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Cutaneous Fungal Infections PowerPoint Presentation

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This medical PowerPoint presentation talks about cutaneous fungal infections, common infections that affect the skin, hair, and nails. They are caused by various types of fungi, including dermatophytes, yeasts, and molds.

Some common types of cutaneous fungal infections include Athletes foot, Ringworm, Jock itch, Nail fungus, and Tinea versicolor.

Tags : Cutaneous Fungal Infections, dermatophytes, yeasts, molds, Athletes foot, Ringworm, Jock itch, Nail fungus, Tinea versicolor, Dermatology, Dermatology PowerPoint presentation

Published on : Mar 31, 2023 | Views : 2061 | Downloads : 0

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Slide 1-

Cutaneous Fungal Infections Dermatophytosis - "ringworm" disease of the nails, hair, and/or stratum corneum of the skin caused by fungi called dermatophytes. Dermatomycosis - more general name for any skin disease caused by a fungus.
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DERMATOPHYTES
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THE SKIN PLANTS Etiological agents are called dermatophytes - "skin plants". Three important anamorphic genera, (i.e., Microsporum, Trichophyton, and Epidermophyton), are involved in ringworm. Dermatophytes are keratinophilic - "keratin loving". Keratin is a major protein found in horns, hooves, nails, hair, and skin. Ringworm - disease called ‘herpes' by the Greeks, and by the Romans ‘tinea' (which means small insect larvae).
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Infections by Dermatophytes Severity of ringworm disease depends on (1) strains or species of fungus involved and (2) sensitivity of the host to a particular pathogenic fungus. More severe reactions occur when a dermatophyte crosses non-host lines (e.g., from an animal species to man). Among dermatophytes there appears to be a evolutionary transition from a saprophytic to a parasitic lifestyle. Geophilic species - keratin-utilizing soil saprophytes (e.g., M. gypseum, T. ajelloi). Zoophilic species - keratin-utilizing on hosts - living animals (e.g., M. canis, T. verrucosum). Anthropophilic species - keratin-utilizing on hosts - humans (e.g., M. audounii, T. tonsurans)
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DERMATOPHYTES Microsporum - infections on skin and hair (M-N-No Nails) Epidermophyton - infections on skin and nails (not the cause of TINEA CAPITIS) Trichophyton - infections on skin, hair, and nails.
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Epidermophyton- E. floccosum Microsporum- M.canis M. gypseum Trichophyton-T. rubrum T. mentagrophytes T. verrucosum T.violaceum
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Major sources of ringworm infection Warm damp areas (e.g., tropics, moisture accumulation in clothing and shoes). Schools, military camps, prisons. Animals (e.g., dogs, cats, cattle, poultry, etc.).
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Clinical manifestations of ringworm infections are called different names on basis of location of infection sites tinea capitis - ringworm infection of the head, scalp, eyebrows, eyelashes tinea favosa - ringworm infection of the scalp (crusty hair) tinea corporis - ringworm infection of the body (smooth skin)
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tinea cruris - ringworm infection of the groin (jock itch) tinea unguium - ringworm infection of the nails tinea barbae - ringworm infection of the beard tinea manuum - ringworm infection of the hand tinea pedis - ringworm infection of the foot (athlete's foot)
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CLINICAL MANIFESTATIONS OF RINGWORM tinea pedis - Athletes' foot infection between toes or toe webs (releasing of clear fluid) - 4th and 5th toes are most common. Soreness and itching of any part of the foot. Fungi probably transmitted host to host through infected squames; flat, keratinised, dead cells shed from the outermost layer of a stratified squamous epithelium. Three causal agents, T. rubrum, T. mentagrophytes, and Epidermophyton floccosum
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CLINICAL MANIFESTATIONS OF RINGWORM SYMPTOMS AND TREATMENT Three Grades of Infection Grade I - Subclinical An itching between toes, skin may be soft and macerated, blistering my occur. Treatment - keeping feet dry and clean, drying between the toes lightly each time you bathe to remove some skin. Application of fungicidal powders or ointments containing (1) salicylic acids to promote peeling of the skin and/or (2) tonaftate or other topical fungicides. Grade II Host is conscious of a burning sensation while walking and standing. Soaks are recommended (paints or liquids) such as 1:4000 KMnO4 (stains the skin purple) or topical fungicides. Remove clear liquid from blisters by having a doctor puncture near the base or unroofing the blister. Dusting powder in morning to help keep feet dry.
