1. Diseases Resulting from Fungi and Yeasts
Dermatophytes

2. Frequency of species Trichophyton (19 spp).
About 76% of the dermatophyte species isolated from humans are Trichophyton rubrum.
 Trichophyton mentagrophytes
 Trichophyton verrucosum
 Trichophyton tonsurans
Trichophyton violaceum

3. ,Microsporum spp,(skin and hair)
Microsporum audouinii, Microsporum canis, 
Microsporum equinum, Microsporum nanum, Microsporum.gypsum
 Epidermophyton floccosum
Skin , nail

4. Tinea capitis 2 major clinical types : 1- Inflammatory types include
A- Kerion , is scaly , erythematous lesion with bogginess & excuding pus caused by M.canis mainly.
B-Favua , is a concave yellow crusts called scutula , can lead to permanent alopecia.
Caused by T.schoenlenii

5. 2- Non-inflammatory
A- Gray patch , multiple scaly lesion with stubs of broken hair. Caused by M.audouinii.
B –Black dot , multiple area of alopecia studded with black dots. T.tonsurans is the usual causative agents

6. Black dot ringworm caused by Trichophyton tonsurans

7. Kerion: inflammatory of tinea capitis caused by Microsporum canis or Trichophyton mentagrophytes

8. Favus of scalp showing scutulae

9. Types of hair invaders
. Ectothrix invasion is characterised by the development of arthroconidia on the outside of the hair shaft. The cuticle of the hair is destroyed and infected hairs usually fluoresce a bright greenish yellow colour under Wood's ultraviolet light.
Common agents include M. canis, M. gypseum, T. mentagrophyte and T. verrucosum

10. Endothrix hair invasion is characterised by the development of arthroconidia within the hair shaft do not fluoresce. The cuticle of the hair remains.
All endothrix producing agents are anthropophilic e.g T. tonsurans and T. violaceum.

11. Ectothrix and Endothrix
Fluorescing hair (under Wood's lamp) is seen in dogs and cats infected with some dermatophytes

12. Culture Final and exact identification of causative fungus.
Several infected hairs are placed on Sabouraud’s glucose agar(4 weeks) or Dermatophyte Test Medium (DTM)-for 2 weeks

13. Treatment
Griseofulvin for 2-4 months, or for at least 2 weeks after a negative microscopic and culture examinations are obtained.
Terbinafine tab.
systemic steroids, to minimize scarring, can be given simultaneously
Selenium sulfide shampoo or ketaconazole shampoo three times weekly can be used as adjunctive therapy to oral antifungal agents

14. Tinea Corporis(Tinea Circinata)
Sites of prediliction are neck, upper and lower extremities, and trunk
Can be caused by any dermatophyte.T. rubrum is is the most common dermatophyte
. Characterized by one or more circular, sharply circumcsribed.
Lesions may be slightly elevated, particularly at the border, where they are more inflamed and scaly than at the central part

15. Tinea corporis: note sharp margin and central clearing

16. Tinea Cruris jock itch Most common in men , on upper inner thigh
Begins as a small erythematous and scaling or vesicular and crusted patch
Spreads peripherally and partly clears in the center
Characterized by its curved, well-defined border, especially at lower edge
May extend downward on thighs and backward on the perineum or anus .Keep dry as possible.
T. mentagrophytes & E. floccosum & T. rubrum are usual cause

17. Tinea cruris in a woman

18. Tinea pedis Popularly called athlete’s foot
Most common fungal disease (by far)
Most commonly the third toe web is involved
Sweat on soles and in between has a high pH, is a good culture medium for the fungus. Trichophyton mentagrophytes produces an acutely inflammatory condition.
Trichophyton rubrum produces non-inflammatory condition(a moccasin or sandel appearance)

19. Tinea pedis showing interdigital scalping
T. mentagrophytes

20. Dermatophytosof the soles
Trichophyton mantagrophytes

21. Trichophyton rubrum T. rubrum causes the majority of cases
Produces a relatively non-inflammatory type of dermatophytosis characterized by a dull erythema and prnounced scaling involving the entire sole and sides of feet
Producing a moccasin or sandel appearance

22. Prophylaxis Dry toes after bathing
Dryness is essential if re-infection is to be avoided
Use good antiseptic powder on feet after bathing-particularly between toes e.g.,
Tolnaftate powder.
Plain talc, may be dusted into socks and shoes to keep feet dry.
Topical Azole &keratolytic agent included in Rx.

