Classification of Fungal Infections

Superficial (SKIN, HAIR & Nails)

- NO PHYSICAL DISCOMFORT
- EASY TO DIAGNOSE
- OUTERLAYER OF THE SKIN AND HAIR CUTICLE

Skin
1. Pityriasis versicolor “liver spots, Dermatomycosis furfuracea”
2. Tinea Nigra” Keratomycosis nigricans palmaris, Pityriasis nigra”

Hair
1. black piedra “ Piedra hortae’
2. white piedra “Trichosporon beigelii”

Fungal Infections/ Mycoses

Superficial mycoses:
2 types: surface and cutaneous mycoses
 Skin, hair & nails.
 Mild but chronic disease
Deep mycoses:
2 types: subcutaneous & systemic mycoses
 Caused by soil saprophytes
 Infection is accidental
 Range from a symptomatic infection to fatal disease

Superficial: Surface mycoses

Live exclusively on dead surfaces of skin and its appendages

No contact with living tissue, hence no inflammatory response

1. Tinea versicolor
2. Tinea nigra
3. Piedra
Deep mycoses
Subcutaneous mycoses
1.Mycotic Mycetoma
2.Chromoblastomycoses
3.Sporotrichosis
4.Rhinosporidiosis
5.Subcutaneous phycomycoses

Systemic mycoses
1.Cryptococcoses
2.Blastomycosis
3.Paracoccidiomycoses
4.Coccidioidomycoses
5.Histoplasmoses

Pityriasis versicolor
Etiologic agent – Malassezia furfur (Pityrosporum orbiculare)
 Lipophylic yeast - like organism
 Found in areas of the body rich in sebaceous glands
 Saturated/unsaturated fatty acids medium to support growth
 Grows as budding yeast
 Common in torso, arms and abdomen
 Scaly hypopigmented or hyperpigmented macular lesion
 “spaghetti & meatballs” on KOH preparation
DX: Microscopic Examination TX: whitefield’s ointment
KOH 10-20% aqueous soln. of
LPCB/MB sodium hyposulfite
1% selenium sulfide
 Also known as Liver spots, Tinea versicolor, Dermatomycosis
furfuracea, Chromophytosis
 Caused by Malassezia furfur (Pityrosporum orbiculare)
 Chronic, non-irritating infection of the stratum corneum characterized by discrete, serpentine,
hyperpigmented or depigmented maculae on the skin (chest, upper back, arms or abdomen)
and in areas rich in sebaceous glands
 Skin pigmentation is altered resulting in blotchy appearance
 Common in hot and humid places esp. in the tropics
LAB DIAGNOSIS
Microscopic: appears as tight clusters of spherical, yeast-like cells w/ hyphal fragments –” SPAGHETTI
AND MEATBALLS “appearance on KOH preparation

Colony: creamy, yeast-like colonies on SDA w/ olive oil in 2-4 days @ 30⁰C; requires olive oil for growth
and Direct microscopic examination

Tinea nigra
 Etiologic agent: Exophiala werneckii
 Dimorphic fungi that produces melanin imparting brown-black color
 Not scaly, flat lesion
 Seen in the palms of the hands (infected skin shows or look as if stained with dark dye)
 Grows as yeast with many cells in various stages of mitosis
 Produces elongated hyphae as the colony ages, older cultures produce mycelia and conidia
Manifestations:
 Asymptomatic, consist well demarcated macular lesion
 Discolored spots on the skin, brown to black lesion seen on palms of the hands and soles
of the feet to other areas of the body
DX: Direct Microscopic of skin scrapings (KOH) = dark pigmented yeast-like, strongly dematiaceous
containing numerous chlamydospore
Culture (SDA) – 7-10 days and dark colonies will form
TX: 3% sulfur and 2% salicylic acid
  Also known as Keratomycoses nigricans palmaris, Pityriasis nigra, Microsporis nigra
 Chronic and asymptomatic infection of the stratum corneum caused by Hortaea werneckii
or Phaeoannelomyces werneckii
 Dimorphic fungus that produces melanin in imparting brown – black color
 Lesion is flat, not scaly
 Seen in the palms (infection skin shows or looks as if stained with dark dye)
 Grows as yeast with many cells in various stages of cell division producing characteristic two
celled ova; structures

