SUPERFICIAL Malassezia furfur DISEASE CAUSED CHARACTERISTICS OF DISEASE Pityriasis versicolor a.k.

a Tinea versicolor, Tinea Flava, Dermatomycosis furfurcea, liver spots Chronic, asymptomatic fungal infection of the stratum corneum Hyperpigmented macules or patches Increase in melanosome size but not in number Folliculitis Sepsis Excessive sweating Chest, upper back, shoulder, upper arms, abdomen hair shafts and nails DIAGNOSIS KOH mount Branching septate hyphae Spaghetti and meatballs Woods light Yellow fluorescence Culture White to creamy Saborauds agar Ketoconazole With very high recurrence rate Psoriasis, mycosis fungoides, febrile systemic syndrome (neonates) Otitis externa of dogs urine, CSF, blood, vaginal, eye & ear discharge, tracheal aspirate -also reported in patients receiving IV lipid hyperalimentation (esp. neonates)

FACTOR COMMON SITES

TREATMENT OTHERS DISEASE CAUSED SITE

Malassezia pachydermatitis

Malassezia sympodialis SITE Pidea hortai DISEASE CAUSED CHARACTERISTICS OF DISEASE COMMON SITES DIAGNOSIS Black piedra (tropics and subtropics) Infected hair: rough, sandy, or granular Nodules :hard, fusiform, firmly attached to hair shaft Scalp hair hair follicles, cortex of hair KOH mount Tightly packed, regularly arranged, thick-walled cells, dichotomously branching, dematiaceous hyphae 8 ascopores Culture Compact, dark-brown to black, conical with short aerial hyphae Grow slowly on Saborauds agar Topical medication Shaving and cutting Males=females Common in regular swimmers Scalp of AIDS patients with Tinea capitis

TREATMENT OTHERS

Trichosporon beigelii

DISEASE CAUSED CHARACTERISTICS OF DISEASE

COMMON SITES DIAGNOSIS

White piedra (temperate) infected hair :softer, mucilaginous, white and to light brown nodules :adherent Facial and genital hair hair follicles KOH mount Softer, less adherent, not as discrete Transparent, greenish, irregular sheath Blastospores and arthrospores Culture Smooth, highly-wrinkled or radially folded, yeast-like, cream-colored Grow moderately Hyaline septate hyphae with many arthrospores Topical medication Shaving and cutting Low incidence in black variety

TREATMENT OTHERS

Cladosporium werneckii or Exophiala werneckii DISEASE CAUSED Tinea nigra a.k.a. Keratomycosis nigricans Palmaris, cladosporiosis epidermica, pityriasis nigra, microsporis nigra Chronic, superficial (upper layers of stratum corneum), asymptomatic, fungal infection Dark patch on the palm with well-defined, irregular margin stained appearance Occ. Pruritus and scaling erythema, induration FACTOR COMMON SITES DIAGNOSIS Hyperhydrotic patients Palms KOH mount Sinous, dematiaceous branching septate hyphae and elongated budding cells Saborauds agar Shiny, moist, yeastlike dirty white to brown covered with masses of conidia and budding cells Turn black in 2-3 weeks Ketoconazole Tropical disease Male:female 1:3 Common under 20 Misdiagnosed as melanoma Low recurrence rate Mycotic keratitis (Keratomycosis) Fungal infection of the cornea Trauma leading to inoculums of eyes Raised cornea ulcers with occasional satellite lesions, plaques, or hypopyon Cornea Demonstration of Hyphae Corneal scrapings Surgical specimens Saborauds agar and Enriched medium Potato dextrose Agar Cottonlike, white, turning pink-vioolet or brown at the center with age Lactophenol cotton blue

CHARACTERISTICS OF DISEASE

TREATMENT OTHERS

Histoplasma capsulatum and Fusarium solani DISEASE CAUSED CHARACTERISTICS OF DISEASE COMMON SITES DIAGNOSIS

 Microconidia with fusiform or oval shape extending gtom delicate lateral phialides Macroconidia are fusiform with appearance of sickle and have 3-5 septae CUTANEOUS ETIOLOGY: Dermatophytes -keratophilic fungi CLINICAL MANIFESTATION: Tinea or Ringworm ANAMORPHIC STATES: MICROSPORUM skin and hair TROCHOPHYTON all (skin, hair, and nails) EPIDERMOPHYTON skin and nail TELEOMORPHIC STATE of Microsporum and Trichophyton is genus Arthroderma DIAGNOSIS Culture (SDA with cycloheximide, chloramphenicol) Macroconidia: large and multicellular Microconidia: small and unicellular Spiral hyphae, chlamydospores, nodular bodies, racquet hyphae, and chandeliers
ASEXUAL STATE OF SELECTED DERMATOPHYTES CLASSIFICATION OF DERMATOPHYTES ACCORDING TO ECOLOGICAL NICHE GENERAL CHARACTERISTICS OF MACROCONIDIA AND MICROCONIDIA OF DERMATOPHYTES

