Musculoskeletal mycosis 2024(1).GGGYGpdf

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1. Musculoskeletal&Integumentarysystems…
LectureonMicrobiologypart
SuperficialMycoses
CutaneousMycoses
1

2. 2
Mycosis:Introduction
•Mycosis(singular),Mycoses(Plural)
•Infectioncausedbyafungus
•4typesbasedontypeanddegreeoftissueinvolvement
•Superficial-hairshaft,deadlayerofskin
•Cutaneous-epidermis,hairandnails
•Subcutaneous-dermis,subcutis
•Systemic(deep)-internalorgans
•Fungigroupedinto2basedonvirulence
•Primarypathogens
•Opportunisticpathogens

3. Superficialmycoses
•Infectionsconfinedto
outermost layeroftheskin
andhair
•Largelycosmeticproblems
•Commontypes
•Tineaversicolor(Pityriasis
versicolor)
•Tineanigrapalmaris
•Tineapiedra
3

4. Pityriasis(Tinea)Versicolor
•Commonsuperficialinfectionoftheskin
•CausedbyMalasseziaspp
(M.furfur,M.globosa,M.restricta)
•Lipophilicyeast
•Normalfloraofhuman’s&animal’sskin
•Mayalsocauseotherinfections
•Seborrheicdermatitis
•Dandruff
•Malasseziafolliculitis
•Systemicinfections
(immunocompromisedhosts,
neonates)
Malasseziaspp.
4

5. 5
Pityriasis(Tinea)Versicolor
Epidemiology
•Worldwideinitsdistribution
•Commoninthetropicswithmorethan60%ofthe
populationinfected
•Commoninhotandhumidenvironments
•ModeoftransmissionforMalasseziaspp
•Endogenous
•Infectionresultswhenthedimorphicyeastchangestoits
mycelialform
•Lesscontagioustootherhumans
•Predisposingfactors
•Immunosuppression(e.g.Steroidtherapy)
•Poorhygiene
•Sweatyandgreasyskin
•Chronicbacterialinfections

6. Pityriasis(Tinea)Versicolor-clinicalmanifestation
•Hyper-orhypopigmentedskin
•Lesionsarewell-demarcated
(white,pinkorbrownish)
•Fawn-coloredmaculesarethe
mostcommonpresentation
•Trunkandupperarms
•Rarelyonneckandface
•Painlessandnotitching
6

7. Pityriasis(Tinea)Versicolor-Labdiagnosis
•Specimen
•skinscrapings
•10%KOHpositiveforshort
hyphae andspores(Spaghetti-
hyphaeand meatballs-yeasts)
•Culturerarelydone
•Sabouraud'sdextroseagar
with chlorhheximideand
chloramphenicol canbeused
7
Courtesy of the department of medicalMycology
St.John’sInstitute of dermatology,kings college
london, UK

8. Tineanigra
•Chronicsuperficialfungal
infection ofthepalmsandsoles
•Rare
•Causedbyblackfungus-
Hortaea werneckii/Exophiala
werneckii)
•Dematiaceous(pigmented
fungi)
•Phylumascomycota
8

9. 9
Tineanigra
Epidemiology
•Commonintropicalorsubtropicalconditions
•Africa,Asia,andCentralandSouthAmerica
•Commonsaprophyticfungus
•Prevalentinsoil,compost,humusandonwood
•Childrenandyoungadultsaremostoftenaffected
•Transmission
•Traumaticinoculationtotheskin
•Notcontagious
•Predisposingfactor
•Excessivesweating

10. Tineanigra:Clinical
manifestation
•Browntoblackmacules
(palmar andplantarandother
surfaces oftheskin)
•Well-defineddarkpatch
with irregularmargin,1-5
cmin diameteronpalm
•Noerythemaorinflammatory
reaction
10

11. Tineanigra:Laboratorydiagnosis
•Clinicalspecimen:Skin
scrapings
•DirectMicroscopy:
•10%KOH
•Culture
•Sabouraud'sdextrose
agar
11

12. 12
Tineapiedra
•Chronicfungalinfectionofthehairshaft
•Etiologicagents
•Piedraiahortae-blackpiedra
•Trichosporonspss–Whitepiedra

