Cutaneous mycoses How are Dermatophytes Disseminated?

Fungal infection involving the superficial keratinized Anthropophilic

tissues of the body such as skin, hair & nails.
Dermatophytes adapted to live exclusively to
They are caused by a group of fungi commonly called human host
dermatophytes
Agents of human disease
Dermatophytoses
Infections are seldom inflammatory
Often these diseases are referred to as: tinea + body
location; athletes foot; jock itch; or simply ringworm. Species identification may be difficult because
most anthropophilic species produces few
These diseases may be spread from man to man, conidia
animal to man and soil to man.
Geophilic
Most are characterized by the presence of clear
(hyaline), septate hyphae, 5-6 microns in diameter. Dermatophytes inhabit the soil

KOH (10-20%) preparations of skin hair or nails are They are spread to man following contact with
used for a preliminary diagnosis. soil

Genera include: Produce large numbers of conidia and are the

most readily identified species
Epidermophyton floccosum
Zoophilic
affecting the skin and nails
Dermatophytes which primarily live on animals
Microsporum spp.
Often cause infections in animals
affecting skin and hair
They are spread to man by contact with infected
Trichophyton spp. animals

affecting skin, hair & nails Fewer conidia are produced by zoophilic fungi
than by geophilic species
Types of Ringworm Site affected
Tinea capitis Head
Tinea favosa Head (distinctive pathology)
Tinea barbae Beard
Tinea corporis Body (glabrous skin)
Tinea manuum Hand
Tinea unguium Nails
Tinea cruris Groin
Tinea pedis Feet
Tinea imbricata Body (distinctive lesion)

Characteristics of Common Dermatophytes

Various forms of Dermatophytoses & the respective
affected sites

Natural habitat of common dermatophytes

Epidermophyton floccosum
Produces only one size of conidia (macroconidia)
 Colonies are yellow-tan, flat with feathered
edges and remain small in diameter
Epidermophyton sp. isolates are notorious for
developing pleomorphic tuft of sterile hyphae in
older cultures.
Distributed worldwide

Microsporum canis
Macroconida are spindle-shaped with echinulate
thick walls
Macroconidia measures 12-25mx5-110m and
have 3 to 15 cells
Microconidia are abundantly formed by most
isolates and these may be the only conidia
maintained in cultures that have been serially
transferred Microsporum gypseum

Colonies are fluffy and white, with the reverse Fusiform, moderately thick-walled macroconidia, measures
side of the colony usually developing a lemon 8 to 5m x 25 to 60m and can have as many as six cells
yellow pigment, especially on potato dextrose
Abundant macroconidia and microconidia produced by most
agar
Infected hair fluoresce bright yellow-green using isolates of this species result in a powdery, granular
appearance on colony surfaces
Woods lamp
Grows well on sterile rice medium
Distributed worldwide
 Colonies that form tan to buff conidial masses Grows poorly on sterile rice grains (rice
are typical of fresh isolates medium)

M. gypseum is a rapidly growing geophilic

species found in soils worldwide

Infected hair do not fluoresce using Woods lamp

Trichophyton mentagrophytes

Macroconidia & microconidia

Microconidia are primarily globose but may appear
tear-shaped and measures 2.5 to 4m in diameter
Microconidia are found primarily in clusters described
as grape-like

Microsporum audouinii

A slow-growing anthropomorphic dermatophyte

Conidia are rarely produced in culture
Colonies of M. audouinii appear cottony white and
generally form little or no pigment on the reverse
Infected hair shafts fluoresce yellow-green
using a Woods lamp Trichophyton rubrum
Addition of yeast extract may stimulate
growth and production of macroconidia
 Known to produce three to eight-celled cylindric
macroconidia that are somewhat smaller than
T. mentagrophytes
Possess microconidia that are extremely variable in
Microscopic picture contains clavate or peg-shaped
shape, ranging from round to peg shapes
microconidia formed along undifferentiated hyphae
When grown on Sabouraud dextrose agar, colonies
Colonies remain white on the surface but may be
usually form a rust-colored pigment on the colonys
yellow to red
reverse
Most strains develop a red to deep burgundy wine-
Leading cause of tinea capitis in children in many
colored pigment on the reverse that diffuses into the
parts of the world including the US
agar
Growth enhanced by thiamine
Distributed worldwide
No specific nutritional requirement
Does not perforate hair in vitro
Does not produce urease

Trichophyton schoenleinii

Colonial morphology: irregularly shaped, smooth

white to cream colony with radiating grooves,
reverse white

Micromorphology: hyphae usually sterile, many antler

type hyphae seen (favic chandelier)

Trichophyton tonsurans
 Microconidia rare, large and teardrop when seen;
macrconidia extremely rare, but form characteristic
rat tail types when seen; many chlamydospores
seen in chains, particularly when colony is incubated
at 37C

Trichophyton violaceum

Port wine to deep violet colony, may be heaped or

flat with waxy-glabrous surface, pigment may be lost
on subculture
Branched, tortuous hyphae that are sterile;
chlamydospores commonly aligned in chains
Growth enhanced with thiamine
Examples of colonies of dermatophytes.

Trichophyton verrucosum

Glabrous to velvety white colonies, rare stains

produce yellow-brown color, rugal folds with Transmission:
tendency to sink into agar surface
Contact with dermatophytes in soil or in animals
 Anthropophilic species are transmitted by direct
contact or fomites

Predisposing factors:
a. Hot & humid climate
b. Crowded living condition
c. Increased perspiration
d. Heavy exposure
e. Young individuals
f. Genetic predisposition

Dermatophytid reaction
An allergic response to fungal antigens wherein
a dermatophyte infection in one area elicits an Hair Infections
allergic reaction elsewhere on the body 1) Ectothrix: This is where spores are seen on the outside
of the hair,
Laboratory diagnosis e.g., Microsporum canis
2) Endothrix: This is where spores or hyphae are seen
Specimens: inside the hair,
skin & nail scrapings, hairs e.g., Trichophyton tonsurans
Examination of infected hairs under Woods light

Microscopic examination using 10-20% KOH ( or Calcoflour

white)
Microsporum spp.
form dense sheaths of spores in a mosaic
pattern around the hair (ectothrix)
Trichophyton spp.
form parallel rows of spore outside (ectothrix)or
inside (endothrix) the hair shaft
T. schoenleinii
favic hairs present characteristic air spaces in
the hair which are readily filled with fluid in KOH
preparation
Culture:
Mycosel, Dermatophyte test medium (DTM), Cornmeal agar (for
production of macroconidia), Inhibitory mold agar, s agar with
antibiotics

Dematophytid reaction is diagnosed by a negative microscopic and

cultural examination of the reaction site and finding of
dermatophytosis elsewhere on the body
Treatment:
Topical antibiotics such as cream preparation of tolnaflate,
miconazole nitrate, haloprogin, clotrimazole, econazole,
ciclopirox
Oral griseofulvin for long periods most effective for scalp
and nail infections
Oral ketocobazole