DERMATOPHYTOSIS

Elmer W. Koneman, M. D.
University of Colorado School of Medicine
Romanian Society of Laboratory Medicine
2008 Congress -- Bucharest, Oct. 20 22
COMMON DERMATOPHYTES

Genus Microsporum
Microsporum canis
Microsporum gypseum
Genus Trichophyton
Trichophyton mentagrophytes
Trichophyton rubrum
Trichophyton tonsurans
Trichophyton verrucosum
Genus Epidermophyton
Epidermophyton floccosum
THE DERMATOPHYTOSES
CUTANEOUS MANIFESTATIONS: TINEA CORPORIS
The lesions illustrated
here are still annular and
demarcated, but
distinctly spreading.
Illustrated are multiple, annular,
sharply marginated lesions with
a raised borderthus the name
ringworm. Skin scrapings for
examination and culture should
be taken from the active outer
margin of growth.
THE DERMATOPHYTOSES
CUTANEOUS MANIFESTATIONS: TINEA CORPORIS
Illustrated in the
photograph is an
inflammatory type of
dermatophytosis with
erythema prominently
displayed.
The lesions here are
distinctly vesicular
with several bullae
clearly visible.
THE DERMATOPHYTOSES
TINEA CAPITIS CLINICAL VARIATIONS
Illustrated is a well-
demarcated area of
hair loss (alopecia)
with mild
inflammation of the
exposed skin.
A more chronic
manifestation of a
circular area of alopecia
that seen upper left,
with surface crusting.
THE DERMATOPHYTOSES
CUTANEOUS MANIFESTATIONS: TINEA CORPORIS
.
Progressive alopecia
(favus) and mild
inflammation
involving the major
portion of the scalp.
Illustrated is the so-called
black dot type of tinea
capitus in which
endothrix-infected hair
shafts break off just above
the surface leaving tiny
black crusts.
THE DERMATOPHYTIC FUNGI
Tinea capitis/corporis and Microsporum canis
Close-in view of scalp
illustrating a
circumscribed area of
alopecia, a picture
consistent with tinea
capitis. M. canis was
recovered in culture.
Close-in view of scalp
illustrating a
circumscribed area of
alopecia, a picture
consistent with tinea
capitis. M. canis was
recovered in culture.
THE DERMATOPHYTIC FUNGI
Tinea manuumDirect presumptive diagnosis
Chronic tinea manuum
infection illustrating
extensive involvement of
the palm of the hand with
scaling and mild erythrma.
Itching is often intense.
10% potassium hydroxide mount
of exfoliated skin scales from a
suspected dermatophyte
infection (left frame). Note the
distinct hyphal strands, that
segment into arthroconidia.
THE DERMATOPHYTIC FUNGI
Microsporum canis
Reverse of colony orange to yellow
Spindle-shaped, some with curved beak
Macroconidia large, rough-walled, many- celled;
microconidia few or absent
Microscopic Identification
From Mycobiotic or Cornmeal Agars
Microsporum canis
THE DERMATOPHYTIC FUNGI
Microsporum canis: Culture characteristics
The colony illustrated here
is cottony. Characteristic
of M. canis is an outer
apron with a lemon-yellow
pigmentation, that can be
observed also on the
reverse of the colony.
Illustrated are multi-
celled, spindle-shaped
macroconidia, each
with a tapered outer
cell, and a break-
away hilar cell (arrow).
The conidia wall is
thickened and rough.
THE DERMATOPHYTIC FUNGI
Microsporum canis: Laboratory Identification
Illustrated are two views of the cottony
colonies with the outer lemon-pigmented
apron characteristic of M. canis.
THE DERMATOPHYTIC FUNGI
Microsporum canis: Laboratory Identification
Illustrated are several spindle-shaped
macroconidia of M. canis. Note that the
terminal cell is tapered and slightly
diplaced to one side (arrows).
