Cutaneous Mycoses

Cutaneous Mycoses
▸ The dermatophytes, a group of ▸ Fungi that only infect
about 40 related fungi divided keratinized tissue cause
into three genera: Microsporum, cutaneous mycoses
Trichophyton, and (skin, hair, and nails).
Epidermophyton, are the most
important.

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Dermatomycoses
Dermatophytosis
▸ Fungal diseases of the ▸ A result of infection
keratinized tissues of with dermatophyte.
humans and other
animals

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Dermatophytic infections
▸ Involve a restricted ▸ Lesion – result of a
region of the host local inoculation of the
▸ Diseases are named with skin with the causative
the portion of the body agent.
affected
▸ Named after where the
site of infection

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Symptoms of Cutaneous
Mycoses
▸ Itching
▸ Scaling
▸ Ringlike patches of the
skin
▸ Brittle, broken hairs
▸ Thick, discolored nails.

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General Characteristics
▸ Keratinophilic
* adapted to grow on
hair, nails, and cutaneous
layers of skin that contain
the scleroprotein keratin.
▸ Dermatophytes sizes of
reproductive cells:
* macroconidium or
microconidium
* Both are anamorphic
or asexual conidia.
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How cutaneous mycoses live
▸ 1. Geophilic –inhabit in ▸ 3. Anthropophilic –
the soil and produce adapted exclusively to
large numbers of human hosts, produce
conidia only few conidia.
▸ 2. Zoophilic – adapted
to live in animals; fewer
conidia are produced.

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Trichophyto
n spp.
▸ Trichophyton rubrum
▸ Trichophyton tonsurans
▸ Trichophyton schoenleiniii
▸ Trichophyton mentagrophytes
▸ Trichophyton verrucosum
▸ Trichophyton violaceum
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 Common Characteristics
▸ Microscopic Feature
▸ Trichophyton is the most common and
• Microconidia – oval-pyriform
widespread cause of foot and nail
• Attached singly, some in clusters
infections.
• Have smooth walls
▸ Colony
• Hyaline septate hyphae
• Mycelia – cream, buff to brown,
▸ Areas affected
granular to wrinkled
• Hair
• Underside – differ (brown to red)
• Skin
• Nails
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 Trichophyton rubrum
▸ Culture Characteristic
• White downy to pink granular
• Reverse: Yellow when the colony is
young, red when old culture.
▸ Microscopy
• Microconidia usually teardrop-shaped.
▸ Disease
• Tinea pedis (Athlete’s foot)
• Tinea corporis
• Tinea cruris

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 Trichophyton tonsurans
▸ Culture Characteristic
• White, tan to yellow or rust, suede like to
powdery
• Reverse: Yellow to tan to rust red
▸ Microscopy
• Microconidia are teardrop or club-shaped
with flat bottoms
▸ Disease:
• Ring worm (infection of the scalp)
• Tinea capitis, Tinea corporis, Tinea pedis

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 Trichophyton schoenleinii
▸ Culture Characteristic
• Smooth, white to creamy colony
• Reverse: White
▸ Microscopy
• Hyphae: Favic Chandeliers
▸ Disease
• Favus (Tinea favosa)

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 Trichophyton mentagrophytes
▸ Culture Characteristics
• White, granular, and fluffy varieties
• Occasional light-yellow periphery in
younger cultures
• Reverse: buff to reddish brown
▸ Microscopy
• Many round to globose microconidia
▸ Disease
• Tinea barbae, tinea capitis, tinea corporis,
tinea cruris, tinea pedis

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 Trichophyton verrucosum
▸ Culture Characteristics
• Glabrous to velvety white colonies
▸ Microscopy
• Microconidia rare, large and teardrop-
shaped
▸ Diseases
• Tinea capitis, Tinea corporis, Tinea
barbae

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 Trichophyton violaceum
▸ Culture Characteristics
• Port wine to deep violet colony
• Heaped or flat with waxy glabrous
surface
▸ Microscopy
• Branched, sterile hyphae
▸ Diseases
• Tinea capitis, Tinea corporis

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Microsporu
mspp.
▸ Microsporum audouinii
▸ Microsporum canis
▸ Microsporum gypseum
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Microsporum spp.
▸ They are ascomycetous molds that produce macroconidial spores that
are unique to this group of dermatophytes, separating them from
Trichophyton and Epidermophyton.

▸ They are keratolytic since they produce the keratinase enzyme, which
digests skin, hair, and nail particles, causing cutaneous diseases.

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Microsporum audouinii
▸ Culture Characteristic
• Downy white to salmon-pink colony
• Reverse: Tan to salmon pink
▸ Microscopy
• Sterile hyphae, terminal
chlamydoconida, favic chandeliers,
and pectinate bodies
▸ Disease
• Tinea capitis

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Microsporum canis
▸ Culture Characteristic
• Membranous with feathery periphery
• Center of the colony is white to buff
over orange yellow
• Reverse: Lemon-yellow or yellow-
orange apron

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Microsporum canis
▸ Microscopy
• Thick-walled, spindle-shaped,
multiseptated rough-walled
macroconidia.

