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mycologymycologymycologymycologyIntroductionIntroductionIntroduction.Introduction.Essential growth factors.Essential growth factors.Classification of fungiClassification of fungiClassification of fungi.Classification of fungi.Clinical syndromes.Clinical syndromes.Colonization and resultant disease.Colonization and resultant disease.Superficial Mycoses.Superficial Mycoses.Cutaneous Mycoses.Cutaneous Mycoses.Systemic MycosesSystemic Mycoses. .

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IntroductionIntroductionF i h t i d ithF i h t i d ithFungi are characterized withFungi are characterized with

Heterotrophic, Eukaryotic, non ChlorophyllHeterotrophic, Eukaryotic, non Chlorophyll ..Are not obligate animal parasites butAre not obligate animal parasites butAre not obligate animal parasites but Are not obligate animal parasites but Dermatophites.Dermatophites.Fewer than Fewer than 100 100 speciesspecies are associated with are associated with pphuman diseases.human diseases.

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Essential growth factorsEssential growth factorsEssential growth factorsEssential growth factors

Carbon sourceCarbon source for energy metabolism andfor energy metabolism andCarbon sourceCarbon source for energy metabolism and for energy metabolism and structure. structure. NitNit f t b li ti df t b li ti dNitrogen sourceNitrogen source for metabolic reactions and for metabolic reactions and structure.structure.Purine and pyrimidinePurine and pyrimidine for synthesis of for synthesis of Nucleic acids and chitin. Nucleic acids and chitin.

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Circumstances for growthCircumstances for growthOptimum Optimum thermal growth in thermal growth in 2222--2727 ْ◌ ْ◌ C. C. ..Optimum Optimum PH for growth in PH for growth in 55..66--77. . ..Optimum Optimum Humidity for growth in Humidity for growth in 7575--8585%.%.

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ClassificationClassificationClassification Classification

PhylumPhylum ChitiridiomycotaChitiridiomycota ((O t )O t )Phylum,Phylum,Chitiridiomycota.Chitiridiomycota.((Oomycete)Oomycete)

Phylum, Phylum, Dikariomycota:Dikariomycota:Sub phylum,Sub phylum, ZygomycotaZygomycota..(Rhyzopus,mucor)(Rhyzopus,mucor)

Sub phylum, Sub phylum, Ascomycta.Ascomycta.((Dermatophytes, Histoplasma)Dermatophytes, Histoplasma)p y ,p y , yy (( p y p )p y p )

SubPhylumSubPhylum,Basidiomycota,Basidiomycota..((Cryptococcus)Cryptococcus)

SubphylumSubphylum DeutromycotaDeutromycota (C did M l i )(C did M l i )Subphylum,Subphylum,DeutromycotaDeutromycota..(Candida, Malassezia)(Candida, Malassezia)

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Clinical SyndromesClinical SyndromesClinical SyndromesClinical Syndromes

Mycotoxicosis & Mycetismus. Mycotoxicosis & Mycetismus. ..Hypersensitivity Diseases. Hypersensitivity Diseases. ..Colonization of the host and infectionColonization of the host and infection. .

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Colonization and InfectionColonization and InfectionColonization and InfectionColonization and Infection

Superficial MycosesSuperficial MycosesSuperficial MycosesSuperficial MycosesCutaneus MycosesCutaneus MycosesSubcutaneus MycosesSubcutaneus MycosesSystemic MycosisSystemic Mycosisy yy yOpportunistic MycosesOpportunistic Mycoses

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Diagnostic methodsDiagnostic methodsDiagnostic methodsDiagnostic methods

Wood’s lightWood’s light::Wood s lightWood s light: : ((fluorescent lesions under UV in λ=fluorescent lesions under UV in λ=395 395 n.m)n.m)Direct examination:Direct examination:Direct examination: Direct examination: KOH method,KOH method, squeezed preparation, scotch squeezed preparation, scotch tape method, stained preparationtape method, stained preparation..tape method, stained preparationtape method, stained preparation..Culture: On variable media, Culture: On variable media, teased mount,teased mount,slide culture method.slide culture method.slide culture method.slide culture method.Serology: Serology: ID, CIE,ID, CIE, CF, LATCF, LATMolecular:Molecular: PCRPCR

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Molecular: Molecular: PCRPCR

