Submitted

Submitted
by =
to = Miss
Rehmat
warda
ullah
Fuuast
Class
Assignment
= 3th year 6
= 3
semester
Contents
• Mycoses • Subcutaneous mycoses
• Superficial mycoses • 2 Disease caused by
• 2 Disease caused by superficial subcutaneous fungi
fungi
• Cutaneous mycoses
• 2 disease by cutaneous fungi
Mycoses
• is an infectious disease caused by pathogenic fungus in humans and
animals. Mycoses are common and a variety of environmental and
physiological conditions can contribute to the development of fungal
diseases. Inhalation of fungal spores or localized colonization of the
skin may initiate persistent infections; therefore, mycoses often start
in the lungs or on the skin.
• Fungal infections of the skin was the 4th most common skin disease
in 2010 affecting 984 million people. An estimated 1.6 million people
die each year of fungal infections.
Classification
1; Superficial mycoses

2; Cutaneous mycoses

3; Subcutaneous mycoses
Superficial mycoses
• The term “suerficial mycosis” applies to diseases affecting the
outermost layer of the skin (stratum corneum), or growing along hair
shafts. The most common superficial mycosis is pityriasis versicolor,
causing patches of hypo- or hyper-pigmentation of the neck,
shoulders, chest, and back, and caused by lipophilic basidiomycete
yeasts of the genus Malassezia.
Diseases are caused by
superficial fungi
1 . Dermatophytosis
• Dermatophytes (from Greek δέρμα derma "skin" (GEN δέρματος
dermatos) and φυτόν phyton "plant") are a common label for a group
of three types of fungus that commonly causes skin disease in
animals and humans. These anamorphic (asexual or imperfect fungi)
mold genera are: Microsporum, Epidermophyton and Trichophyton.
There are about 40 species in these three genera. Species capable of
reproducing sexually belong in the delomorphic genus Arthroderma,
of the Ascomycota (see Teleomorph, anamorph and holomorph for
more information on this type of fungal life cycle).
• Dermatophytes cause infections of the skin, hair, and nails, obtaining
nutrients from keratinized material.
Dermatophytes

