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Fungal Infections
Fungal Infections
Fungal Infections are classified into 3
groups:-

a- Allergies
b- Mycotoxicosis
c- Mycosis
a- Allergies
Some spores cause allergies if inhaled resulting in an
allergic condition that may be mild in form or rhinitis,
running nose or high fever or asthmatic attach of sever.
b- Mycotoxicosis:
Caused by exotoxins produced by some fungi; exotoxins
produced by fungus is called mycotoxins
c- Mycosis (Pleural Mycoses):-
- Divided according to the level of infection
- Main five disease are known.
1- Cutaneous mycosis:
Affection of epidermis of skin, hair, nails eg:
Dermatophytosis
2- Superficial mycosis:-
Fungal infection of the superficial layer of the dermis
e.g.:
 Pityrasis versicolor
 Tinea nigra
 Black piedra
 White piedra
3- Subcutanous mycosis:
This infection usually starts in the subcutaneous tissue and
extend deeply to affect muscles and out rally to skin e.g.:
 Sporotrichoses
 Chromoblastomycosis
 Mycetoma
4- Deep or Systemic mycosis
Mainly it caused by dimorphic Fungi.
Any system of the body can be affected
5- Opperfunistic infection:-

-These are now increasing because of poor nutrition ,

immunocompermised patients, chronic infection.

-Most of them are caused by Candida, Aspergillus and

sometimes by Deutromycetes and Rhizopus.
Cutaneous Infection: Dermatophytosis
Dermat = Skin Phyte=Like osis=Infection
Dermatophytosis:
It is cutaneous infection of skin and associated kertinized
tissues like hair and nails, by a group of Filamentous
fungi collectively known as Dermatophytes
-Dermatophytes have ability to produces keratinase
enzyme which breakdown keratin into simpler
substances which the Fungus use it to grow.
-Dermatophytes has two important properties :
1- Keratinolytic
2- Keratinophilic
-Dermatophytes is one of the most prevalent diseases
over the world but it is superficial infection not debilitating
or Life - threating and with no systemic involvement.
-Dermatophytes are filamentous fungi divided into 3
genera and more than 40 species: the three genera are:-
1- Microsporum:- Which have 17 different species. The
most pathogenic species are:
 M. canis
 M. audouinii
 M. gypseum
2- Trichophyton:
Which have 21 species. The most important species are:
 T. mentagrophytes
 T. rubrum,
 T. schoenleinii
 T. tonsurans
 T. verrucosum
3 – Epidermatophyton:- Which have two species one of
them are important which is E. Floccosum.
These 3 genera of dermatophytes differs clinically and
mycologically from each other .
 Clinically: Site of infection

Hair Nails Skin Species

x x x
Trichophyton
x x
Microsporum
x x
Epidermstophyten
Reaction to Ultra Violet Light

-Source of Uv light is wood’s lamp.

