that has
not been isolated in
culture
It is characterized by the
appearance of large
vegetable outgrowths
containing sporangia
RHINOSPORIDIOSIS
Causative agent
Rhinosporidium seeberi
Natural reservoir: fish, aquatic insects
Spherules ( large sporangia ) filled with
endospores (in tissue)
Has not been cultured in vitro on
artificial media
Endemic in Ceylon and India, but seen in
Argentina and Brazil.
Diagnosis Lab.
Rh.seeberi belum dapat dibiakkan
secara in vitro di lab. sehingga deskripsi
morfologiknya adalah berdasarkan
kepada appearance organisme ini di
jaringan tubuh terinfeksi yaitu :
DIAGNOSIS LABORATORIUM
Histopatologi : H & E stain :
#
TROPHOCYTE
SPORANGIA
RHINOSPORIDIOSIS
Treatment
Ethylstilbamidine
Surgery
(Local injection)
Rhinosporidiosis
Lobomycosis
LOBOMYCOSIS
Pathogenesis & Clinical features
Chronic, subcutaneous, progressive inf.
Traumatic inoculation of the fungus
Natural infection : in dolphins
Hard, painless nodules on extremities,
face and ear
Verrucous / ulcerative lesions
Lesions mimic those of chromoblastomycosis, mycetoma, Carcinoma.
LOBOMYCOSIS
Causative agent
Loboa loboi ( Lacazia loboi )
Multiple budding yeast cells
Forming short chains
Asteroid body
Has not been cultured in vitro on
artificial media
Lobomycosis
Lobomycosis
Lobomycosis
Diagnosis Lab.
Dengan pewarnaan GMS dan PAS ,
dan H&E :thick doubly contoured
hyaline cell wall dengan lebih satu
haematoxylinophilic nuclei
Loboa loboi
Morfologi dan pola dari budding
L.loboi ini harus dibedakan dari :
P.brasiliensis ( multiple buds)
B.dermatitidis dan H.capsulatum
var,duboisii ( tidak dijumpai chains of
cells)
S.schenckii dan H.capsulatum
var.capsulatus ( ukuran lebih kecil)
Lacazia loboi : belum dapat di kultur in
vitro.
LOBOMYCOSIS
Treatment
Surgery
Clofazimine
Amphotericin B
Sulphonamides
Entomophtoramycosis
Subcutaneous zygomycosis
Caused by entomophthorale
Basidiobolus coronatus : Basidiobolomycosis
Conidiobolus ranarum : Conidiobolomycosis
Entomophthoramycosis
Candidiasis
Thrush
Vaginal
Chlamydospores of C.albicans
Dont Litter
Keep our class
clean
Candidiasis
Thrush
Vaginal
Cutaneous Mycoses
Infections strictly confined
to keratinized epidermis
(skin, hair, nails) are called
dermatophytoses ringworm & tinea
39 species in the genera
Trichophyton, Microsporum,
Epidermophyton
Communicable among
humans, animals, & soil
Infection facilitated by
moist, chafed skin