MYCOLOGY

fungi reside in nature and are essential in breaking down

and recycling organic matter (a saprobe organism that
brings about decay)
used in production of food and spirits
in medicine, they provide useful bioactive secondary
metabolites such as antibiotics and immunosuppressive
drugs
used in model systems for the investigation of a variety of
eukaryotic processes
are phytopathogens that cause huge agricultural losses
(major pathogens of plants)
only a few hundred species of fungi have been implicated
in human disease
90% of human infections can be attributed to a few dozen
fungi

MACROSCOPIC EXAMINATION

Colony texture (the way the colony looks)

a. Glabrous

leathery or waxy

little if any aerial mycelium

b. velvety

resembles plush or velvet fabric or

suede

have short aerial hyphae, few conidia

or sopres
c. yeastlike

resembles colonies of coagulasenegative staphylococci

bacteria like

yeasts appear dryer and duller

no aerial mycelia
d. cottony

develop when colonies produce long

aerial hyphae
e. granular

fungi that conidiate or sporulate

heavily

Colony topography (the way the colony surface is arragned)

a. Flat

FUNGI

a group of nonmotile eukaryotic organisms that have

definite cell walls, devoid of chlorophyll and reproduce by
means of spores (or conidia)
each fungal cell has at least one nucleus and nuclear
membrane, ER, mitochondria and secretory apparatus
cell walls contain chitin or cellulose, or both
are heterotrophs uses many different organic compounds
as nutrients
are obligate or facultative aerobes
are chemotrophic, secreting enzymes that degrade a wide
variety of organic substrates into soluble nutrients, which
are then passively absorbed or taken into the cell by active
transport
often reside on body surfaces as transient environmental
colonizers but obtain no obvious benefit

DEFINITIONS

hyphae long strand of cells with or without crosswalls

(septa) ; filamentous tubular structures which grow by
elongation at the tips or by branching
septa crosswalls; hyphae may be septate or aseptate

mycelium masses of hyphae which comprises the colony of

the fungus (also called thallus)
yeasts single round to oval cell that usually buds to form
daughter cells; unicellular form
thermally dimorphic fungi develop mould-form colonies at
RT and another form at human body temperature
Conidium refers to any reproductive structure
moulds fungi that form hyphae (as opposed to yeast)
Mycosis (mycoses) are any disease caused by a fungus

b.

Folded

c.

Rugose

d.

Crateriform

e.

Cerebriform

f.

Verrucose

3 types of mycelia (generally cannot be distinguished from one another)

1.
2.
3.
-

Vegetative mycelia
grow in or on the medium
absorbs nutrients from the medium
Aerial
grow above the surface of the agar
forms most of the visible part of the colony
Fertile or reproductive mycelia
from which the reproductive structures arise

FUNGAL INFECTIONS

MYCOTOXICOSES

1.

fungi are metabolically versatile organisms and sources of

innumerable secondary metabolites such as alkaloids and
other toxic compounds
mycotoxicoses are most often the result of the accidental
or recreational ingestion of fungi that produce these
compounds
source of toxin is determined by obtaining the history of
the patient
when fungi are ingested, emesis (vomiting) should be
induced, and supportive measures should be instituted
consistent with the physiological signs exhibited by the
patient
Ergot Alkaloids
produced when grain is infected with Claviceps
purpurea
history of epidemics (St. Anthonys fire) associated
with consumption of bread and other bakery products
made with contaminated rye
symptoms
o
inflammation of the infected tissues
(cellular response to injury)
o
necrosis (cell death)
o
gangrene (death of large masses of tissue)
pharmacologically they produce alpha-adrenergic
blockade, w/c inhibits responses to epinephrine and 5hydroxytryptamine
o
create marked peripheral vasoconstriction
restricts blood flow

2.

3.