-Lesions caused by Microsperum florcence when UV light
is applied giving an apple green color, while the lesion of
Trichophyton and Epidermatophyton do not
fluorescence.
B- Mycologically :
There are differ in conidia and the presence of special
structures.
 Microsporum:
 Most species produce many macroconidia which are:
 Large, spindle-shaped, thick-walled, multicellular and all
smooth except M.canis which have small projection
known specules making them rough seen in cultures not
in pathological specimens.
 M. audouninii:
 Not produce macrocroconidia but some produce
microconidi.
 Produce special structure: pectinate body at the hyphae
which help in identification
2- Trichophyton:-
-Produce few macroconidia which are elongated, pencil or
cigar shaped, thin-walled and multicellular.
-Produce also microconidia which are differ in size, shape
and arrangement. They may be small, rounded, in
clusters, oval or elongated.e.g.:
-T. mentagrophytes microconidia are: small, rounded
found in clusters.
-T. rubrum: Micro canidia are alternated
 In addition to above Trichophyton produce special
structures:
T- mertogrophtes :
-Produce spiral hypae in the terminal part.
T-Schoenleini.
 Special structure: Anther body or Favic chandelier
 i.e hyphae with many projections.
3- Epidermatophyton Floccosum
-Produce many macroconidia (but no microconiedia) with
chalamydospores.
-Macroconidia are: large, clump-shaped, thin-walled and
multicelluar.
-Lesions caused by dermatophytes are called Tinea or
Ringworm because they are rounded or ring shaped.
They are dry, scaly, painless and itching. Sometimes
there is inflammation.
Epidemiology:
-Dermatophytosis is a worldwide disease sometimes it
occurs in small epidemic forms. It is more commonly
affected by climate (hot, humidity) and the habits of the
people.
-The nutritional status determine the prevalence , so it is
found in poor people where there is malnutrition,
overcrowding and poor hygiene.
-It is affected all age groups.
 Hair infection are more seen in children than in adults
because the children sebaceous glands are immature
but at puberty there is increased secretion of sebum
making the scalp resistant to infections.
-Skin and nails infection are more seen in adults than
children.
-Male are more affected than females by the ration of 3:1
-No occupational references except in Zoophilic reference.
Sources of infections:
There are 3 potential sources of infections, there are:
1 - Man:
Some Dermatophytes can parasitized man only, they are
known as Anthropophilic Fungi. The disease only
transmitted from man to man.
E.g: M. Audouirii
T. schoenleini
2- Animal:
Some Dermatophytes can parasitized animals and from
them the disease can be transmitted to the people in
contact, these are called Zoophilic Fungi and the
diseases they cause are called Zoonotic diseases.
E.g. M.Canis : which affect cats and dogs, they usually
affected children of families who keep pets at home.
T.verrucossum: which affected cattles so farmers are
affected.
3- Soil:
Some Dermatophytes live in soil they known saprophytic
or Geophilic Fungi.
E.g. M. gypseum: From soil, either man or animal is
affected.
Clinically:
There are differences between Anthropophilic and
Zoophilic infection.
Anthropophilic lesions:
-Mild, lesions are dry, scaly.
-Don’t respond well to treatment so tend to become
chronic and even if treated recurrence rate is high.
Zoophilic Lesions:
Aggressive, with a lot of inflammation and pus formation. .
Well respond to treatment and recurrence rate is low.
Mode of Spread:
-It spreads via spores by the sharing of clothes, brushes,
combs, towels.. etc. .e.g.:
-Tinea capitis (scalp infection)which occurs by sharing of
hair combs, hair brushes.
 Tinea corporus (body infection) which occurs by sharing
of clothes and towels.
 Tinea Pedis ( infection of legs) which happens by
walking bared-foots in swimming pools.
Pathogensis:
-The mode of spread is via spores which fall on the
stratum corneum of the skin, geminate, produce
keratinase which breaks down keratin of the skin into
simpler substances for Fungal growth.
-Then the fungi entre the hair follicles and grow through
hair shafts, then it produces also keratinase that make
the hair brittle and breaks easily little of the skin giving a
rounded area known as Alopecia with no hair or with
stumps of broken hair.
Microsporum of some Trichophyton:
-Spores grow between the hair sheath and hair shaft
(not inside the shaft)so it can be seen in longitudinal
section , but in real life if we look at a whole hair (not
a section), we find spores all around it.
-These spores are called Ectothrix spores, they are
seen directly in pathological specimens using wet
preparation of scalp scraping. So if we find ectothrix
spores then either microsporum or Trichophyton.
Most Trichophyton species:
Spores grow inside the hair –shaft and produces
spores inside learning the hair-sheath clear. These
spores are called Endothrix spores, they are seen
in direct wet preparation. They are diagnostic of
Trichophyton.
T schoeleirii:
Grows inside the hair shaft but doesn't produce ecto or
endospores. They grow as hyphae and sometimes,
produces arthrospores when the hyphae die they are
replaced by air and this is diagnostic of T.schoeleini
infection.
In skin:
The organism spreads in an annular manner which
resembles spreading of Proteus. As growing, the central
part becomes dry, scaly, the fungus dies in centre
whereas the peripheral is raised and active and this is
where viable organisms are found.
Clinical features:

The name of the infection is given the prefix “Tinea”

followed by the Latin name of the site affected.
1- Tinea Capitis:
-Infection of scalp, eye brow, eye lashes.
-Occurs more commonly in children and sometimes
occurs as epidemics especially in boarding schools and
poor families with poor hygiene.
-It is not debilitating disease but can affect the academic
carriers of the children.
-There are 2 forms:
1- It can be antropophilic caused by M . audouinii.
-The condition there known as favus. The organism
penterates very deeply in the hair follicles and
completely destroys them, and produces a lot of
arthropores .
Tinea Capitis