Basic culture mediaBasic culture mediaBasic culture media Basic culture media

S: sabouraud dextrose agarS: sabouraud dextrose agarS: sabouraud dextrose agarS: sabouraud dextrose agarSC: S+ChloramphenicoleSC: S+ChloramphenicoleSCC: SC+cyclohexamideSCC: SC+cyclohexamideCMA: Corn Meal AgarCMA: Corn Meal AgarggPDA: Potato Dextrose AgarPDA: Potato Dextrose AgarPFA: Potato Flake AgarPFA: Potato Flake AgarPFA: Potato Flake AgarPFA: Potato Flake AgarCzapek Dox AgarCzapek Dox Agar

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Superficial MycosesSuperficial MycosesSuperficial MycosesSuperficial Mycoses

Pityriasis versicolorPityriasis versicolorPityriasis versicolorPityriasis versicolorPityrosporosisPityrosporosisTinea nigraTinea nigraErythrasmaErythrasmayyPiedraPiedraOtomycosisOtomycosisOtomycosisOtomycosis

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Pit i iPit i iPityriasis Pityriasis yyversicolorversicolorversicolorversicolor

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DefinitionDefinitionDefinitionDefinition

AA chronic recurrentchronic recurrent macularmacular superficialsuperficialA A chronic, recurrentchronic, recurrent,, macularmacular, superficial , superficial fungal infection. fungal infection. ..Caused by: Caused by: Malassezia fur furMalassezia fur fur ,M globosa,M ,M globosa,M

t i t M di li M l f Mt i t M di li M l f Mrestricta,M sympodialis,M sloofeae,M restricta,M sympodialis,M sloofeae,M pachydermatis,M obtusa M dermatis,M pachydermatis,M obtusa M dermatis,M

M iM inana,M equinana,M equi the lipophilic yeast , encountered in skin .the lipophilic yeast , encountered in skin .

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Clinical manifestationClinical manifestationClinical manifestationClinical manifestation

MacularMacular sharply marginated very slightly raisedsharply marginated very slightly raisedMacular,Macular, sharply marginated, very slightly raised.sharply marginated, very slightly raised.Sites of infection : Sites of infection : Neck, flexor, aspects of arms, Neck, flexor, aspects of arms, abdomen axillae and pubic areaabdomen axillae and pubic areaabdomen, axillae and pubic area.abdomen, axillae and pubic area.Papular form on seborrheic area of trunkPapular form on seborrheic area of trunk..World wideWorld wideWorld wide.World wide.common in hot and humid climates.common in hot and humid climates.Treatment:Treatment: White field selenium sulfideWhite field selenium sulfideTreatment: Treatment: White field, selenium sulfide White field, selenium sulfide Clotrimazol, MiconazolClotrimazol, Miconazol

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Mycological DiagnosisMycological DiagnosisMycological DiagnosisMycological Diagnosis

Macroscopically observationMacroscopically observation goldishgoldish--yellowyellowMacroscopically observation Macroscopically observation goldishgoldish--yellow yellow fluorescence in front of Woods light.fluorescence in front of Woods light.Direct smear:KOHDirect smear:KOH 1010--2020% or scotch tape% or scotch tapeDirect smear:KOH Direct smear:KOH 1010--2020% or scotch tape.% or scotch tape.Microscopically result:Microscopically result:Spaghetti and Spaghetti and meatball or blastoconidia andmeatball or blastoconidia andmeatball or blastoconidia and meatball or blastoconidia and pseudohypha.pseudohypha.Culture:Culture: Is not necessaryIs not necessary in ordinary clinicalin ordinary clinicalCulture: Culture: Is not necessaryIs not necessary in ordinary clinical in ordinary clinical situation .situation .S+streptomycin+sterile olive oilS+streptomycin+sterile olive oil

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S+streptomycin+sterile olive oil. S+streptomycin+sterile olive oil.

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TreatmentTreatmentTreatmentTreatment

SulfurSulfur 33%%Sulfur Sulfur 33%%Salicylic acid Salicylic acid 22%%ClotrimazoleClotrimazoleKetoconazoleKetoconazole

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DandruffDandruffDandruffDandruff

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PityrosporosisPityrosporosisPityrosporosisPityrosporosis

Definition: Seborrheic dermatitidis orDefinition: Seborrheic dermatitidis orDefinition: Seborrheic dermatitidis or Definition: Seborrheic dermatitidis or Pityriasis simplex, A chronic superficial Pityriasis simplex, A chronic superficial infection with scalesinfection with scales (dandruff).(dandruff).infection with scales infection with scales (dandruff).(dandruff).Cause: Cause: Malassezia globosa, Malassezia Malassezia globosa, Malassezia resticta .resticta .resticta .resticta .Clinical manifestation: Clinical manifestation: Seborrhea sicca, Seborrhea sicca, Oleasa and EczemaOleasa and Eczema, scales appears on, scales appears onOleasa and EczemaOleasa and Eczema, scales appears on , scales appears on scalp and face. scalp and face. Treatment: Selenium sulfide, Perithion zincTreatment: Selenium sulfide, Perithion zinc

