[MT 301] Medical Mycology

Sultan Kudarat State University Cutaneous Mycoses

Cutaneous Mycoses: Fungal ▪ Infections that extend deeper into the epidermis, as well as invasive hair and nail diseases.
infections affecting the deeper layer ▪ These diseases are restricted to the keratinized layers of the skin, hair and nails. Unlike the superficial mycoses, various
(stratum germinativum) of the skin, the cellular immune responses may be evoked; causing pathologic changes in the host that may be expressed in the
hair and the nails. deeper layers of the skin.
▪ The agents causing these diseases are termed dermatophytes. The diseases are referred to as ringworm or tinea.
▪ All of the dermatophytic diseases are caused by members of three genera, Microsporum, Trichophyton and
Epidermophyton

1. Microsporum species: They produce numerous macroconidia and microconidia has a roughened surface. They maybe multiseptate, spindle shaped and
are usually borne single on the conidiophores.
Microsporum canis(zoophilic) Microsporum gypseum (geophilic) Microsporum audouinii C

a. Large, multicelled, spindle shapes, rough a. 3-9 celled, broadly spindle-shaped, rough a. Conidia absent or bizarre if present
walled macroconidia walled macroconidia b. Atypical vegetative hyphae with terminal
b. Terminal end sometimes curved b. terminal ends are rounded chlamydospores, racquet hyphae of favic
c. Microconidia can be few or basent c. Microconidia, if present could be single or in chandeliers
d. Green-yello flouresence of ectothrix hairs. small clusters c. Apple green fluorescence of ectothrix hairs.

2. Trichophyton species:
Trichophyton rubrub Trichophyton mentagrophytes Trichophyton tonsurans

a. Microconidia are tear shaped single and a. Microconidia are spherical often in grape- a. It produces many microconidia of various
lateral along hyphae; Macroconidia are few like clusters, it posses a spiral hyphae; size and shapes, with flattened base;
pencil-shaped attached directly to the Macroconidia are few-smooth-walled, cigar produces “balloon forms” on aged
hyphae. shaped, connected to hyphae with definite pleomorphic microconidia.
b. It produces abundant, wine red water narrow attachment. b. Macroconidia are usually absent or rare or
soluble red pigment which diffuses in culture b. It produces scant red pigment in some strains distorted
medium if cultured c. Colonies are slow growing, wrinkled, suede-
c. On hair baiting test it grows on surface of hair c. Penetrates the hair shaft in hair baiting test. like, may not grow without thiamine
and doesn’t penetrate d. Produces Urease after 1-3 days. d. Second most common cause of epidemic
d. It could be weak delayed or cannot *The first two species are the most commonly tinea capitis
produce Urease. trichophyton species most commonly
recovered in clinical laboratory
Rqd2 ONTANILLAS, BSMT-3 Instructor: Mandy A. Delfin, RMT, AMT, MSMT
[MT 301] Medical Mycology
Sultan Kudarat State University Cutaneous Mycoses
Trichophyton verrucosum Trichophyton schoenleinii Trichophyton violaceum

a. On SDA with thiamine microconidia are a. Conidia is absent a. Conidia usually absent with swollen hyphae
large clevate and lateral b. Produces the so called favic chandeliers containing cytoplasmic granules
b. Macroconidia are rare, 3-5 cells, thin walled and chlamydospores are common b. Colonies are very slow growing, with violet-
and describes as “rat-tail” c. Colony are very slow growing (30 days or purple, waxy, with characteristic violet or
c. Colony cuts into agar and grows on more to mature) small, wrinkled and waxy. deep red pigment, and grows better with
subsurface. It requires thiamine, inositol and d. Causes favus type tinea capitis thiamine.
with at optimum growth at 37C. c. Causes favus type of tinea capitis.

3. Epidermophyton species:
a. Macroconidia are smooth walled that are borne either singly or in clusters, they maybe obovate or
broadly clavate.
b. They produce no microconidia, but when found they are in pairs and are usually referred to as the
“dutch pants” fuseaux.
c. The only specie under this is Epidermophyton floccosum.

Clinical manifestations:
DISEASE ETIOLOGICAL AGENT SYMPTOMS INDENTIFICATION OF ORGANISM
Tinea capitis Microsporum sp. Trichophyton sp. ringworm lesion of scalp presence/absence and shape of micro-and
Epidermophyton sp. macroconidia in scrapings from lesion
Tinea corporis Microsporum sp. Trichophyton sp. ringworm lesion of trunk, arms, presence/absence and shape of micro- and
Epidermophyton sp legs macroconidia in scrapings from lesion
Tinea manus Microsporum sp. Trichophyton sp. ringworm lesion of hand presence/absence and shape of micro- and
Epidermophyton sp macroconidia in scrapings from lesion
Tinea cruris "jock Microsporum sp. Trichophyton sp. ringworm lesion of groin presence/absence and shape of micro- and
itch" Epidermophyton sp macroconidia in scrapings from lesion
Tinea pedis Microsporum sp. Trichophyton sp. ringworm lesion of foot presence/absence and shape of micro- and
"athlete's foot" Epidermophyton sp macroconidia in scrapings from lesion
Tinea unguium Microsporum sp. Trichophyton sp. infection of nails presence/absence and shape of micro- and
Epidermophyton sp macroconidia in scrapings from lesion
Ectothrix Microsporum sp. Trichophyton sp. infection of hair shaft surface mycelium and spores on hair shaft
Epidermophyton sp
Endothrix Microsporum sp. Trichophyton sp. infection of hair shaft interior mycelium and spores in hair shaft
Epidermophyton sp