THE DERMATOPHYTIC FUNGI
Microsporum canis: Clinical Correlation
Microsporum canis is world-wide in distribution
The major natural reservoir for M. canis is cats and dogs
M. canis most commonly produces tinea capitis and tinea
corporis ringworm type infections in humans
Hair invasion is ectothrix in type
The lesions tend to be inflammatory and generally resolve
without progressing to chronic infections
Other animals may be infected with different species:
M. canis var. distortum is found in rural areas of New
Zealand and Australia, with monkeys serving as host
M. canis, var. obesum is also native to monkeys an
apes
M. canis, var. equinum has been recovered primarily
from horses
THE DERMATOPHYTIC FUNGI
Microsporum gypseum
Microsporum gypseum
Colony cinnamon-colored
Spindle-shaped, rounded ends
Macroconidia large, rough-walled, many-celled
microconidia few or absent
Microscopic Identification
From Mycobiotic or Cornmeal Agars
THE DERMATOPHYTIC FUNGI
Tinea corporis and Microsporum gypseum
Immature colony of M.
gypseum after 3 days at
30
o
C. The granular
surface indicates sporu-
lation. The cinammon-
yellow pigment is typical.
Mature colony of M.
gypseum illustrating a
powdery (sportulating)
surface and cinammon-
buff pigmentation.
Macroconidia of M.
gypseum. Note the oval
outline and the rounded
terminal cell, in contrast to
the tapered structure of the
macroconidia of M. canis.
THE DERMATOPHYTIC FUNGI
Microsporum canis: Laboratory Identification
THE DERMATOPHYTIC FUNGI
Microsporum gypseum: Clinical Correlation
Microsporum gypseum is commonly recovered from soil
throughout the world
M. gypseum, similar to M. canis, produces tinea capitis and
tinea corporis ringworm type infections in humans
Hair invasion is ectothrix in type with the arthroconidia
arranged in chains
The lesions tend to be inflammatory and may become
vesicular or pustular, with rapid development and resolution
Other animals that may be infected and serve as sources of
infections for humans include cats, dogs, rodents, horses,
and monkeys
THE DERMATOPHYTIC FUNGI
Trichophyton mentagrophytes
Tri chophyton mentagrophytes
grape-l i ke clusters of round microconidia,
few spiral hyphae may be present on CMA
Posi ti ve
Urea Agar
Star-shaped col onies on Potato Dextrose Agar
Many mi croconi di a; smooth,elongated macroconidia few or absent
Mi croscopic I dentifi cati on
From Mycobioti c or Cornmeal Agars
THE DERMATOPHYTIC FUNGI
Trichophyton mentagrophytes: Laboratory Diagnosis
Inflammatory type of
dermatophytosis,
commonly observed in
infections caused by
Trichophyton
mentagrophytes.
Young colony of
Trichophyton
mentagrophytes
illustrating a smooth to
floccose white surface.
THE DERMATOPHYTIC FUNGI
Trichophyton mentagrophytes: Laboratory Diagnosis
Mature colony of T.
mentagrophytes after 5 days
incubation at 30
o
C. This colony
becomes more floccose to
granular indicating sporulation.
Trichophyton mentagrophytes
produces many microconidia that are
spherical, uniform in size, and
aggregate in loose clusters. Macro-
conidia are few or absent.
THE DERMATOPHYTIC FUNGI
T. mentagrophytes: Laboratory Features in Review
A. A fluffy colony of T.
mentagrophytes, with a
slight tinge of reddish
pigmentation at the
periphery. The micro-
scopic morphology (B)
supports this identifi-
cation. The diagnosis is
confirmed by evidence
of invasion of a hair
shaft in the hair penetra-
tion test shown by the
arrow (C) and the strong
positive urease test
(diffuse red pigmenta-
tion) in Frame D.
THE DERMATOPHYTIC FUNGI
Trichophyton mentagrophytes:
Clinical Correlation
Trichophyton mentagrophytes is comopolitan and among the
most commonly recovered dermatophyte from humans and
animals.
T. mentagrophytes produces inflammatory lesions of tinea
capitis, tinea corporis, tinea unguium, and tinea barbae
infections in humans
T. mentagrophytes is the usual etiologic agent of ringworm
infections in labodratory animals and humans in the US.
Hair invasion is small spore ectothrix type
In tinea unguium infections, invades the nail plate, causing
white-spot nail diseaseT. mentagrophytes
THE DERMATOPHYTIC FUNGI
Tri chophyton rubrum
Tear-shaped mi croconi di a
produced along hyphae
Red pi gment on Corn Meal Agar
Negati ve
Urea Agar
Many mi croconi di a; smooth,elongated macroconidia few or absent
Mi croscopic I dentifi cati on
From Mycobioti c or Cornmeal Agars
Trichophyton rubrum
THE DERMATOPHYTIC FUNGI
Photograph of mild
chronic tinea pedis
infection with scaling
and mild erythrma.
