Fungal Groups A.

Zygomycetes (phycomycetes)
SUPERFICIAL SKIN INFECTIONS
A. Pityriasis (tinea) versicolor
 Malassezia furfur
B. Tinea nigra
 Hortaea werneckii / Phaeoannellomyces
werneckii, (Exophiala werneckii and
Cladosporium werneckii)
CUTANEOUS MYCOSES
A. Tinea capitis (ringworm of the scalp, skin,
and hair)
 septate fungi. Common genera are Mucor and Rhizopus
B. Dermatophytes
 filamentous fungi causing cutaneous infections:
o Trichophyton
o Epidermophyton
o Microsporum
C. Thermally dimorphic fungi :
 Histoplasma
 Blastomyces
 Coccidioides
 Sporothrix
D. Dematiaceous fungi
 darkly pigmented fung
 disrupts melanin synthesis  stratum corneum epidermidis
 hypopigmented or hyperpigmented skin patches  trunk of the
body
 fungemia in premature infants on IV lipid supplements
 Dx : potassium hydroxide (KOH)
 short, curved, septate hyphae and yeastlike cells (spaghetti and
meatballs appearance)
 on the palmar or plantar surfaces causing benign, flat, dark,
melanoma-like lesions.
 by a dematiaceous (darkly pigmented) fungus that produces melanin
 dx : KOH skins crapings
 Dermatophytes or Candida spp.
 Dermatophytes
o Epidermophyton, Microsporum, and Trichophyton
(cutaneous infections), do not disseminate
 Candida infections
o mucocutaneous or in skin folds and sometimes disseminate
 Skin, hair, or nails - infections are classified by the area of the
body involved
 zoophilic (animals): inflammatory
o Microsporum canis
o Trichophyton rubrum
 anthropophilic (humans) : less inflammatory
o Epidermophyton floccosum
o Microsporum audouinii
 skin, hair, or nail material - 10% KOH  unbranched hyphae
sometimes with arthroconidia
 Microsporum infections  Wood’s UV lamp
 dermatophytid (or “id”) reaction  treatment response
1. Anthropophilic tinea capitis (gray patch)
 by Microsporum audouinii
 prepubescent children and is epidemic
 noninflammatory ; gray patches of hair

2. Zoophilic tinea capitis (nonepidemic):

 Microsporum canis or Trichophyton mentagrophytes
 inflammatory
 ‘kerion’
 3. Black-dot tinea capitis
 Trichophyton tonsurans
 chronic infection in adults  hair breakage

B. Tinea barbae  Trichophyton verrucosum

 acute or chronic folliculitis of beard, neck, or face
 pustular or dry, scaly lesions

C. Tinea corporis  T. rubrum

 T. mentagrophytes
 M. canis
 affects glabrous skin (non hairy)
 annular lesions with an active border
D. Tinea cruris  E. floccosum
 T. rubrum
 T. mentagrophytes
 yeasts like Candida
 groin  “jock itch”
 accompanied by athlete’s foot or nail infections

E. Tinea pedis  T. rubrum

F. Favus (tinea favosa)
MUCOCUTANEOUS CANDIDIASIS/C. ALBICANS AND OTHER SPP. OF CANDIDA
SUBCUTANEOUS MYCOSES
A. Sporotrichosis (”rose gardener’s disease”)
 T. mentagrophytes
 E. floccosum
 “athlete’s foot”
 3 common clinical presentations:
1. Chronic intertriginous tinea pedis
2. Chronic dry, scaly tinea pedis
3. Vesicular tinea pedis
 Trichophyton schoenleinii
 highly contagious and severe form of tinea capitis
 scutula (crust) formation and permanent hair loss
 yeasts - body surfaces
 in infected tissues as pseudohyphae, true hyphae, blastoconidia,
and yeast cells but is still referred to as a yeast
 Oral thrush
 Vulvovaginitis or vaginal thrush
o thick yellow-white discharge
o burning sensation
o curd-like patches on the vaginal mucosa
o inflammation of the peritoneum
 dx : KOH mount of “curd”
 Cutaneous candidiasis involves the nails (increases with prolonged
use of false nails), skin folds
 Lesions : eczematoid or vesicular and pustular
 moist conditions
 traumatic implantation fungus but remain localized in the
cutaneous/ subcutaneous tissues
 Sporothrix schenckii – dimorphic
 37°C - cigar-shaped to oval, budding yeasts
 25°C - sporulating hyphae
 found on plant materials such as roses, plum trees, or sphagnum
moss
 traumatically introduced by florist’s wires, splinters, or rose or
plum tree thorns into subcutaneous tissues.