• The organisms colonize the keratin tissues causing inflammation as the host responds to metabolic byproducts. Colonies
of dematophytes are usually restricted to the nonliving cornified layer of the epidermis because of their inability to
penetrate viable tissue of an immunocompetent host. Invasion does elicit a host response ranging from mild to severe.
Acid proteinases (proteases),[5] elastase, keratinases, and other proteinases reportedly act as virulence factors.
Additionally, the products of these degradative enzymes serve as nutrients for the fungi.[5] The development of cell-
mediated immunity correlated with delayed hypersensitivity and an inflammatory response is associated with clinical
cure, whereas the lack of or a defective cell-mediated immunity predisposes the host to chronic or recurrent
dermatophyte infection. Some of these skin infections are known as ringworm or tinea (which is the Latin word for
"worm"), though infections are not caused by worms.[3][6] It is thought that the word tinea (worm) is used to describe
the snake-like appearance of the dermatophyte on skin.[6] Toenail and fingernail infections are referred to as
onychomycosis. Dermatophytes usually do not invade living tissues, but colonize the outer layer of the skin. Occasionally
the organisms do invade subcutaneous tissues, resulting in kerion development.
Pathogenesis
• In order for dermatophytoses to occur, the fungus must directly contact the skin.[
Likelihood of infection is increased if the skin integrity is compromised, as in
minor breaks.The fungi use various proteinases to establish infection in the
keratinized stratum corneum. Some studies also suggest that a class of proteins
called LysM coat the fungal cell walls to help the fungi evade host cell immune
response.The course of infection varies between each case, and may be
determined by several factors including: "the anatomic location, the degree of
skin moisture, the dynamics of skin growth and desquamation, the speed and
extent of the inflammatory response, and the infecting species.
• The ring shape of dermatophyte lesions result from outward growth of the fungi.
The fungi spread in a centrifugal pattern in the stratum corneum, which is the
outermost keratinized layer of the skin.
Diagnosis and identification
• Usually, dermatophyte infections can be diagnosed by their
appearance. However, a confirmatory rapid in-office test can also be
conducted, which entails using a scalpel to scrape off a lesion sample
from the nail, skin, or scalp and transferring it to a slide. Potassium
hydroxide (KOH) is added to the slide and the sample is examined
with a microscope to determine presence of hyphae.Care should be
taken in procurement of a sample, as false-negative results may occur
if the patient is already using an antifungal, if too small a sample is
obtained, or if sample from a wrong site is collected.
Transsmission
• Dermatophytes are transmitted by direct contact with an infected host
(human or animal)[3] or by direct or indirect contact with infected shed
skin or hair in fomites such as clothing, combs, hair brushes, theatre seats,
caps, furniture, bed linens, shoes,socks, towels, hotel rugs, sauna,
bathhouse, and locker room floors. Also, transmission may occur from soil-
to-skin contact.Depending on the species the organism may be viable in
the environment for up to 15 months.While even healthy individuals may
become infected, there is an increased susceptibility to infection when
there is a preexisting injury to the skin such as scars, burns, excessive
temperature and humidity. Adaptation to growth on humans by most
geophilic species resulted in diminished loss of sporulation, sexuality, and
other soil-associated characteristics.
Treatment
• Tinea corpora (body), tinea manus (hands), tinea cruris (groin), tinea pedis (foot)
and tinea facie (face) can be treated topically.
• Tinea unguum (nails) usually will require oral treatment with terbinafine,
itraconizole, or griseofulvin. Griseofulvin is usually not as effective as terbinafine
or itraconizole. A lacquer (Penlac) can be used daily, but is ineffective unless
combined with aggressive debridement of the affected nail.
• Tinea capitis (scalp) must be treated orally, as the medication must be present
deep in the hair follicles to eradicate the fungus. Usually griseofulvin is given
orally for 2 to 3 months.[17] Clinically dosage up to twice the recommended dose
might be used due to relative resistance of some strains of dermatophytes.
• Tinea pedis is usually treated with topical medicines, like ketoconazole or
terbinafine, and pills, or with medicines that contains miconazole, clotrimazole,
or tolnaftate.[17] Antibiotics may be necessary to treat secondary bacterial
infections that occur in addition to the fungus (for example, from scratching).
2;Pityriasis versicolor
• Pityriasis versicolor is a common yeast infection of the skin, in which
flaky discoloured patches appear on the chest and back.
• The term pityriasis is used to describe skin conditions in which the
scale appears similar to bran. The multiple colours of pityriasis
versicolor give rise to the second part of the name, versicolor.
Pityriasis versicolor is sometimes called tinea versicolor, although the
term tinea should strictly be used for dermatophyte fungus
infections.
Cause of pityriasis versicolor
• Pityriasis versicolor is caused by mycelial growth of fungi of the genus
Malassezia.
• Pityriasis versicolor most frequently affects young adults and is
slightly more common in men than in women. It can also affect
children, adolescents, and older adults.

