1. 2. 3. 4. 5.

The Superficial Mycoses The Cutaneous Mycoses The Subcutaneous Mycoses Dimorphic Systemic Mycoses Opportunistic Systemic Mycoses

 These are superficial cosmetic fungal infections of the skin or hair shaft. No living tissue is invaded and there is no cellular response from the host. Essentially no pathological changes are elicited. These infections are often so innocuous that patients are often unaware of their condition.

 Caused by Malassezia furfur. Infects the stratum corneum epidermidis and causes hypopigmentation or hyperpigmentation on the trunk of the body. Scaly patches of skin fluoresce with Woods lamp.

 The diagnosis is confirmed by direct microscopic examination of scrapings of infected skin, treated with 10 20% KOH or stained with calcofluor white. Characteristic spaghetti and meatballs morphology is observed microscopically. Blunt ended short hyphae and clusters of spherical spores.

 A lipid oil overlay is required for culture because Malassezia species are lipophilic yeasts, and most require lipid in the medium for growth. Treated with daily applications of selenium sulfide. Topical or oral azoles are also effective.

 Superficial infection of the stratum corneum epidermidis caused by the dermatiaceous fungus, Exophiala werneckii. The infection is characterized by brown to black, non-scaly patches on the palms of the hands.

 Black, yeasty colonies develop short olive gray mycelia with age. Microscopically, dark septate hyphae with one- or two-celled blastoconidia are demonstrated in clusters along the hyphae. The fungus hydrolyzes casein. Treated with keratolytic solutions, salicylic acid, or azole antifungal drugs.

 Infection of the hair shaft that produces hair breakage.

Treatment is cutting or shaving infected hairs and use of topical antifungals.

Infections may disseminate in immunocompromised individuals.

 Caused by Trichosporon beigelli. Forms soft, light brown nodules around the beard and mustache hairs. Microscopically, the fungus demonstrates hyaline hyphae with blastospores and arthrospores on CMT 80 agar; crushed nodules in KOH show hyaline hyphae and arthrospores.

Caused by Piedraia hortae

Forms firmly attached hard, black nodules around the outside of scalp hairs. Microscopically, it produces dark thick-walled hyphae with swellings (chlamydospores) in culture; crushed nodules in KOH preparation show numerous oval asci, containing 2-8 aseptate ascopores which are spindle-shaped (fusiform) and have a filament at each pole.

Caused by fungi that infect only the superficial keratinized tissue (skin, hair, and nails).

 Usually caused by dermatophytes (infect only the superficial keratinized tissue - skin, hair, and nails) belonging to the 3 genera:

o o o

Microsporum- affects skin and hair Trichophyton- affects skin, hair and nails Epidermophyton- affects skin and nails

Dermatophytes are unable to grow at 37 C or in the presence of serum. Some cutaneous mycoses can also be caused by Candida species. No living tissue is invaded, however a variety of pathological changes occur in the host because of the presence of the infectious agent and its metabolic products.

Infections are commonly referred to as tinea infections or dermatophytoses.

Ringworm is another dermatophytic infections. name for

Dermatophytes are classified depending on whether their usual habitat:

Geophilic soils Zoophilic animals Anthropophilic humans

Geophilic soils Microsporum gypseum

Zoophilic - animals Microsporum canis (dogs and cats) Microsporum gallinae (fowl) Microsporum nanum (pigs) Trichophyton equinum (horses)

Anthropophilic humans Epidermophyton floccosum Microsporum audouinii Trichophyton mentagrophytes var interdigitale

Trichophyton verrucosum (cattle)

Trichophyton mentagrophytes var mentagrophytes (rodents)

Trichophyton rubrum
Trichophyton schoenleinii Trichophyton tonsurans Trichophyton violaceum

Disease

Causative organisms

Incidence

Dermatophytosis Ringworm of the scalp, glabrous skin and nails.

Dermatophytes (Microsporum, Trichophyton, Epidermophyton)

Common

Candidiasis of skin, mucous membranes and nails.

Candida albicans and related species.

Common

Dermatomycosis

Non-dermatophyte moulds Hendersonula toruloidea Scytalidium hyalium Scopulariopsis brevicaulis

Rare

Tinea is transmitted via the feet by desquamated skin scales in substrates like carpet and matting .

Tinea of the nails caused by T. rubrum

Sub-mammary tinea corporis caused by E. floccosum

Tinea of the beard "Tinea barbae" caused by T. rubrum

Diagnosis is made by macroscopic and microscopic observations of the fungi and location of the infection in the body. Dermatophytes are identified by their colonial appearance and microscopic morphology after growth for 2 weeks at 25 C on Sabouraud's dextrose agar.
Microscopically, the fungi demonstrate microconidia and macroconidia. Both conidia types or only one type may be demonstrated by a fungus.

 may infect hair, skin, or nails develop cylindric, smooth-walled macroconidia and characteristic microconidia. Infected hair does not fluoresce using Woods lamp.

Tend to produce distinctive multicellular macroconidia with echinulate walls .

Both types of conidia are borne singly in these genera.

 These are chronic, localized infections of the skin and subcutaneous tissue following the traumatic implantation of the etiologic agent.
The causative fungi are all soil saprophytes of regional epidemiology whose ability to adapt to the tissue environment and elicit disease is extremely variable.

Disease

Causative organisms

Incidence

Sporotrichosis

Sporothrix schenckii

Rare

Chromoblastomycosis

Fonsecaea, Phialophora, Cladosporium etc.

Rare

Phaeohyphomycosis

Cladosporium, Exophiala, Wangiella, Bipolaris, Exserohilum, Curvularia

Rare

Mycotic mycetoma

Pseudallescheria, Madurella, Acremonium, Exophiala etc.

Rare

Subcutaneous zygomycosis (Entomophthoromycosis)

Basidiobolus ranarum Conidiobolus coronatus

Rare

Subcutaneous zygomycosis (Mucormycosis)

Rhizopus, Mucor, Rhizomucor, Absidia, Saksenaea etc.

Rare

Rhinosporidiosis

Rhinosporidium seeberi

Rare

Lobomycosis

Loboa loboi

Rare