MYCOSES 3.

10% KOH with LPCB/MB/Calcofluor

white stain
 Superficial Mycoses
 Cutaneous Mycoses
 Subcutaneous Mycoses
 Deep/Systemic Mycoses

SUPERFICIAL MYCOSES

 Affects the superficial layer of the skin.

 Confined to the Striatum corneum.  Fungi appears as short, thick septate hypha with
 Does not illicit inflammation. numerous yeast-like cells in cluster = “SPAGHETTI
and MEATBALL APPEARANCE”

A. Tinea versicolor M. Furfur on KOH Mount (direct microscopy)

 Ptyriasis versicolor/Tinea flava/Dermatomycosis
furfuracea
 Mild chronic fungal infection affecting the epidermal
layer.
 Manifested by the appearance of
hypopigmented/hyperpigmented skin lesions.
 Generally non-inflammatory, pruritic, fine scaly
macular patches on the trunk, chest, shoulder CULTURE
 CAUSATIVE AGENT: Malassezia furfur
 Culture on SDA enhances with Olive oil – bacteria
like colonies (1-2 weeks) appearing as shiny or pasty,
white to cream colored colonies.

Malassezia furfur

 a species of yeast that is naturally found on the skin

surfaces of humans and some other mammals (s.
corneum)
 Occurs as a commensal on normal smooth skin.
 Lipopilic
 Interferes with the normal pigmentation of the skin.
DIAGNOSIS
 Clinical features may be sufficient to diagnose.
 Specimen source:
1. Skin scrapings
2. Blood or tissue samples – systemic infection
is suspected.
 Laboratory examination
1. Wood’s lamp examination 🡪 golden
yellow to light green fluoresce.
2. Staining with alkali stain (Crystal
violet, Iodine, MB)
EPIDEMIOLOGY/ TREATMENT
 Occurs worldwide in temperate and tropical climates.
 Risk factors: Excessive sweating, poor nutrition,
pregnancy, Cushing syndrome.
 Direct skin Contact
 Treatment: Anti-Fungal (topical/oral), Salicylic acid,
Sulfide/sulfur
B. Tinea nigra palmaris
 Ptyriasis nigra / Keratomycosis nigricans palmaris
 is a superficial chronic and asymptomatic infection of
the stratum corneum characterized by the
development of a single, sharply demarcated brown
to black non scaly macules.
  Causative agent: Hortaea (Exophiala) werneckii Black Piedra

LABORATORY
DIAGNOSIS CUTANEOUS MYCOSES
 Wet mount preparation – presence of dark brown  involve the integument and its appendages, including
mycelial fragments hair and nails (stratum corneum or deeper layers of
 KOH Prep’n – interspersed throughout epithelial the epidermis)/ KERATINIZED layers.
cells as filaments, with small spherical spores.  Can illicit inflammation
 Culture media- Modified SDA, Littman Oxgail Agar  DERMATOPHYTOSIS/TNIEA/RINGWORM
- incubate at 25-30C  Dermatophytes: Trichophyton, Microsporum,
- after 7 days of culture, colonies appear as Epidermophyton
shiny, moist, dark gray yeast-like colonies 🡪
dark olive green to dark olive black as aerial
mycelia develops.

Dermatophytes by Location

A. Arthrophilic – “people loving” (infect humans only)

C. Piedra
Ex: Trichophyton rubrum, Epidermophyton
 Superficial hair infection with nodular masses of
floccosum, Microsporum audouinii
fungal elements surrounding the hair shaft.
 Trichosporon beigelli and Piedra hortae B. Geophilic – “Earth loving” (free living soil
saphrophytes)

Ex: Microsporum gypseum

C. Zoophilic – “animal loving” (infect man and animals)

Ex: Trichophyton verrucosum, Microsporum canis

Dermatophytes By Morphology

A. Epidermophyton – involves SKIN, NAILS

B. Microsporum – SKIN, HAIR
C. Trichophyton – SKIN, HAIR, NAILS

Dermatophytid Reaction (ID)

 Hypersensitivity reaction to fungal antigens causing

eruptions such as vesicles on fingers.

White piedra

CLINICAL FEATURES

 Chronic infections are usually found in warm, humid

parts of the body.
 Typical ringworm lesions are circular, dry,
erythematous, scaly, itchy which has an inflamed
 border containing papules and vesicles surrounding a  Affects the bearded areas of the skin.
clear area of normal skin.  causes red, ring-shaped skin rashes. Inflamed areas
 Nails are thickened, friable, discolored, accumulation called kerions can lead toscarring and hair loss.
of debris.  T. rubrum, T. mentagrophytes, T. verrucosum

A. Tinea corporis
 Ringworm of the body
 Mostly affects trunk, limb usually an itchy, circular
rash with clearer skin in the middle.
 T. rubrum, T. mentagrophytes