Fungal Infections of the Hair

Black piedra
 Etiologic Agent = Piedra hortae
 colonizes the hair shaft
 brown to reddish - black mycelia
 consist of specialized structures with asci containing spindle - shaped ascospore
 colonies are dark brown and may have metallic green tinge
 hard nodules found along infected shaft containing asci and ascospores
DX: Microscopic Examination of affected hairs

White piedra
 Etiologic agent: Trichosporon beigelii
 Grows well on mycosel agar (w/o cycloheximide)
 White & pasty consistency on young cultures, aged culture develops deep radiating
furrows with yellowish coloration and creamy texture, smooth to slightly wrinkled not
fuzzy
 Infected hair shaft appears as sleeve or collarette around the hair and consist of mycelia
that rapidly fragment into arthroconidia
DX: microscopic exam = septate hyphae that fragment rapidly to arthroconidia and many cells form
blastoconidia
: carbohydrate assimilation = (+)
TX: 3% sulphur or benzoic acid, topical keratolytic agents
shaving or cropping the infected hairs & proper personal hygiene
Diagnosis
 Microscopic examination of affected hair reveals septate hyphae that fragment rapidly to
arthroconidia and many cells form blastoconidia
 Biochemical test – ability to assimilate certain carbohydrates

Treatment
 removal of the organism
 Use of topical keratolytic agents (selenium disulfide, hyposulfite, salicylic acid)
 Topical preparation containing miconazole nitrate
 3% sulphur or benzoic acid
 Shaving or cropping infected hairs
 Proper personal hygiene

CUTANEOUS MYCOSES
 DERMATOPHYTOSES are infections of the skin, hair, or nails caused by dermatophytes
(keratinophilic fungi) and so are able to break down the keratin surfaces of these structures.
 In the case of skin infections, the dermatophytes invade only the upper, outermost layer of
the epidermis, the stratum corneum.
 DERMATOPHYTOSIS – COMPLEX DISEASE caused by any several species of filamentous fungi in
the genera TRICOPHYTON, MICROSPORUM, EPIDERMOPHYTON
 Referred to as ringworm tinea depending on the anatomical site involved, human dses.
Varies w/age, sex, ethic group, cultural & habits of the population
 Dermatophytes have the ability to use keratin as a source of nutrition

Tinea or ringworm infections

Tinea pedis – fungal infection of the feet
Tinea capitis – fungal infection of the scalp
Tinea manus – fungal infection of the hands
Tinea ungiuum – fungal infection of the nails
Tinea corporis – fungal infection of the body
Tinea cruris – fungal infection of the groin
Tinea barbae – fungal infection of the beard

Tinea/ringworm of the skin

HIGHLY SPECIFIC FOR SKIN INFECTIONS – they fail to become systemic
both to: host’s defenses (serum growth inhibitors), inhibition at 37𝑜 𝐶
and fungistatic property (transferrin, w/c chelates Fe, inhibits fungi)
Cutaneous mycoses are the FIRST recognized infectious diseases and
the MOST COMMON fungal infections in humans; usually referred to as
TINEA (“worm” or “ringworm”) because of the raised, circular lesion on
skin

Tinea - Central healing ring covered by an active outer ring

Common Tinea Infections
Tinea barbae
 Ringworm of the beard
 Most often caused by Trichophyton mentagrophytes
 Zoophilic; occupational hazard for farm workers

Tinea capitis
 Ringworm of the scalp
 Gray-patch ringworm – common in children; EA
M.canis and M. audouinii
 Black-dot ringworm – endothrix infections caused by
T. tonsurans
 Inflammatory – ectothrix infections caused by T.
mentagrophytes

Tinea corporis
 Ringworm of the body
 Most often caused by T. rubrum, T. tonsurans
 Geophilic are associated w/ M. canis and M. gypseum