• Pityriasis versicolor is more common in hot, humid climates than in

cool, dry climates. It often affects people that perspire heavily. It may
clear in the winter months and recur each summer
Diagnosed
• Pityriasis versicolor is usually diagnosed clinically. However, the following tests
may be useful.
• Wood lamp (black light) examination— yellow-green fluorescence may be
observed in affected areas
• Dermoscopy of pityriasis versicolor - pallor, background faint pigment network,
and scale is seen
• Microscopy using potassium hydroxide (KOH) to remove skin cells—hyphae and
yeast cells that resemble spaghetti and meatballs are observed
• Fungal culture—this is usually reported to be negative, as it is quite difficult to
persuade the yeasts to grow in a laboratory
• Skin biopsy—fungal elements may be seen within the outer cells of the skin
(stratum corneum) on histopathology. Special stains may be required.
Treatment of pityriasis versicolor
• Mild pityriasis versicolor is treated with topical antifungal agents.
• Topical azole cream/shampoo (econazole, ketoconazole)
• Selenium sulfide
• Terbinafine gel
• Ciclopirox cream/solution
• Propylene glycol solution
• Sodium thiosulphate solution
 • Cutaneous mycoses extend deeper into the
epidermis, and also include invasive hair and
nail diseases. These diseases are restricted to
the keratinized layers of the skin, hair, and nails.
Unlike the superficial mycoses, host immune
Cutaneous responses may be evoked resulting in pathologic
changes expressed in the deeper layers of the
mycoses skin. The organisms that cause these diseases
are called dermatophytes, the resulting diseases
are often called ringworm, dermatophytosis or
tinea. Dermatophytes only cause infections of
the skin, hair, and nails, and are unable to
induce systemic, generalized mycoses, even in
immunocompromised hosts.
Aspergillosis
• Aspergillosis is infection,
usually of the lungs, caused
by the fungus Aspergillus. A
ball of fungus fibers, blood
clots, and white blood cells
may form in the lungs or
sinuses. People may have no
symptoms or may cough up
blood or have a fever, chest
pain, and difficulty breathing.
Sign & Symptom
• Fever and chills.
• A cough that brings up blood (hemoptysis)
• Shortness of breath.
• Chest or joint pain.
• Headaches or eye symptoms.
• Skin lesions.
Treatment
 • Tinea corporis is a superficial fungal infection
2 Tinea of the skin that can affect any part of the
body, excluding the hands and feet, scalp,
corporis face and beard, groin, and nails. It is
commonly called ‘ringworm’ as it presents
with characteristic ring-shaped lesions.
Tinea corporis
• Tinea corporis is found in most parts of the world, but particularly in hot humid
climates. It is most commonly seen in children and young adults, however all age
groups can be infected including newborns.
• Medical risk factors include:
• Previous or concurrent tinea infection
• Diabetes mellitus
• Ichthyosis.
• Environmental risk factors include:
• Household crowding
• Infection of household members
• Keeping house pets
• Wearing occlusive clothing
 • Subcutaneous mycoses include a
heterogeneous group of fungal infections
that develop at the site of transcutaneous
trauma and can occur in both
immunocompetent and
immunocompromised patients. Infection
Subcutaneous evolves slowly as the etiological agent
mycoses survives and adapts to the adverse host
tissue environment. The main subcutaneous
fungal infections include sporotrichosis,
chromoblastomycosis, mycetoma,
lobomycosis, rhinosporidiosis, subcutaneous
zygomycosis, and subcutaneous
phaeohyphomycosis .
Subcutaneous mycoses
• The common fungal etiologic agents like Sporothrix schenkii, Cladophialophora
carrionii, Fonsecaea pedrosoi, Phialophora verrucosa, Rhinocladiella aquaspersa,
Exophiala jeanselmei, Exophiala spinifera, Wangiella dermatitidis, Acremonium
spp., Conidiobolus coronatus and Basidiobolus ranarum have been associated
with subcutaneous mycotic infections . The subcutaneous mycoses caused by rare
fungi such as Colletotrichum species, Diaporthe, Fusarium subglutinans,
Chaetomium funicola etc. have been described in the literature so far . We report
a case of subcutaneous mycoses in an immunocompetent male caused by a
dematiaceous fungus belonging to genus Rhytidhysteron.
1.Sporotrichosis;
• porotrichosis (also known as “rose gardener’s disease”) is an infection
caused by a fungus called Sporothrix. This fungus lives throughout the
world in soil and on plant matter such as sphagnum moss, rose
bushes, and hay.1,2 People get sporotrichosis by coming in contact
with the fungal spores in the environment. Cutaneous (skin) infection
is the most common form of the infection. It occurs when the fungus
enters the skin through a small cut or scrape, usually after someone
touches contaminated plant matter. Skin on the hands or arms is
most commonly affected.
 Diagnosis & Testing

• Your healthcare provider will take a small

tissue sample (biopsy) of the infected area of
the body for laboratory tests. The laboratory
will usually perform a fungal culture to find
out what is causing the infection. Blood tests
can help diagnose severe sporotrichosis, but
usually can’t diagnose skin infections.
2. Chromomycosis
• Chromoblastomycosis is a chronic fungal infection
of the skin and the subcutaneous tissue caused by
traumatic inoculation of a specific group of
dematiaceous fungi (usually Fonsecaea pedrosoi,
Phialophora verrucosa, Cladosporium carrionii, or
Fonsecaea compacta) through the skin.
Prevention
• No preventive measure is known aside from avoiding the traumatic
inoculation of fungi. At least one study found a correlation between
walking barefoot in endemic areas and occurrence of
chromoblastomycosis on the foot.
Rehmat ullah