Rqd2 ONTANILLAS, BSMT-3 Instructor: Mandy A. Delfin, RMT, AMT, MSMT

[MT 301] Medical Mycology
Sultan Kudarat State University Cutaneous Mycoses
1. Tinea pedis o Infections by anthropophilic dermatophytes are usually caused by the shedding of skin scales containing viable infectious
hyphal elements [arthroconidia] of the fungus. Desquamated skin scales may remain infectious in the environment for months
or years. Therefore transmission may take place by indirect contact long after the infective debris has been shed.
o Substrates like carpet and matting that hold skin scales make excellent vectors. Thus, transmission of dermatophytes like
Trichophyton rubrum, T. interdigitale and Epidermophyton floccosum is usually via the feet. In this site infections are often
chronic and may remain subclinical for many years only to become apparent when spread to another site, usually the groin
or skin.
o It is important to recognise that the toe web spaces are the major reservoir on the human body for these fungi and therefore
it is not practical to treat infections at other sites without concomitant treatment of the toe web spaces.
o This is essential if a "cure" is to be achieved. It should also be recognized that individuals with chronic or subclinical toe web
infections are carriers and represent a public health risk to the general population, in that they are constantly shedding
infectious skin scales.

2. Tinea cruris o Tinea cruris refers to dermatophytosis of the proximal medial thighs, preum and buttocks. It occurs more commonly in males
and is usually due to spread of the fungus from the feet. Thus the usual causative agents are T. rubrum, T. interdigitale and E.
floccosum

3. Tinea unguium o Trichophyton rubrum and T. interdigitale are the dominant dermatophyte species involved.
(dermatophyte o Dermatophyte onychomycosis may be classified into two main types;
onychomycosis) a. superficial white onychomycosis in which invasion is restricted to patches or pits on the surface of the nail.
b. invasive, subungual dermatophytosis in which the lateral, distal or proximal edges of the nail are first involved, followed
by establishment of the infection beneath the nail plate. Distal subungual onychomycosis is the most common form of
dermatophyte onychomycosis. The fungus invades the distal nail bed causing hyperkeratosis of the nail bed with
eventual onycholysis, and thickening of the nail plate.
o As the name suggests, lateral subungual onychomycosis begins at the lateral edge of the nail and often spreads to involve
the entire nail bed and nail plate. In proximal subungual onychomycosis, the fungus invades under the cuticle and infects the
proximal rather than the distal nail bed causing yellowish-white spots which slowly invade the lunula and then the nail plate.

4. Tinea corporis o Tinea corporis refers to dermatophytosis of the glabrous skin and may be caused by anthrophophilic species such as T. rubrum
usually by spread from another body site or by geophilic and zoophilic species such as M. gypseum and M. canis following
contact with either contaminated soil or an animal host.

5. Tinea capitis o Tinea capitis refers to dermatophytosis of the scalp. Three types of in vivo hair invasion are recognized:
a. 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. equinum and T.
verrucosum.
b. Endothrix hair invasion is characterised by the development of arthroconidia within the hair shaft only.
The cuticle of the hair remains intact and infected hairs do not fluoresce under Wood's ultraviolet light. All endothrix
producing agents are anthropophilic eg T. tonsurans and T. violaceum.
c. Favus usually caused by T. schoenleinii, produces favus-like crusts or scutula and corresponding hair loss.

Rqd2 ONTANILLAS, BSMT-3 Instructor: Mandy A. Delfin, RMT, AMT, MSMT

[MT 301] Medical Mycology
Sultan Kudarat State University Cutaneous Mycoses
Laboratory diagnosis
Clinical Material Direct Microscopy Culture
o Skin Scrapings, nail scrapings and epilated hairs. For a laboratory o Skin Scrapings, nail scrapings and o Specimens should be
diagnosis, clinicians should be aware of the need to generate an epilated hairs should be inoculated onto primary
adequate amount of suitable clinical material. examined using 10% KOH and isolation media, like
Parker ink or calcofluor white Sabouraud's dextrose agar
o The laboratory needs enough specimen to perform both microscopy mounts. containing cycloheximide
and culture. Routine turn around times for direct microscopy should be (actidione) and incubated
less than 24 hours, however culture may take several weeks. at 26-28C for 4 weeks.

o In patients with suspected dermatophytosis of skin [tinea or ringworm] o The growth of any
any ointments or other local applications present should first be dermatophyte is significant.
removed with an alcowipe. Using a blunt scalpel, tweezers, or a bone
curette, firmly scrape the lesion, particularly at the advancing border.
In cases of vesicular tinea pedis, the tops of any fresh vesicles should be
removed as the fungus is often plentiful in the roof of the vesicle.

o In patients with suspected dermatophytosis of nails [onychomycosis]

the nail should be pared and scraped using a blunt scalpel until the
crumbling white degenerating portion is reached. Any white keratin
debris beneath the free edge of the nail should also be collected.

o Skin and nail specimens may be scraped directly onto special black
cards which make it easier to see how much material has been
collected and provide ideal conditions for transportation to the
laboratory.

Rqd2 ONTANILLAS, BSMT-3 Instructor: Mandy A. Delfin, RMT, AMT, MSMT