FUNGAL DISEASES

1. FUNGAL ALLERGIES AND
INFECTIONS
BY
V.SAI KRISHNA SAKETH
YEREVAN HAYBUSAK UNIVERSITY

2. SUPERFICIAL MYCOSES
1.Tinea versicolor
2.Tinea nigra
3.Piedra
4.Dermatophytoses
SUBCUTANEOUS MYCOSES
1.Mycotic mycetoma
2.Chromoblastomycosis
3.Sporotrichosis
4.Rhinosporidiosis
SYSTEMIC MYCOSES
1.Coccidioidomycosis
2.Histoplasmosis
3.Blastomycosis
OPPURTUNISTIC MYCOSES
1. Aspergillosis
2.Candidiasis
3.cryptococcus
4.Mucormycosis

3. SUPERFICIAL MYCOSES
1.TINEA VERSICOLOR
2.TINEA NIGRA
3.PIEDRA
4.DERMATOPHYTOSES

4. TINEA VERSICOLOR-
PYTIRIASIS VERSICOLOR
chronic involving s.corneum mainly in tropics.
causative agent- Malassezia furfur
Clinical features- Decolorations on chest,skin, abdomen , upper limbs
Laboratory Diagnosis-yeast like cells and brached filaments on skin
scrapings.
Treatment
Topical lotions like selenium sulfide shampoo, ketoconazole
shampoo or cream,. terbinafine cream should be used for 2
weeks.

5. TINEA NIGRA
causative agent- Exophiala werneckii and
Exophilia castellani.
Clinical features- Infections oof S.corneum of
palms and back, producing black lesions.
Laboratory Diagnosis- Skin scrapings show
brownish septhate hyphae.

6. PIEDRA
nodule formation on hair shaft,
which may be either black or white in color
White Piedra--Trichosporon beigelli
Black Piedra-piedraria hortae

7. DERMATOPHYTOSES
Commonly known as tinea by a group of keratinophilic fungi known as dermatophytes.
They digest keratin by keratinases
• Trichophytonspecies: lnfect skin, hair and nail.
• Microsporum species: Infect skin and hair.
• Epidermophyton species: lnfect skin and nail
Clinical features-
lesions on skin-- circular,dry,scaly and itchy.
lesions on hair-kerion,favus,alopecia and scarring
kerion- nails infected are deformed, fabrile and discoloured.
favus- chronic type that develop in hair.

8. 1 . Tinea corporis (body) : "ringworm"
2. Tinea cruris (groin ) : "jock itch"
3. Tinea pedis (feet): "athlete's foot"
4. Tinea capitis (scalp)
5. Tinea unguium (nail): "Onychomycosis"

9. • Diagnosis- Wood lamps examination
positive for various Microsporum species and Trichophyton
schoenleinii.
Specimen Collection
• Skin scrapings, hair plucks and nail clippings
Direct Examination
specimen is mounted in KOH and is examined for the presence of thin
septate hyaline hyphae and arthroconidia.
TREATMENT
Oral terbinafine or itraconazole

10. SUBCUTANEOUS MYCOSES
1.Mycotic mycetoma
2.Chromoblastomycosis
3.Sporotrichosis
4.Rhinosporidiosis

11. Mycotic mycetoma
chronic granulomatous infection of the
skin and subcutaneous tissues.

12. • Laboratory Diagnosis-
examination of granules and biopsy of the lesion
Treatment
surgical removal of the lesion followed by use of:
Antifungal agents for eumycetoma (itraconazole or amphotericin
B for 8- 24 months)
Antibiotics for actinomycetoma such as Welsh regimen
(amikacin plus cotrimoxazole).

13. Chromoblastomycosis
causative agent-
Phialophora verrucosa ,Cladosporium carrionii, Fonsecaea species
RESERVOIR
copper-coloredsoil saprophytes can be found on rotting wood
Clinical features-Following a puncture wound, a small ,violet wart-like
lesion develops. With time, clusters of these skin lesions can develop
(resembling cauliflower)
DIAGNOSIS
• Skin scrapings with KOH prepreveal copper-colored cells, called
sclerotic bodies
TREATMENT
1 . ltraconazole
2. Local excision

14. Sporotrichosis
causative agent-Sporothrix schenckii
RESERVOIR--Found on rose thorns
Clinical features
1 . Subcutaneous nodule g raduallyappears at site of thorn prick
2 . This nodule becomes necrotic and ulcerates This ulcer heals, but
new nodules pop up nearby along the lymphatictracts
DIAGNOSIS
Dimorphic Culture at 25°C: will grow branching hyphae Culture at
37°C will grow yeastcells
TREATMENT
ltraconazole,Fluconazole andOral potassium iodide