4.

directly stimulates smooth muscle contraction

used as oxytocic agents to induce labor (increases
force and frequency of uterine contractions)
affects CNS by stimulating the hypothalamus and other
sympathetic portions of MB
Psychotrophic Agents
used by primitive tribes
recreation use of agents such as psilocybin and
psilocin as well as the semisynthetic derivative,
lysergic acid diethylamide (LSD)
Aflatoxins
contamination with Aspergillus flavus
resulted in outbreak of Turkey X disease in England
Turkey developed symptoms:
o
Lethargy
o
Anorexia
o
Muscle weakness
o
Spasms
o
Eventually death
postmortem studies revealed gross hemorrhage and
necrosis of the liver
histophath = parenchymal cell degeneration and
extensive proliferation of the bile duct epithelial cells
etiological agents were A. flavus toxins that are
bisfuranocoumarin metabolites
are potent carcinogens but have not been shown to
play specific role in human carcinogenesis
Others
yellow rice toxicosis (Japan)
alimentary toxic aleukia (Soviet Union)

to measure degree of air pollution, fungal spore counts are

conducted because they are ubiquitous in nature
airborne spores and other fungal elements can be an
antigenic stimulus and may induce (depending on an
individuals immunological status), hypersensitivity from
the production of immunoglobulins or sensitized
lymphocytes
clinical manifestation of hypersensitive pneumonitis:
o
rhinitis
o
bronchial asthma
o
alveolitis
o
forms of atopy
growth of the fungus in the tissues is not required for the
development of hypersensitivity; clinical manifestations are
seen only in sensitized persons, after subsequent exposure
to the fungus, its metabolites, or other cross-reactive
materials

in general people have a high level of innate immunity to

fungi
most fungal infections are mild and self-limiting
skin primary barrier to any infection caused by fungi that
primarily colonize the superficial, cutaneous and
subcutaneous layers of skin
mucosal surfaces discourage colonization by organisms
that cause pulmonary infections
Fatty acid content, pH, epithelial turnover and normal
bacterial flora of the skin contribute to host resistance
Transferrin (humoral factors) restrict the growth of
several fungi by limiting the amount of available iron
Some fungi have gained significance with their association
with acquired immunodeficiency syndrome
o
Result of low pathogenic potential
o
Produce
disease
only
under
unusual
circumstances involving host debilitation
Some circumstances that lead to infection by once
innocuous saprobes are:
o
Change in normal intestinal flora (use of broadspectrum drugs)
o
Debilitation of the host by the use of therapeutic
measures (cytotoxins, xray, steroids)
o
Alteration of hosts immune system by underlying
endocrine disorders (DM)

GENERAL PROPERTIES AND CLASSIFICATION OF FUNGI

Fungi grow in 2 basic forms:

1.

yeasts
unicellular, spherical to ellipsoid fungal cells that
usually reproduce by budding
some species produce buds that characteristically fail
to detach and become elongated
o
continuation of the budding process then
produces a chain of elongated yeast cells
called pseudohyphae
colonies are usually soft, opaque and cream-colored
yeast species are identified on the basis of physiologic
tests and few key morphologic differences
some species of fungi are dimorphic and are capable
of growth as yeast or mold depending on
environmental conditions

2.

molds
growth is by production of multicellular filamentous
colonies
colonies consist of branching cylindric tubules called
hyphae
the mass of intertwined hyphae that accumulates
during active growth is a mycelium
some hyphae are divided into cells by cross-walls
called septa, forming at regular intervals during
hyphal growth
substrate hyphae hyphae that penetrate the
supporting medium and absorb nutrients

HYPERSENSITIVITY DISEASES

categories reflects their usual portal of entry and initial

site of involvement
overlaps do occur, since systemic mycoses can have
subcutaneous manifestations and vice versa
patients who develop opportunistic infections have serious
underlying diseases and compromised host defenses
during infections, most patients develop significant cellular
and humural immune responses to the fungal antigens

COLONIZATION AND DISEASES

necrosis and gangrene

-

most pathogenic fungi are exogenous

natural habitats
o
water
o
soil
o
organic debris
Candidiasis and dermatophytosis (mycoses with the highest
incidence) are caused by fungi that are part of the normal
microbial flora or highly adapted to survival on the human
host
Mycoses may be classified as: (refer to table1)
o
Superficial
o
Cutaneous
o
Subcutaneous
o
Systemic
o
Opportunistic

aerial hypahe project above the surface of the

mycelium and usually bear the reproductive structures
of the mold
molds produce colonies with characteristic features
such as rates of growth, texture, and pigmentation
the genus of most clinical molds can be determined by
microscopic examination of the ontogeny and
morphology of their asexual reproductive spores, or
conidia

