SUPERFICIAL MYCOSES

caused by fungi affecting the skin,

hairs and nails.
CA: dermatophytes
Infection : Tinea or ringworm
Aymptomatic

MALASSEZIA FURFUR

disease : Ptyriasis vesicolor

growth in-vitro possible when
cultured in medium overlaid with
olive oil or provided with other
sources of fatty acids.
Clinical morphology : creamy and
smooth
Microscopic: colonies have oval
budding cells with broad-based
isthmus
elongation to form hyphal elements
is rare.

Clinical features:

chronic, non-irritating superficial

infection of the stratum corneum
on the chest, upper back, arms,
abdomen and face.

Lesion: superficial brownish scaly

areas on the skin.
Predisposing factors:
1. hot and humid climate
2. excessive perspiration
3. corticosteroid use
4. malnutrition

conidia along hyphae

10. Old culture: hyphae are SEPTATED,
dark and laterally produce oval
conidia that are colorless or
pigmented.
11. Conidia form on mature yeast-like
cells or at points along hyphae.
Clinical features:
12. blackish-brown macular patches
resembling faded silver nitrate
stains seen on the palms & soles or
elsewhere in the body.
13. Lesions are flat, smooth, not scaly,
irregular in shape brown to black.
14.
Lab Dx:
1. Wet or permanent mount : skin
scrapings
a. Olive or brown pigment,
branched, sepate hyphae
& budding yeast cells that
are 1 or 2-celled
b. Culture
on
SDA
with/without
antibiotics
Treatment:
1. simple shaving of superficial
epidermis with scalpel
2. topical
application
of
keratolytic solutions of sulfur,
salicylic acid or tincture of
iodine.
PIEDRAIA HORTAE
-disease: White piedra
- rate of growth: slow, mature in 21
days
- Colonial morphology : small,
adherent, compact, raised, dark
greenish, brown to black covered
with very short aerial hyphae
- reverse: black

Lab Dx:
1. direct mount
2. blunt-ended
shorthyphae
and
clusters of spherical spores that
form SPHAGETTI &MEATBALLS
pattern.
3. Woods light
4. lesions fluoresce golden yellow or
brownish
Treatment:
1. Topical application: 2.5% selenium
sulfate,
miconazole
and
ketoconazole.
2. Folliculitis: oral ketoconazole
EXOPHIALA WERNECKII
3.
4.
5.
6.
7.
8.
9.

disease : Tinea nigra / Tinea nigra

palmaris
rate of growth: slow (within 14
days)
Colonial morphology : light colored,
moist, shiny, yeast-like & becomes
olive black
Grayish-green hyphae forms at
periphery
Reverse : black
Microscopic morphology
Early phase: mainly of YEAST-LIKE
CELLS.
Young culture: heavy clusters of

3.

4.

Microscopic:
closely septae hyphae, dark, thickwalled
with
many
intercalary
chlamydoconidia-like cells
Clinical features:
infection of hairs in scalpy char by
small, stony hard dark nodules
distributed irregularly along the
length of the hair shaft; felt easily
by palpation

Lab Dx:
1. Wet & permanent mount
2. nodules are crushed in KOH
3. numerous oval asci with 2-8
aseptate ascospores which are
spindle-shaped of fusiform having a
filament at each pole.
2.Culture : medium with Cycloheximide
Treatment: cutting the infected hair

TRICHOSPORON
BEIGELII
TRICHOSPORON CUTANEUM
4.
5.

disease
:
white
piedra
/
trichosporosis
rate of growth: rapid (5days);
sensitive to Cycloheximide

Colonial Char:
6. yeast like
7. cream colored, moist, soft, which
later becomes finely wrinkled, more
adherent to agar and color darkens
to yellowish gray
Microscopic Morphology
8. culture in CORNMEAL-TWEEN 80
AGAR AT 25C 72H, produce true
hyphae & pseudohyphae with
blastoconidia arranged singly or in
shrt chains
9. hyphae are hyaline and septated
that
fragment
into
oval
or
rectangular arthroconidia.
10. PRESENCE
OF
BLASTOCONIDIA
ALONG THE HYPHAE (this differ
from Geotrichum)
Clincial fetaures:
11. superficial infection
12. hair char by soft, white nodules
locate along the shaft of hairs
13. usually involved the hairs of the
beard & mustache but may infect
also the hairs on the scalp & pubic
hairs
Lab Dx and treatment: similar to black
piedra
CUTANEOUS
DERMATOMYCOSES

