03/10/2022

DERMATOPHYT INFECTIONS
(DERMATOPHYTOSIS)

Pepy Dwi Endraswari, dr., M.Si., Sp.MK

Departemen Mikrobiologi Klinik FK-UA
7 Oktober 2022

DERMATOPHYTOSIS
(=Tinea = Ringworm)
• Infection of the skin, hair or nails caused
by dermatophytes
Dermatophyte Skin Hair Nails

Microsporum X X

Trichophyton X X X

Epidermophyton X X

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DERMATOPHYTES
• Digest keratin by their keratinases
• Resistant to cycloheximide
• Classified into three groups depending on their usual
habitat

Epidemiology
• Anthropophilic CHRONIC
• Man : Trichophyton rubrum INFECTION
• Zoophilic
Animals:
• Microsporum canis: cats and dogs
• Microsporum nanum: swine ACUTE
• Trichophyton verrucosum: horse and swine INFECTION
• Geophilic
• Soil : Microsporum gypseum

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DERMATOPHYTOSIS
Pathogenesis and Immunity
• Contact and trauma
• Moisture
• Crowded living conditions
• Cellular immunodeficiency →(chronic inf.)

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DERMATOPHYTOSIS
Clinical Classification
• Infection is named according to the
anatomic location involved:
a) Tinea barbae
b) Tinea corporis
c) Tinea capitis
d) Tinea cruris (Jock itch)
e) Tinea pedis (Athlete’s foot)
f) Tinea manuum
g) Tinea unguium

Clinical classification of Dermatophytosis

Tinea cruris Tinea barbae

Tinea Unguium Tinea corporis

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DERMATOPHYTOSIS
Clinical manifestations
Skin:
• Circular, dry, erythematous, scaly, itchy lesions
Hair:
• Typical lesions,”kerion”, scarring, “alopecia”
Nail:
• Thickened, deformed, friable, discolored nails, subungual
debris accumulation
Favus (Tinea favosa)

Clinical manifestationof Dermatophytosis

Tinea capitis: kerion, grey patch, black dot

"Kerion" : T. verrucosum & T .mentagrophytes Grey patch: M. canis.

Black dot: T. tonsurans dan T. violaceum

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Tinea capitis
• Hair
1.Ectothrix invasion is characterised by the
development of arthroconidia on the outside of the hair
shaft. The cuticle of the hair is destroyed and infected
hairs usually fluoresce a bright greenish yellow colour
under Wood's ultraviolet light. Common agents
include Microsporum canis, Nannizzia.gypsea,
Trichophyton equinum and T. verrucosum.

2.Endothrix hair invasion is characterised by the

development of arthroconidia within the hair shaft only.
The cuticle of the hair remains intact and infected hairs do
not fluoresce under Wood's ultraviolet light. All endothrix
producing agents are anthropophilic eg Trichophyton
tonsurans and T. violaceum.
KOH mount of infected hairs

Favus usually caused by Trichophyton schoenleinii,

produces favus-like crusts or scutula and corresponding
hair loss.

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Transmission
• Close human contact
• Sharing clothes, combs, brushes,
towels, bedsheets (Indirect)
• Animal-to-human contact (Zoophilic)

Laboratory Diagnosis
• Specimen collection
• Direct examination
• Culture
• Identification

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Laboratory Diagnosis: Adequate Specimen Collection

• Hair
• Plucked, not cut, from edge of lesion
• Skin
• Wash, scrape from margin of lesion
• Nails
• Scrapings from nail bed or infected area
• Transport in sterile petri dish
Black collection card showing (a) a suitable amount of nail
material for a good sample and (b) an inadequate
specimen.

Laboratory Diagnosis
Specimen processing
• Hair
• Cut into short segments
• Nails
• Mince into small pieces

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Laboratory Diagnosis
Direct Examination
• Examine specimen for fungal elements
• 10% KOH
preparation
• Calcofluor
white stain

KOH mount of infected skin scales (left) and nail material

(right) showing typical dermatophyte hyphae breaking up
into arthroconidia

Laboratory Diagnosis
Culture Media

• Select two media types

• General purpose – Sabouraud’s agar Sabouroud
• Selective – Mycosel agar, Dermatophyt Test Medium agar

• Antibiotics
• Gentamicin: inhibits normal bacterial flora
• Cycloheximide: inhibits saprophytic fungi

DTM

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Laboratory Diagnosis
Culture Growth Requirements

• Place specimen pieces on culture media

• Incubate at 30°C in ambient (room) air
• Growth at 3 days to 3 weeks
• Examine plates frequently for 4 weeks

Laboratory Diagnosis
Identification
• Colony morphology
• Microscopic morphology

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Microscopic examination: Microsporum,

Epidermophyton, and Trichophyton species

• Microsporum has numerous thick-walled macroconidia with

RARE microconidia
• Epidermophyton has numerous club-shaped macroconidia
hanging out in groups of 2-3 with NO microconidia
• Trichophyton has thin-walled macroconidia and MANY
microconidia.

Identification: Microsporum species

Characteristic appearance of the macroconidia, and the

general appearance of the hyphae (such as pectinate
bodies). As a group, Microsporum have few to absent
microconidia.

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Microsporum canis
• Colony Microscopic
morphology:
morphology:

Microsporum gypseum

Colony morphology: • Microscopic

morphology:

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Microsporum audouinii

• Colony • Microscopic
morphology: morphology:

Epidermophyton floccosum

Colony morphology: • Microscopic

morphology:

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Trichophyton rubrum

• Microscopic
Colony morphology: morphology:

Trichophyton rubrum
• Physiological tests
• Urea: negative
• Hair perforation: negative

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Trichophyton mentagrophytes
• Colony morphology:

Downy Granular Velvet

Trichophyton mentagrophytes
• Microscopic
morphology:

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Trichophyton mentagrophytes
• Physiologic tests:
• Urea: positive
• Hair perforation:
positive

DERMATOPHYTOSIS
Treatment

• Topical
Miconazole, clotrimazole,
econazole, terbinafine
• Oral
Griseofulvin
Ketaconazole
Itraconazole
Terbinafine

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