TYPES OF SEXUAL REPRODUCTION

1.
2.
3.

a single zygosporangium containing zygospore is produced

by mating of two compatible hyphal branches
multiple basidiospores form on denticles at the tips of the
club-shaped basidia within a basidium
Ascospores form w/in asci inside the protective ascocarp (a
perithecium is shown)

Asexual spores
o
Are mitotic progeny (ie. Mitospores)
o
Genetically identical
o
Fungi produce 2 major types of asexual spores

Conidia

Sporangiospores (zygomycetes)
Features include
o
Ontogeny

Conidiogenic structures
o
Morphology

Size

Shape

Texture

Color

Uni or multicellularity
vegetative cells may transform into conidia (eg.
Arthroconidia, chlamydospores)
conidia are sometimes produced by conidiogenous cell such
as a phialide, which itself may be attached to a specialized
hypha called a conidiophore
In zygomycetes, sporangiospores result from mitotic
replication and spore production w/in a sac-like structure
called a sporangium, which is supported by a
sporangiophore

TAXONOMIC CLASSFIICATION (refer to table1)

based on the mechanism and spores that result from sexual

reproduction (involves mating, nuclear fusion, meiosis, and
the exchange of genetic information)
a species may be recognized and defined on the basis of its
asexual state, but its telemorph, or sexual identity, may
have a different name

GROWTH AND ISOLATION OF FUNGI

most fungi occur in nature and grow readily on simple

sources of nitrogen and carbohydrate
Traditionally, Sabourauds agar (contains glucose and
modified peptone pH7.0) has been used because it does not
readily support the growth of bacteria
o
Used to exhibit morphologic characteristics of
fungi
Inhibitory mold agar used to recover fungi from clinical
specimens
Antibiotics
(gentamicin,
chloramphenicol)
and
cycloheximide are added to media to inhibt bacteria and
saprophytic molds respectively in recovery of fungi from
clinical specimens

MEDICAL CATEGORIES OF FUNGAL IMPORTANCE

1.
2.
3.
FUNGAL CELL WALL

are rigid and determines the shape of the fungi

cell walls are composed:
o
largely of carbohydrate layers
o
long chains of polysaccharides
o
glycoproteins
o
lipids
during infection
o
surface components of the cell wall mediate
attachment of the fungus to host cells
o
cell wall polysaccharides may activate the
complement
cascade
and
provoke
an
inflammatory response

are poorly detected by the host and

can be detected by special stains
o
release immunodominant antigens that may elicit
cellular immune responses and diagnostic
antibodies
dematiaceous fungi yeasts or molds that have melanized
cell walls, imparting a brown or black pigment

Mycotoxicoses
Hypersensitivity diseases
Colonization of the host and resultant disease

TABLE 1 MAJOR TAXONOMIC GROUPS

GROUP
Zygomycetes

chances of survival are increased when fungi produce

spores
characteristics:
o
readily dispersed
o
more resistant to adverse conditions
o
can germinate when conditions of growth are
favorable
o
can be derived from asexual (anamorphic state)
or sexual (teleomorphic state) reproduction

EXAMPLE
Rhizopus
Absidia

Asexual reproduction occurs

via sporangia

Ascomycetes

SPORES

CHARACTERISTICS
Sexual reproduction results
in a zygospore

Vegetative
hyphae
are
sparsely septate
Sexual
reproduction
involves a sac or ascus in
which
karyogamy
and
meiosis occur producing
ascospores

Pilobolus

Asexual reproduction is via

conidia

Arthroderma
(anamorphic
genera,
microsporum,
trichophyton)

Molds have septate hyphae

Basidiomycetes

Mucor

Sexual reproduction results

in
four
progeny
basidiospores supported by

Ajellomyces
(anamorphic
genera,
blastomyces,
histoplasma)