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Tinea Pedis – Athlete’s Foot Infection
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CLINICAL MANIFESTATIONS OF RINGWORM SYMPTOMS AND TREATMENT Grade III A secondary bacterial infection sets in. Patient should go to bed. Use systemic antibiotics to fight bacterial infection. Use of soaks and compresses. After infection subsidies, go to treatments as for Grade I or II infections. For persistent cases, (T. rubrum is usually the culprit), resort to systemic griseofulvin therapy or other antifungal systemic drugs (i.e., Lamisiltrademark or terbinafine HCl) Griseofulvin is fungistatic, so it won't kill the fungus, just inhibit its growth. Improvement occurs in 2-6 weeks as long as 6 months. Sometime griseofulvin treatment is ineffective. Some patients may not tolerate terbinafine HCL depending on sensitivity to drug.
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CLINICAL MANIFESTATIONS OF RINGWORM Allergic reactions are sometimes associated with tinea pedis and other ringworm infections. dermatophytid - an "id" allergic reaction. toxins get into blood stream and reaches a site other than the site of infection. blistering occurs on fingers and hands. treat the primary site of infection where the antigen is being produced. treat secondary site - blisters.
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Dermatophytid Reaction
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CLINICAL MANIFESTATIONS OF RINGWORM tinea corporis - body ringworm Generally restricted to stratum corneum of the smooth skin. Produces concentric or ring-like lesions on skin Severe cases -raised and inflamed. All forms of tinea corporis caused by T. rubrum, T. mentagrophytes, T. tonsurans, M. canis, and M. audouinii... Transmission - infected scales hyphae or arthroconidia on the skin. - direct contact between infected humans or animals, by fomites Normally resolves itself in several months.
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Tinea corporis – body ringworm
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CLINICAL MANIFESTATIONS OF RINGWORM SYMPTOMS AND TREATMENT tinea cruris - ringworm of the groin and surrounding region More common in men Infection seen on scrotum and inner thigh, the penis is usually not infected. Epidemics associated with grouping of people into tight quarters - athletic teams, troops, ship crews, inmates of institutions. Several causes of tinea cruris include T. rubrum (does not normally survive long periods outside of host), E. flocossum (usually associate with epidemics because resistant arthroconidia in skin scales can survive for years on rugs, shower stalls, locker room floors), T. mentagrophytes
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Tinea Cruris – Jock Itch
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CLINICAL MANIFESTATIONS OF RINGWORM tinea unguium - ringworm of the nails Tinea unguium or onchomycosis can take two forms: Leukonychia mycotica - superficial white onychomycosis, invasion of fungus restricted to patches or pits on surface of the toenail. Invasive subungual dermatophytosis - Invasion of nail plates by dermatophytes. Most commonly caused by T. rubrum, then E. floccosum or other Trichophyton species. Resistant to treatment, rarely resolves spontaneously.
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Tinea Unguium – Nail Infection
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CLINICAL MANIFESTATIONS OF RINGWORM tinea capitis - ringworm of the scalp, eyebrows and eyelashes Cause- Microsporum and Trichophyton. Fungus grows into hair follicle. Ectothrix infection - fragmentation of mycelium into conidia (called arthroconidia) around the hair shaft or just beneath the cuticle with destruction of the cuticle. Caused by M. audounii, M. canis Endothrix infection - arthroconidia formation occurs by fragmentation of hyphae with the hair shaft with destruction of the cuticle. T. tonsurans (most common cause). "Id" reaction may occur.