13. Blackpidera
•Conditionaffectingthehair,
primarilythe scalp
•CausedbyPiedraiahortae
•Ascomycetousfungus
•Growsveryslowly,
formingdark hyphae
•Existsinthesoils
13

14. 14
Blackpidera
•Epidemiology
•Commonintropicaland
subtropicalenvironments
•Generallyrarebutaffectsboth
sexesofallages
•Transmission
•Usuallyacquiredfromsoils
•Contagious-epidemicsin
families
•Predisposingfactor
•Poorhygiene
•Longhair
•Applicationofplantoilstowet
hair

15. Blackpidera:ClinicalManifestations
•Doesnotpenetratethehairfollicle
•Scalphair:rough,sandy
•Infectedhairs:hardblacknodules
ontheshaft
•Nodules:hard,fusiform,
firmly attachedtohair
shaft
•Thickpart:fungalyeast
cemented together
•Thinpart:hyphalelements
15

16. Blackpidera:Laboratorydiagnosis
•ClinicalSpecimen
•Hairswithhardblacknodules
•DirectMicroscopy
•Use10%KOH
•Darklypigmentednodules:hair
shaft
•Nodules:pigmented
center containingasci
•Culture
•Canbeculturedon
routine mycologic
media
PlatecultureofPiedraia
hortae
16

17. WhitePiedra
•Superficialcosmeticfungal
infectionof thehairshaft
•Affectsscalp,axilla,facialand
genitalhair
•CausedbyTrichosporonspps.
(Trichosporonbeigelii)
•Yeastlikefungusofthegenus
Trichosporon
•Basidiomycota
•Inhabitsthesoil,butisalso
normalfloraof thehumanskin
andrespiratorytract
Trichosporonspecies
17

18. 18
WhitePiedra
•Epidemiology
•Commonlyfoundintropicalandsubtropicalregions
•Generallyrarebutcommoninyoungadults
•Transmission
•Mayformbiofilmundercertainconditionsofhumidity
ofthehair
•Contaminationfromsoil
•Directpersontopersonisuncommon
•Possibletransmissionfromgenitalregionthrough
sexualactivity
•Predisposingfactor
•Longhair
•Excessivemoisture
•Poorhygiene
•Diabetesmellitus

19. WhitePiedra:Clinical
Manifestations
•Whitetobrownswelling
alongthe hairstrand
•Noduleslooselyadhering
tothe hairs
•1.0-1.5mminlength
•Nopathological
changesare elicited
19

20. WhitePiedra:Laboratorydiagnosis
•DirectMicroscopy
•Use10%KOH
•Arthroconidiaand/or
buddingyeast cells
•Culture
•Mycologicmedia
without cycloheximide
(cycloheximidewill
inhibitTrichosporon
spp.)
PlatecultureTrichosporonspecies
2820

21. CutaneousMycoses
•Dermatophytosis-"ringworm"diseaseofthenails,
hair,and/or stratumcorneumoftheskincausedby
fungicalleddermatophytes.
•Dermatomycosis-moregeneralnameforanyskin
diseasescausedby afungus.
21

22. 22
Cutaneousmycoses
•Fungalinfectionofkeratinizedlayersoftheskin
(epidermis),hair, andnail.
•Ringworm–disease(Tinea)
•Mainetiologicagents-dermatophytes-“Skinplants”
•Dermatophytes
•Keratinophilicandkeratinolytic
•Digestkeratinbytheirkeratinases
•Resistanttocycloheximide
•Morphologicallysimilarwithseptatehyphae,and
chainsofarthroconidia

23. 23
Dermatophytes
3generabasedonetiologicalaspects
•Microsporum
•hair,skin,rarelynails
•children,rarelyinadults
•spontaneousremission
•Trichophyton
•hair, skin&nails
•bothchildren&adults
•chronic
•Epidermophyton
•skin,nails,rarelyhair
•Adultsrarelychildren

24. 24
Dermatophytes–commonspecies
•Epidermophyton-E.floccosum
•Microsporum-M.canis
•M.gypseum
•Trichophyton-T.rubrum
•T.mentagrophytes
•T. verrucosum
•T. violaceum

25. 2
5
DistributionofConidia-usedfordifferentiation
DermatophyteMacroconidia Microconidia
TrichophytonRare,thinwalled Abundant
Microsporum Numerous,thick
walled, rough
Rare
EpidermophytonNumerous,smooth
walled
Absent

