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CUTANEOUS MYCOSES

Cutaneous Mycoses

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Fungi causing human skin infections

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CUTANEOUS MYCOSES

CUTANEOUS MYCOSESMycoses - Fungal InfectionsSuperficial MycosesSurface Mycoses Dead layers of skin & its appendagesPityriasis versicolor, Tinea nigra, PiedraCutaneous Mycoses Full thickness of skinDermatophytosisMuco-cutaneous Candidiasis

Subcutaneous MycosesSystemic MycosesOpportunistic Mycoses

DERMATOPHYTOSESDERMATOPHYTESFilamentous fungi infecting superficial keratinised tissues - Skin, Hair and NailDermatomycosis v/s DermatophytosisDermatophytoses = Tinea,Ringworm

GENUSSKINNAILHAIRTRICHOPHYTON+++EPIDERMOPHYTON++_MICROSPORUM+_+

Dermatophytes - morphologyIn Tissues Hypahe & Arthrospores

In Culture Thin, septate, branching hyphaeMicroconidia Small asexual sporesMacroconidia Large asexual spores

Dermatophytes morphology.GENUSCOLONYMICROCONIDIAMACROCONIDIATRICHOPHYTONPowdery/ velvety / waxy

PigmentationAbundantRelatively lessElongated, blunt ends

MICROSPORUMCottony / velvety/ powderyWhite / brown ScantyNumerousSpindle shapedEPIDERMOPHYTON

Powdery,

Greenish yellowAbsentManyPear-shaped in clustersDematophyte speciesTrichophytonT. rubrumT. violaceumT. mentagrophytesT. verrucosum

MicrosporumM. gypseumM. canisM. nanum

Epidermophyton floccosumTrichophyton mentagrophytes

Microsporum canis

Epidermophyton floccosum

Microsporum gypseum

Trichophyton rubrum

PATHOGENESISSOURCE Patient - AnthropophilicAnimal - ZoophilicSoil Geophilic

Grow only in keratinised tissuesDo not penetrate living tissuesFungal products Local inflammationHypersensitivity Distant lesionsCLINICAL PRESENTATIONSRingworm Scaly erythematous lesion with central clearing

CLINICAL PRESENTATIONSTinea capitis

Tinea corporis

CLINICAL PRESENTATIONSTinea barbae(Barbers itch)

Tinea cruris(Jock itch)

CLINICAL PRESENTATIONSTinea pedis(Athletes foot)

Moccasin type of Tinea pedis

Tinea unguium

Tinea imbricata

KerionFavus

Dermatophyte Hair InfectionEctothrixEndothrix

ID Reaction (Dermatophytid)Dermatophyte infection Hypersensitivity ID reaction at a distant site

ID lesions sterile

Disappear after treating the primary lesion

LAB DIAGNOSISSPECIMENS: in sterile paper packetsSkin scrapingsNail clippingsPlucked Hair

WOODs Lamp

MICROSCOPYKOH 10% - Digest keratinCalcofluor white Fluorescent technique

CULTUREOn Sabouraud Dextrose AgarMicroscopic study of growth

TREATMENTLimited infection Topical antifungalsExtensive /widespread lesions Oral antifungals

AZOLES Itraconazole, Clotrimazole, Ketoconazole, FluconazoleGriseofulvin Oral drug of choiceTerbinafineMUCOCUTANEOUS CANDIDIASISCANDIDACandida albicansNon-albicans Candida sppYeast-like fungusPseudohyphaeInfection of skin & mucosa; rarely of internal organs

PathogenesisCandidiasis/ Candidosis/ MoniliasisNormal inhabitant of skin and mucosaDiabetes mellitus MC risk factorOther risk factors AIDS, Steroids, Immunosuppression

Cutaneous CandidiasisMucosal CandidiasisSystemic Candidiasis - rare

CUTANEOUSINTERTRIGINOUSSkin macerated by perspirationGroin, perineum, axillae, inframammary fold

PARONYCHIAFrequent immersion of hands in water

Mucosal candidiasisOral ThrushBottlefed, elderly, etcVaginal candidiasisBalanoposthitisIntestinal candidiasisBronchopulmonary

Lab DiagnosisSPECIMENS:Scrapings, swabs, sputum, blood, etc

Microscopy budding yeast cells, pseudohyphaeCultureGerm tube testCornmeal agar ChlamydosporeSugar assimilation & Fermentation testsAntifungal susceptibility testCULTURESabouraud Dextrose Agar Creamy white, yeasty odour

Germ tube test in plasma

Chlamydospores on Cornmeal agar

Reynold Braude phenomenon

TREATMENTRemoval of predisposing factor

TOPICALNystatinAzoles

SYSTEMICAmphotericin B5 FluorocytocineAzole

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