Gray Patch
-Thousands of these arthropores accumulate in hair
opening and usually crust (yellow and dry) which smell
like the mice it is called scutulum.
-The mousy odour of it is very characteristic. If we remove
it we will find an oozing surface which dries up and result
in an area of alopecia.
-If the condition is n not treated early and promptly , it can
starts in childhood and persists till adulthood and the
child may suffer from permanent alopecia.
-If it is Zoopholic caused by M. canis and T.verrulossum, it
results in a lesion called Kerion, which is usually an
inflamed area that looks like a bag of pus with loss of
hair. It is easily to be treated and once treated the hair
grow without permanent alopecia.
Tinea corporus :
Infection of the skin of the body excluding groins & feet .
Can be multiple lesions .
The lesion spread in an annular manner.
Tinea corporis – body ringworm
Tinea barbae:
-Infection of the bread and moustach in males.
-It occurs in people who share at barbers. An extensive
form of it is called psychosis barbae.
Tinea mannus:
-Infection of hands of interdigital spaces .
-This is more commonly seen in people who immerge their
hands in water for a longtime.
-It starts in interdigital spaces and appears as an
inflammed red area covered by a white macerated skin.
It can spread to another interdigital spaces and also it
can affects the palm and sometimes nails.
- Tinea barbae - ringworm of the bearded
areas of the face and neck.
Tinea cruris:
-Infection of the groins of external genitlia.
-It can transmitted either sexually or through sharing of
under wares and towels.
- It starts in the groins as red inflammed areas with
irregular margins and they are extremely itching- when
scratched, they spread to another area specially the
genitalia.
2- Tinea pedis:
-Infection of the feet and interdigital species
-It also known as athlete foot, because it occur more
commonly in athlerletes because they always wear
occlusive shoes that makes their legs moist and worm
and this favors growth of the Fungi.
Tinea Cruris – Jock Itch
Tinea Pedis – Athlete’s Foot
Infection
-It usually starts between the 4th and 5th toe either as a
fissure (dry type), or as an inflammed area covered by
white macerated skin (moist type).
-From the 4th space, the condition can spread to another
spaces and to the sub digital and planter surfaces of the
foot.
-The condition is very itchy and tend to be chronic, even it
treated the recurrence rate is high . It is one of the worst
conditions.
7- Tinea unguium:
-Infection of the nail of fingers of toes.
-It is known as onychomycosis (Onych=nail, mycosis=
fungal infection)
Tinea Unguium – Nail Infection
-Nails become lusterless (loose their shiny color), irregular,
thickened, brittle (easy to broken), later on it infect nail
bed, a lot of debris accumulates
-By microscope we can see dead epithelial cells, Fungal
hyphae and spores. So the debris are characteristic.
-Sometimes, especially in chronic extensive lesions, the
person get allergic response to fungal elements, as
vesicular eruptions at a site away from the site of
infection e.g:
-In extensive Tinea pedis infection, vasicular eruption
appear in hands. They are fluid they contain doesn’t
contain any fungal element (Sterile fluid ) if sever the
skin peaks off. This condition is called the Dermatophytid
or id reactions.
1- Clinical diagnosis:
-Examine the site of infection:
* If it is a scalp lesion, exclude Epidematophyton
* If nails infection exclude Microsporum

-See if the lesion is dry and scaly or wet to distinguish

anthropophilic form Zoophilic infections.

-Apply UV Light, if the lesion flourcense it will be

Microsporum infection, so the clinical diagnosis can be of
some help.
1- Laboratory diagnosis:
Specimen:
-Skin scraping
-Scalp scraping
-Nails clipping
Collect the specimens in clean piece of paper, fold it, label
it with patient’s name, age , site of collection and date.
Direct microscopic examination:
By wet preparation in 20% KOH heat it by passing through
a flame 3 times or incubate at 37 C0 for ½ hr.
Under microscope:
For skin scraping:
 We see epithelial cells, nuclie
 In positive specimens we see branching fungal hyphae
and small arthospores. Fungal hyphae with or without
spores are diagnostic for dermatophytosis.
For Scalp scraping:
Look for:
1- Ectothrix spores: Microspurum , Trichopyton
2- Endothrix spores : Trichopyton
3- Fungal hyphae and air spaces : T. Schoelieni
Ectothrix and Endothrix

Fluorescing hair (under

Wood's lamp) is seen in dogs
and cats infected with some
dermatophytes
DERMATOPHYTES

Arthroconidia on
hair
For nail clipping:
Same as for skin. i.e. we see hyphae, but the epithelial
cells of the nails are flattened ,
So direct microscopy is diagnostic for dermatophytosis
3- Culture:
-To isolate and identify the causative agents.
- SDA with chloramphenical and cyclohexamide. Incubate
at 26 C0 (saprophytes) or at 37 C0. It takes from few
days to weeks to grow then after growth note the
followings:
1- Rate of growth :
Some grow quicker e.g:
M.canis ,takes 4-7 days to grow while T.verrucosum takes three weeks or
longer
2- configuration of the colonies :
Colonies either :
Fluffy , cribriform ,powdery ,velvety
3- pigment production :
Some produce pigments :
T.verrucosum:violet color
T.rubrum:red color
T.schoelieni : yellow color
T.soudanense: yellow color
T .verrucosum produce a violet pigment which is localized
to the colony and the medium colour doesn’t
Change, while the other three produce pigment that
diffuse, changing the colour of the media.
4- Needle mount (most important)
- Here we examine the organism as it is growing in the
media
- We take wedge-shaped part of the colony to a clean
slide upright, ad few drops of alcohol then we add the
dye lactrophenol cotton blue.
- Cover with a clean cover-glass of examine it under the
microscope.
- We see hyphae, spores, conidia and so by size , shape
and arrangement we can identify the organism.
5- Biological Tests:
Rarely used.
6.Treatment of Dermatophytosis:
As dermatophytosis is a superficial infection thus most of
the treatment is topical.
Drug of Choice include:
 Asoles:
 Clotemazol – micronzole – Econozole -
Ketoconazole
-Ideally, the treatment should be continued till the patient is
clinically and mycologically cured, i.e. : skin become
intact and no fungal elements found in specimens and
cultures. But this is not feasible and many patients can
not afford it so we rely on clinical criteria, roughly:
1- In skin infections : treatment for 2 weeks
2- in scalp infection: continue treatment for 4-6 weeks
3- In nail infections: continue treatment 6 months to one
year or more
4- In Toe nails: take longer time to be treated than finger
nails)
* Automycosis: (Infection of External ear Canal)
This can result from untreated scalp infection. e.g.:
Favus .