Classification of Fungal Diseases

 Mycoses can be classified into the following Four Categories;

 Superficial mycoses,
 Cutaneous mycoses,
 Subcutaneous mycoses and
 Systemic mycoses.

Superficial Mycoses
 Are fungal infection of the outer surface of hair shafts and the outermost, non-
living layer of the skin (epidermis)

A. Pityriasis versicolor

B. Tinea nigra

C. Piedra: White piedra and Black piedra

A. Pityriasis versicolor

Causative fungal agent: Malassezia species (Malassezia globosa, Malassezia

restricta and other Malassezia furur complex)

 Is a chronic superficial infection of the stratum corneum

 Discrete,serpentine, hyper- or hypopigmented macules or patches occurs on the
skin usually on the chest, upper back, upper arm, or abdomen.
 May extend to – thigh, neck, forearms
 The condition can lead to discoloration of the skin, with color ranging white to
red to brown.
 With sunlight exposure the skin around the patches will tan, but the patches will
remain white.

Malassezia species

 are lipophilic yeasts and most require lipid in the medium for growth
  The organism is found in both the yeast (spore) stage and filamentous (hyphal)
form.
 Species of malassezia are considered part of microbial flora and can be isolated from
skin and scalp.
 They have been implicated as a cause of or contributor to seborrheic dermatitis or
dandruff.

Diagnosis

 Confirmed by direct microscopic examination of scrapings of infected skin,

treated with 10-20% potassium hydroxide (KOH) or stained with calcofluor white.
 This revealed hyphae and spherical cells are observed.
 Malassezia can look like spaghetti (hyphae) with meetballs (spherical yeast)
 The lesion also fluoresce under Wood’s lamp.

Treatment

 Daily application of selenium sulfide

 Topical or oral azoles are also effective

Epidemiology

 Occurs worldwide, more frequently in areas with a high temperature

Etiology

 Occurs in healthy individual with no immunologic deficiencies.

 Several factors predispose some people to develop this condition.; warm,
humid environment, immunosuppression, and malnutrition.

B. Tinea nigra

Causative fungal agent: Hortaea werneckii

 A chronic, superficial, usually asymptomatic infection of the stratum corneum.

 more prevalent in warm coastal regions and among young women
 the lesions appear as a dark (brown to black) (hyperpigmented) discoloration, often
on the palm.
  The sole and, more rarely, other areas of the body, can also be affected

Hortaea werneckii

 a dematiceous fungus – fungi whose cell walls contain melanin which imparts a
brown to black pigment.

Diagnosis

 microscopic examination of skin scraping from the periphery of the lesion will
reveal branched, septate hyphae and budding yeast cells with melaninized cell walls.

Treatment

 Keratolytic solutions, salicylic acid, or azole antifungal drugs.

C. PIEDRA

White piedra

Causative fungal agent: Trichosporon beigelii

 present as layer, softer, yellowish nodules on the hairs

 fungal infection of moustache, beard, pubic, and axilla hair. (usually on facial
and genital hair)
 hair follicles not affected

Black piedra

Causative fungal agent: Piedraia hortai

 fungal infection of scalp hair and, less commonly, eyesbrows and eyelashes
 hair follicles not affected

Laboratory Diagnosis

Direct examination:

KOH mount – white piedra

  sees only blastospores and arthrospores

KOH mount – Black piedra

 asci are found within the locules containing up to 8 ascospores

Treatment

 for both types consists of removal of hair and application of topical antifungal agent.
 Piedra is endemic in tropical underdeveloped countries

Cutaneous mycoses
 Caused by fungi that infect only the superficial keratinized tissue (skin, hair, and
nails).
 they are caused by molds collectively referred to as dermatophytes.

Three genera:

 Microsporum,
 Trichophyton, and
 Epidermophyton

 These fungi secrete an enzyme called keratinase, which digests keratin.

 Since keratin is the primary structural protein of skin, nails, and hair, the digestion
of keratin manifests as scaling of the skin, loss of hair, and crumbling of the nails.

