cutaneous mycoses - khon kaen university
TRANSCRIPT
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ผศ. กญัญลกัษณ์ ชัยค ำภำ
Fungal infection of skin
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Superficial mycoses
Pityriasis versicolor
Cutaneous mycoses
Dermatophytoses
Candidiasis
Subcutaneous mycoses
Mycetoma
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Objectives
• Etiologic agent of infection
• Sign and symptoms
• Characteristic appearance
• Lab diagnosis
• Prevention and treatment
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1. Pityriasis (Tinea) versicolor (เกล้ือน)
chronic, superficial fungal disease of the skin
Fungus Malassezia furfur
at least 20 different Malassezia spp. recognized
currently
M. furfur ***
M. globosa ***
M. sympodialis ***
M. slooffiae
M. restricta
M. obtusa etc.
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Hypopigment lesion
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Pityriasis or Tinea versicolor (เกลือ้น)
Fungus : normal flora
Factors effect invasive power
-squamous cell turnover rate
-sweaty / oily skin
-extracellular glycogen
-poor hygiene
-corticosteroids / antibiotics
symptoms small macule on chest, back, arm, neck
usually no inflammation, no itch
Most common in adolescent and young adult males
Stratum corneum Hypopigment Hyperpigment
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Pityriasis foliculitis
Dandruff (= Pityriasis capitis)
– caused by M. globosa
– accellerated shedding of skin cells
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Lab diagnosis
Direct examination
10-20% KOH
budding yeast, short hyphae
Culture
lipophilic yeast (Suppl.: olive oil)
Treatment
mild fungicidal / keratolytic agent
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Tissue form / parasitic form
“ spaghetti & meatballs ”
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2. Dermatophytoses (กลาก)
Ringworm, Tinea
Dermatophytes or keratinophilic fungi
3 genera
• Trichophyton
• Microsporum
• Epidermophyton
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2. Dermatophytoses
Ringworm, Tinea
Dermatophytes or keratinophilic fungi
3 genera
Genus Macroconidia Microconidia
Trichophyton Pencil +++
Microsporum Spindle ++
Epidermophyton Club absent
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Dermatophyte Origin Fungi
Geophilic soil M. gypseum
Zoophilic animal M. canisT. mentagrophyte
Anthropophilic human T. rubrumE. floccosum
“active border”
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Diseases named by lesion site
Tinea capitis Tinea corporis
Tinea faciei Tinea cruris
Tinea barbae Tinea manuum
Tinea unguium Tinea pedis
Tinea imbricata Tinea favosa
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Tinea capitis
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Tinea corporis
Tinea faciei
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Tinea cruris Tinea barbae
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Tinea unguiumTinea manuum
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Tinea pedis
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Tinea imbricata
Tinea favosa
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Lab diagnosis
1. Direct exam. 10% KOH
branching septate hyphae
arthrospore
2. Culture 25oC
SDA= Sabouraud’s dextrose agar
Mycosel= SDA+ chloramphenicol+
cycloheximide
Slide culture
Treatment : Griseofulvin, azoles
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Tissue form
Slide culture
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3. Candidiasis ( Candidosis )
Fungus: genus Candida -- “yeast-like fungi”
-Yeast
-Blastospore
-True hyphae
-Pseudohyphae
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3. Candidiasis ( Candidosis )
Fungus: genus Candida -- “yeast-like fungi”
spp.---- C. albicans (90%), C. tropicalis,
C. glabrata, C. dubliniensis etc.
Source: normal flora, H2O, soil, food
opportunistic infection
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Disease caused by Candida spp.
1. Mucocutaneous candidiasis
-oral thrush
-vaginal candidiasis
-candidal balanitis
2. Cutaneous candidiasis
-skin
-nail
( 3. Systemic candidiasis )
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Candidiasis
Oral thrush
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Paronychia
Onychomycosis
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Virulence factors of Candida - Adhesins- Yeast-hypha transition - Hydrolytic enzyme : proteinase, phospholipase etc.- Phenotypic switching
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Yeast-hypha transition
germ tube
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Phenotypic switching
in
Candida albicans
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Switching
White
Opaque
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Stages of a Candida infection
adhesion & colonisation
epithelial penetration
vascular dissemination
endothelial colonisation and penetration
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Lab diagnosis
1. Direct exam. KOH preparation, Gram’s stain
2. Culture SDA (chloramphenicol) 37oC
Yeast colony
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Lab diagnosis
1. Direct exam. KOH preparation
Gram’s stain
2. Culture SDA (chloramphenicol) 37oC
Presumptive test for C. albicansGerm tube formation
plasma 37oC, 2-3 hrs.
Terminal chlamydospore
Corn meal agar + Tween 80
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Germ tube
Terminal chlamydospore
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Lab diagnosis
1. Direct exam. KOH preparation
Gram’s stain
2. Culture SDA (chloramphenicol) 37oCnon-albicans Candida spp.
Germ tube formation
plasma 37oC, 2-3 hrs.
Terminal chlamydospore
Corn meal agar + Tween 80
Biochemical test
Treatment : Nystatin, Amphotericin B, Azoles
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4. Mycetoma
tumefaction
draining sinusgrain or granule
*Actinomycetoma
*Eumycetoma
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Dematiaceous
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5. Sporotrichosis
“ Rose-picker's disease ”
Sporothrix schenckii dimorphic fungi