Tinea cruris
 Ringworm of the groin
 Common infection in athletes, military personnel, and
others who share towels or clothing
 Frequently caused by E. floccosum
Tinea pedis
 Ringworm of the foot
 AKA ATHLETE’S FOOT
 Common infection on soles of feet and b/n toes
 Characterized by itching, scales, and possible seeping
 Most often caused by T. mentagrophytes, T. rubrum
and E. floccosum

Tinea unguiun
 Ringworm of the nails
 Infection begins at the edge of the nail becoming thick and
brittle
 Known as ONYCHOMYCOSIS – non-dermatophytic infection
due to yeast and other fungi
 Frequently caused by T. rubrum, T. mentagrophytes and E.
floccosum

Identification
 Identified on the basis of their colonial appearance and microscopic morphology
 MICROSPORUM SPECIES – distinctive homothallic, multicellular macroconidia w/
echinulate or rough walls
 TRICHOPHYTON SPECIES – cylindrical, smooth-walled macroconidia and characteristic
microconidia
 EPIDERMOPHYTON – produces only MACROCONIDIA (smooth-walled and clavate [one end
thicker than the other]); produced in groups of 2 or 3

Nutritional tests: Those requiring thiamine:

 T. tonsurans
 T. violaceum
 T. verrucosum – also require inositol
Specialized tests
 Growth on rice grains (M. canis vs M. audouinii)
 In vitro hair perforation (T. mentagrophytes vs T. rubrum)
 Enhanced growth @ 37C (T. verrucosum vs T. schoenleinii and T. tonsurans)
Microsporum species
Most significant isolates:
 Microsporum audouinii
 Microsporum canis
 Microsporum gypseum
 Cause infection on skin and hair only
 Grow well on RICE MEDIUM except M. audouinii

Immediately recognized by the presence of:

 MACROCONIDIA: large, spindle-shaped, rough-walled w/ thick walls that contain 4 or
more septa EXCEPT Microsporum nanum (produces macroconidia w/ only 2 cells)
 MICROCONIDIA: small, club-shaped borne on hyphae
 CULTURE: rapid or slow growing (5-14 days); aerial mycelium produces powdery or velvety
colonies

Microsporum: large, spindle-shaped macroconidia

Macroconidia and/or microconidia are often not produced on primary

isolation media and it is recommended that sub-cultures be made onto
BOILED POLISHED RICE GRAINS TO STIMULATE SPORULATION.
Microsporum canis
 Zooophilic infection: tinea capitis, tinea corporis in cats and
dogs
 MOT: direct contact w/ infected animal; human to human
transmission has been reported
 Infected hairs fluoresce a bright-yellow green color using
Wood’s lamp
 Direct exam w/ calcofluor or KOH: reveal small spores
outside infected hair
 Grows well on sterile, polished rice grains

MACROCONIDIA – numerous, spindle-shaped MICROCONIDIA – can be few or many;

echinulate, multiseptated , thick-walled rarely seen

- Green yellow flourescence on ectothrix

hair

Colony – 1 - week incubation @ 25-30deg C

TOP - white to buff granular/cottony surface REVERSE – bright yellow; orange to brown on
aging
Tinea capitis and corporis caused by M. canis following contact with infectious kittens.

Tinea capitis showing extensive hair loss caused by M. canis.

"Kerion" lesion caused by M. canis.

Microsporum audouinii
 Anthrophilic; Infection: tinea capitis, tinea corporis in humans
 MOT: direct contact w/ infected hairs, caps, combs, upholstery, or barber clippers
 Once a leading cause of tinea capitis in children but now rarely found
 Infected hairs fluoresce yellow green w/ Wood’s light
 FAILS to grow on RICE MEDIUM

MACROCONIDIA – bizarre-shaped, MICROCONIDIA –w/ HYPHAE – w/ favic

thick-walled, club or spindle-shaped, TERMINAL chandeliers and pectinate
multiseptated w/ rough surface CHLAMYDOSPORES; rarely bodies
seen
Colony - Colonial appearance based on growth on SDA; 2 weeks’ incubation @ 25-30deg C