Dermatophytoses classification

Anthropophilic species
 Causes the greatest number of human infection, cause relatively mild and
chronic infections in humans, produce few conidia in culture, and may be
difficult to eradicate.
 Some species are geography restricted, but others, such as
- Epidermophyton floccosum,
- Trichophyton mentagrophytes var interdigitale,
- T rubrrum, and T tonsurans, are globally distributed.
 Geophilic species and Zoophilc species
 Less adopted to human host, produce more acute inflammatory infections that
tend to resolve more quick.
 Most common Geophilic species causing human infections is Microsporum
gypseum.
 Zoophilic species (their natural hosts)-
- Microsporum canis (dog and cat)
- Microsporum gallinae (fowl)
- Microsporum nanum (pig)
- Trichophyton equinum (horse)
- Trichophyton verrucosum (cattle)

MORPHOLOGY AND IDENTIFICATION

 Identified by their colonical appearance and microscopic morphology after growth

for 2 weeks at 25°C on Sabouraud’s dextrose agar.

Trichophyton species - develop cylindric, smooth walled macroconidia

- infect hair, skin, or nail and characteristic microconidia

 T mentagrophytes - Display abundant grape-like clusters of

spherical microconidia on terminal branches.
- Coiled or spiral hyphae are commonly found in
primary isolates.
 T rubrum - Has a white, cottony surface and deep red,
nondiffusible pigment when viewed from the
reverse side of the colony.
 T tonsurans - The microconidia are small and piriform (pear-
shaped)
- Produce a flat, powdery to velvety colony on the
microconidia are the mostly elongate.
Microsporum species Tend to produce distinctive multicellular
Infect only hair and skin macroconidia with echinulate walls.
M canis A colony with a white cottony surface and a
deep yellow color on reverse; thick-walled,
8 to 15-celled macroconidia frequently
have curved or hooked tips.
M gypseum Produced a tan , powdery colony and
abundant thin-walled, 4 to 6-celled
macroconidia

Epidermophyton Epidermophyton floccosum

Infect only skin and nail but not hair The only pathogenic in this genus, produces
only macroconidia, which are smooth-
walled, clavate, 2 to 4-celled, and formed in
small clusters

General Characteristic of Macroconidia and Microconidia of Dermatophytes

Genus Macroconidia Microconidia

Microsporum Numerous thick-walled rough Rare
Epidermophyton Numerous, smooth-walled Absent
Trichophyton Rare, thin walled smooth Abundant

Clinical Findings
1. Tinea corporis (body)

 Invasion of the horny layer of the skin, the fungi spread ,forming a ring shape with
red , raised border.
 This expanding raised red border represents areas of active inflammation with a
healing center

2. Tinea pedis (athlete’s Foot)

 This infection commonly begins between the toes, and cause cracking and peeling of
the skin.
 Infection requires warmth and moisture, so occurs commonly in those wearing
shoes

3. Tinea cruris (jock it)(groin)

 Patients develop itchy red patches on the groin and scrutum

4. Tinea capitis (scalp)

 Primary occurs in children.

 The infecting organisms grow in the hair and scalp, resulting in scaly red lesions
with loss of hair
 Infection appears as an expanding ring

5. Tinea unguium (onychomycosis)

 The nails are thickened, discolored, and brittle

Host susceptibility may be enhanced by:

 Moisture, warmth, specific skin chemistry, composition of sebum and

perspiration, youth, heavy exposure, and genetic predisposition.

Diagnostic Laboratory Test

A. SPECIMEN:

 scrapings from the skin and the nails plus hair plucked from involved area

B. Microscopic Examination

 specimen are placed on a slide in a drop of 10-20% potassium hydroxide, with or

without calcofluor white, which is a nonspecific fungal cell wall stain viewed with a
fluorescent microscope.
 In skin or nails, regardless of the infecting species, branching hyphae or
chains of arthroconidia (arthrospore) are seen
 In hair, most Microsporum species form dense sheaths of spores around the
hair (ectothrix)
 T tonsurans and T violaceum are noted for producing arthroconidia inside the
hair shaft (endothrix)

C. Culture

 Inoculation onto inhibitory mold agar or Sabouraud’s agar slants containing

cyloheximide and chloramphenicol to suppress mold and bacterial growth,
 Incubated for 1-3 weeks at room temperature, and further examined in slide
cultures if necessary.

Treatment

Topical imidazoles – first-line drugs for treatment of dermatophytoses

Oral griseofulvin – used with Tinea capitis and Tinea unguium