MYCOSES/

14. fungal infections involving the

superficial keratinized tissues of the
body
Epidermophyton : skin and nails:
1. Epidermophyton floccosum
Microsporum : skin and hair:
1. M. audouinii
2. M. canis
3. M. gypseum
Trichophyton: skin, hair & nails:
1. T. mentagrophytes
2. T. rubrum
3. T. schoenleinii
4. T. tonsurans
5. T. verrucosum
6. T. violaceum
EPIDERMOPHYTON FLOCCOSUM
7.
8.

produces infection in nails and skin

rate of growth : mature within 10
days

Colonial morphology:
9. surface: brownish yellow to olive
gray or khaki
10. at 1st lumpy & sparse, then folded
in center & grooved radially
becoming velvety
11. fluppy white sterile mycelium
covers the colony after secveral
weeks
12. reverse : orange to brownish with
thin yellow border
Microscopic:
13. septate
hyphae,
numerous
macroconidia,
seen
in
young
cultures, are smooth, both thin and
thick-walled, CLUBBED-SHAPE WITH
ROUNDED ENDS & FOUND IN
SINGLY OR CLUSTER
14. with age: macroconidia transform
into chlamydoconidia
15. NO MICROCONIDIA
16. In tissues: appears segmented,
branching
mycelial
elements
identical with Microsporum &
Trichophyton.

MICROSPORUM GYPSEUM
17. infects the scalp and skin
18. infections are more common in
animals than humans
19. rate of growth: moderately rapid;
mature within 6 days
Colonies:
20. surface : flat and spreading,
powdery to granular, with irregular
fringed border
21. buff at first, then tan to cinnamon
brown
22. colony often develops a sterile
white hyphal border or cottony
white center
23. reverese:
yellow,
orange-tan,
brownish red or purplish red in
spots.
Microscopic:
24. septate hyphae
25. macroconidia
:
numerous,
symmetric, rough, thin-walled with
NO MORE THAN 6 CELLS, ends are
rounded.
26. Microconidia
are
club-shaped
usually present along the hyphae.
MICROSPORUM CANIS
27. causes infections of the scalp, skin;
nails rarely affected
28. MOST prevalent in children
29. Human
infections
are
mostly
acquired from infected dogs or cats
30. Rate of growth : moderate
Clinical morphology:

31. surface: whitish, coarsely fluffy with

yellow pigment at periphery
32. may develop closely spaced radial
grooves
33. reverse: brigh or deep yellow
becoming brownish yellow or dull
orange-brown with age

from the macroconidia

51. macroconidia may be abundant,
rare or absent; they are long &
narrow, thin-walled with parallel
sides & have 2-8 cells
52. arthroconidia tend to form from
both hyphae and macroconidia.
TRICOPHYTON MENTAGROPHYTES

Microscopic :
34. septate hyphae with ABUNDANT 815 COILED macroconidia, long,
spindle-shaped, rough thick walls &
taper to a distinct knoblike ends.
35. ECHINULATES are apparent at the
knobs
36. Microconidia are few, clavate
usually sessile on the hyphae
37. Spiral hyphae produced in Rice
Medium
MICROSPORUM AUDOUINII
38. formerly
cause
epidemics
of
ringworms of the scalp in children
39. also infects skin on other parts of
the body
40. very rarely infects adults
41. rate of growth: moderate
Colonies:
42. surface: flat, downy to silky, grayish
or tanish white
43. reverse: light salmon with reddishbrown center pigment best seen on
Potato Dextrose Agar
Microscopic:
44. septate hyphae with terminal
chlamydoconidia that are pointe
don the end
45. pectinate hyphae are seen
46. USUALLY ALMOST DEVOID OF
CONIDIA but sometimes forms
poorly-shaped,
abortive
microconidia or macroconidia that
are identical with other species of
Microsporum.
TRICHOPHYTON RUBRUM
47. infects the skin & nails, only rarely
the beardm hair or scalp
48. MOST COMMON dermatophyte to
infect humans
49. Rate of growth : slow (14 days)

53. invades all parts of the body

surface, including hairs and nails
54. common cause of Athletes foot
55. rate of growth :moderate (7-10
days)
Colonial morphology:
56. surface: buff and powdery or
granular; white & become pinkish
or yellowish
57. powdery or granular form: exhibits
concentric and radial folds
58. from granular colonies will develop
to fluffy, cottony growth, pure white
in color
Microscopic morphology:
59. septate hyphae
60. macroconidia : cigar-shaped, thinwalled, with nparrow attachment to
hyphae & may contain 1-6 cells
61. microconidia
in
(a)
powdery
cultures: round & clustered on
branched conidiphores (b) fluffy
forms: smaller, fewer, teardrop
shaped
62. COILED SPIRAL HYPHAE maybe
present, considered as DISTINCT
characteristics
63. Nodular bodies are seen in some
strains.