B. Tinea cruris
 Ringworm of the groin
 Affects the Groin/inguinal area.
 affect keratinized structures such as hair and the
epidermis' stratum corneum resulting in a
characteristic rash (red to reddish-brown, scaly
lesions that usually are symmetric and have well-
demarcated borders or fine, oozing vesicles)
 T. rubrum, T. mentagrophytes, E. floccosum
F. Tinea unguium
 RW of the nail, Onychomycosis
 Affects toenails, fingernails.
 causes thickened, deformed, and discolored nails
instead of a rash.
 T. rubrum, T. mentagrophytes, E. floccosum
G. Tinea capitis
 RW of the Scalp, Tinea tonsuran, Ptyriasis capitis
 Affects the scalp, eyebrow, eyelashes.
 causes itchy, scaly, bald patches on the head.
 Microsporum audouinii, T. tonsurans

C. Tinea pedis
 Ringworm of the Foot/ Athlete’s foot
 Affects the sole of the foot, Interdigitating areas.
 characterized by peeling, maceration, and fissuring.
 T. rubrum, T. mentagrophytes, E. floccosum H. Tinea favosa
 Honeycomb Ringworm
 Affects Scalp hair.
 honey-like exudate in some scalp infections.
 Mousy odor
 T. schoenleinii
D. Tinea manuum
 Ringworm of the skin on hands
 Affects palm of the hands and in between fingers
 tchy, round patches on the back of your hands and
dry, thickened skin onyour palms
 T. rubrum, T. mentagrophytes, E. floccosum LABORATORY DIAGNOSIS

 Specimens consist of scrapings from both the skin

and the nails plus hairs plucked from involved areas.
 Microsporum-infected hairs fluoresce under Wood's
light in a darkened room.
 Specimens are placed on a slide in a drop of 10–20%
potassium hydroxide, with or without calcofluor
E. Tinea barbae
 Ringworm of the beard, Barber’s itch
 white, which is a nonspecific fungal cell wall stain
viewed with a fluorescent microscope.
 In skin or nails, regardless of the infecting species,
branching hyphae or chains of arthroconidia
(arthrospores) are seen.
 In hairs, most microsporum species form dense
sheaths of spores around the hair (ectothrix).
 T tonsurans and T violaceum are noted for producing
arthroconidia inside the hair shaft (endothrix)
ENDOTHRIX
 usually confined to the subcutaneous tissues, but in
rare cases they become systemic and produce life-
threatening disease.
A. Mycetoma
 chronic subcutaneous infection induced by traumatic
inoculation with any of several saprophytic species of
fungi or actinomycetous bacteria that are normally
found in soil.
 local swelling and interconnecting—often draining—
sinuses that contain.
 granules, which are microcolonies of the agent
embedded in tissue material.
 Madura foot

CULTURE

 Specimens are inoculated onto inhibitory mold agar

or Sabouraud's agar slants containing cycloheximide
and chloramphenicol to suppress mold and bacterial CAUSATIVE AGENTS
growth, incubated for 1–3 weeks at room
temperature, and further examined in slide cultures if  Actinomycotic/Actinomycetoma – Fungus like
necessary. Bacteria
1. Actinomyces
BIOCHEMICAL TEST 2. Nocardia
 Eumycotic – True fungi
Hair Perforation test Urease Test
1. Exophiala
T. rubrum - -
2. Pseduallescheria boydii
T. mentagrophytes + +
3. Madurella mycetomatis – Most Common

Microscopic findings of M.
TREATMENT
mycetomatis (KOH prep with
 Therapy consists of thorough removal of infected and Parker Ink: branching filaments,
dead epithelial structures and application of a topical abundant aerial mycelium, and
antifungal chemical or antibiotic. long chains of spores.
 To prevent reinfection, the area should be kept dry,
and sources of infection, such as an infected pet or
shared bathing facilities, should be avoided. B. Chromoblastomycoses
 a chronic granulomatous infection of the skin and
SUBCUTANEOUS MYCOSES
subcutaneous tissue resulting in the formation of
Types of Subcutaneous Mycoses slow-growing, warty plaques, cauliflower-like lesions
which may ulcerate.
 Mycetoma  fungi are introduced into the body usually by trauma.
 Chromoblastomycoses  common in the tropics and subtropics
 Sporothrichosis  more common in agricultural workers
GENERAL FEATURES OF THE FUNGI

 normally reside in soil or on vegetation

 enter the skin or subcutaneous tissue by traumatic
inoculation with contaminated material.

 In general, the lesions become granulomatous and

expand slowly from the area of implantation. CAUSATIVE AGENTS

 reside in soil and vegetation.