TOP - cream, tan, buff or light brown, velvety REVERSE – salmon pink or orange brown
colony

Microsporum gypseum
 Geophilic; free-living in soil
 Infection: tinea capitis, tinea corpori, tinea unguium
 Rarely causes human or animal infection
 Infected hairs DO NOT fluoresce w/ Wood’s light
 Mx exam of hair: irregularly covered w/ spores, some in chains, ectothrix type are larger than
other Microsporum spp

MACROCONIDIA – thick-walled, rough, cigar-shaped MICROCONIDIA – few or none

elliptical, spindle-shaped w/ rounded end,
single or in small clusters
multiseptated; 3-9 celled broadly spindle shaped
Colony - Colonial appearance based on growth on SDA; 1-week incubation @ 25-30deg C

TOP - cinnamon-colored, powdery colony REVERSE – light tan, rose brown, red-brown

Other microsporum species

Zoophilic
 Microsporum gallinae
 Microsporum equinum
Geophilic
 Microsporum cookie
 Microsporum fulvum
 Microsporum nanum

Epidermophyton species
 Only member of this genus is Epidermophyton floccosum
 Causes infection on skin and nails
 Common cause of tinea cruris and tinea pedis
 Organism is susceptible to cold temperatures
Immediately recognized by the presence of:
 MACROCONIDIA: numerous, smooth, thin-walled, club-
shaped (clavate), multiseptated. Rounded at the tip w/ 2-4
cells occurring singly or in clusters of 3-4
 MICROCONIDIA: none; useful differentiating characteristic
from Trichophyton spp
 CULTURE: colony tends to be folded and khaki-green;
periphery is yellow; reverse is yellowish brown w/ folds

Epidermophyton floccusum – typical clavate macroconidia

Epidermphyton floccosum: numerous, club-shaped
macroconidia w/ 2-4 cells occurring singly or in clusters; NO
MICROCONIDIA

Colony - They form yellow-colored, cottony cultures and are usually readily identified by the thick,
bifurcated hyphae with multiple smooth, club-shaped macroconidia

Trichophyton species
Important species:
 Trichophyton mentagrophytes
 Trichophyton rubrum
 Trichophyton tonsurans
 Trichophyton schoenleinii
 Trichophyton violaceum
 Trichophyton verrucosum
 All are capable of invading the hair, skin and nails
 Infections: tinea pedis, tinea capitis, tinea unguium
 Infections are seen more in adults
 Do not fluoresce under Wood’s light
 MACROCONIDIA: smooth, club-shaped, thin-walled, w/ 8-10 septa; borne @ the ends of hyphae
 MICROCONIDIA: these are the PREDOMINANT FORMS; spherical, pyriform (tear-shaped), or
clavate (club-shaped)
 CULTURE: colonies may be powdery, waxy or velvety
 Takes 2-3 weeks to grow in culture.
Trichophyton Agars
Nutritional requirement tests for the differentiation of Trichophyton species
Trichophyton Agar 1 – Basal (casein agar base; vitamin-free)
Trichophyton Agar 2 - casein agar base and inositol
Trichophyton Agar 3 - casein agar base with thiamine and inositol
Trichophyton Agar 4 – casein agar base and thiamine
Trichophyton Agar 5 – casein agar base and nicotinic acid
Trichophyton Agar 6 – ammonium nitrate agar base
Trichophyton Agar 7 – ammonium nitrate agar base and histidine

Trichophyton rubrum
 Infection: tinea capitis, tinea corporis, tinea unguium in humans
 Urease (-); grows on Trichophyton agars numbers 1,2,3 and 4
 It does not perforate hair in vitro (HAIR-BAITING PROCEDURE)
 flock of hair is placed into a sterile plate w/ water; hair to be tested is added
 POSITIVE test – hair shaft is invaded or perforated in mix exam

