Fungal Infection in HairDr Vishal Kulkarni

MBBS MD (Microbiology)

IntroductionHair is one of the defining characters

of humans. Fungi that causes infection of hair

- Trichosporon spp.- Piedra Hortae- Dermatophytes.

Piedra-• Superficial infection of hair shaft.• Often asymptomatic• Piedra (spanish)- stone• Two types-• White piedra (Trichosporon spp.)• Black piedra ( Piedra hortae)

White PiedraCaused by yeast-like fungal species of

genus Trichosporon.Present as branched hyphae & arthrospores

both within and around hair shaft.Trichomycosis nodularis OR

Trichosporonosis nodosa.Systemic infection- Trichosporonosis.Was first described by Biegel in 1865.

Mycology- Family- CryptococcaceaeClass- Basidiomycetes.

White piedra 1.Head- Trichosporon ovoides2.Pubis- Trichosporon inkin

Epidemology- Inhabits in soil & human skin. Has also been described in horses,

monkeys, dogs etc. Affects temperate & tropical areas

including Eastern Europe, Asia, South America.

More common in Black people. Incidence varies according to hair styling

fashion, social customs, hygienic conditions, humidity.

Pathogenesis & Pathology- Infection starts just beneath cuticle

following damage. Organism may grow inward & through shaft

to form nodular swellings spaced irregularly along the axis.

Hair weakened at these point hence easily breaks.

Growth occurs as collarette around hair shaft & consist of mycelia that rapidly fragment into arthrospores.

Clinical features- Soft, white, grayish or light brown

nodules on hair shaft. Seen mainly on distal portion of facial &

axillary hair, beard, moustache, pubic hair

Pruritis, pain, inflammation. Hair can be easily breaks. Mass can be

easily detached from shaft. Infection may accompanied by bacteria

like corynebacterium.

Nodules of white piedra

Differential diagnosis-- Trichomycosis axillaris- Phthiriasis pubis- Pediculosis capitis.- Geotrichum spp. infection.

Lab diagnosis- Do not fluoresce on Wood’s Lamp

examination. On microscopy- fungus is seen like concretion

that are composed of hyphae & rectangular arthrospores within & around hair. (KOH & LPCB)

Culture is done on SDA with chloramphenicol. Moist yeast like cream colored colonies.

Assimilation of glucose, maltose, sucrose, galactose & lactose.

Breaks down urea.

Black PiedraIs also nodular type of infection caused by

Piedra hortae.Also called as ‘tinea nodosa’.Mycology-

- Exists in a perfect state during colonisation.- Family- Piedraiaceae- Order- Dothideales- Class- Pyrenomycetes.- Phylum- Ascomycota.

Epidemology- Found in tropical countries in warm &

humid climates. Central & South America, Southeast Asia in

population where hair care is done with oily substances.

Exists in soil. Affects humans & animals.

Pathogenesis and pathology- Infection starts under cuticle of hair shaft

with stone hard, black nodule. Fungal mass enlarge & grow outside the

hair & completely envelop the shaft. Mature nodule in periphery composed of

aligned hyphal strands Fungus destroys cuticular layers, cortex

leads to destruction of hair shaft & breakage of hair.

Clinical features- Formation of discrete, gritty, hard, brown

black nodules firmly attached to hair shaft.

Affect mainly hair of scalp. Moustache, beard & pubic hair may be

affected. Itching usually absent.

Lab Diagnosis- Crushed brittle nodules on KOH mount. Dark colored thick walled septate

hyphae. Culture on SDA with chloramphenicol,

glycerine & cycloheximide. Slow growing, adherent, coal black,

cerebriform colonies. LCB mount shows dark walled septate

hyphae with chlymydospores. Microculture technique using DTM

Treatment & prophylaxis- Ideal T/t for both piedra is shaving off hair

in affected part. May not feasible in women. Oral azols × 3-4 weeks with topical

antifungals × 3-4 months Topical azols, ciclopirox olamine,

chlorhexidine solution, amphotericin B lotion etc.

