Slide 1

Agents of Cutaneous Mycoses

Clinically Significant
Species

Charlie Cruz
Course Instructor

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General Characteristics
 Grow on hair, nails (onychomycosis), and
cutaneous skin layers with keratin
➢ Commonly referred to as dermatophytes
• Example: athlete’s foot (Tinea pedis)
 Etiologic agents
➢ Trichophyton (hair, skin, and nails)
➢ Microsporum (hair and skin)
➢ Epidermophyton (skin and nails)

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General Characteristics
 Two sizes of reproductive cells—important in
species ID
➢ Macroconidium and microconidium
 Some members also have teleomorphic
stages.

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Types of Infections
 Infections involving hair
➢ Affects different body sites with different symptoms
➢ Scalp infections most severe
 Infections involving the nails
➢ Onychomycosis
 Tinea pedis (athlete’s foot)
 When disease progresses around the side of
the foot from the sole
➢ Moccasin foot

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Ringworm
 Disease—Causes cutaneous mycoses
➢ Tinea corporis—Ringworm of the body
➢ Tinea cruris—Ringworm of the groin
➢ Tinea capitis—Ringworm of the scalp
➢ Tinea barbae—Ringworm of the beard
➢ Tinea unguium—Ringworm of the nail
➢ Tinea pedis—Ringworm of the feet

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Slide 6

Tinea corporis

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Tinea corporis (Waist and inframammary area). Tinea corporis is a superficial fungal
skin infection of the body caused by dermatophytes. Tinea corporis can be found
worldwide. It is specifically defined by the location of the lesions that may involve the
trunk, neck, arms, and legs.
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Tinea cruris

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Tinea cruris also commonly known as jock itch, is a surface (superficial) fungal infection
that affects the skin of your genitals, inner thighs and buttocks. Tinea cruris is most
often seen in adult men. Tinea cruris causes an itchy, red, often ring-shaped rash in
these warm, moist areas of your body.
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Tinea capitis

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Tinea capitis, also known as ringworm or herpes tonsurans infection, is a fungal

infection of the scalp hair. It is caused primarily by the dermatophyte species
Microsporum and Trichophyton. The fungi can penetrate the hair follicle's outer root
sheath and ultimately may invade the hair shaft. Clinically, tinea capitis can be divided
into inflammatory and non-inflammatory types. The non-inflammatory type usually will
not be complicated by scarring alopecia. The inflammatory type may result in a kerion, a
painful nodule with pus, and scarring alopecia.
Slide 9

Tinea barbae

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Tinea barbae is a superficial fungal infection of the skin, hair, and hair follicles caused
by dermatophytes. Though dermatophyte infections are one of the most common skin
infections in humans, tinea barbae is relatively rare. Lack of awareness about the
disease in the medical community often leads to missed diagnosis and
mismanagement.
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Tinea unguium

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Onychomycosis is a fungal infection of the nail unit. When onychomycosis is caused by

dermatophytes, it is called tinea unguium. The term onychomycosis encompasses not
only the dermatophytes but the yeasts and saprophytic molds infections as well. An
abnormal nail that is not caused by a fungal infection is a type of dystrophic nail. The
most frequent cause of onychomycosis is Trichophyton rubrum, but other
dermatophytes, including Trichophyton
mentagrophytes and Epidermophyton floccosum, can be caused as well. The
dermatophytes are identified in 90% of the toenail and 50% of fingernail
onychomycosis. Candida albicans accounts for 2% of onychomycosis, occurring
especially in fingernails.
Slide 11

Tinea pedis

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Athlete’s foot, or tinea pedis, is an infection of the skin and feet that can be caused by a
variety of different fungi. Although tinea pedis can affect any portion of the foot, the
infection most often affects the space between the toes. Athlete’s foot is typically
characterized by skin fissures or scales that can be red and itchy.
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Systemic Dermatophyte Infections

 Immunocompromised
 In disseminated disease
➢ Nodules with varying size to granulomas possible
 Primarily in kidney transplant patients and is
thought to have spread from athlete’s foot or
onychomycosis