MACROCONIDIA – rare, thin-walled, smooth, MICROCONIDIA – TEAR-SHAPED, borne

PENCIL –SHAPED attached directly to hyphae laterally from long strands of hyphae

Colony
TOP - white to pink, fluffy or granular REVERSE – cherry red or wine red when grown
on cornmeal agar or PDA; observed after 3-4
weeks of incubation
Trichophyton mentagrophytes
 Infection: tinea capitis, tinea corporis, tinea unguium in humans
 Produces 2 types of colonies: fluffy and granular
 Granular colonies may show red pigmentation on the reverse and may be confused w/ T.
rubrum
 (+) urease in 2-3 days’ incubation; grows in Trichopyton agars numbers 1,2,3 and 4
 To differentiate from T. rubrum: T mentagrophytes is (+) for hair perforation, T. rubrum is (-)
MACROCONIDIA – thin-walled, MICROCONIDIA – many round to globose in grapelike
smooth, club-shaped, clusters; spiral hyphae seen in 1/3 of isolates
multiseptate, numerous or rare
depending on strain; CIGAR-
SHAPED

Colony
TOP - different colonial types: REVERSE – buff to reddish brown; red pigment in
Downy – white, fluffy colonies, cottony culture medium
Granular – light yellow, coarse

Downy Variety - From

pxs w/ tinea pedis

Granular - From lesions

acquired by contact w/
animals
Trichophyton tonsurans
 Responsible for an epidemic form of tinea capitis occurring more in children than in adults; is
now the primary cause of tinea capitis
 Causes “black dot” ringworm – stubs of hair remain in the scalp after the brittle hairs have
broken off
 Nutritional requirement: thiamine or inositol
 Grows well in Trichophyton agars numbers 3 and 4 only
MACROCONIDIA – rare; cylindrical or clavate, MICROCONIDIA – teardrop or club-shaped
absent or distorted w/ flat bottoms; balloon forms (swollen and
elongated) upon aging

Bald, itchy scalp, pus-filled lesions and small BLACK DOTS on the scalp.
TOP - white, tan to yellow or rust, suede-like to REVERSE – yellow-tan-rust red
powdery; wrinkled w/ heaped or sunken center,
may not grow w/o thiamine
Trichophyton verrucosum
 Causes a variety of lesions in cattle and in humans; most often seen in farmers who often
acquire the infection from cattle
 Lesions are found chiefly on the beard, neck, wrist, and back of the hands
 Requires thiamine and inositol, grows better at 37C
 It is recognized by its early hydrolysis of casein and very slow growth (2-3 wks)
MACROCONIDIA – extremely rare but form MICROCONIDIA – rare; large clavate and
characteristic thin –walled “RAT-TAIL” types ;many teardrop when seen
chlamydoconidia are seen when incubated @ 37
deg C

Colony
TOP - glabrous to velvety white, disk-shaped; rare REVERSE – non-pigmented but may be
strains produce yellow-brown color; rugal folds w/ yellow
tendency to skin into agar surface; very slow growth 2-3
weeks
Microscopy shows broad, irregular hyphae with many terminal and intercalary chlamydospores.
Chlamydospores are often in chains. The tips of some hyphae are broad and club-shaped, and
occasionally divided, giving the so-called "ANTLER" effect

Tinea manuum - severe infection of the hands due to Trichophyton

verrucosum.

Trichophyton schoenleinii
 Causes a severe type of infection called FAVUS – yellowish cup-shaped crusts or scutulae,
scarring of the scalp, sometimes, permanent alopecia
 Favic type of hair – presence of large inverted cones of hyphae and arthroconidia
 HYPHAE are STERILE: NO MACROCONIDIA AND MICROCONIDIA
HYPHAE – knobby and club-shaped at the terminal “FAVIC CHANDELIERS”, or with “NAIL HEAD”
ends, w/ the prodxn of many short lateral and tips which are often present in the submerged
terminal branches- ANTLER TYPE mycelium
Colony
TOP - irregularly heaped, smooth white to REVERSE – tan or non-pigmented; white
cream colony w/ radiating grooves; submerged
hyphae that tends to crack the agar; slow
growing 30 days or longer