Yeast
genera
(saccharomyces
)
Mushrooms
Filobasidiella

a club-shaped basidium
Hyphae have complex septa
Deuteromycete
s

An artificial grouping of the

imperfect fungi for which a
teleomorph
or
sexual
reproduction has not been
discovered

neoformans
(anamorph,
Crytococcus
neoformans)
Coccidioides
immitis

caused
by
fungi
that
infect
because
of
compromising
situations

Paracoccidioide
s brasiliensis

Cryptococcus neoformans

Crytococcosis

Aspergillus fumigatus and

other aspergillus species

Aspergillosis

Species
of
rhizopus,
absidia, mucor, and other
zygomycetes

Mucormycosis
(zygomycosis)

Penicillium marneffei
Anamorphic
characterized
conidia

state
is
by asexual

Candida
albicans

Penicilliosis

TABLE 2 MAJOR MYCOSES AND CAUSATIVE FUNGI

TYPE OF
MYCOSES

CAUSATIVE FUNGAL AGENTS

MYCOSIS

Superficial

Malassezia furfur

Pityriasis versicolor

infections
limited to the
outermost
dead layers
of skin and
hair
Cutaneous

Hortaea weneckii

Tinea nigra

Trichosporon species

White piedra

Peidraia hortae

Black piedra

Microsporum
species,
trchophyton species, and
Epidermophyton
floccosum

Dermatophytosis

Candida albicans and

other candida species

Candidiasis of
mucosa, or nails

Sporothrix schenckii

Sporotrichosis

Phialophora
Fonsecaea
others

Chromoblastomycosis

Infections
that extend
deeper
into
the epidermis
as well as
invasive hair
and
nail
disease
(keratinized
portions)
Subcutaneou
s
Infections
involving the
dermis,
subcutaneous
tissues,
muscles and
fascia

Endemic
(primary,
systemic)
Infections
that originate
primarily
in
the lung but
may spread to
many
organ
systems
(lymphatic,
circulatory)
Opportunistic
Infections

verrucosa,
pedrosoi,

skin,

Pseudallescheria boydii,
Madurella mycetomatis,
others

Mycetoma

Exophiala,
bipolaris,
exserohilum, and others
Coccidioides immitis

Phaeohyphomycosis

Histoplasma
capsulatum

Histoplasmosis

Blastomycoses
dermatitidis

Blastomycosis

Paracoccidioides
brasiliensis

Paracoccidioidomycosis

Candida albicans and

other candida species

Systemic candidiasis

Coccidioidomycosis

o
o

Dacryoliths
Sinusitis

Pityriasis versicolor
usually: asymtomatic, hyperpigmented macules or patches
common sites - chest, upper back, shoulder, upper arms,
abdomen
may extend to - thighs, neck, forearms
rare in - scalp, palms, feet
hair shafts & nails - not infected
color varies according to :
(1) pigmentation
(2) exposure to sunlight
(3) severity
CLINICAL PRESENTATION OF PITYRIASIS VERSICOLOR

Hyperpigmented
Tinea
Versicolor
Round, hyperpigmented, barely
palpable plaques and some
perifollicular
patches
are
evident on the upper abdomen.
(A)

Hyperpigmented
Tinea
Versicolor
Perifollicular round patches of
hyperpigmented lesions are
tightly grouped on the upper
back. (B)
SUPERFICIAL MYCOSES
INFECTIONS DUE TO Malassezia Species

3 Species of Medical Importance

Malassezia furfur

Malassezia pachydermatis

Malassezia sympodialis

Hyperpigmented Tinea Versicolor

The fine, branny scaling is not readily
evident until lesions are gently scraped
with the end of a glass microscope
slide. (C)

MALASSEZIA FURFUR

causes Pityriasis versicolor a chronic, usually

asymptomatic fungal infection of the stratum corneum
synonyms for Pityriasis versicolor - tinea versicolor, tinea
flava, dermatomycosis furfuracea, liver spots
member of the normal skin flora

Inflammatory Tinea Versicolor

HISTORY

1846 - detected by Eichstedt & named the disease

pityriasis versicolor
1853 - Robin named the fungus Microsporon furfur
1874 - Malassez described the yeast-like cells from lesions
of the scalp
1889 - Baillon created genus Malassezia
1939 - Benham described the lipophilic nature of the fungus