Terbinafine 250mg/day × 6 wks for Black piedra.

Good personal hygiene.

Dermatophytes causing Hair infectionAre most common types of cutaneous

fungal infections in humans affecting skin, hair & nail.

Also known by terms like ‘tinea’ OR ‘ringworm’.

Trichophyton Skin, Hair & Nails

Microsporum Skin & Hair

Epidermophyton Skin & Nails

Hair infections caused by dermatophytes- Tinea capitis Favus Kerion Tinea barbae

Tinea capitis- Infection of shaft of scalp hair & present

as Inflammatory Noninflammatory Infected hairs appears dull & grey. Base of hair shaft & follicle are involved. Breakage of hair at follicular orifice which

creates patches of alopecia with ring formation.

Clinical types

Kerion-- Caused by T. verrucosum & T.

mentagrophytes- Severely painful inflammatory reaction

producing raised, boggy mass on scalp- Follicles discharging pus, sinus formation at

multiple points- Thick crusting with matting of adjuscent

hairs.- ‘Kerion celsi’

Favus (Tinea Favosa) Caused by T. schoenleinii Form cup like crusts around infected follicles. Fungal growth within hair is minimal which remains intact. Patchy alopecia, scarring.

Black-dot Caused by T. tonsurans & T. violaceum Endothrix like invasion. Breakage of hair near surface results in

blackdot appearance.

Ectothrix infections• The arthrospores

appear as mosaic sheath around hair or on surface of hair shaft.

• Cuticle remains intact.

Endothrix infection• Hyphae form

arthrospores within the hair shaft

• Cuticle usually get destroyed.

Ectothrix Endothrix T.mentagrophytes T.schoenleinii

M.canis T.tonsuransM.gypseum T.violaceumM.audouinii T.Soudanense

T.verrucosumT.Rubrum

Tinea barbae Caused by T.verrucosum,

T.mentagrophyte, M.canis Ringworm infection of beard &

moustache areas Also called as ‘Barber’s itch’. Erythematous patches on face, scaling Fragile & lusterless hair.

Diagnosis- Clinical examinationHistory- age, occupation, hobbies, living

conditions, onset, duration & progress.Lab diagnosis-

Microscopy Isolation of fungus in cultureSerological tests

Direct examination-KOH wet mount simple & reliableBasal root portion of hair is taken by plucking &

not by clippingFungus is seen as branching hyaline mycelia with

arthrospore production

Wood lamp examination-

Principle Flurescence produced mainly by microsporum &

rarely by trichophyton spp.

Microorganisms Fluorescence colorM.Audouinii Bright greenM.Canis Bright greenM.ferrogineum Blue greenM.gypseum Dull yellowT.schoenleinii Dull yellowMalessezia furfur Golden yellowCoeynebacterium minutissimum

Coral red

Fungal culture-SDA with cycloheximide incubated at 3 temp.

i.e. 25˚C, 30 ˚C & 37 ˚C.Colony morphology & LCB microscopy DTM – dermatophytes turns medium into red

color.DIM- to avoide false positive results given by

DTMSpecies Colony morphology LCB mount

Trichophyton spp.

Powdery, velvety, waxy with pigment

Macroconidia- sparse, pensil shaped with blunt endMicroconidia-abundunt

Microsporum Cottony, velvety, powdery with white to brown pigment

Macroconidia- abundunt, spindle shaped, rough.Microconidia- scanty

ImmunodiagnosisSkin test with dermatophytic Ag ‘trichphytin’.Serological tests- immunodiffusionPCR fingerprinting

Animal pathogenicity- To study the nature of the lesion & immunity

produced by organisms.

Treatment & prophylaxis- Topical antifungals Oral griseofulvin 10mg/kg (for nail & scalp) Or single dose 2gm in adults. Micronised prepatrations. Resistance Itraconazole, fluconazole & terbinafine therapy

for 12 weeks ‘Live spore vaccine’, killed cell vaccine &

soluble cytoplasmic extract for T. mentagrophyte.

Good personal hygiene.

Thank you…