TRICHOPHYTON TONSURANS
64. most commonly associated with
scalp ringworm but also infects the
skin and nails
65. rate of growth: moderately slow (12
days)
66. has
partial
requirement
for
THIAMINE

Colonial morphology:
-surface: granular or fluffy, white to buff &
becomes velvety
reverse: deep red or deep rose purple.
Pigmentation spread into the marginal
hyphae. Best seen in Cornmeal Dextrose
Agar

Colonies:
67. highly variable
68. surface: white, grayish, yellowish,
rose or brownish with many radial
or concentric folds with deep
crater-like depression in the center
of the colony
69. reverse: reddish brown (pigment
may
diffuse
into
medium)
sometimes yellow or colorless.

Microscopic morphology:
50. septate
hyphae
with
teardrop-shaped
or
microconidia whch form

Microscopic morphology:
70. spectate
hyphae
with
many
micronidia along the hyphae or on
short
conidiospores
that
are

lateral
oblong
directly

perpendicular to the parent hyphae

71. microconidia : usually teardrop or
club-shaped but may elongate or
enlarge to round forms
72. macroconidia: rare, irregular &
thick walled
73. may
have
spiral
coils
&
arthrospores
74. INTERCALARY
AND
TERMINAL
CHLAMYDOCONIDIA COMMON IN
OLDER CULTURES.
TRICHOPHYTON SCHOENLEINII
75. usual cause of FAVUS, a chronic
scarring scalp infection that results
in permanent hair loss
76. may infect the nails and skin
77. rate of growth : slow (2-3 weeks)
Colony morphology:
78. colony whitish, waxy or slightly
downy, irregularly raised or folded
with radiating grooves
79. growth is often submerged in agar
80. reverse: colorless or yellowishorange to tan in color
Microscopic morphology:
81. hyphae septate, highly irregular,
knobby
82. subsurface
hyphae:
form
characteristic antler-like branching
structures
called
FAVIC
CHANDELIERS
83. have swollen tips: resemble nail
heads
84. chlamydoconidia : numerous
85. rare microconidia
86. macroconidia- virtually absent

seen in SDA but may form in

Thiamine-enriched media
TRICHOPHYTON VERRUCUSOM
95. infects scalp, beard, nails & skin on
various parts of the body
96. acquired from the cattles
97. rate of growth : slow; 2-3 weeks;
mature in 14-21 days
98. grows best @ 37C
Colonial morphology:
99. usually small, heaped & button-like;
sometimes flat with rugal folds with
tendency to sink into agar surface
100. waxy or slightly downy, white to
gray or yellow color
101. reverse: variable (non-pigmented
to yellow)
Microscopic morphology on SDA:
102. forms
hyphae
chlamydoconidia, in chains
some favic branches

Microscopic morphology on Thiamineenriched media:

103. produces small, delicate, single
microconidia & occasional long,
thin, irregular microconidia shaped
like STRING BEANS or RATs TAIL
104. microconidia teardrop shaped
CLINICAL INFECTION
Natural Habits of common dermatophytes
1.

TRICHOPHYTON VIOLACEUM
87. infects the scalp, hair, skin and
nails
88. rate of growth : slow (2-3 weeks)
89. mature in 14-21 days
2.
Colonial morphology:
90. original cultures are waxy, glabrous
surface; wrinkled, flat with deep
purplish red or port-wine color
91. subcultures: more downy and paler
in color compared to original
culture colonies
Microscopic morphology:
92. hyphae are tangled, branched,
irregular (tortuous), granular with
intercalary chlamydoconidia
93. chlamydospores: commonly aligned
in chains
94. Micro/macro conidia : NOT usually

with
with

ANTHROPHILIC (humans)

1.
2.
3.
4.

E. floccosus

5.
6.
7.

T. schoenleinii

M. andouinii
T. rubrum
T.
mentagrophytes
interdigitale

var

T. tonsurans

T. violaceum
produces relatively mild & chronic
infections in man

2, ZOOPHILIC (animals)
M. canis dogs and cats
T. mentagrophytes var mentagrophytes
rodents
T. verrucosum cattles
- cause more inflammatory and
acute infections that respond better to
treatment
- infection does not recur
3.