EPIDEMIOLOGY

worldwide distribution but more prevalent in the tropics &

subtropics
some countries - 50% of people are infected
occurs in both sexes, all ages, all races
major factor - excessive sweating
other factors - poor hygiene, malnutrition, poor health,
pregnancy, systemic steroids, Cushings syndrome

Folliculitis
uncommon variant
lesions resemble acne - papules & pustules
history of antibiotic or steroid intake
may resolve spontaneously or evolve into abscesses
Sepsis
-

catheter-acquired
neonates & adults on prolonged IV lipid hyperalimentation
peripheral blood is usually negative
usual source - patients skin or medical personnel
other
conditions

Other Conditions
CLINICAL MANIFESTATIONS

Pityriasis versicolor
Folliculitis
Sepsis
other conditions
o
Peritonitis
o
Nipple discharge

peritonitis
nipple discharge
dacryoliths
sinusitis

DIAGNOSIS

Direct Examination
o
KOH mount

short,

angular,

occasionally

branching, septate hyphae & clusters of budding

yeast
Woods light - most lesions fluoresce yellow

other changes - mild acanthosis & perivascular lymphocytic

infiltrate

TREATMENT
Skin scrapings stained with periodicacid schiffs stain showing typical
yeast-like and hyphal fragments of
Malassezia furfur, the etiology agent
of Pityriasis Versicolor

MALASSEZIA PACHYDERMATIS

KOH wet mount of Tinea Versicolor

Abundant short hyphae and round
spores,
so-called
Spaghetti
and
meatballs are apparent. (A)

Adding a small amount of Parkers

blue-black ink to the KOH stains
Pityrosporon organisms blue and
facilitates their identification from
the skin scrapings.

o
o
o

selenium sulfide
Na thiosulfate
salicylic acid
benzoyl peroxide
the azole family eg. Ketoconazole
NB. recurrence rate - very high despite treatment

Culture
o

often
not
necessary,

tedious & meticulous

Sabourauds agar with antibiotics at 37C
overlay with olive oil or whole-fat milk
colonies appear dry, smooth or lightly wrinkled,
glistening or dull, white to creamy

first isolated in 1925 from Indian rhinoceros

often associated with otitis externa of dogs
in man - associated with psoriasis or mycosis fungoides,
febrile systemic syndrome (neonates)...
isolated from urine, CSF, blood, vaginal, eye & ear
discharge, tracheal aspirate
also
reported
in
patients
receiving
IV
lipid
hyperalimentation (esp. neonates)
grows on agar at 37C without the addition of oil

MALASSEZIA SYMPODIALIS

isolated from the scalp of an AIDS patient with tinea capitis

(1990)

PIEDRA (Black & White)

DEFINITIONS

a chronic, fungal infection of the hair shaft, forming firm,

irregular nodules or encrustations composed of fungal
elements
2 varieties - black & white, produced by 2 different species
synonyms - tinea nodosa, trichomycosis nodularis,
trichomycosis nodosa, Beigels disease, Chignon disease

ETIOLOGY

Black Piedra - Piedraia hortai

White Piedra - Trichosporon beigelii

Gram stain and calcofluor white preparation of Malassezia furfur

Hair infected wth Piedraia
hortae. The hard black nodule
contains asci and ascospores,
the sexual
phase of the fungus.

Clinical presentation of white

piedra

DIFFERENTIAL DIAGNOSIS

steroid-induced acne
acne vulgaris
vitiligo
pigmentary disorders eg. Chloasma
inflammatory conditions eg. tinea circinata, seborrheic
dermatitis, pityriasis rosea, erythrasma, syphilis, pinta

IMMUNOLOGY

rare in children under 10 years, associated with increase

sebaceous gland activity
sweating - predisposing factor
genetics - may play a role
antibodies - detectable in chronic cases
indirect IF - organism in skin scales & culture

PATHOLOGY

limited to the stratum corneum

moderate hyperkeratosis may be seen
increase in melanosome size but not in number