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Slide 13

Epidermophyton floccosum
 Colony morphology
➢ Yellow to yellow tan with feathered edges; small in
diameter
 Microscopically
➢ Only one size of conidia—known as macroconidia
• Club-shaped macroconidia often clustered in groups
• Three to five cells with thin smooth walls
• Look like beaver tails
 Distributed worldwide

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Culture of Epidermophyton
floccosum

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Colonies are usually slow growing, greenish-brown or khaki-coloured with a suede-like

surface, raised and folded in the centre, with a flat periphery and submerged fringe of
growth. Older cultures may develop white pleomorphic tufts of mycelium. A deep
yellowish-brown reverse pigment is usually present.
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Macroconidia and chlamydoconidia

of E. floccosum

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Microscopic morphology shows characteristic smooth, thin-walled macroconidia which

are often produced in clusters growing directly from the hyphae. Numerous
chlamydospores are formed in older cultures. Microconidia are not formed.
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Microsporum
 Large, spindle-shaped, rough-walled
macroconidia
 Thick walls with four or more septa
 Small and club-shaped microconidia
 Cultures that produce aerial hyphae
➢ Texture—Velvety, powdery, glabrous, or cottony
➢ Color—Whitish, buff to cinnamon brown

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Microsporum canis
 Causes ringworm in children and adults
 Is spread by infected animals
 Infected hair shafts fluoresce yellow-green
under a Wood’s lamp

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Microsporum canis (continued)

 Colony
➢ Initially white, fluffy, silky to granular with a
characteristic lemon-yellow fringe at periphery
➢ Reverse side is bright yellow
 Microscopically
➢ Spindle-shaped, multicelled macroconidia
➢ Pointed and slightly turned at one tip
➢ Thick spiny (echinulate) wall with cross-septations
➢ Scattered microconidia laterally from hyphae

 Worldwide distribution

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Slide 19

Macroconidia of M. canis

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Microsporum canis showing spindle-shaped, echinulate macroconidia with thick walls

and tapered ends, which are key features in identification of this species (unstained,
×450).
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Microsporum gypseum
 Colony morphology
➢ Flat, initially white, turning light brown to reddish-
brown on maturity
➢ Sugary or granular appearance
 Microscopically
➢ Fusiform, moderately thick-walled conidia
➢ Up to six cells
➢ Some isolates have thin, filamentous distal end tail
 Found in soils worldwide

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Slide 21

Macroconidia of M. gypseum

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Microsporum gypseum showing fusiform, moderately thick-walled macroconidia

containing several cells (lactophenol cotton blue preparation, ×450).
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Microsporum audouinii
 Slow-growing anthropomorphic dermatophyte
➢ Used to be leading cause of tinea capitis among
school children
 Spread by infected hair
 Infected hair shafts fluoresce yellow-green under
a Wood’s lamp

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Microsporum audouinii (continued)

 Rare conidia
➢ Some isolates produce terminal chlamydoconidium-
like swellings.
 Colonies
➢ Cottony and white with little to no pigment on reverse
➢ Produce velvety aerial mycelium that is colorless to
light gray
➢ Reverse side: appears salmon-pink to reddish brown

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Slide 24

Culture of Microsporum audouinii

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Colonies are flat, spreading, greyish-white to light tan-white in colour, and have a dense
suede-like to downy surface, suggestive of mouse fur in texture. Reverse can be yellow-
brown to reddish-brown in colour. Some strains may show no reverse pigment.
Slide 25

Chlamydoconidium of Microsporum
audouinii

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Macroconidia and microconidia are rarely produced, most cultures are sterile or produce
only occasional thick-walled terminal or intercalary chlamydospores. When present,
macroconidia may resemble those of M. canis but are usually longer, smoother and
more irregularly fusiform in shape; microconidia, when present, are pyriform to clavate
in shape.
Slide 26

Growth on rice grains:

Microsporum audouinii

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(left) Microsporum audouinii showing poor growth on rice grains, usually being visible
only as a brown discolouration and (right) Microsporum canis on rice grains showing
good growth, yellow pigmentation and sporulation.
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Trichophyton
 General characteristics
➢ Is widely distributed
➢ Responsible for tinea corporis, tinea capitis, tinea
unguium, and tinea barbae
➢ Infected hairs do not fluoresce under Wood’s lamp
(ultraviolet [UV])
 Invasion
➢ Endothrix—Hair shaft is filled with arthroconidia
➢ Ectothrix—Spores are found around the hair shaft

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Trichophyton (continued)
 Identification
➢ Macroconidia—Smooth, club-shaped, and thin-
walled
➢ Microconidia—Spherical, pyriform (teardrop), or
clavate (club-like)

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Trichophyton mentagrophytes
 Perforates hair
 Rapid growing
 Has a rose-brown reverse surface
 Macroscopically
➢ Colonies: downy to granular based on number of
microconidia present

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Slide 30

Trichophyton mentagrophytes
(continued)
 Microscopically
➢ Microconidia form loose grapelike clusters (en
grappe).
• Globose to tear shaped
➢ Macroconidia present in very low numbers or
absent.
• Thin-walled, smooth-walled, cigar-shaped four to five
cells separated by parallel cross-walls (2-5 septa),
narrow attachment to base
 Worldwide distribution

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Slide 31

Example of Globose, Tear-Drop

Microconidia

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Trichophyton mentagrophytes showing globose, teardrop-shaped microconidia

(Nomarski optics, ×450).
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T. mentagrophytes

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A, Trichophyton mentagrophytes showing numerous microconidia in grapelike clusters. B,

Several thin-walled macroconidia also are present (500).
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Trichophyton rubrum
 Does not perforate hair
 Slow growing
 Has a cherry-red reverse surface
 Colony morphology
➢ Initially white with cottony, fluffy, velvety, or
granular colonies
➢ Key observation
• Water-soluble wine-red pigment on the reverse of the
colony

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Slide 34

Trichophyton rubrum (continued)

 Microscopically
➢ Microconidia are tiny, clavate or peg shaped, and
distributed on either side of the hyphal strands.
• “Birds on a fence”
➢ Macroconidia similar to T. mentagrophytes
• Thin-walled
• Smooth-walled
• Multicelled
• Elongated and pencil shaped or cigar-shaped (3-8 septa)
• Rare

 Worldwide distribution

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Slide 35

Microconidia of T. rubrum

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Trichophyton rubrum showing clavate- or peg-shaped microconidia (lactophenol cotton

blue preparation, ×450).
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Microconidia of T. rubrum

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Trichophyton rubrum showing numerous pyriform microconidia borne singly on hyphae (750).
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Trichophyton tonsurans
 Colony morphology
➢ Rust-colored pigment on colony’s reverse when
grown on Sabrouad dextrose agar
 Microscopic
➢ Microconidia extremely variable in shape
• Ranges from round to peg shapes
 Leading cause of tinea capitis in children in
many parts of the world (including the United
States)

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Slide 38

Trichophyton tonsurans cultures

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T. tonsurans cultures show considerable variation in texture and colour. The colour may
vary from pale-buff to yellow to dark-brown. The reverse colour varies from yellow-
brown to reddish-brown to deep mahogany.

Colonies show considerable variation in texture and colour. They may be suede-like to
powdery, flat with a raised centre or folded, often with radial grooves. The colour may
vary from pale-buff to yellow, (the sulfureum form which resembles Epidermophyton
floccosum), to dark-brown. The reverse colour varies from yellow-brown to reddish-
brown to deep mahogany. Hyphae are relatively broad, irregular, much branched with
numerous septa.
Slide 39

Trichophyton tonsurans
microconidia and macroconidia

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Numerous characteristic microconidia varying in size and shape from long clavate to
broad pyriform, are borne at right angles to the hyphae, which often remain unstained
by lactophenol cotton blue. Very occasional smooth, thin-walled, irregular, clavate
macroconidia may be present on some cultures. Numerous swollen giant forms of
microconidia and chlamydospores are produced in older cultures.