CN2 & 3: Mycoses & Lice Flashcards
Examples of these are dermatophytes (agents of ringworm, athletes foot) and infxns s/a tinea nigra and piedra, all infect keratinized tissues including pityriasis versicolor
Superficial and cutaneous mycoses
This includes chromoblastomycosis, mycetoma, and pheohypomycotic cyst
Subcutaneous mycoses
Occur primarily in immunocompromised px
Opportunistic
Superficial mycoses and their causative fungal agents
Pityriasis versicolor - Malassezia sp.
Tinea nigra - Hortea werneckii
White piedra - Trichosporon sp.
Black piedra - Piedreia hortae
PM, TH, WT, BP
Cutaneous mycoses and their causative fungal agents
Dermatophytosis - Microsporum sp., Trichophyton sp., And Epidermophyton floccosum
Candidiasis of skin, mucosa, or nails - Candida albicans and other cand
Subcutaneous mycoses and their causative fungal agents
Sporotrichosis - Sporothrix schenckii
Chromoblastomycosis - Phialophora vemucosa, Fonsecaea pedrosoi
Mycetoma - Pseudaescheria boydii, Madurella mycetomatis
Phaeohyphomycosis - Exophiala, Bipolaris, Exserohilum, and other cematiaceous molds
Endemic (primary, systemic) mycoses and their causative fungal agents
Coccidioidomycosis - Coccioides posadasii and immitis
Histoplasmosis - H. capsulatum
Blastomycosis - B. dermatitidis
Paracoccidioidomycosis - P. brasiliensis
Opportunistic mycoses and their causative fungal agents
Systemic candidiasis - C. albicans
Cryptococcus - Cryptococcus neoformans and Cryptococcus gattii
Aspergillosis - fumigatus
Hyalohyphomycosis - Fusarium, Paecilomyces, Trichosporon
Phaeohyphomycosis - Ciadopholalophora bantiana; sp of Alternaria, Cladosporium, Bipolaris, Exserohilum
Mucomycosis (zygomycosis) - Rhizoos, Absidia, Cuninghamella
Penicilliosis - Penicillium marneffei
What is the etiologic agent of Pityriasis or T. versicolor?
Malassezia furfur or Pityrosporum orbiculare (ovale)
Chronic, mild asymptomatic superficial infection involving most commonly the trunk (chest, upper back, arms, or abdomen)
Pityriasis or P. versicolor
Sharply marginated white macule with fine scaling plaques. Occur as discrete, serpentine, hyper – or hypopigmented maculae. Inflammation and irritation are minimal.
Superficial Mycoses – Pityriasis or Tinea Versicolor
Morphology: oval – or – bottle shaped cells that exhibit monopolar budding in the presence of a cell wall with a septum at the site of the bud scar. Small hyphal fragments are observed. Small yeasts without the presence of psudohyphae.
Malassezia furfur or Pityrosporum Orbiculare (ovale) – dermatophytes
Laboratory diagnosis: Direct microscopy of skin scrapings shows characteristic round yeast forms. Cluster of oval budding yeast cells 3.5 x 4.5 mm long with short, septae and occasionally branching hyphae. The microscopic appearance of the yeast is classically describe as “spaghetti and meatballs”
Malassezia furfur or Pityrosporum Orbiculare (ovale) – dermatophytes
What are are caused by fungi that infect only the superficial keratinized tissue (skin, hair, and nails)?
Cutaneous mycoses
The most important of these are the dermatophytes, a group of about 40 related fungi that belong to three genera:
Microsporum, Trichophyton, and Epidermiphyton
In skin they are diagnosed by the presence of hyaline, septate, branching hyphae or chains of arthroconidia.
Cutaneous mycoses
Dermatophytes are identified by their colonial appearance and microscopic morphology after growth for 2 weeks at 25C on what agar?
SDA
They develop cylindric, smooth – walled macroconidia and characteristic microconidia depending on the variety, colonies of T. mentagrophytes may be cottony to granular; both types display abundant grape – like clusters of spherical microconidia on terminal branches.
Trichophyton species - infect hair, skin, or nails
- Commonly found in primary isolates: coiled or spiral hyphae
What has a white, cottony surface and a deep red, nondiffusible pigment when viewed from the reverse side of the colony?
T. rubrum
What are small and piriform (tear – shaped). T tonsurans produces a flat, powdery to velvety colony on the obverse surface that becomes reddish – brown on reverse; and are mostly elongate?