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eat e t Se e u su de, e t o ceat e t Se e u su de, e t o c

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Mycological DiagnosisMycological DiagnosisMycological DiagnosisMycological Diagnosis

Direct examination: Skin scrapping fromDirect examination: Skin scrapping fromDirect examination: Skin scrapping from Direct examination: Skin scrapping from seborrheric lesions. seborrheric lesions. Squeezing in a drop of Squeezing in a drop of water staining with methylene blue showwater staining with methylene blue showwater staining with methylene blue show water staining with methylene blue show large numbers of budding cells.large numbers of budding cells.C ltC lt i ti t t k tht k thCulture: Culture: is not necessaryis not necessary to make the to make the diagnosis.diagnosis.

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MalasseziaMalassezia yeastsyeasts

Basidiomycetous yeastsBasidiomycetous yeastsBasidiomycetous yeastsBasidiomycetous yeastsMonopolar budidingMonopolar budidingLipid Lipid –– dependent or lipophilicdependent or lipophilicCurrently Currently 10 10 species (+ species (+ 2 2 ))yy p ( _p ( _ ))

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TheThe speciesspeciesTheThe speciesspecies

M.furfurM.furfurM.globosaM.globosaM sympodialisM sympodialisM.sympodialisM.sympodialisM.pachydermatisM.pachydermatisM.obtusa M.obtusa M.restrictaM.restrictaM.slooffiae M.slooffiae M.dermatisM.dermatisM.nanaM.nanaM.equiM.equi

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Skin diseasesSkin diseasesSkin diseasesSkin diseases

Pityriasis versicolorPityriasis versicolor: : M.globosa,M.globosa, M. sympodialis , M. sympodialis , M.slooffiae, M. restricta, M.furfur (rare) M.slooffiae, M. restricta, M.furfur (rare) Seborrheic dermatitisSeborrheic dermatitis:: M restrictaM restricta M globosaM globosaSeborrheic dermatitisSeborrheic dermatitis: : M.restricta,M.restricta, M. globosa, M. globosa, M.sympodialis, M. furfur (rare) M.sympodialis, M. furfur (rare) Atopic dermatitisAtopic dermatitis: : M.furfur,M.furfur, M. globosa andM. Restricta M. globosa andM. Restricta ((9090%%) , M. furfur and sympodialis, M.dermatis) , M. furfur and sympodialis, M.dermatis((9090%%) , M. furfur and sympodialis, M.dermatis) , M. furfur and sympodialis, M.dermatisMallassezia folliculitisMallassezia folliculitis: ?: ?DandrufDandruf::M. restricta and M.globosaM. restricta and M.globosaPsoriasisPsoriasis:: M globosaM globosa M slooffiae M restrictaM slooffiae M restrictaPsoriasisPsoriasis:: M. globosa,M. globosa, M. slooffiae, M. restricta M. slooffiae, M. restricta OnychomycosisOnychomycosis : : M.M. furfurfurfurMucosal sitesMucosal sites :: M. FurfurM. Furfur

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Other clinical importance of Other clinical importance of Malassizia yeastMalassizia yeastMalassizia yeastMalassizia yeast

M furfurM furfur : systemic and mucosal sites: systemic and mucosal sitesM. furfurM. furfur : systemic and mucosal sites, : systemic and mucosal sites, bone marrow transplant patients bone marrow transplant patients (rare)neonate nosocomial out breaks(rare)neonate nosocomial out breaks(rare)neonate, nosocomial out breaks(rare)neonate, nosocomial out breaksM. PachydermatisM. Pachydermatis : neonates , nosocomial : neonates , nosocomial

tb ktb koutbreaksoutbreaks

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AssociationsAssociations of Malasseziaof Malassezia ononskinskin

M. globosa , M. sympodialis, M sloofiaeM. globosa , M. sympodialis, M sloofiaePVPV و ھمچنين پوست سالمو ھمچنين پوست سالم اغلب دراغلب در

M.globosa +M.globosa + M. sympodialis M. sympodialis 3030% % PVPVgg y py pM. globosa + M. sloofiae M. globosa + M. sloofiae 77% % PVPV

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Animal relationshipsAnimal relationshipsAnimal relationshipsAnimal relationships