B. Eumycotic mycetoma
C. Chromoblastomycosis
PNEUMONIAS/SYSTEMIC MYCOSES (CAUSED BY FUNGAL PATHOGENS)
A. Histoplasmosis/Histoplasma capsulatum
B. Blastomycosis/Blastomyces dermatitidis
(North America)
C. Coccidioidomycosis / Coccidioides immitis
OPPORTUNISTIC MYCOSES
 Generally not painful
o (lymphocutaneous sporotrichosis)
 Dx : culture, histology (-)
 Tx : itraconazole
 Pseudallescheria boydii and Madurella spp
 presence of “sulfur” granules (microcolonies) in the exudate
 Filamentous true fungi  soil or on vegetation
 in rural
 by dematiaceous (dark) fungi and seen in tissues as pigmented,
yeastlike bodies
 colored lesions that start out scaly and become raised, cauliflower-
like lesions
 Histoplasma, Coccidioides, and Blastomyces
 filamentous, grow in specific environments,
 produce airborne spores
 true virulence factors
 3 basic forms:
1. Acute self-limited pneumonia
2. Chronic (generally pulmonary) disease
3. Disseminated infection
 thermally dimorphic, facultative intracellular, fungal pathogen
(with NO capsule)
 great river plains of the Ohio, Missouri, and Mississippi Rivers and
the St. Lawrence Seaway plus Latin America
 in soil enriched with bat or bird guano as hyphae with distinctive
tuberculate macroconidia and nondescript microconidia
 Bat caves, old chicken coups, starling roost
 o thick blood smears and blood cultures are extremely useful for
diagnosis
 filamentous fungus with small conidia in rotting organic material
including wood
 thick walls and broad bases on buds
 clinical symptoms:
o Acute pulmonary blastomycosis
o Chronic pulmonary blastomycosis (coin lesions)
o Disseminated blastomycosis
 “valley fever”
 endemic in California’s San Joaquin Valley and the Lower Sonoran
Desert of the southwestern United States and Mexico
 spherules with internal endospores  inhaled arthroconidia
 Acute, self-limiting coccidioidomycosis  similar to acute
histoplasmosis except that erythema nodosum or multiforme are
more likely
 Itraconazole or fluconazole  high risk
 Disseminated coccidioidomycosis  meninges and mucous
membranes
 painful mucous membrane or cutaneous infections in mildly
compromised patients
 by endogenous or ubiquitous organisms of low inherent virulence

A. Candidiases
B. Malassezia furfur septicemia
C. Cryptococcal meningitis or
Meningoencephalitis
D. Rhinocerebral zygomycoses (phycomycoses or
mucormycoses)
E. Pneumocystis pneumonitis/pneumonia
F. Aspergillosis
 Candida, Cryptococcus, Aspergillus, Pneumocystis, Rhizopus, Mucor,
and Pneumocystis
 most common opportunists
 most common cause is C. albicans
 Systemic candidiases :
o Fluconazole
o Lipid-based amphotericin B, or capsofungin
 premature neonates on intravenous lipid emulsions
 Cryptococcus neoformans
 yeast  antigenic polysaccharide capsule
 weathered pigeon droppings
 CNS disease
o patients with Hodgkin’s lymphoma, diabetes, AIDS (where
it is the dominant meningitis), leukemias, or leukocyte
enzyme deficiency disease
o headache of increasing severity
 Dx :
o CSF latex particle agglutination test
o India ink wet mount, and culture following lysis of white
blood cells in CS
 Tx : amphotericin B plus 5- fluorocytosine or fluconazole
 phylum Zygomycota, genera Rhizopus, Absidia, Mucor, and
Rhizomucor
 patients with acidotic diabetes or leukemia
 Clinical symptoms:
o facial swelling and blood-tinged exudate in the turbinates
and eyes, mental lethargy, blindness, and fixated pupils.
 Diagnosis : rapidly, KOH mount of necrotic tissue or exudates from
the eye, ear, or nose
 Treatment : aggressive treatment with amphotericin B or
Posaconazole
 Pneumocystis jiroveci (formerly Pneumocystis carinii)
 obligate fungal organism of humans (cannot be grown in vitro) 
extracellular, growing on the surfactant layer over the alveolar
epithelium
 ground-glass appearance  patchy, diffuse appearance
 Pneumocystis jiroveci pneumonia (PCP):
o one-third of deaths in AIDS patients.
o morbidity and mortality when CD4+ counts decrease to
less than 200/mm3 u
o dx : microscopy of biopsy specimen or alveolar fluid
o tx : prophylaxis with trimethoprim-sulfamethoxazole or
trimethoprim and dapsone
 Aspergillus fumigatus/Aspergillus flavus
 major opportunistic human pathogen
 asymptomatic except when disseminated
 characteristic halo and/or air crescent signs
 dx : culture and microscopic examination: nonpigmented, septate
hyphae with dichotomous branching
 Asexual conidia are arranged in chains, carried on elongated cells
called “sterigmata,” borne on expanded ends (vesicles) of
conidiophores
 Tx and prevention : IV amphotericin and rifampicin, HEPA filtration
Tuazon, Marielle Anne B.