KOH 10% (skin), 20% (hair) except:

Trichophyton schoenleinii Disease caused Characteristics of disease Factor Common sites Diagnosis Favus Infected hair :with waxy mass of hyphal elements (scutulum) Hyperhydrotic patients Palms Microscopic exam Degenerated hyphal elements coursing throughout the hairshaft Azoles -interfere with cytochrome p450 Griseofulvin -fungistatic, affects microtubular system -oral route

Treatment

Others: Tinea capitis Tinea corporis Tinea mannum Tinea cruris Tinea pedis Tinea favus

with erythematous edge part of the rtorso hand with abrasions, prutirus, very itchy jock itch, inguinal, pubic and perennial athletes foot, crackling of skin but moist inner also affects hair follicles causing hairloss

SUBCUTANEOUS individual Sporothrix schenckii DISEASE CAUSED CHARACTERISTICS OF DISEASE Sporotrichosis Gardeners disease (spores on thorns) Form granuloma-like filled with inflammatory cells Lymphocutaneous Chronic Fixed cutaneous, subcutaneous and lymphatics KOH Cigar-shaped bodies Culture @37: white greeny colonies @25: brown to black moulds-hyphal elements with microspores (infectious) Potassium Iodide (KI) -oral Itraconazole Most common

COMMON SITES DIAGNOSIS

TREATMENT

OTHERS Loboa loboi DISEASE CAUSED CHARACTERISTICS OF DISEASE FACTOR COMMON SITES DIAGNOSIS

Lobomycosis Kelloidal blastomycosis Small, hard, subcutaneous nodules Painless but may become verrucous and ulcerative Extremeties, face and ear lymph nodes KOH mount Skin scrapings, biopsies, exudates Large yeast cells with multiple buds and form 3-4 short chains DOC: Sulfa drugs Surgery Rhinoentomophthoromycosis Hard, subcutaneous nodules large disfurging tissue mass

TREATMENT Entomophthora coronata DISEASE CAUSED CHARACTERISTICS OF DISEASE FACTOR COMMON SITES DIAGNOSIS TREATMENT

Nasal mucosa blood vessels Biopsy numerous branching hyphae Surgery KI Amphotericin B Rhinosporidiosis chronic polyploidy masses(pedunculated) in the nasal mucosa compromised respiration due to polyps sporangia nose, nasopharynx, soft palate, occ. genitals other mucocutaneous sites: conjunctiva, genitalia, rectum KOH or HP

Rhonosporidium seeberi DISEASE CAUSED CHARACTERISTICS OF DISEASE

COMMON SITES DIAGNOSIS

 sporangia TREATMENT OTHERS Phycomycosis several Dematiaceous fungi Fonsecae Phialophora Cladosporium Most common: F. pedrosoi DISEASE CAUSED Chromomycosis CHARACTERISTICS OF Slow development of verrucous, cutaneous vegetations DISEASE Verrucous cauliflower-like lesions Systemic invasion is rare COMMON SITES Lower extremeties DIAGNOSIS Biopsy KOH Sclerotic bodies TREATMENT Excision (early stages) Amphotericin B (late) Fluocytosine Itraconazole OTHERS Temperate and tropical Caused by traumatic implantation Surgery Dapsone Stimulate proliferation of epithelial cells

Dematiaceous fungi Exophiala Wangiella Cladosporium Phialophora DISEASE CAUSED Phaeohyphomycosis CHARACTERISTICS OF Subcutaneous cysts DISEASE -suually solitary, discrete, firm, non-tender Cutaneous and systemic Brain abcess with deep-tissue invasion COMMON SITES DIAGNOSIS KOH or HP Brown septate hyphae TREATMENT Excision (early stages) Amphotericin B (late) Fluocytosine Itraconazole Caused by traumatic implantation

OTHERS

Actinomycotic Actinomadura Nocardia Streptomyces granules: contain very fine, delicate hyphae Eumycotic Actinomycetes: Eumycetes