▸ Disease
• Tinea capitis associated with
alopecia

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Microsporum gypseum
▸ Produces abundant macroconidia brownish-yellow

▸ Macroconidia usually have 4-6 septa or crosswalls, up to 40 µm long

▸ Surface of culture colony is often cottony and powdery in appearance

▸ Reverse of colony often appears ragged around edges

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Microsporum gypseum
▸ Culture Characteristic
• Cinnamon-colored, powdery colony
• Reverse: Light tan
▸ Microscopy
• Thick-walled, rough, elliptical
multiseptated macroconidia
▸ Disease
• Tinea capitis

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Epidermophyt
on spp.
▸ Epidermophyton floccosum

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Epidermophyton floccosum
▸ Human skin and nail infections are caused by this filamentous dermatophytic fungus.

▸ It is an anthropophilic dermatophyte, it can be passed from person to person.

▸ Because it is an ascomycete, it is found all over the world.

▸ Only pathogenic species in this genus

▸ Often causes tinea pedis, tinea cruris, tinea corporis and onychomycosis. It is not known
to invade hair in vivo and no specific growth requirements have been reported.

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Epidermophyton floccosum
▸ Culture Characteristic
• Center of colony tends to be folded
and is khaki green
• Reverse: Light tan
• Mycelium: yellow-green, gentle
folds, slow grower
• Underside: green to brown

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 Epidermophyton floccosum
▸ Microscopy
• Macroconidia are large, smooth-walled,
multi-septate, clavate
• Clubbed-shaped
• 2-5 cell macroconidia
• Hyaline hyphae
▸ Disease
• Tinea pedis (Athlete’s foot)

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Subcutaneous
Mycoses
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Subcutaneous Mycoses
▸ Heterogeneous group of fungal infections characterized by the appearance
of clinical lesions in the subcutaneous tissues at the site of etiological
agent inoculation.

▸ The disease process begins after a minor trauma, which is the only source
of infection.

▸ Lesions develop at the site of implantation of the etiological agent in the

subcutaneous tissue.

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Subcutaneous Mycoses
▸ Many subcutaneous mycoses are only found in tropical and subtropical
areas, but some, like sporotrichosis, can also be found in temperate areas
with verrucal lesions are the most common symptom.

▸ Only the subcutaneous tissues and lymphatics are affected.

▸ They must be introduced into the subcutaneous tissue via a puncture

wound contaminated with fungi-containing soil because they are unable to
penetrate the skin.

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Subcutaneous Mycoses
▸ Subcutaneous Mycoses includes:
• Sporotrichosis
• Rhinosporidiosis
• Mycetoma
• Chromoblastomycosis
• Phaeohyphomycosis
• Lobomycosis

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Symptoms
▸ Nasal obstruction, drainage, and sinus
pain are all symptoms.

▸ In the nasal and perinasal regions,

subcutaneous nodules form, and
generalized facial swelling may develop.

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 Treatment
▸ Subcutaneous mycoses is a fungal infection that affects the dermis,
subcutaneous tissues, muscles, and bones. As a result, treating this type of
infection is challenging, and surgical intervention is frequently used.

▸ Antifungal agents and/or surgical excision are commonly used in treatment.

▸ The etiologic agent must be identified by culture in order to make prognostic
and management decisions.
▸ Antifungal susceptibility test results may be useful in determining the best
treatment option.

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Sporothrix schenkii
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Sporothrix schenkii
▸ Dimorphic fungus

▸ Most common in USA

▸ Found in plant, thorns and timber

▸ Culture Characteristic
• Small, moist, and white to cream-
colored

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 Sporothrix schenkii
▸ Microscopy
• Hyphae are delicate (approximately 2 mm in
diameter), septate, and branching
• Single-celled conidia 2-5 mm in diameter are
borne in clusters from the tips of single
conidiophores (flowerette arrangement)

▸ Disease: Rose-Gardener’s disease

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Sporotrichosis
 Sporotrichosis
▸ Caused by Sporothrix schenkii

▸ Infection is acquired through thorn pricks or other minor injuries

▸ Pathogenesis
• Spreads from primary site to the regional lymph nodes through
lymphatics and mostly affects the upper limbs.
• Pyogranulomatous reaction

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 Sporotrichosis
▸ Clinical features
• Nodules on the skin, subcutaneous tissue and in the
lymph nodes which later soften and ulcerate

▸ Laboratory Diagnosis
• Specimen that can be used are pus, exudate and
aspirate from nodules, and curettage or swabs from
open lesions

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 Sporotrichosis
▸ Culture
• Inoculated on 2 sets of Sabouraud Dextrose Agar
(SDA) and Brain Heart Infusion Agar (BHIA)
• Incubated at 25º and 37º C

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