GEOPHILIC (soil)

Transmission:
4. Direct contact with dermatophytes
in soils and animals
5. Direct contact orthrough fomites

(anthrophilic species) : infected

hairs on hats, caps, combs or
barbers clippers.
Predisposing factors
1. hot humid climate
2. crowded living condition
3. increased perspiration
4. genetic predisposition
5. young individuals
Clinical Forms of Dermatophytes
6.

7.
8.

TINEA raised , circular lesion

which has an outer ring of an active
progressing infections with central
healing within the ring
RINGWORM
Name of infection based on location
or area of the body involved

TINEA CAPITIS (SCALP)

Invasion may be:
9. ENDOTHRIX: presence of
arthroconidia
(from
fragmentation of hyphae)
within
hair
shaft
but
without
destruction
of
cuticle
10. ECTOTHRIX: presence of
arthroconidia around or on
the surface of hair shaft
with destruction of cuticle

C.A.
:
T.
rubrum,
M.
canis,
T.
mentagrophytes
Manifestations:
circular
patches
with
advancing red vesiculated border &central
scaling, pruritic
TINEA CRURIS (JOCK ITCH)
Site: groin, perineum, perineal regions or
genitocrural folds
C.A. : T. rubrum, T. mentagrophytes, E.
floccosum
Manifestations: erythematous scaling lesion
in intertriginous area, pruritic
TINEA PEDIS (ATHLETES FOOT)
Site : feet particularly toes, webs and soles
C.A. T. rubrum, T. mentagrophytes, E.
floccosum
Manifestations:
a. acute : itching, red, vesicular
lesions
b. chronic: itching, scaling, fissures
TINEA MANNUS
Site: interdigital areas and palms
C.A. same as tinea pedis
Manifestations: usually associated with T.
pedis;
hyperkeratotic
(white
flakes,
vesicular or erythematous)
TINEA UNGUIM (ONCHOMYCOSES)

Most commonly isolated:

a. Epidermic
b. T. tonsurans
c. T. violaceum
d. Non-epidemic
e. M. canis
f.
T. verrucosum
g. M. gypseum

Site: nails
C.A. T. rubrum, T. mentagrophytes, E.
floccosum
Manifestations:
a. nails thickens or crumbles diatally
b. white patches on surface or
invasive infection beneath nail
plates
c. usually associated with T. pedis

TINEA BARBAE ( BARBERS ITCH)

Lab Dx:

Site of lesion : bearded areas of face and

neck
C.A. : T. rubrum, T. verrucosum
Manifestations
:
mild
superficial,
edematous, erythematous lesions or severe
deep pustular folliculitis.

Specimen: skin & nail scrapings; hair

Lab Procedures:
1.

TINEA FAVOSA (FAVUS)

Site of lesion: scalp, torso
C.A. T. schoenleinii
Manifestations:
a. formation
of
yellowish
cupshapedncrusts or scutulae
b. extensive alopecia & scarring of
scalp
c. mousy odor of scalp
TINEA CORPORIS (body)
Site : arms, legs and torso

Wet mount preparations

a. Microsporum dense sheaths
of spores in mosaic pattern
around the hair
b. Trichophyton parallel rows of
spores outside or inside hair
shaft
c. T. schoenleinii favic hairs
present char air spaces in the
hair which are readily filled
with fluid in KOH prep

Lab Differentiation of different species

A.

Microsporum sp.

1.

M. audouinii: infected hair shafts

fluoresce yellow green in woods
lamp

2.
3.
4.
5.
6.

addition of yeats extract stimulate

growth
and
production
of
macroconidia
grows poorly on sterile rice grains
(rice medium)
M. canis : infected hairs fluoresce
bright yellow-green in woods lamp
grows well on rice grains
M. gypseum : infected hairs
generally do NOT fluoresce in
woods lamp

7.

TRichophyton sp: infected hairs do

NOT fluoresce using woods lamp

1.

T. rubrum : No specific nutritional

requirement, negative hair baiting
test; negative urease test
T. mentagrophytes : (+) hair bait
test; (+) urease test

2.

Culture
3. use of special culture media to
observe for characteristics colonial
morphology & color produce on the
reverse side of plate
Treatment
1. topical antifungal
2. oral Griseofulvin for long periods :
for scalp and nail infections
3. oral ketoconazole

One BIG fight

Deus te benedicat.
Ad Astra Per Aspera
MP 2015.

V5 & ASSOC

2012