Allescheria Madurella Phialophora, granules: contain large, coarse, septate hyphae DISEASE CAUSED Mycetoma CHARACTERISTICS OF Local tumefaction and interconnecting often draining sinuses that contain granules DISEASE COMMON SITES feet, lower extremities, hands, exposed areas DIAGNOSIS KOH or HP granules Color Size Texture hyaline or pigmented hyphae Amphotericin B Ketoconazole Topical Nystatin Fluocytosine Debridement Common In Central and South America, Africa, India

TREATMENT

OTHERS SYSTEMIC Blastomyces dermatitides DISEASE CAUSED CHARACTERISTICS OF DISEASE

DIAGNOSIS

Blastomycosis a.k.a. Gilchrists disease, North America Blastomycosis Similar to PTB Suppurative and granulomatous lesions Skin lesions Pulmonary -mimic TB Systemic :granulomatous lesions and abceses Cutaneous :crusty lesions, with well defined margins (verrucous borders) with microabcesses Body thick walled yeast cells with broad-based bud Environment mycelia form with oval-shaped conidia on a laterally branching hyphae (infectious) sputum, skin scrapingsm biopsy Itroconazole -oral antifungal Soil-dweller fungi Common in men vs. TB: Cons granules: tubercle bacilli surrounded by immunes cells solid lesion Paraccocidioidomycosis a.ka. South American Blastomycosis Granulomatous disease Lymph node enlargement Skin, lymph nodes, mucous membranes, and internal organs Gingival (loss of teeth) large yeast cells with multiple buds (Mariners wheel) -may be mistaken for Rhinosporidium SDA white fluffy colonies

TREATMENT OTHERS

Paraccocidoides brasiliensis DISEASE CAUSED CHARACTERISTICS OF DISEASE COMMON SITES DIAGNOSIS

TREATMENT OTHERS Coccidiodes immitis DISEASE CAUSED CHARACTERISTICS OF DISEASE

Gomori, LCB Serologic Tests (C fixation, immunodiffusion) @37 hyphal form with infectious spore Itraconazole -oral antifungal Common in men 20-30 y/o

COMMON SITES DIAGNOSIS

TREATMENT OTHERS

Coccidiodomycosis Primary pulmonary flu-like symptoms Benign form (+) skin test Lung cavitation Disseminated form Spread to internal organs Precipitin titer diminish Barrel-shaped infectious arthrospores Cutaneous or sucutaneous Thick-walled sporangia or spherule containg multiple endospores Culture Fluffy white colonies on micro will reveal barrel-shaped arthroconidia Calcoflour white (also Silver Stain) Fluorescence due to fungal wall skin, sputum, other tissues Ampothericin B -oral antifungal Highest risk race: Filipnos, African-Americans, Hispanics, Other asianas Common in dark skinned individuals and men

Histoplasma capsulatum Var. capsulatum Var. duboisii (birds) Var. farciminosum (horse) DISEASE CAUSED Histoplasmosis a.k.a. Reticulo-endothelial cytomycosis, Cave disease, Spleunkers disease, Darlings disease CHARACTERISTICS OF Primary acute DISEASE flu-like or asymptomatic (+) histoplasmin skin test Chronic cavitary cavitary lung lesion destroy alveolar walls Severe Disseminated affect RES COMMON SITES DIAGNOSIS Non encapsulated intracellular yeast cells -may be mistaken with Leishmania spp. Culture Whte fluffy colonies Microscopy Microconidia: tuberculate Macroocnidia @25: mistaken for mariners wheel @35-37: yeast form

TREATMENT OTHERS

Histoplasmin skin test Precipitin Test CfAb titer Itraconazole Thrives in bird and bat droppings MOA: inhalation of microconidia

Histoplasma capsulatum var duboisii (birds) DISEASE CAUSED COMMON SITES DIAGNOSIS TREATMENT OPPURTUNISTIC Candida albicans DISEASE CAUSED CHARACTERISTICS OF DISEASE Candidiasis SUPERFICIAL
--infection of the skin, hair, nails and mucous membranes a. cutaneous infection b. chronic mucocutaneous infection c. onychomycosis -involves the fingernails due to frequent exposure to water (laundry women, cannery workers etc) d. oropharyngeal infection -occurs in infants, patients with diabetes mellitus, those receiving broad spectrum antibiotics, and those with HIV infection e. vulvovaginitis -occurs most commonly in postpubertal women who have DM, have been taking antibacterial drugs, are in the third trimester of pregnancy, or are sexually active -vaginal discharge, which may be curd-like, itching, burning, and dyspareunia are the most common symptoms f. keratitis g. conjunctivitis -a complication of the long-term use of corticosteroid eye drops -other risk factors are breaks in the corneal epithelium such as those caused by bullous keratopathy or corneal ulcers due to herpes simplex -findings include conjunctival erythema, cheesy discharge in the conjunctival sac, and progressive corneal ulceration

