SUPERF~1.PPT

8/14/2019 SUPERF~1.PPT

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SUPERFICIAL MYCOSES

Paramasari D phDDarukutni dr


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SUPERFICIAL MYCOSES

DermatophytosisPityriasis versicolorKeratomycosisTinea nigra

Black piedraWhite piedra


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DERMATOPHYTOSIS(=Tinea = Ringworm)

Infection of the skin, hair or nails

caused by a group of keratinophilicfungi, called dermatophytes

Microsporum Hair, skin Epidermophyton Skin, nail Trichophyton Hair, skin, nail


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DERMATOPHYTES

Digest keratin by theirkeratinases

Resistant to cycloheximide

Classified into three groups

depending on their usual habitat


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DERMATOPHYTES

ANTROPOPHILICTrichophyton rubrum...

GEOPHILICMicrosporum gypseum...

ZOOPHILICMicrosporum canis: cats and dogsMicrosporum nanum: swine

Trichophyton verrucosum:horse andswine


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DERMATOPHYTOSISPathogenesis and Immunity

Contact and trauma

Moisture

Crowded living conditions

Cellular immunodeficiency

(chronic inf.)Re-infection is possible (but,

larger inoculum is needed, the

course is shorter )


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DERMATOPHYTOSISClinical Classification

Infection is named according tothe anatomic location involved:

a. Tinea barbae e. Tinea pedis(Athletes foot)

b. Tinea corporis f. Tinea manuum

c. Tinea capitis g. Tinea unguiumd. Tinea cruris

(Jock itch)


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DERMATOPHYTOSISClinical manifestations

Skin: Circular, dry,erythematous, scaly, itchy lesions

Hair: Typical lesions,kerion,scarring, alopecia

Nail: Thickened, deformed,friable, discolored nails, subungualdebris accumulation

Favus (Tinea favosa)


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DERMATOPHYTOSISTransmissionClose human contact

Sharing clothes, combs, brushes,towels, bedsheets... (Indirect)

Animal-to-human contact

(Zoophilic)


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Tinea corporis


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Tinea capitis


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Gray patch tinea capitis


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Tinea cruris


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Tinea favosa


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kandidosis


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kandidosis


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kandidosis


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kandidosis


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DERMATOPHYTOSISDiagnosis

B. CultureMycobiotic agarSabouraud dextrose agar


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DERMATOPHYTESIdentification

A. Colony characteristicsB. Microscopic morphology

Macroconidium MicroconidiumMicrosporum----fusiform---------------(+)Epidermophytonclavate-----------------(-)

Trichophyton-- -(few)cylindrical/ --- --(+)clavate/fusiform single,

in clusters


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DERMATOPHYTESIdentification

C. Physiological tests

In vitro hair perforation testSpecial amino acid and vitamin

requirementsUrea hydrolysisGrowth on BCP-milk solids-glucose

mediumGrowth on polished rice grains

Temperature tolerance and enhancement


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DERMATOPHYTOSISTreatment

Topical

Miconazole, clotrimazole,econazole, terbinafine...Oral

GriseofulvinKetaconazoleItraconazole

Terbinafine


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PITYRIASIS VERSICOLOR

Superficial chronic infection ofStratum corneum

Etio:Malassezia furfur(Pityrosporum orbiculare)(Lipophilic yeast)

Clinical findings:Hyperpigmentedor depigmented maculae on chest,back, arms, abdomen


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Tinea versicolor


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Tinea versicolor


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PITYRIASIS VERSICOLOR

Systemic infection (parenterallipid solution)

Micr.: Short hyphae, yeast cellsCulture: Yeast (suppl.: olive oil)Treatm.: Topical selenium

sulfideOral ketaconazole

Oral itraconazole


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KERATOMYCOSIS(=Mycotic keratitis)

Posttraumatic / postsurgical

corneal inf.Etio:Saprophytic fungi

(Aspergillus, Fusarium,

Alternaria, Candida), Histoplasmacapsulatum

Clinical findings:Corneal ulcer


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KERATOMYCOSIS

Micr.: Hyphae in corneal

scrapings

Treatm.: Surgery (keratoplasty)

Topical pimaricin

NystatinAmphotericin B


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TINEA NIGRA

Superficial chronic infection ofStratum corneum

Etio:Hortae(Exophiala)werneckii (pigmented)

Frequent in tropical areasClinical findings: Brownish

maculae on palms, fingers, face


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Tinea nigra


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TINEA NIGRA

Micr.:Septate hyphae and yeastcells (brown in color)

Culture:Black colonies

Treatm.:Topical salicylic acid,tincture of iodine


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BLACK PIEDRA

Fungal infection of the scalp hair

Etio:Piedraia hortaeFrequent in tropical areas

Clinical findings: Discrete, hard,

dark brown to black nodules onthe hair


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BLACK PIEDRA

Micr.Septate pigmented hyphae,and asci; unicellular and fusiformascospores with polar filament(s)

Culture:Brown to black colonies

Treatm.:Topical salicylic acid,azol cremes


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WHITE PIEDRA

Fungal infection of facial, axillaryor genital hair

Etio:Trichosporon (yeast)

Frequent in tropical and

temperate zones


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WHITE PIEDRA

Clinical findings: Soft, white toyellowish nodules loosely

attached to the hairMicr.: Intertwined septate

hyphae, blasto- and arthroconidia

Culture:Soft, creamy colonies

Treatm.:Shaving, azoles


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Coba bandingkan


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keratomikosis


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keratomikosis


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Tinea imbricata


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Piedra hitam

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