15. Rhinosporidoisis
causative agent- Rhinosporidium seeberi
Clinical features- mainly confined to mucous membranes and lesions seen in
nasal cavity, eye,skin etc
DIAGNOSIS- endospores are seen in lesions examinbations.
TREATMENT-
exicision of the polyp

16. SYSTEMIC
1.Coccidioidomycosis
2.Histoplasmosis
3.Blastomycosis

17. Coccidioidomycosis
causative agent-Coccidioides immitis
RESERVOIR- Desert areas of the southwestern US
Clinical features- 1 . Asymptomatic (in most persons)
2 . Respiratorytransmission
2. Pneumonia
3. Disseminated: lungs,skin, bones, and meninges
A small percentage of individualswith this infection willdevelop painful
erythematousnodular lesions called erythemanodosum
DIAGNOSIS-Dimorphic Culture at 25°C: will grow branching hyphae Culture
at 37°C will grow yeastcells
1.Biopsy of affected tissue: lung biopsy, skin biopsy, etc.
A. Silver stain or KOH prep
B. Culture on Sabou raud's agar
2. Serology
3. Skin test
TREATMENT . Amphotericin B, ltraconazole and Fluconazole

18. Histoplasmosis
causative agent-Histoplasma capsulatum
RESERVOIR- Present in bird and bat droppings
Respiratory transmission
Clinical features- . Asymptomatic (in most persons)
2 . Pneumonia: lesions calcify , which can be seen on chest X-ray
3 . Disseminated
DIAGNOSIS-Lung biopsy
A. Silver stain specimen
B . Culture on Sabouraud's agar will reveal hyphae at 25 °C,and yeast at 37 °C.
2 . Serology
3. Skin test (tests for exposure only)
4. Urine antigen test
TREATMENT- ltraconazole andAmphotericin B

19. Blastomycosis
causative agent-Blastomyces dermatitidis
RESERVOIR-Resides in soilrotten wood
Respiratory transmission
Clinical features- 1.Asymptomatic (uncommon)
2 . Pneumonia: lesions rarely calcify
3. Disseminated
4. Cutaneous: skin u lcers
DIAGNOSIS - Biopsy of affected tissue: lungbiopsy, skin biopsy, etc .
A. Silver stain speci men
B . Culture on Sabouraud's agar
2 . Serology
3. Skin test
TREATMENT-. ltraconazole,Ketoconazole and Amphotericin B

20. OPPURTUNISTIC MYCOSES
1. Aspergillosis
2.Candidiasis
3.cryptococcus
4.Mucormycosis

21. Aspergillosis
causative agent-Aspergillus fumigatus, Aspergillus flavus and Aspergillus
niger
Clinical features- 1.Allergic bronchopulmonaryaspergillosis (lgE mediated):
asthmatype
2. Aspergilloma (fungus ball) :associated with hemoptysis
3 . Invasive aspergillosis: necrotizingpneumonia. May disseminate in
immunocompromised
4 . Aflatoxin consumption can cause liverdamage and liver cancer
DIAGNOSIS- aspergillosis - high levels of IgE and eosinophills
Aspergilloma: diagnose with chest X-ray
TREATMENT-Amphotericin B

22. Candidiasis
causative agent-Candida albicans
RESERVOIR- normal inhabitants of skin and mucous
Clinical features- cutaneous candidiosis , Mucosal lesions , intestinal
candidiosis , bronchiopulmonary candidiosis and catheter assosiated
and systemic infections
DIAGNOSIS--Gram +ve cells from lesions and formation of
chlamydospores in sarrbouraud agar culture.
TREATMENT- Amphotericin B

23. cryptococcus
• causative agent-Cryptococcus neoformans
• RESERVOIR- soil saprophyte and found in feaces of pigions and birds
• Clinical features- Meningitiss , pnemonia and skin lesions
• DIAGNOSIS-. India-ink stain of (CSF) : observe encapsulatedyeast
2.cryptococcal antigen test of C S F :detects polysaccharide antigens
• 3 .Fungal culture
• TREATMENT- Amphotericin B

24. Mucormycosis
causative agent-Rhizopus ,Rhizomucor and Mucour
RESERVOIR- Saprophytic molds ubiquitous in nature
Clinical features- 1.Rhinocerebral : starts on nasal mucosa and
invades the sinus and orbit
2. Pulmonary mucormycoses
DIAGNOSIS-Biopsy and Black nasal discharge
TREATMENT - I.V Amphotericin B combined with surgical
Drainage.

25. REFERENCES-
1. Ananthanarayan and paniker's Textbook of Microbiology. 10th edition.
2.Clinical microbiology made Ridiculously simple - 6th edition

26. THANK YOU