African Histoplasmosis Skin, lymph node, bone Rare pulmonary Large yeast cells inside giant cells Same mycelia form Itraconazole

DEEP
a. b. c. d. e. f. a. b. c. d. e. f. g. h. i. j. Local inoculation Esophagitis (candida esophagitis) Gastrointestinal candidiasis Urinary tract infection (includes fungus ball of the ureter, cystitis, renal abscess, and pyelitis Peritonitis intra-abdominal abscess Respiratory Tract Candidiasis Candidemia Chronic disseminated (hepatosplenic) candidiasis Disseminated Candidiasis due to heroin abuse Suppurative phlebitis Endocarditis Endophthalmitis Arthritis (Candida Arthritis) Osteomyelitis (Candida Osteomyelitis) Candida Endysphthalmitis CNS Candidiasis

HEMATOGENOUSLY DISSEMINATED (fever, DIC, shock)

COMMON SITES DIAGNOSIS TREATMENT OTHERS

Pseudohyphae (germ tube) or budding yeast cells within 24-28hrs Ampothericin B Most common cause of systemic mycoses Infect any organ system Burn patients and IV frug users Cryptococcosis a.k.a. Torulosis, European blastomycosis, Buss-Buschke disease AIDS (neoformans)

Cryptococcus neoformans var neoformans and gatti DISEASE CAUSED CHARACTERISTICS OF

DISEASE

COMMON SITES DIAGNOSIS

*Gatti may infect those non-immunocompromised Pulmonary Pneumonia Disseminated Meningitis (other causes are also encapsulated except Meninggococcemia) Respiratory tract and skin of healthy people With affinity to nervous tissue 10% KOH or India Ink Encapsulated yeast cells Culture Urease (+) [like Proteus, Providencia, Morganella) Clean white to yellow brown colonies SDA Does not require cyclohexamide, sensitive unlike candida which is resistant HP Mucicarmine stain Serologic (more sensitive and specific Cryptococcal Ag Latex Agglutination Test (CALA) Source of fungi neoformans: pigeon droppings gatti: eucalyptus camaldulensis or red gum

TREATMENT OTHERS

Apergillus fumigatus most common for invasive and noninvasive flavus 2 most common from invasive
nd

niger 3 most common of invasive pulmonary

rd

DISEASE CAUSED CHARACTERISTICS OF DISEASE

Aspergillosis a) invasive lings to other organs b) noninvasive pulmonary *allergic bronchopulmonary -similar to asthma *aspergilloma - fungus balls (mass of hyphale elements in lungs) hyphal form in sputum and expectorated mucus : dichotomously branching septate hyphae Removal of fungus ball and oral antifungal for invasive type Inhalation of spores (conidia) Airborne spores or through hosp supplies

COMMON SITES DIAGNOSIS TREATMENT OTHERS

Class Zygomycetes, order Mucorales - thermotolerant : Genus: Rhizopus Rhizomucor Abdisia Cunninghamella Mucor Syncephalastrum DISEASE CAUSED CHARACTERISTICS OF DISEASE

Mucormycosis a) rhinocerebral -infect nasal mucosa and deeper tissues, sinuses, eye, bones and brain -presence of sporangiospores in nasal passages, invades blood vessels and able to cause necrosis and thrombosis

b) thoracic - spores are lodged in the lungs (pulmonary) - acquired through inhalation of sporangiospores COMMON SITES DIAGNOSIS TREATMENT OTHERS Penicillin marneffei DISEASE CAUSED CHARACTERISTICS OF DISEASE COMMON SITES DIAGNOSIS TREATMENT OTHERS Pneumocystic carinii DISEASE CAUSED CHARACTERISTICS OF DISEASE COMMON SITES DIAGNOSIS TREATMENT Pneumocystic pneumonia Major cause of death in AIDS pariend Lymph node, lung, liver , skin Thin-walled trophozoites and thick walled cyst Produce fungal cell wall seen with calcoflour white Co-trimoxazole, Trimethoprim sulfamethoxsazole -prophylactic antibiotic Pentamide -AIDS Newest Neutralization: CMI Penicillinosis Nonspecific manifestations Lymph node, lung, liver , skin Biseriate, dichotomous held by a metula hyphal form Amphotericin B First isolated in bamboo rats Produces an antibiotic Broad hyphae of uneven thickness, irregular branching, sparsely septated Surgical removal of germinating fungi Rapid administration od antifungal (Ampothericin B) Syncephalastrum: medusa-like

OTHERS