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Ectothrix and Endothrix Fluorescing hair (under Wood's lamp) is seen in infection with some dermatophytes
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Treatment of Tinea Capitis Ectothrix infections often resolve on their own. Endothrix infections my become chronic and may continue into adulthood. Topical treatments are ineffective (don't bother using tonaftate or topical griseofulvin) Fungistatic agents are somewhat effective (miconazole, clotrimazole) in combination to systemic administration of griseofulvin. Vigorous daily scrubs of scalp help removal of infectious debris. Do not use this treatment on patients with porphyria (an accumulation of blood pigment called porphyrins in blood stream and urine) or is hypersensitive to griseofulvin.
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FAVUS KERION. GREY PATCH
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Tinea Capitis Gray Patch
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Lab Diagnosis Note the symptoms. Woods Lamp examination Sample- skin &nail scrappings (edge), plucked hair Direct Microscopic examination of slides of skin scrapings, nail scrapings, and hair with10 % KOH branching hyaline septate hyphae
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CULTURE SDA (with chloramphenicol & cycloheximide) 25, 300 , 370 CX21 days DTM=25oC- red Hair Perforation test Urease test
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DERMATOPHYTES
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Distribution of Conidia
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DERMATOPHYTES Microsporum audouinii No teleomorph state (sexual reproduction has yet to be observed in this species). Usually devoid of conidia (macro- or microconidia). Septate hyphae with terminal chlamydoconidia, often pointed at the end. Macroconidia are often irregular or non-uniform in shape. Colonies on culture media are flat, silky in appearance. Growth of colonies on culture media is tight. On reverse of colony - pigment is reddish-brown in color.
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Microsporum audouinii http://www.doctorfungus.org/thefungi/microsporum_audouinii.htm http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Microsporum/Microsporum_audouinii.html
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DERMATOPHYTES Microsporum canis complex? Teleomorph is an ascomycete called Arthroderma otae. Almost all clinical isolates are minus mating type. Macroconidia are abundant, thick-walled with many septa, up to 15. Macroconidia are often hooked or curved at ends. Microconidia are small and clavate (club-shaped).
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Microsporum canisTeleomorph: Arthroderma otae http://www.doctorfungus.org/thefungi/microsporum_canis.htm http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Microsporum/Microsporum_canis.html
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Microsporum canis Colony growth is rapid, downy to wooly, cream to yellow on the surface with a yellow to yellow- orange reverse. Microconidia are club-shaped but typically are absent. Macroconidia are fusoid, verrucose, and thick walled. They have a recurved apex and contain 5-15 cells. Lab tests: hair perforation test positive and urease positive. Infection in humans occurs on the scalp and glabrous skin. It is also a cause of ringworm in cats and dogs.
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DERMATOPHYTES Microsporum gypseum complex Teleomorphs are Arthroderma gypseum and A. incurvatum. Produces abundant macroconidia brownish-yellow due to large numbers macroconidia. Surface of culture colony often is powdery in appearance. Reverse of colony often appears ragged around edges. Macroconidia usually have 4-6 septa or crosswalls. Microconidia are smaller than in M. canis. Macroconidia up to 40 µm long In lactophenol, water is extracted and can cause the macroconidia walls to collapse. This is an artifact due to mounting media. Macroconidia do not form on infected hair!
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Microsporum gypseum http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Microsporum/Microsporum_gypseum.htm http://www.doctorfungus.org/thefungi/microsporum_gypseum.htm
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Microsporum gypseum Colony growth is rapid, downy, becoming powdery to granular, cream, tawny-buff, or pale cinnamon on the surface with a beige to red-brown reverse. Microconidia are moderately abundant and club-shaped. Macroconidia are abundant, ellipsoidal to fusiform, sometimes verrucose, and thin walled. They typically contain 3-6 cells. Lab tests: hair perforation test positive and urease positive. Infection in humans is found on the scalp and glabrous skin; it is more frequently isolated from the soil and from the fur of small rodents.