BLACK PIEDRA
Piedraia hortai on hair

HISTORY

1865 - Beigel first observed white piedra

1901 - Malgoi-Hoes described black piedra
1911 - Horta differentiated black from white piedra
1928 - Fonseca & Leao named the etiology of black piedra,
Piedraia hortai
1936 - Langeron summarized findings on both varieties

EPIDEMIOLOGY BLACK PIEDRA

tropics & subtropics

males = females
common among regular swimmers

EPIDEMIOLOGY WHITE PIEDRA

more common in the temperate zone

affects both sexes of all age group
lower incidence than black variety

CLINICAL MANIFESTATION BLACK PIEDRA

usually on scalp hair only

infected hair - rough, sandy or granular
nodules - hard, fusiform, firmly attached to hair shaft
thick part - layers of fungal cells cemented
thin part - single layer of cells & hyphae
does not penetrate cortex of hair
hair follicles not involved

CLINICAL MANIFESTATION WHITE PIEDRA

usually on facial & genital hair

nodules are softer, mucilaginous, white to light brown in
color
nodules are not as adherent
hair follicles not affected

DIFFERENTIAL DIAGNOSIS

pediculosis (pubic hair)

trichomycosis axillaries
o
Gram stain - cocci & short bacilli
o
UV light - (+) fluorescence
o
due to Corynebacterium tenuis
nits & lice
tinea capitis

LABORATORY DIAGNOSIS

Direct Examination]
o
KOH mount Black Piedra

nodules are composed of tightly packed,

regularly arranged, thick-walled cells

dichotomously branching, dematiaceous

hyphae

central part - fungal cells cemented

periphery - aligned hyphal strands

asci are found within the locules

containing up to 8 ascospores
KOH mount White Piedra

nodules are softer, less adherent, not as

discrete

often - transparent, greenish, rregular

sheath

cells are not as organized

one sees only blastospores & arthrospores

Culture
o

Culture - Piedraia hortai

compact, dark-brown to black, conical

colonies with short aerial hyphae

grows slowly on Sabourauds agar (24wk) at 25-30C

some
colonies
:
reddish-brown,
diffusable pigment on agar

examination - dematiaceous, septate,

branching hyphae
with
asci
&
ascospores
Culture - Trichosporon beigelii

grows moderately on Sabourauds agar

(1-2 weeks) at 25-30C

colonies
appear
smooth,
highlywrinkled or radially folded, yeastlike,
cream-colored

examination - hyaline, septate hyphae

with many arthrospores

TREATMENT BLACK & WHITE

shaving affected area or cutting infected hair

topical medication in lotion

TINEA NIGRA
DEFINITION

a chronic, superficial, usually asymtomatic, fungal

Infection usually of the palms
synonyms - keratomycosis nigricans palmaris, cladosporiosis
epidermica, pityriasis nigra, microsporis nigra
primary medical importance - often misdiagnosed as
melanoma

ETIOLOGY

Cladosporium werneckii or Exophiala werneckii

HISTORY

1891 - first observed in Brazil by Cerqueira

1916 - Cerqueira-Pinto reported his own observation & his
fathers
1921 - Ramos e Silva reported first case in Rio de Janeiro;
Horta isolated a fungus from the same patient:
Cladosporium werneckii
1970 - von Arx transferred the genus to Exophiala

EPIDEMIOLOGY

considered a tropical disease but extends to the temperate

zone (esp. WH)
occurs in any age group but more common under 20
male:female (1:3)
no known predisposing factor although many patients are
hyperhydrotic
transmission not known to occur

CLINICAL MANIFESTATION

usually asymptomatic
lesion - usually, a dark patch on the
palm of one hand
with well-defined, irregular margin about 1-5 cm in
diameter
other locations - sole of foot, interdigits, wrists, forearm,
trunk, neck
no induration, no erythema, and has the characteristic
stained appearance
ocassionally - pruritus & scaling

TINEA NIGRA: Dark pigmentation in

the center of palm

TINEA NIGRA: Dark pigmentation

in the center of palm

TINEA NIGRA: Dark

pigmentation in the
center of palm

DIFFERENTIAL DIAGNOSIS

melanoma
junctional nevus
contact dermatitis
pigmentation of Addisons disease

phialides. Macroconidia are fusiform,

usually
curved,
giving
the

post-inflammatory melanosis
syphilis
pinta
staining from chemicals

PATHOLOGY

confined to the
upper layers of the
stratum corneum
mild hyperkeratosis
may be seen
pigmentation is due
to the fungus

appearance of a sickle and have three to five septae.