Itching is often intense.
Tinea unguium begins
with the accumulation
of subungual debris
under the leading edge
of the nail, or along the
sides. The nail
becomes thickened,
chalky or yellow, often
showing signs of
cracking.
Tinea unguium may
continue until the entire
nail is involved.
Loosening of the distal
nail may occur,
potentially with detach-
ment. Infection of the
adjacent skin
(paronychia) is evident
in this photograph.
Tinea rubrum: Clinical Infections
THE DERMATOPHYTIC FUNGI
Trichophyton rubrum: Laboratory Features
Photomicrographs of colonies of T. ruburm after 5 days
incubation at 30
o
C on Sabourauds dextrose agar. The surface of
the colony (left frame) is flat and yellow-buff. Note the intense
red water-soluble pigment produced by the isolate shown in the
center frame. This characteristic pigment production (rubrum)
may be best observed on the reverse side (right frame).
THE DERMATOPHYTIC FUNGI
Trichophyton rubrum: Laboratory Features
The hyphae are hyaline,
septate, and delicate.
Diagnostic is the production
of uniform, tiny, spherical
microconidia that line up in a
birds- on-a-fence arrange-
ment along the hyphal strand.
Macroconidia may be
observed. They are multi-
celled, long and pencil
shaped with a thin, smooth
wall, in contrast to the
thick-walled, rough conidia
seen with Microsporum sp.
THE DERMATOPHYTIC FUNGI
Trichophyton rubrum: Clinical Correlation
Trichophyton rubrum is a common anthropophilic species and
has become the most frequent etiologic agent of
tinea cruris, tinea corporis, tinea pedis, and tinea manuum
infections in humans throughout the world
Hair invasion is uncommon but may be endothrix in type,
serving as a reservoir for repeated exacerbations of disease
The infection with T. rubrum is often chronic, and some
individuals become lifetime carriers.
In tinea unguium infections, T. rubrum does not invade the nail
plate
THE DERMATOPHYTIC FUNGI
Tri chophyton tonsurans
Tri chophyton Agar 4
enhanced growth
Ball oon-shaped, pl eomorphi c mi croconi di a
produced along hyphae
No red pi gment on Corn Meal Agar
Negati ve
Urea Agar
Many mi croconi di a; smooth,elongated macroconidia few or absent
Mi croscopic I dentifi cati on
From Mycobioti c or Cornmeal Agars
Trichophyton tonsurans
THE DERMATOPHYTIC FUNGI
Tinea capitis/corporis and Trichophyton tonsurans
T. tonsurans may cause both tinea capitis and tinea corporis.
Tinea capitis is of the black-dot type, with black points of
crusting where the endothrix-invaded hair shaft has fractured
above the skin surface (left frame). Tinea corporis (right
frame) is usually erythematous and spreads with a distinct
outer border. Such infections are contagious and can be
spread through human to human contact.
THE DERMATOPHYTIC FUNGI
Trichophyton tonsurans: Laboratory Identification
The colony of T. tonsurans is
relatively slow growing ( 5 7
days). It is thiamine dependent
and will not grow on
Trichophyton #1 agar. It has a
distinctive buff-brown, granular
surface, often with radial rugae.
The identification can be made by
observing delicate hyphae that
produce birds on a fence
conidia along the sides (similar to
T. rubrum); however, those of T.
tonsurans are larger, irregular in
size, with balloon and club forms.
THE DERMATOPHYTIC FUNGI
Trichophyton tonsurans: Clinical Correlation
Trichophyton tonsurans is an anthropophilic species causing
tinea capitis and tinea corporis, the latter being spreading in
type and contagious via direct human contact
T. tonsurans is worldwide in distribution and is particularly
prevalent in Mexico and other Latin American countries
T. tonsurans less commonly causes tinea pedis and tinea
unguium infections
In cases of tinea capitis, hair invasion is common, and
endothrix in type, with the invaded hairs tending to break
near the surface of the scalp, resulting in a black dot
appearance

THE DERMATOPHYTIC FUNGI
Trichophyton verrucosum
Enhanced growth on Trichophyton 4
Colonies very slow growing; heaped colonies;
colonies partially submerged,smooth without
aerial hyphae
Colony white and wrinkled;
may be ochre colored or pale yellow
Conidia not usually produced, small hyphae seen
Microscopic Identification
From Mycobiotic or Cornmeal Agars
Trichophyton verrucosum
THE DERMATOPHYTIC FUNGI
Trichophyton verrucosum: Laboratory Features
T. verrucosum is slow-growing,
requiring 10 20 days for colonies
to reach maturity. The colonies
appear white with a smooth
surface. Growth is enhanced in
Trichophyton agars #3 and #4,
which contain inositol and
thiamine, serving as growth
supplements respectively.