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DERMATOPHYTES Epidermophyton floccosum Only one pathogenic species in this genus. Tinea unguium and tinea cruris are often caused by this fungus. Culture starts out white/turns sulfur color. Cultures may be wrinkled to cottony in appearance. No microconidia. Shape of macroconidia is a distinguishing characteristic - clavate macroconidia.
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Epidermophyton floccosum http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Epidermophyton/ http://www.doctorfungus.org/thefungi/epidermophyton.htm
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Epidermophyton floccosum Colony growth is slow, powdery, with a yellow to khaki surface color and chamois to brown reverse. Macroconidia are club shaped, with thin smooth walls and can be solitary or grouped in clusters. Chlamydospores are often produced in large numbers. Microconidia are absent. Lab tests: hair perforation test negative, urease positive, growth at 37°C. Infections are commonly cutaneous, especially of the groin or feet.
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TRICHOPHYTON Spp. Trichophyton species The word "trichophyton" literally means "hair plant". Presence of macroconidia in cultures varies and may not help in identification of cultures. Microconidia shape and presence varies. Microconidia are globose (round-shaped), pyriforme (pear-shaped), or clavate (club-shaped). Most common species include: Trichophyton mentagrophytes T. rubrum T. tonsurans T. verrucosum T. violaceum T. schoenleinii T. ajelloi (rare infects humans). ON SKIN: Scrapings from skin and nails cannot distinguish species in this genus. ON HAIR: Pattern of infection can help distinguish etiologic or causal agent. For Microsporum species - infections on hair lead to a mosaic pattern of arthrospores. For Trichophyton species - infections on hair follow one of the 4 patterns. Ectothrix - more or less parallel rows of arthrospores produced on surface of hair. 1. Small-spored ectothrix (arthrospores are < 5 mm in diameter) - caused by T. mentagrophytes or T. rubrum (rare). Spores are about the same size as those produced by Aspergillus. 2. Large-spored ectothrix (arthrospores are 5- 10 mm in diameter) - caused by T. verrucosum. Endothrix - growth inside hair shaft only! 3. "Black-dot" endothrix (hair stubs filled with arthrospores) - caused by T. tonsurans or T. violaceum. 4. "Favus hair" endothrix (honeycomb pattern of damage seen on surface of hair shaft) - caused by T. schoenleinii. http://www.doctorfungus.org/thefungi/trichophyton.htm
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Trichophyton mentagrophytes Most common dermatophyte on humans and animals. Highly variable in culture. Globose microconidia in grape-like clusters - en grappe. Macroconidia, when present, are cigar-shaped. Spiral hyphal cells. Cultures tend to be white and downy (some pigmentation on reverse colony) Common cause of tinea pedis. Causes small-spored ectothrix. Teleomorph is Arthroderma benhamiae or A. vanbreuseghemii.
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Trichophyton mentagrophytes http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Trichophyton/mentagrophytes.html
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Trichophyton mentagrophytes Colony growth is moderately rapid, powdery to granular, white to cream colored on the surface with a yellowish, brown or red-brown reverse. Microconidia are numerous, unicellular, round to pyriform and found in grape like clusters. Spiral hyphae are often present. Macroconidia are multiseptate, club-shaped and often absent. Lab tests: hair perforation test positive, urease positive, growth at 37°C. Infection is typically found on the feet, hands, or groin, but can also be associated with inflammatory lesions of the scalp, nails, and beard.
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Trichophyton rubrum Infects nails and smooth skin (rarely found on hair). Most common and widely distributed dermatophyte on man and rarely isolated from animals, never from soils. No teleomorph (possibly lost in transition from saprophytic lifestyle to man). Resistant and persistent (some people become carriers for life). Slow-growing in culture. When intensely pigmented in culture the color is reminiscent of port burgundy wine or venous blood. Production of pigment increased, if fungus grown on corn meal agar. Microconidium are clavate or "teardrop" shape with a broad attachment point of the hyphae. Microconidia may develop on sides of macroconidium. In vitro - lack of hair penetrating organs, unlike T. mentagrophytes. T. violaceum grows poorly without thiamine. T. megninii grows poorly without L-histidine. T. rubrum requires neither thiamine or L- histidine.
