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8. Superficial Mycosis

8. Superficial Mycosis

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Published by: Luqman Al-Bashir Fauzi on Mar 21, 2011
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02/03/2013

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SUPERFICIAL MYCOSES
= DERMATOMYCOSES= SUPERFICIAL MYCOSES= CUTANEOUS MYCOSES
MYCOLOGY
Dermatophytes (literally: Skin plants)Separated primarily by morphology of their MACROCONIDIA and MICROCONIDIASexual forms for many Microsporum & Trichophyton sppIdentified and assigned to genera ASCOMYCETE (Arthroderma, Nannizzia)Most grow best at 25 C on Sabourauds agar.Hyphae are spetateConidia either directly on hyphae or on conidiophoresSmall microconidia may or may not be formedLarger & more distinct MACROCONIDIA  identificationGenus Epidermaphyton-
 
Macroconidia: smooth-walled, singlt or in clusters-
 
Micr: nilGenus MicrosporumMac: rough-walled, fusiform or culindricalMic: few, pear-shaped, alone, along hyphaeGenus TrichophytonMac: smooth-walled, cylindricalMic: numerous, spherical/pear shaped, appear in clusters along hyphae
D
ERMATOPHYTES
(Disease  dermatophytosis)Moulds/fungi which infect KERATINIZED TISSUES (i.e superficial areas of the body) which include theSKIN, HAIR and NAILSCurrent number of fungal species ~ 50,000Those that are known to cause disease in man ~ 100-150
 
At least 40 species of dermatophytes infect humansOnly about 15  common causes of superficial mycosisClassified as DEUTEROMYCETES (FUNGI IMPERFECTI)Family: MONOLIACEAE and 3 (THREE) GENERA
y
 
MICROSPORUM/ARTHRODERMA -> Infection: MICROSPOROSIS(NOT microspora!  protozoa -> MICROSPORIDIOSIS)
y
 
Trichophyton ->INFECTION: trichophytosis(not Trichomoonas!  flagellated protozoa -> TRICHOMONIASIS
y
 
Epidermophyton -> infection: EpidermophytosisAll the 3 fungi/GENERA have rather similar MORPHOLOGY, INFECTIVITY and PATHOGENICITY.Therefore usually categorized according to the CLINICAL SYNDROME and PREFERRED ANATOMICSITE with which they are associated. And these superficial mycoses often manifest as serpenginousskin markings  thereby often referred to as:
TINEA
(Latin) = grub/moth larva/worm = ringwormTINEA (RINGWORM) : examplesExamples:Tinea Capitis  Ringworm of the scalpTinea Corporis  Ringworm of the bodyTinea Pedis  Ringworm of the athletes footTinea Unguium  Ringworm of the nails (Onychomycosis)Tinea Imbricata (Tokelau/Oriental ringworm)  island in NZEtc, etc + at least 15 others  refer
to big medical dictionary or dermatology textbook!
+Tinea versicolor  strictly not a dermatophytosis but included as it affects the superficial skin layers.EPIDEMIOLOGYDERMATOPHYES  specially adapted to 3 sites/niches: on/inHumansAnimalsSoil  Geophilic
 
y
 
Occur worldwide
y
 
Vary in presentation according to site of infection
y
 
High living standards= Lowered incidence of T. capitis= Increased incidence of T.Pedis (athletes foot. Shoes & stockings -> warmth & moisture)
y
 
Increased Dermatomycosis due to Trichophyton rubrum (an anthropophilic dermatophytethe most common dermatophyte pathogen worldwide)
y
 
Transmission of zoophilic dermatophytesDirect contactFomites
y
 
Geophilic dermatophytesFarmersGreenhouse workers
y
 
The most common of the 3  anthropophilic dermatophytes
PATHOGENESIS OF
D
ERMATOPHYTOSES
HOST FACTORS which favour diseaseAbraded skinOcclusive clothing, footwear, dressingsPresence of other cutaneous diseases like atopic dermatitisDermatophyte invade keratinized layer of skin -> produce keratinases that digest keratinMost lesions contained within this anatomic boundaryMay be self-limitingWidespread infection seen in patients:-
 
With HIV/AIDS-
 
On immunosuppressive drug regimes-
 
Have endocrinopathies like Cushings disease
Superficial Mycosis II
Pathogenic features  refer diagrama.
 
Normal continual shedding of stratum corneum  protects from dermatophytesb.
 
Inflammatory reactions following dermatophytoses1.
 
Penetration of stratum corneum  CMI response2.
 
Vesiculation occurs in severe cases3.
 
Stratum corneum contains nucleated cells!-
 
Inflammatory reaction increases epidermal cell division rates  pass more rapidlythrough epidermis-
 
Full differentiation of cells of different strate does not take place

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