Trichophyton violaceum
 Infection: tinea capitis, tinea corporis in the Mediterranean region, Middle east, Far East and
Africa
 Hair invasion is the endothrix type; causes “black dot” type of tinea capitis
 Mx: using calcofluor white or KOH, non-fluorescing hairs show dark, thick hairs filled w/ masses
of arthroconidia
 Requires thiamine, growth on T4 agar; colony: heaped, PURPLE
 HYPHAE are STERILE: NO MACROCONIDIA AND MICROCONIDIA
HYPHAE – branched tortuous hyphae that are
sterile; chlamydoconidia commonly aligned in
chains, swollen hyphae containing
cytoplasmic granules

TOP – violet to purple, waxy; port wine color of REVERSE – purple or nonpigmented
colonies; violet or deep red pigments
Pathogenesis and Immunity
 Host susceptibility to dermatophyte infections are enhanced by:
 Moisture
 Warmth
 Specific skin chemistry
 Composition of sebum
 Perspiration
 Youth
 Heavy exposure
 Genetic predisposition
 Incidence is higher in hot, humid climates, and crowded living conditions
 Patients w/ genetic or acquired cellular immunodeficiency and familial endocrinopathies (e.g.
Cushing’s syndrome)

Laboratory Diagnosis
Direct Examination
 Cases of suspected tinea capitis shld
be examined under Wood’s light
(365nm), where hairs infected w/
Microsporum or T. schoenleinii exhibit
green fluorescence
 HAIRS can be examined directly under
the microscope for
 ENDOTHRIX involvement
(formation of arthroconidia KOH mount of infected skin scales (left) and
inside the hair) fragmentation nail material (right)
of hyphae w/n hair shaft or
 ECTOTHRIX (sheath of spores around the shaft) mosaic pattern around hair –
produced by T. tonsurans and
T. violaceum
 FAVIC HAIRS (caused by T.
schoenleinii) present
characteristic air spaces

KOH mount of infected hairs

 SKIN AND NAIL infections may be diagnosis by dissolving skin scrapings or nail clippings in 10-
20% KOH – observe for hyaline, branched, septate hyphae among squamous epith. cells;
Calcofluor white

 Dermatophytid (id) id reaction is diagnosed on the basis of a (-) microscopic and cultural
examination of the site and finding dermatophytosis elsewhere in the body
Culture
 DTM/MA/SDA @ 25-30C w/ antibiotics
 Dermatophyte Test Medium (DTM) -
dermatophytes produce alkaline
metabolites, w/c raise the pH (yellow to
red) if dermatophyte is present
 Mycosel or Mycobiotic Agar – primary
isolation of dermatophytes from hair,
skin and nails; w/ cycloheximide and
chloramphenicol inhibit saprophytic fungi
& many pathogens
 Isolates are identified on the basis of:
 Colony appearance of surface &
reverse of colony
 Microscopic morphology

Black collection cards showing a suitable amount of

nail material for a good sample.

Treatment
 Multiple daily applications of antibiotics like cream prep of tolnaftate, miconazole NO3,
haloprogin, clotrimazole, econazole, or ciclopirox; KETOCONAZOLE, selenium sulfide “Selsun
blue”
 Whitefield’
 Griseofulvin – most effective antibiotic esp in scalp and nail infections (oral); poorly
absorbed drug is concentrated in stratum corneum, where it exhibits hyphal growth; adult
dosage is 250-500mg/day of the ultramicrosized form; orally taken for 2-3 months
 For athlete’s foot: Keep feet dry. Frequent change of socks and apply powder, scrubbed
thoroughly daily and dried with towel
 % of cure for long standing is low for nails & toenails infected area
Clinical manifestations
 Asymptomatic and consist of well demarcated macular lesion
 Discolored spots on the skin, brown to black lesion seen on the palms and soles of feet
DIAGNOSIS
 Direct microscopic examination of scrapings taken from areas of the body
 2 drops of 10 % KOH
 Dark pigmented yeast like and hyphal fragments
 Culture (SDA) 7-10 days’ dark colonies will form
 TREATMENT
 3% SULFUR AND 2 % SALICYLIC ACID
Subcutaneous Mycoses/Deep mycoses
 Involve the dermis, subcutaneous tissue, muscle and fascia
 Results from traumatic puncture from thorns & vegetation w/fungi
 Often become chronic, deeply invasive or disseminated disease
Species:
1. Chromoblastomyces
2. Mycetoma
3. Phaeohyphomycoses
4. Sporotrichosis

