cutaneous mycoses - khon kaen university
TRANSCRIPT
ผศ. กญัญลกัษณ์ ชัยค ำภำ
Fungal infection of skin
Superficial mycoses
Pityriasis versicolor
Cutaneous mycoses
Dermatophytoses
Candidiasis
Subcutaneous mycoses
Mycetoma
Objectives
• Etiologic agent of infection
• Sign and symptoms
• Characteristic appearance
• Lab diagnosis
• Prevention and treatment
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.
Hypopigment lesion
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
Pityriasis foliculitis
Dandruff (= Pityriasis capitis)
– caused by M. globosa
– accellerated shedding of skin cells
Lab diagnosis
Direct examination
10-20% KOH
budding yeast, short hyphae
Culture
lipophilic yeast (Suppl.: olive oil)
Treatment
mild fungicidal / keratolytic agent
Tissue form / parasitic form
“ spaghetti & meatballs ”
2. Dermatophytoses (กลาก)
Ringworm, Tinea
Dermatophytes or keratinophilic fungi
3 genera
• Trichophyton
• Microsporum
• Epidermophyton
2. Dermatophytoses
Ringworm, Tinea
Dermatophytes or keratinophilic fungi
3 genera
Genus Macroconidia Microconidia
Trichophyton Pencil +++
Microsporum Spindle ++
Epidermophyton Club absent
Dermatophyte Origin Fungi
Geophilic soil M. gypseum
Zoophilic animal M. canisT. mentagrophyte
Anthropophilic human T. rubrumE. floccosum
“active border”
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
Tinea capitis
Tinea corporis
Tinea faciei
Tinea cruris Tinea barbae
Tinea unguiumTinea manuum
Tinea pedis
Tinea imbricata
Tinea favosa
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
Tissue form
Slide culture
3. Candidiasis ( Candidosis )
Fungus: genus Candida -- “yeast-like fungi”
-Yeast
-Blastospore
-True hyphae
-Pseudohyphae
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
Disease caused by Candida spp.
1. Mucocutaneous candidiasis
-oral thrush
-vaginal candidiasis
-candidal balanitis
2. Cutaneous candidiasis
-skin
-nail
( 3. Systemic candidiasis )
Candidiasis
Oral thrush
Paronychia
Onychomycosis
Virulence factors of Candida - Adhesins- Yeast-hypha transition - Hydrolytic enzyme : proteinase, phospholipase etc.- Phenotypic switching
Yeast-hypha transition
germ tube
Phenotypic switching
in
Candida albicans
Switching
White
Opaque
Stages of a Candida infection
adhesion & colonisation
epithelial penetration
vascular dissemination
endothelial colonisation and penetration
Lab diagnosis
1. Direct exam. KOH preparation, Gram’s stain
2. Culture SDA (chloramphenicol) 37oC
Yeast colony
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
Germ tube
Terminal chlamydospore
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
4. Mycetoma
tumefaction
draining sinusgrain or granule
*Actinomycetoma
*Eumycetoma
Dematiaceous
5. Sporotrichosis
“ Rose-picker's disease ”
Sporothrix schenckii dimorphic fungi