26. Microsporumcanis
Macroconidia
26

27. EpidermophytonfloccosumMacroconidia
36

28. 28
Dermatophytes
•EcologyandEpidemiology
•Anthropophilicspecies-humans(e.g.,M.audounii,T.
tonsurans)
•Geophilicspecies-soilsaprophytes(e.g.,M.gypseum,
T.ajelloi).
•Zoophilicspecies-animals(e.g.,M.canis,T.verrucosum).
•Severityofringwormdiseasedependson
•Strainsorspeciesoffungusinvolved
•Sensitivityofthehosttoaparticularpathogenicfungus.

29. 29
Majorsourcesofringworm
infection
•Warmdampareas(e.g.,tropics,moisture
accumulationin clothingandshoes)
•Schools,militarycamps,prisons.
•Animals(e.g.,dogs,cats,cattle,poultry,etc.).

30. 30
•Diseases
•Hairyareas
•Tineacapitis
•Tineabarbae
•Skin
•Tineacorporis
•Tineacruris
•Tineamanum
•Tineapedis
•Nail:
•Tineaunguium

31. Tineacapitis(head,hair)
•Ringwormofthescalp,eyebrows
and eyelashes
•Fungusgrowsintohair
follicle
•Baldpatches,moist,
itchy,scaly
•Papulestopustules
•Friablehair
•Commonetiologies
•T.mentagrophytes
•M.canis
31

32. TineaCapitis
GrayPatch
32

33. •Tineabarbae
•Ringworminfection
ofthebeard
33

34. HairInfectionsCausedByDermatophytes
Invasionpattern
•Ectothrix-arthrosporesproducedon
surfaceof hair.
•M.audouinii,M.canis,T.
mentagrophytes
•Endothrix-growthinsidehairshaftonly!
"Black-dot“
•T.tonsuransandT.violaceum
•"Favushair"endothrix(honeycomb
patternof damageseenonsurfaceof
hairshaft)
•T.schoenleinii
34

35. Tineacorporis(thebody)
•ClinicalManifestations
•“Ringworm”ofthebody
•Papulestopustuleswithclearcenterand
active borders(peripheralpustulesand
scaling),itchywith inflammatory,vesicular,
enlargingmargins
•Transmission
•Directcontactbetweeninfected
humansor animals,byfomites
•Normallyresolvesitselfinseveralmonths.
•Commonetiologies
•T.rubrum,T.mentagrophytes,T.tonsurans
•M.canis,M.audouinii
•E.floccosum
35

36. Tineacorporis–bodyringworm
36

37. Tineacruris(groin)–jockitch
•Oftenstartonthescrotumand
spreadtothegroinasdry,itchy
lesions
•Transmission
•Sharingoflinens,towelsor
clothes
•Commonetiologies
•T.rubrum
•T.mentagrophytes
•E.flocossum
37

38. 38
Tineapedis-Athletes'footinfection
•Betweentoesortoewebs(releasingofclearfluid)-4th
and5th toesaremostcommon
•Sorenessanditchingofanypartofthefoot.
•Transmission
•Directcontactbetweeninfectedhumansorbyfomites
•Commonetiologies
•T.rubrum
•T.mentagrophytes
•E.floccosum

39. TineaPedis–Athlete’sFootInfection
39

40. Tineaunguium(nails)-
onychomycosis
•Ringwormofthenails
•Commonetiologies
•T.rubrum,
•T.mentagrophytes
•E.floccosum
•Resistanttotreatment,rarely
resolves spontaneously
40

41. TineaUnguium–NailInfection
41

42. 42
LabDiagnosis
•Notethesymptoms
•WoodsLampexamination
•Sample
•skin&nailscrappings(edge),pluckedhair
•DirectMicroscopicexaminationofslidesofskin
scrapings,nail scrapings,andhairwith10%KOH
•Branchinghyalineseptatehyphae

43. 43
CULTURE
•Sabouraudagar,withandwithoutantibiotics
•25,30
0,37
021days
•dermatophytetestmedium25
oC-red
•Ureasetest
•T mentagrophytes +
•T rubrum -

44. 44
•Thankyou!