23. Onychomycosis(Tinea Ungium)
Fungal infection of nail
Represents up to 30% of diagnosed superficial fungal infections
Etiologic agents are species: Epidermophyton,, and Trichophyton fungi
Nail plate become friable, yellow, or white as in trichophyton infections
May also be caused by C. albicans and here nail plate remains hard .

24. Candidiasis
Candida proliferates in outer layers of the stratum corneum where horny cells are desquamating
It does not attack hair,
It is largly an opportunisitic organism, able to behave as a pathogen mainly in impaired immune status, or in body folds
Moisture promotes its growth, in moist lip corners

25. Diagnosis
Demonstration of the pathogenic yeast C. albicans establishes the diagnosis
Under microscope KOH prep may show spores and pseudomycelium
On gram stain yeast forms are dense, gram-positive, ovoid bodies, 2-5 um in diameter
In culture
Culture on Sabouraud’s glucose agar shows a growth of creamy, grayish, moist colonies in about 4 days .
Azole & Terbinafine can be included in treatment.

26. Oral Candidiasis (BabiesThrush)
Mucous membrane of the mouth may be involved in healthy newborn & marasmic infant
Newborn infection may be acquired from contact with vaginal tract of mother
Grayish white membranous plaques are found on surface.
Base of plaques are moist, reddish, and macerated.
It can occur in adult in immunocompromised pt. Papillae of tongue are atrophied, surface is smooth, glazed, and bright red.
Papillae of tongue are atrophied, surface is smooth, glazed, and bright red

28. Candidal Vulvovaginitis
C. albicans is a common inhabitant of vaginal tract
May cause severe pruritus, irritation, and extreme burning
Labia may be erythemtous, moist, and macerated and cervix hyperemic, swollen, and eroded, showing small vesicles on its surface
Vaginal discharge is not usually profuse but is frequently thick and tenacious

29. Risk factors Due to disruption of normal microbiota
May develop during in pregnancy, in diabetes, or secondary to therapy with a broad- spectrum antibiotic , I.U.C.D
Recurrent vulvovaginal candidiasis has been associated with long-term tamoxifen, oral contraceptive pills.

30. Candidal Intertrigo
Pruritic intertriginous eruptions caused by C. albicans may arise between folds of genitals; in groins or armpits; between buttocks; under large pendulous breasts; under overhanging abdominal folds; or in umbilicus
Pinkish intertriginous moist patches are surrounded by a thin macerated epidermis (“collarette” scale)

31. Pseudo Diaper Rash
In infants, C. albicans infection may start in perianal region and spread over entire area
Dermatits is enhanced by maceration produced by wet diapers
Scaly macules and vesicles with maceration in involved areas cause burning, pruritis .
Diagnosis may be suspected by finding involvement of folds and occurrence of many small erythematous desquamating “satellite” or “daughter” lesions scattered around edges.
Perianal candidiasis can occur & can involve entire G.I.T

32. Candidal Paronychia Chronic inflammation of nail fold produces
occasional discharge of thin pus, gradual
thickening and brownish discoloration of nail
plates, and development of pronounced transverse
ridges
Mostly finger nails are affected
frequently occur in person whose hands in water or who handle moist objects

33. Onychomycosis caused by Candida albicans in mucocutaneous candidiasis

34. Intertrdigital candidal infection
Usually white, thick and does not peel off freely
On feet fourth interspace is most often involved
Areas are apt to be multiple
Clinically indistinguishable from tinea pedis
Dx made by culture
Tx is with topical anticandidal preparations

35. Candida fingerweb erosion：related to fatness , occupation etc.

36. THE END
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