TINEA NIGRA: Hematoxylin-eosin-stained section of palmar skin

Show abundant dark-colored fungal elements.
LABORATORY DIAGNOSIS

Direct Examination
o
KOH
mount
long,
dematiaceous branching,
elongated budding cells

sinuous,
strongly
septate hyphae &

CUTANEOUS MYCOSES

diseases of the skin, hair, and nails

involves the keratinized layers of the skin and its
appendages
clinical manifestation: tinea or ringworm
o
Ex. Tinea pedis, tinea ungium,tinea corporis

ETIOLOGY : Dermatophytes
Yeastlike cells of Exophiala werneckii, the causative agent of tinia nigra

Culture
o
o
o

Sabourauds agar with antibiotics at 25-30C

colonies appear shiny, moist, yeastlike,
dirty
white to brown,
covered with masses of
conidia & budding cells
will turn black in 2-3 weeks

TREATMENT

sulfur
salicylic acid
Na thiosulfate
the azoles eg. Ketoconazole
NB. recurrence rate low

Classification in anamorphic state:

1. Microsporum
2. Trichophyton
3. Epidermophyton
Teleomorphic state of Microsporum and Trichophyton is
genus Arthroderma

ECOLOGY AND EPIDEMIOLOGY

Classification according to ecological niche:

1. Geophilic dermatophytes- isolated from the soil
2. Zoophilic dermatophytes- associtation with domestic
and wild animals and birds
3. Anthropophilic dermatophytes- associated with
humans and their habitats

MYCOTIC KERATITIS (KERATOMYCOSIS)

FUNGAL INFECTIONS OF THE CORNEA

o
cause: History of trauma leading to the inoculum
of eyes with a fungus

ETIOLOGIC AGENTS

Histoplasma capsulatum
Fusarium solani

Asexual State of Selected Dermatophytes

EPIDEMIOLOGY

More often in males and individual below the age of 50

years.

CLINICAL MANIFESTATIONS

Raised cornea ulcers with occassional satellite lesions,

plaques or hypopyon

DIAGNOSIS

Direct examination (demonstration of hyphae)

o
corneal scrapings
o
Surgical specimens
Culture
o
Fusarium species grow rapidly in:

Sabourauds medium

Enriched medium

Fusarium spp. Colony on potato dextrose agar. The colonies appear to be

cottonlike, usually white, turning pink-violet or brown at the center with age

Fusarium spp. Stained with lactophenol cotton blue. Typical Fusarium spp:
Microconidia with a fusiform or oval shape extending from delicate lateral

Classification of Dermatophytes According to Ecological Niche

A. Stratum corneum; B. Ectothrix hair infection; C. Entothrix hair infection;

D. favic hair infection

LABORATORY DIAGNOSIS

General Characteristics of Macroconidia and Microconidia of

Dermatophytes

KOH: 10%, 20%

Except: T. schoenleinii causing favus:
o
infected hair have a waxy mass of hyphal
elements(scutulum) surrounding the base of the
hair follicle at the scalp line.
o
microscopic exam: degenerated hyphal elements
coursing throughout the hairshaft
Fungal Culture : SDA w/ cylcoheximide, chloramphenicol
o
conidia:

macroconidia large and multicellular

microconidia - small and unicellular

o
spiral hyphae, chlamydospores, nodular bodies,
racquet hyphae and chandeliers

TREATMENT
PATHOGENESIS

keratophilic fungi use keratin as a substrate

keratinases

1.

Schematic Diagram of Tissues Colonized by Dermatophytes

2.

Azoles miconazole, clotrimazole, econazole (topical)

Mechanism of action:
o
interferes
with
cytochrome
P-450dependent enzyme system s at the the
demethylation step from lanosterol to
ergosterol
Griseofulvin
fungistatic, affects the microtubular system of fungi
interferes with the mitotic spindle and cytoplasmic
microtubules
oral route