Sporulation is poor and both
macroconidia and microconidia are
usually absent in microscopic
preparations. Observed instead
are most commonly only
branching antler-like hyphae
(upper left) and/or chains of
chlamydospores (right frame).
THE DERMATOPHYTIC FUNGI
Microsporum verrucosum: Clinical Correlation
Microsporum verrucosum is a cosmopolitan zoophilic species
serving as a principal cause of ringworm in cattle
Humans most commonly contract M. verrucosum infections
directly from cattle.
Tinea barbae in the past has been a common manifestation as
a result of hand-milking of infected cows
The lesions are inflammatory, usually on the scalp or face,
often appearing as sycosis (inflammation of hair follicles) of
the lips and chin
Invasion of hair is large-spored ectothrix type and
arthroconidia are produced in chains on the hair shaft.
THE DERMATOPHYTIC FUNGI
Epidermophyton floccosum
Colony khaki colored with white areas
Large, smooth-walled, club-shaped conidia
arranged singly or in clusters of two or three
Microscopic Identification
From Mycobiotic or Cornmeal Agars
Epidermophyton floccosum
THE DERMATOPHYTIC FUNGI
Epidermophyton floccosum: Clinical/Colony Presentations
Common cause of tinea cruris.
Infections more common in men
involving the groin, perineum,
scotum, and perianal area. Lesions
are erythematous, spreading, and
hyperpigmented. The margin is
usually well delineated.
Colony growth is observed
in 5 14 days at 30
o
C on
Sabourauds dextrose agar.
The surface is typically
granular, with a khaki
pigment when mature. The
reverse of the colony is
devoid of pigmentation.
THE DERMATOPHYTIC FUNGI
Epidermophyton floccosum: Microscopic Features
The macroconidia of E. floccosum are large, smooth-walled,
multiseptate and clavate, often borne in clusters of two or three.
Microconidia are not produced. In contrast, the macroconidia
of Microsporum gypseum (frame to the right) have a thick,
roughened cell wall and microconidia are observed.
THE DERMATOPHYTIC FUNGI
Microsporum nanum
Colony is white-yellow-pink;
red-brown reverse
pear or egg-shaped; clavate microconidia may be seen
Macroconidia smaller, rough-walled, 1-3- celled;
microconidia few or absent
Microscopic Identification
From Mycobiotic or Cornmeal Agars
Microsporum nanum
THE DERMATOPHYTIC FUNGI
MICROSPORUM NANUM/TRICHOPHYTON AJ ELLOI
Trichophyton ajelloi
M nanum is a geophilic species causing
ringworm in pigs. Human infections are
uncommon, but cases of tinea capitis have
been reported.
The colonies are rapidly growing, initially
white, and later turning a buff color as
conidia are formed (left frame).
The conidia are small, oval to elliptical,
usually with two cells, covered by a thick,
rough outer wall (frame to right).
T. ajelloi is a soil fungus that
has been recovered as a
commensal from human skin.
Colonies grow rapidly and are
buff colored with production of
purple pigment.
Microscopically, long, fusiform-
to-cylindrical, thick-walled
macroconidia are produced,
possessing from 5-12 cells.
Microconidia may be observed.
Miscellaneous: TINEA VERSICOLOR
Malassizia furfur
Malasseizia furfur is a fungus that
causes superficial skin infections
that present as macular or scaly
spots ranging in color from yellow-
brown to dark brown, interspersed
with areas of discoloration (left
upper frame). Diagnostic is the
microscopic observation in KOH
mounts of skin scrapings (left
lower frame) of short, 3um in
diameter abortive hyphae, and
clusters of spherical, 4 8um in
diameter conidia , simulating
sphagetti and meat balls. M.
furfur is lipophilic and grows on
the agar surface as yellow-white
yeast-like colonies only in the drip
areas where olive oil is present
(photograph to the right).
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