  DEMATIACEOUS fungi – produce brown-
pigment/melanin-like pigment in their hypha.
 produce thick-walled, single, or multicelled clusters =
SCLEROTIC BODIES
 identified by their modes of conidiation (formation of
Conidia)
 Phialophora-
DIMORPHIC FUNGI
accumulate in CLUSTERS.
 Cladosporium -
abundant branched acropetal CHAINS of olive green
to brown conidia
 Fonsecaea – conidia singly or in short chains that
eventually become branched.
DEEP/SYSTEMIC MYCOSES
C. Sporotrichosis
 “rose gardener's disease”
 involves suppurating subcutaneous nodules that
progress proximally along lymphatic channel.
 Causative agent: Sporothrix schenckii (saprophytic
dimorphic fungus)
 Transmitted by the mold form from organic matter
through cutaneous inoculation.
 initial reddish, necrotic, nodular papule of cutaneous
sporotrichosis generally appears 1-10 weeks after a
penetrating skin injury.
 Oral itraconazole or another of the azoles is the
treatment of choice.
Sporothrix schenckii
 Asteroid Bodies - extracellular eosinophilic structures
from Ag-Ab reaction
- central yeast, surrounded by eosinophilic
spicules.
formed
 RT– mold with flowerette arranged- conidia
 37C– yeast with Cigar shape conidia
 Causec by DIMORPHIC fungi affecting internal
organs.
 most infections are initiated in the lungs following
inhalation of the respective conidia/spores.
 Associated with chronic administration of
corticosteroids or other immunosuppressive agents;
with hematologic diseases (leukemia, lymphoma,
aplastic anemia)
 Specimens include swabs and scrapings from
superficial lesions, blood, spinal fluid, tissue
biopsies, urine, exudates, secretions, and material
from removed intravenous catheters.
 EXOANTIGEN- specific Ag produce by fungi; ID
by Exoantigen test base on the principle of Precipitin
formation after Ab reaction
A. Blastomycosis
 North American Blastomycosis / Gilchrist’s Dse
 fungal infection caused by the organism Blastomyces
dermatitidis presents as a pulmonary infection
following the inhalation of spores, oftentimes
ASYMPTOMATIC.
 Endemic in the soils of the Ohio and Mississippi
River Valleys, Great Lakes region
 Acute or chronic pneumonia can occur, and, in
elderly or immunocompromised patients, acute
respiratory distress syndrome can result.
LABORATORY DIAGNOSIS
 Sputum specimens stained with 10% potassium
hydroxide or a fungal stain.
 Biopsy and histopathological examination of skin
lesions reveal pseudoepitheliomatous hyperplasia
with neutrophilic abscesses.
 EXOANTIGEN- specific A band
 Culture is the most sensitive method for detecting
and diagnosing blastomycosis (5-10 days)
CULTURE
LABORATORY DIAGNOSIS
 RT: mold with Lollipop Conidia
 37C: Yeast form with broad based single budding cell
B.
C. Histoplasmosis
 Darling’s disease
 infection caused by breathing in spores of a fungus
often found in bird and bat droppings.
 Caused by Histoplasma capsulatum.
 Most individuals with histoplasmosis are
asymptomatic.
 endemic to the Ohio, Missouri, and Mississippi River
valleys in the United
 States
 Calcofluor white stain that binds chitin in the cell
wall of all fungi is useful to identify H. capsulatum.
 Culture: Brain heart Media Infusion Agar
 EXOANTIGEN: H and M Ag
 RT: mold with the presence of smooth
MICROCONIDIA then becoming TUBERCULATE
MACROCONIDIA (pyriform/spindle shape conidia)
 37C: yeast phase with narrow-budding cells

Paracoccidioidomycosis
 South American Blastomycosis
 mycosis of the lungs, skin, mucous membranes,
lymph nodes, and internal organs
 caused by Paracoccidioides brasiliensis D. Coccidiomycosis
 occurs only in discrete foci in South and Central  San Joaquin Valley Fever/ Dessert Fever/ Valley
America Fever
 with infection due to inhalation of conidia which is  an acute, benign, asymptomatic or self-limited
converted to invasive yeasts in the lungs and are respiratory infection (acute pneumonia to
assumed to spread to other sites via blood and disseminated extrapulmonary disease)
lymphatics.  caused by the fungi Coccidioides immitis
 Affect areas of the southwestern United States
LABORATORY DIAGNOSIS include Arizona, the central valley of California.
 Microscopic visualization: Direct examination with  A MAJOR BIOHAZARD to laboratory personnel
potassium hydroxide (KOH) (specimen: suppurative (the major cause of clinical laboratory-acquired
skin lesion and in sputum samples or biopsy material fungal infections)
from affected sites) LABORATORY DIAGNOSIS
 Culture: Sabouraud dextrose agar is the ideal fungal
media to recover  RT: mold with arthroconidia
 Histologic findings: Methenamine silver stain or  37C: yeast phase with thick-walled SPHERULE
periodic acid Schiff stain is used to identify fungal (thick-walled spherical structure containing spores)
elements in tissue samples.
 Blood tests: These are useful for diagnosis and for
monitoring response to therapy. Quantitative
immunodiffusion testing is the most widely available
assay in endemic regions.
 RT: mold phase with CHLAMYDOCONIDIA
 37C: yeast with multiple budding cells (PILOT
WHEEL/SHIP WHEEL)