Fungal infection 2

DR.DHUHA KHALIL

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 id’s reaction
idiosyncratic reaction

It is allergic reaction(cell mediated immune What's it's characteristics?

reaction) that occur at sites faraway from (1)

primary lesions.
It is usually occur after severely inflamed (2)
lesions or after effective treatment.
treatment.
It is usually resolved spontaneously when the (3)
primary lesions are completely healed.
negative.. (4)
The skin scraping are usually negative
It is typically pruritic Causes itching
(5)

papularlvesicularlsometime follicular
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How to diagnose fungal infection
(1) clinical features
‫هيدروكسيد البوتاسيوم‬
(2) wet KOH
10%
prep. Exam.
• How to collect sample ?Scrape to obtain the sample
• How to exmine ?Examination using microscope
• What to see ?
Hyphae ‫الخيوط مال فطر‬

(3) Sabeurad’s media

(4) Wood’s light
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 sample?
How to collect sample?
Cleanse skin with alcohol or soap/water and
allow to dry.
Scrape scale from the advancing border of
lesion with no.15
no.15 blade or glass slide.
Club piece of nail .
accordingly.
Or belage hairs accordingly.

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Culture : Sabeurad’s media .
Wood’s light:some SPP.of ectothrix tinea
capitis give yellow green light.

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 Treatment
Topical
They are effective for all dermatophyte infections
except deepl inflammatory lesions of the body and
scalp. They have no effect on tinea of the nail.
Tinea Capitis Tinea unguium

imidazole group
‫ همة‬systemic ‫ ويحتاج‬Topical‫الي ما يستجيبون لل‬
1-deep
2-inflammatory lesions
3-scalp lesion (tinea capitis)
4-nail lesion (Tinea unguium)

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 imidazole group
Clotrimazole
Ketoconazole
‫مو مهم اسمائهن‬

Miconazole
Oxiconazole
systemic

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 Systemic treatment
indication
Keratin is thick in this case
Tinea manuuml
manuuml capitisl
capitisl and unguium
unguium..
Infections involving extensive areas of skinl
In hairy sites other than the scalp (e.g. tinea
barbae))
barbae
Associated with excessive inflammatory
Reactions. Immune compromised patients

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 Systemic‫انواع ال‬

Griseofulvin
Mode of action :inhibiting mitosis in
dermatophytes(fungistatic)‫يوقف نشاط الفطريات بس ما يقتلها‬
Dose : Microsized
15-.5 mg/Kg
ultramicrosized
10-15 mg /Kg
→ 0.5 – 1/grm/a day
after fatty meal
For how long ?T.capitus:6-8wks
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 Side effects
Headache and gastrointestina
gastrointestinall disturbances.
Less oftenl it leads to cutaneous side effects
such as fixed drug eruptionsl
eruptionsl photosensitivityl
petechiaell pruritus
petechiae pruritusll exfoliative
dermatitislurticaria
dermatitisl urticaria//angioedemal
angioedemal and serum
sickness--like reactions.
sickness
Drug interaction:decrease level of warfarin and
CCP..
CCP ‫نسأل اذا اذا ياخذون‬
‫هاي االدوية‬

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Imidagole group Fungistatic
ketoconazole .00- 400mg /a day

Fluconozole 150mg /aweek

Itraconazole 100-400 mg/ a day

‫اسم تجاري‬
Terbinafine ( Lamisil )

The only Fungicidal ‫يقتل الفطريات لهل سبب مدة اعطائه اقل‬

.50 mg/ a day 1-. weeks

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 Candidiasis
Candida is one of the normal flora of GITlGUT.
Predisposing factors for mucocutaneous
candidiasis include:

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Diabetes mellitusl Chronic disease ‫يقلل املناعة‬
Xerostomia..Dry mucous membranes (dry mouth)
Xerostomia
Occlusion.
Sweating
Hyperhidrosis..‫يخلق بيئة مناسبة للفطريات‬
Hyperhidrosis
The use of corticosteroids or broad- broad-spectrum
antibiotics.
Immunosuppression .
It superimposed pre existing dermatitis like
napkin dermatitis or intertrigo
intertrigo..Candidiasis
these
occurs secondary to

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Candidiasis is characterized by . features:
1.Involving deep folds.
..Satellate papules at the borders of the
lesions.
Usually presented as whitish membrane easely
removed leaving red row area.
Treatment :with topical and or systemic
nystatin.
imidazole group or nystatin.
Griseofulvin doesn't work
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on candida
Candidiasis

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Candidiasis

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Candidiasis in hospitalized pt.

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 Tinae versicolor
It is fungal infection caused by Malassezia
furfur .
Usually present with multiple oval-
oval-to-
to-round
maculesll patches or thin plaques with mildl
macules
fine scales.
It is usually confluent centrally espacially
seborrheic regionsl
regionsl in particular the upper
trunk and shouldersl less often on the face
(especially in children
children)l
)l scalpl antecubital
fossaell submammary regionl and groin
fossae groin..
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Tinae versicolor

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Tinae versicolor

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 Diagnosis
KOH examination of associated scale is
typically diagnostic. both hyphal and yeast
forms are seen;called “spaghetti and meatball.
meatball.
Tinea versicolor usually responds to topical
antifungal therapyl but oral treatment can be
considered when:
There is more extensive involvement.
patients..
Immunocompromised patients

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Yeast and short hyphal forms in the
stratum corneum

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Tinea versicolor

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Tinea vercicolor

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What is the most likely diagnosis?

Tinea manum

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What is the most likely diagnosis?

Candidiasis

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What is the most likely diagnosis‫؀‬

Tinea faciei

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What is the most likely diagnosis

Tinea unguium

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 What is the most likely diagnosis?

Herpetic whitlow

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candidiasis

Contact
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dermatitis
Candidiasis differ from tinea cruris by
all of the following except
A.Involving deep folds.
B.Satellate papules.
C.Affecting the scrotum.
D.Respond well to griseofulvin . D
D.Occur in patients on long standing broad
antibiotics.
spectrum systemic antibiotics.

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 Tinea capitis characterized by all
except
A.Mostly affecting children.
B.Black dot of non inflamatory type.
C.It is one of indication of systemic antifungal
treatment.
D.It is contagious disease.
E.Favus is mild form.

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Regarding tinea versicolor all true
except:
A. Contagious disease in genetically
predisposing individual.
B.Caused by M.furfur and M.globosa
M.globosa..
C.Recurrance rate is low.
D.Show spaghetti and meatball
microscobically..
microscobically
E.Face is rare presentation in adults.
C

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 Indication of systemic antifungal
include all of the following except:
A.Tinea manum.
manum.
B.Wide spread infection.
C.Tinea corporis.
corporis.
D.Hairy area other than the scalp.
reaction..
E.Sever inflammatory reaction

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 Regarding dermatophytes all true
except:
A.Keratophilic.
A.Keratophilic.
B.Secreate keratinase enzyme that allow invasion
of keratin.
C.Assume annular shape.
D.They have material in the cell wall that inhibit
host immune response and increase epidermal
proliferation.
E.Have active border with less inflamed center

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