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Trichophyton rubrum http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Trichophyton/rubrum.htm
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Hair Perforation Test Trichophyton mentagrophytes, Hair perforation test is positive. Trichophyton rubrum, Hair perforation test is negative.
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Urease Test T ment + T rubrum -
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TREATMENT Mild- topical imidazole Severe- Oral- Griseofulvin or Ketoconazole, itraconazole,fluconazole Skin- 4-6 wks Hair- 3-6 mths Nails – 1 yr
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Test Your Knowledge Answer View dermatophyte differentiation table View index slide Return to previously viewed slide View correct answer Each unknown slide has the following navigation buttons to help you:
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Answer Unknown 1 Colony growth is rapid, downy to wooly, cream to yellow on the surface with a yellow to yellow- orange reverse.
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Answer Unknown 2 Colony growth is moderately rapid, powdery to granular, white to cream colored on the surface with a yellowish, brown or red-brown reverse.
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Answer Unknown 5 Colony growth is slow to moderate, downy, white on the surface with a red to brown reverse.
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Answer Unknown 6 Colony growth is rapid, downy, becoming powdery to granular, cream, tawny-buff, or pale cinnamon on the surface with a beige to red-brown reverse.
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ppt slide no 56 content not found
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DERMATOPHYTES Trichophyton tonsurans Anthropophilic and on hair causes endothrix. Third most common cause of tinea capitis Other leading causes of tinea capitis are M. audouinii (transmission is generally from child to child) and M. canis (transmission is from animal to human). Colonies whitish and folded. Colonies are yellowish-brown color on reverse of colony. Microconidia are longer and larger than in T. rubrum. Intercalary and terminal chlamydoconidia common in older cultures. Macroconidia not common, irregular in form.
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Trichophyton tonsurans http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Trichophyton/tonsurans.html
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Trichophyton tonsurans
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DERMATOPHYTES Trichophyton violaceum Attacks hair, scalp, skin and nails. Nail infections are persistent. Endothrix (black dot infection of scalp). Found in humans, rarely in animals. Disease has been reported in horses, cats, dogs, mice and pigeons. Very slow growing in culture with a waxy appearance. Colony deep violent in color, purplish pigment diffuses into media. Rarely produces microconidia and macroconidia. In culture this species requires thiamine for proper growth. Hyphae coarser in appearance than seen in other dermatophytes. Chlamydoconidia are seen in culture.
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Trichophyton violaceum http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Trichophyton/violaceum.html
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DERMATOPHYTES Trichophyton verrucosum Associated with cattle ("barn itch"). Large-spored ectothrix. Causes severer infections in humans on the scalp and beard. Very slow growing, no pigment on reverse to yellow. Grows best at 37 C. On unenriched media - chains of chlamydoconidia and antler-like hyphae. On thiamine-enriched media, produces many small microconidia and occasionally macroconidia are produced.
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Trichophyton verrucosum http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Trichophyton/verrucosum.html
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Trichophyton verrucosum
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DERMATOPHYTES Trichophyton schoenleinii Endothrix infection of hair. Causes tinea favosa (cup-shaped crusts on scalp called favus). tinea favosa may lead to alopecia or permanent baldness. Colonies waxy to suede-like; off white in color. Colony may become convoluted from folds that develop No conidia (micro- or macro-) even on enriched media . Grows will at 37 C.
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Trichophyton schoenleinii http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Dermatophytes/Trichophyton/schoenlenii.html
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Trichophyton schoenleinii
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DERMATOPHYTES Trichophyton ajelloi Teleomorph - Arthroderma uncinatum. Common soil dermatophilic fungus. Rarely causes infection in man or animals (cattle, dogs, horses, squirrels). Readily isolated from soil by hair baiting. Cigar-shaped macroconidia with smooth ends.
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Trichophyton ajelloi