CatCat: : M. pachydermatis , M. sympodialsis M. fur fur M. pachydermatis , M. sympodialsis M. fur fur DogDog:: M. pachydermatis, M. nana M. fur fur M. M. pachydermatis, M. nana M. fur fur M.

btbtobtuseobtuseHorseHorse:: M. fur fur. M sloofiae , Mobtusa, M. M. fur fur. M sloofiae , Mobtusa, M. globosa M. restricta . M. equiglobosa M. restricta . M. equiglobosa M. restricta . M. equi globosa M. restricta . M. equi CattleCattle:: M. globosa , M. furfur. M. sloofiae, M. M. globosa , M. furfur. M. sloofiae, M. sympoolialis, M. nana sympoolialis, M. nana ShSh M di li M l b M t i tM di li M l b M t i tSheepSheep:: M. sympodialis , M globosa , M. restricta M. sympodialis , M globosa , M. restricta OstrichOstrich:: M. furfur M. furfur

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Significance of the currentlySignificance of the currentlyg yg yrecognized speciesrecognized species

Sampling is difficultSampling is difficultSampling is difficultSampling is difficultPurifying a culture is difficultPurifying a culture is difficult

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Healthy skinHealthy skinHealthy skinHealthy skin

M. sympodialisM. sympodialis : Trunk (: Trunk (6060%) , glans penis%) , glans penisM. glogosaM. glogosa : scalp , forehead, trunk (: scalp , forehead, trunk (1010%) %)

l il iglopesis glopesis M.slooffiaeM.slooffiae : trunk (: trunk (11%) %) M restricaM restrica : scalp(: scalp(2020%)%)M. restricaM. restrica : scalp(: scalp(2020%) %) M. furfurM. furfur :low :low –– very low (but very low (but 1111% Japan)% Japan)M. pachydermatisM. pachydermatis : glans penis (: glans penis (44..11%)%)p yp y g p (g p ( ))NeonatiesNeonaties:: colonization with M. Sympodialis and colonization with M. Sympodialis and globosaglobosa

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TreatmentTreatmentTreatmentTreatment

Selenium sulfideSelenium sulfideSelenium sulfideSelenium sulfideKetoconazoleKetoconazole

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Tinea nigraTinea nigraTinea nigraTinea nigra

Definition:Definition:Definition: Definition: Disease of warm humid climates Disease of warm humid climates characterized bycharacterized by macules on glabrous skinmacules on glabrous skincharacterized by,characterized by,macules on glabrous skinmacules on glabrous skin..Cause: Cause: E hil kiiE hil kii (Cl d i kii(Cl d i kiiExophila werneckiiExophila werneckii (Cladosporium werneckii (Cladosporium werneckii A yeastA yeast--like dematiaceus fungus, like dematiaceus fungus, S b li i il t tiS b li i il t tiSaprobe, living soil or vegetations. Saprobe, living soil or vegetations.

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Clinical manifestationClinical manifestationClinical manifestationClinical manifestation

Brownish or black maculesBrownish or black maculesBrownish or black maculesBrownish or black maculesOn glabrous skin: On glabrous skin: palm, sole, bodypalm, sole, bodySharply marginated, AsymptomaticSharply marginated, AsymptomaticLittle or Little or no scalesno scales on lesionson lesionsResemble to cutaneus Resemble to cutaneus silver nitrate stainssilver nitrate stains. .

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MycologyMycologyMycologyMycology

Direct examination of skin scrapping byDirect examination of skin scrapping byDirect examination of skin scrapping by Direct examination of skin scrapping by KOH KOH 1010--20 20 %.%.R lt D kR lt D k t t h h d b ddit t h h d b ddiResult: Dark,Result: Dark, septate hyphae and budding septate hyphae and budding cells, swelling spores.cells, swelling spores.Culture: On sabouraud medium: Culture: On sabouraud medium: Yeast like cells often doublet form Yeast like cells often doublet form Dark,septate hyphae, clusters of conidiaDark,septate hyphae, clusters of conidia..Treatment: Treatment: salicilate salicilate 22%,%, sulfure sulfure 33%.%.

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ErythrasmaErythrasmaErythrasmaErythrasma

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ErythrasmaErythrasmaErythrasmaErythrasma

Definition:Definition: MacularMacular lesions onlesions on wrinkle areawrinkle areaDefinition: Definition: MacularMacular, lesions on , lesions on wrinkle areawrinkle areaskin.skin.CC C b t i i ti iC b t i i ti i ffCause: Cause: Corynebacterium minutissimumCorynebacterium minutissimum from from diphtheroid bacteria.diphtheroid bacteria.Clinical manifestation: Red to Brownish red Clinical manifestation: Red to Brownish red and black macules on wrinkle area skin : and black macules on wrinkle area skin : groin, axilla and breast. groin, axilla and breast.