Chromoblastomycosis (monomorphic molds)

 Caused by infection w/ dematiaceous fungi (colony surface & reverse dark color); a group of
dark, slow growing fungi that are found in vegetation and in the soil; chronic fungal infection
acquired through traumatic inoculation of the organism
Clinically significant fungi in this group:
1. Fonsecaea pedrosoi – frequently found worldwide
2. Fonsecaea compactum
3. Phialophora verrucosa
4. Cladosporium carrioni
5. Exophiala jeanselmi
6. Wangiella dermatitidis

 warty-, tumor-like lesion at the site of the traumatic tissue resembling cauliflower
 Sclerotic bodies which are copper-colored septate that appear to be dividing by binary fission
 An infection causing hyperplasia of the epidermis of the skin w/c may be mistaken for squamous
cell carcinoma
Chromoblastomycosis
 Infection is initiated through a punctured wound or trauma to the skin involving fungally
contaminated vegetation (soil org.)
 A local infection in the underlying tissue that results with the development of chronic, non-
healing hard, warty tumor-like lesions (cauliflower-like)
 Lesions reveals characteristic sclerotic bodies, copper-colored septate cells
 Infections most frequently involves the feet and the lower legs
 Seen most often in the tropics in areas in w/c agricultural workers do not wear protective
clothing and suffer thorn or splinter puncture
Culture: SDA @ RT; scrapings from crusted lesion to 10%KOH (sclerotic bodies)
Types of sporulation:
a. Cladosporum - Elliptical conidia in chain
b. Acrotheca – clusters of conidia borne singly at one end & sides of conidiophore
c. Phialophora – clusters of conidia from flask -shape

Mycetoma (madura foot/Maduromycosis)

 Chronic granulomatous infection of the cutaneous and subcutaneous tissues and bone, involves
the lower extremities
 Characterized by swelling, purplish discoloration tumor-like deformities with abscesses,
draining sinuses and granulomatous pus containing yellow, white, red or black granules
 Infections occurs worldwide but is seen most frequently in the tropics and subtropics including
Africa and Arabian Peninsula
 Acquired as an occupational infection from the environment on contaminated vegetation or soil
 The disease is usually contracted through a punctured wound in the foot
 Infection progresses to involve the bone, muscle & other tissue ultimately requires amputation
in most progressive cases
Two types of mycetoma
1. Actinomycotic Mycetoma (fungal-like bacteria) – results from infection with aerobic
actinomycosis such as: Nocardia, Actinomadura and Actinomyces, Streptomyces spp.
- the granules produced by these org. contains fine, delicate filaments
- respond to antibacterial antibiotic for gram (+) bacteria
2. Eumycotic mycetoma (true fungi) – associated with several fungal species that have septate
hyphae including Pseudoallescheria, Aspergillus, Exiophiala, Acremonium, Curvularia and Madurella
- granules contain large, coarse septate hyphae
- causative agents of black grain mycetomas
- no effective therapy except amputation of the infected extremity
- all mycetoma causing org. lives in the soil and is more common among people who have great
deal of contact with the soil

Pseudoallescheria boydii
 An org. that exhibit both sexual and asexual reproduction
 Grows rapidly (5 to 10 days)
 White, fluffy colony that changes in several weeks to brownish gray (mousy gray colony) the
reverse of the colony progresses from tan to dark brown
Exophiala jeanselmi
- Appears yeast-like and darkly pigmented (olive to black) and develop a more velvety
appearance
Curvularia spp.
- Produce a fluffy or downy olive-gray to balck colony and growth is rapid

