Professional Documents
Culture Documents
Dr. M. Dissanayake
Classification of mycosis
Superficial mycosis Dermatophytosis Tinea versicolor Tinea nigra Candidiasis
Deep mycosis Subcutaneous Mycetoma Chromomycosis Sporotricosis Rhinosporidiosis Phycomycosis Systemic Candidiasis Aspergilosis Cryptococcosis Histoplasmosis Blastomycosis
Genus epidermophyton:
Sources of Dermatophytes
Anthropophilic Tricophyton rubrum Tricophyton mentographyte Tricophyton schoenleinii Microsporum audouinii Tricophyton
Zoophilic
Geophilic
Microsporum gypseum
INFECTION
By Dermatophytes
Tinea corporis
Distal-subungual type
Superficial-white type
Proximal-white type
Differentialdiagnosis Mycosis-Eczema
Diagnosis of dermatophytosis
Diagnosis of dermatophytosis is essentially clinical
Investigations to confirm the diagnosis
Microscopic investigation of scrapings Culture in Sabourouds dextrose agar Woods lamp examination
KOH-preparation
of skin, nail, or epilated hair
1 drop 15 % KOH solution on glass slide Cover with glass Slightly warm up microscopy with 10x10 under dimmed light
Trichophyto n rubrum
Therapy of Tinea
1958 Griseofulvin
1959 Fluconazol 1991 Itraconazol
1992 Terbinafin
Thiazoles
Itraconazole Flucanazole
oral oral
Topical Topical & oral
Thiocarbamat
Tolnaftate
Polyene
Pyridine Azole
Allylamine
Tinea Versicolor
Clinically, pale, scaling develop insidiously over the skin of the chest and back in young adults although other sites can get affected too. Diagnosis is made by identification microscopically of grape-like clusters of spores and a mesh work of pseudomycelium in the scraping. Skin patches often fluoresce an apple green in Woods light.
Malassezia species
Direct examination of scales in 15 % KOH: characteristic round and budding blastospores and short curved hyphae Spagetti and meatballs
Culture on SAB-Agar with thin layer of sterile olive oil
Treatment of T. versicolor
Topical Imidazole creams (e.g. micanazole, clotrmazole, ecanazole) applied once daily over 6 weeks Ketaconazole shampoo to wash once daily for 5 days Older remedies- 20% sodium thiosulphate and selinium disulphate shampoo Oral Ketaconazole 200mg /day for 10 days Itraconazole 200mg/day for 7-15 days
Candidiasis
Candidiasis is an acute or chronic, superficial or disseminated mycotic infection caused by the fungus candida albicans and occasionally by other species of candida. It commonly involves skin and the mucous membranes and sometimes the viscera.
Clinical findings
Oral candidiasis
1. 2. 3. 4. 5. Acute pseudomembranous or thrush. Chronic atrophic candidiasis, often under a denture. Acute atrophic candidiasis- HIV/AID. Chronic hyperplastic candidiasis D.D. leucoplakia. Angular chelitis
Clinical finding
Genital candidiasis- vulvovaginitis/ balanitis exclude diabetes mellitus Candidal intertrigo- Typical sites include the groin, axillae and beneath the breast. Good clinical clue is the presence of satellite pustules. Diaper candidiasis Candida paranychia
Diagnosis of candidiasis
1. Direct examination under the microscope mount in 10% KOH solution Gram + yeast and pseudohyphae. More brilliantly seen under GMS stain or PAS in histopathology sections 2. Culture on Sabourauds Dexrose Agar White creamy colonies in 2-3 days
Germ tube test candida albicans can be identified within 2 hours( wet mount prepared from yeast incubated in human serum for 2 hours.
Advised Good personal hygiene Use gloves with cotton liners while working in water Use cotton underwear and socks Use open footwear Thoroughly dry the intertriginous areas Simultaneously treat the sexual partner even if asymptomatic in case of balanitis and vaginitis
Candidiasis- Therapy
Systemic Flucanazole is the most widely used systemic agent. 150mg single dose for vulvovaginitis 50-100mg daily for 7- 14 days- oral candidiasis Nystatin- ( Polyene anitimycotic agent) oral rinses Orally for boel infections Amphotecin B IV or flucanazole orally for systemic infection Topical Azole creams, lotions Nystatin