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Mycological DiagnosisMycological DiagnosisMycological DiagnosisMycological Diagnosis

Direct Examination: Scrapping of macularDirect Examination: Scrapping of macularDirect Examination: Scrapping of macular Direct Examination: Scrapping of macular lesions lesions squeezing in a drop of watersqueezing in a drop of water. . Staining with gramStaining with gram oror methylene bluemethylene blue show:show:Staining with gramStaining with gram or or methylene bluemethylene blue show: show: Diphtheroid, China characters and Diphtheroid, China characters and filamentous bacilli gram positivefilamentous bacilli gram positivefilamentous bacilli, gram positivefilamentous bacilli, gram positive..Culture is not necessary. Culture is not necessary.

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TreatmentTreatmentTreatmentTreatmentErythromycineErythromycine

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Black piedraBlack piedraBlack piedraBlack piedra

Definition:Definition:Definition: Definition: A hair disease of western hemisphere A hair disease of western hemisphere tropicstropics and Indonesiaand Indonesiatropicstropics and Indonesia.and Indonesia.Cause: Cause: Pi d i h tPi d i h t b i h biti thb i h biti thPiedraia horteaPiedraia hortea; a saprobe inhabiting the ; a saprobe inhabiting the soil in tropics. soil in tropics.

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Clinical manifestationClinical manifestationClinical manifestation Clinical manifestation

Black nodulesBlack nodules along the hair shaftalong the hair shaftBlack nodulesBlack nodules along the hair shaftalong the hair shaftMultiple, hard,Multiple, hard, firmly adherentfirmly adherentSize; up to Size; up to 11mm in diametermm in diameterOn hairs of the On hairs of the scalp, beard, moustachescalp, beard, moustache. . p, ,p, ,

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MycologyMycologyMycologyMycology

Direct examination:Direct examination:Direct examination: Direct examination: Mature nodules containing Mature nodules containing asciasciPigmented hypheaPigmented hypheaPigmented hypheaPigmented hyphea..On sabouraud Agar after On sabouraud Agar after 21 21 days: days: D k thi k ll d d t t h hD k thi k ll d d t t h hDark, thick walled and septate hyphaeDark, thick walled and septate hyphaeSwollen cells and chlamydosporeSwollen cells and chlamydosporeS ti d ti fS ti d ti f iiSometimes production of Sometimes production of asciasci

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White PiedraWhite PiedraWhite PiedraWhite Piedra

A hair disease seen occasionally inA hair disease seen occasionally in southsouthA hair disease seen occasionally in A hair disease seen occasionally in south south America.America...Cause: Cause: Trichosporon beigelliTrichosporon beigelli

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Clinical ManifestationClinical ManifestationClinical ManifestationClinical Manifestation

Whitish or brownish nodulesWhitish or brownish nodules along hairshaftalong hairshaftWhitish or brownish nodulesWhitish or brownish nodules along hairshaft.along hairshaft.Size: up to Size: up to 11mm in diametermm in diameterHair are weak and fracturedHair are weak and fracturedThe favored sites; The favored sites; axilla, pubic hair, beard, axilla, pubic hair, beard, ;; , p , ,, p , ,moustache and scalp.moustache and scalp.

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MycologyMycologyMycology Mycology

Direct examination:Direct examination:Direct examination: Direct examination: Blastoconidia and arthrosporesBlastoconidia and arthrospores within the within the hair shaft and on the surfacehair shaft and on the surfacehair shaft and on the surface.hair shaft and on the surface.Culture on Culture on Sabouraud medium, C.M.ASabouraud medium, C.M.A : : H h d d h hH h d d h hHyphae and pseudohyphae Hyphae and pseudohyphae Blastoconidia (single or short chains) Blastoconidia (single or short chains) A th ( t l )A th ( t l )Arthrospores (rectangular). Arthrospores (rectangular).

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TreatmentTreatmentTreatmentTreatmentHgClHgCl22

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M Fur furM Fur furM.Fur furM.Fur fur

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M globosaM globosaM.globosaM.globosa

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M pachydermatisM pachydermatisM.pachydermatisM.pachydermatis

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M sympodialisM sympodialisM.sympodialisM.sympodialis

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M slooffiaeM slooffiaeM.slooffiaeM.slooffiae

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M obtusaM obtusaM.obtusaM.obtusa

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M restrictaM restrictaM.restrictaM.restricta

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M dermatisM dermatisM.dermatisM.dermatis

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