Microconidia
Microsporum species tend to produce distinctive what?
Multicellular macroconidia with echinulate walls
What forms a colony with a white cottony surface and a deep yellow color
on reverse; the thick – walled, 8- to 15 celled macroconidia frequently have curved or hooked tips?
M. canis
What produces a tan, powdery colony and abundant thin – walled, four- to six-celled macroconidia?
M gypseum
Microsporum species infect only what?
Hair and skin
What is the only pathogen in this genus, produces only macroconidia, which are smooth – walled, clavate, two- to four-celled, and formed in small clusters?
Epidermophyton floccosum
The colonies are usually flat and velvety with a tan to olive – green tinge. It infects the skin and nails but not the hair.
E. floccosum
Flat feathery colonies w a central fold and yellow to dull gray-green pigment. Yellow to brown reverse pigment.
Microscopic: no microconidia, numerous thin and thick-walled, club-shaped macroconidia
E. floccosum
Flat and white to grey w widely spaced radial grooves. Tan to salmon reverse pigment. Salmon-pink pigment on PDA. No growth on polished rice.
Microscopic: Terminal chlamydoconidia and pectinate (comb-like) hyphae
M. audouinii
Flat and white to yellow, coarsely hairy, w closely spaced radial grooves. Yellow to orange reverse pigment. Yellow on PDA. Growth on polished rice.
Microscopic: few microconidia, numerous thick-walled and echinulate macroconidia w terminal knobs
M. canis
Flat and granular w tan to buff pigment, no reverse pigment.
Microscopic: few microconidia, numerous thinwalled macroconidia w/o knobs
M.gypseum
White to creamy w a cottony, mounded surface. None to light brown reverse pigment on PDA Urease positive.
Microscopic: Clustered round microconidia, rare cigar-shaped macroconidia, occasional spiral hyphae. Hair perforation (+)
T. mentagrophytes
Mounded white center w maroon periphery. Maroon reverse pigment. Cherry red on PDA. Urease negative.
Microscopic: few tear-shaped microconidia, rare pencil-shaped macro. HP (-)
T. rubrum
Heaped or folded and whitish. Colorless to yellow-tan reverse pigment.
Microscopic: knobby antler-like hyphae (chandeliers), numerous chlamydoconidia
T. schoenleinii
Suede-like w feathery periphery, white to yellow or maroon. Reverse pigment usually dark maroon, sometimes none to yellow. Partial thiamine requirement
Microscopic: numerous multiform microconidia and are rare cigar-shaped macroconidia
T. tonsurans
Small and heaped, though sometimes flat, white to yellow-grey. Reverse pigment none to yellow. Requires thiamine and usually inositol for growth.
Microscopic: chains of chlamydoconidia on SDA. Long and thin “rat-tail” macroconidia w thiamine
T. verrucosum
Waxy and heaped, deep purplish-red. Purple rev pig. Partial thiamine requirement.
Microscopic: Irregular hyphae w intercalary chlamydoconidia. No micro or macro on SDA, rare micro and macro w thiamine
T. violaceum
- Scrapings of the skin or nails, is collected using a scalpel blade or edge of a glass microscopic slide. KOH 5 – 10% is applied at the side of the coverslip. KOH solution and gentle heating softens keratin and highlights the dermatophytes.
- In potassium hydroxide 5 to 20% solution preparation, fungal hyphae appear as septate and branching structures.
Potassium hydroxide preparation (KOH)
- Hairs infected with microsporum spp. Fluoresce. Greenish. Darken room and illuminate affected site with wood lamp.
Coral red fluorescence of intertriginous site confirms diagnosis of erythrasma.
Wood lamp
- Specification of superficial fungi is based on the colonial morphology,
microscopic morphology metabolic characteristics. - Sabouraud’s dextrose agar is the most commonly used isolation medium. Facilitates growth of dermatophytes and inhibits growth of Non-Candida albicans, Protheca species, Cryptococcus.
Fungal culture
- Scales from the advancing border, subungual debris or affected hair are embedded in the medium
- Medium contains the pH indicator phenol red. Dermatophytes use proteins which result in excess ammonium ion and an alkaline environment.
Dermatophyte test medium
- Special stains: Periodic acid-schiff (PAS) highlights fungal elements in pink color or Grocott methenamine silver (GMS) in black color, within the stratum corneum or superficial epidermis
Histopathology