Phaeohyphomycosis
 rare infection by dematiaceous saprobes
 Characterized by darkly pigmented septate hyphae
 maybe superficial, local, subcutaneous or systemic and may include endocarditis, sinusitis,
mycotic keratitis and pulmonary and systemic infections
 Usually opportunistic
Fungi associated with Phaehypomycosis:
a. Bipolari
b. Curvularia
c. Phialophora richardsiae
d. Cladosporium trichoides
Sporotrichosis (dimorphic fungus)
 Etiologic agent: Sporothrix schenkii
 Chronic subcutaneous mycosis with eventual lymphatic involvement
 Untreated cases may become generalized infection and involve bones, joints & internal organs
 Occurs from a skin trauma caused by finger prick from thorny plants “Gardener’s disease”
 World-wide prevalence
 Grown on SDA at 25 C; appears as small, cream-colored, wrinkled, leathery colonies that
later become black and pigmentation is enhanced on potato dextrose or cornmeal agar
 On BHI at 37C appears as soft, white cream –tan colored colonies
 cigar-shaped yeast cell which may be spherical or oval or multiple budding

Yeast and yeast-like fungi

 Yeast
- unicellular, budding, round to oval organisms
- Multiply asexually through the production of blastoconidia
- Under favorable condition yeast from hyphae produces pseudohyphae
- Grows on medium in 48 – 72 hours as smooth, creamy, pasty colonies yeast as mucoid
- Germ tube test is the 1st step to be performed in the ID of an unknown yeast isolate; also useful
in the ID of C. albicans
- Yeast isolated in small numbers from the sputum, urine, vagina or stool is not considered to be
pathogenic; however large number of yeast isolated from non-sterile is considered pathogenic
and must be identified`

Most frequently isolated yeast:

 Candida
Several species of candida are part of man’s normal flora where they can be isolated from the GIT and
mucocutaneous areas.
1. C. albicans – prime etiologic agent of candidiasis
- Appears as budding yeast with blastoconidia or pseudohyphae showing no signs of constriction
- Stains gram (+), grows on BAP & SDA
- Colonies characterized by a spider-like projection on EMB
- Only yeast that produces germ tube when inoculated with sterile serum for 1-3 hrs a @ 37C
- Produces chlamydospores on cornmeal agar @24- 48 hrs
- Urease (-), Nitrate (-)
Candidiasis
- a disease that can mimic anything from dermatophytic infection of the skin to tuberculosis
- An acute or chronic superficial disseminated mycoses by species of the genus candidia
Forms of Candidiasis:
1. Thrush – a disease of oral mucosa characterized by the formation of white, creamy patches seen most
often on the tongue and the underlying tissue is bright fiery red color, usually seen in 90% of AIDS
patients
2. Mycotic vulvovaginitis – a common disease of diabetics, pregnant women and those of the birth
control pills. The lesion resembles a simple eczematoid dermatitis or may show vesicular pustules or
form a gray white pseudomembrane
3. Onychomycosis (nail infections) – stimulate ringworm infections, nail become hardened and
thickened but not brittle and assume a brownish color
4. Systemic candidiasis – may cause pulmonary disease or endocarditis or become widely disseminated
to almost any organ, even the meninges may become involved
- Usually seen in individuals with underlying immunologic deficiencies and these forms are
frequently fatal
- Predisposition to Candida infections can be attributed to several host factors:
- - TB - cancer - tooth extraction -diabetes
- - pregnancy - steroid therapy –surgery of any type – smoking
- - drug addiction – AIDS – Hormonal & nutritional inbalance

Diagnosis:
Microscopic Examination
1. PAS appear pink in color
2. GMS stain brown to black
3. KOH preparation
Culture:
- SDA, colonies usually develop in 2 to 3 days as white typical yeast colonies
- In vitro all candida specie cell at any temperatures are considered monomorphic growing as
non-encapsulated yeast

Other species of candida

1. C. tropicalis – associated with vaginitis & UTI, & systemic infection
- Forms pseudohyphae that resemble true germ tube by producing a constriction at the point of
origin of the yeast cell after incubation for 3 hrs. w/c may be mistaken for germ tube.
2. C. paralysilosis associated with endocarditis, otitis externa and nail infections
3. C. krussei – a rare cause of endocarditis, UTI and vaginitis