fungal infection

fungal infections

Cutaneous: dermatophytes, pityriasis versicolor, candidiasis.
Subcut.: mycetoma
Systemic: histoplasmosis, candidiasis, aspergillosis

Dermatophytes=ringworm=tinea

3 genera: trichophton, microsporum, epidermophyton.
All give similar clinical picture.
Invade keratin only.
Zoophilic, anthropophilic and geophilic
Clinical features depend on the site

Tinea pedis

* swimming pools, occlusive footwear.
* clinically: interdigital scaling
diffuse scaling of sole
recurrent vesicles of the sole
mostly 3rd toe web, itchy , painful or asymptomatic


Interdigital scaling

Diffuse scaling of foot

Bullous tinea pedis

Tinea unguium (onychomycosis)

Toe nail more common than finger nail due to spread from a near focus of tinea pedis
Free edge becomes yellow proximal invasion with darkening of color
Thickening of the nail plate and onycholysis


onychomycosis





9

Main clinical finding ?

Bilateral big toe nail discoloration
Diagnosis ?
Onychomycosis [T. unguium]
Prove the Dx.
Nail clipping for KOH exam. & culture

Tinea corporis

Erythematous scaly plaque, grow peripherally and clear centrally annular configuration
=active border
Close inspection vesicles and pustules

Tinea cruris

Affects inguinal folds, mostly men, summer
Erythematous plaque, scale, active border, not affects scrotum, vesicles and pustules
Differential diagnosis:
*Flexural ps.
*candidiasis: satellite papules, pustules
*seborrheic derm.:

T. cruris

Tinea faciei

Erythematous annular plaque- face
Diff. diag.:
* seborr. Derm.: nasolabial, eyebrows, eyelashes, ears
* Rosacea: bilateral, telangiectasia.


Tinea capitis
Patch of hair loss, scales, easily epilated hair.
Usually children
Zoophilic spp.: Intense inflamm., boggy swelling, pustules = kerion
Diff. diag.:
alopecia areata: no inflamm.
trichotillomania: psych. upset, broken hair

15

Non-scarring scaly patches with hair loss

Tinea capitis
Diagnosis ?
Clinical findings ?
KOH / Culture / Wood’s lamp
Gray patch non-inflammatory T. capitis
Type of T. capitis ?
Confirm the diagnosis ?
Treatment ?
Gresiofulvin 10mg/kg/day/6weeks


16


This boy presented with a hemispherical crusted mass with hair loss on the lower part of the scalp of one month duration.
Kerion
Diagnosis ?
Cause ?
Zoophilic Fungi
Treatment ?
Griseofulvin

Investigations

Skin scraping, nail clipping, hair plucking + KOH
Culture on sabouraud’s dextrose agar
wood’s light green fluorescence in some cases of T. capitis

Treatment

Topical imidazoles ex. Clotrimazole, miconazole, econazole Few patches of T corporis, facei, cruris and pedis.
Systemic therapy ex. Griseofulvin, terbinafine, imidazoles ex. Fluconazole, ketoconazole, itraconazole


Tinea capitis, t. unguium, t.incognito, wide spread t. corporis, pedis and feciei

Candidiasis

Opportunistic inf.
Predisposing: age extremes, D.M, low immunity, ill fitted denture, obesity, antibiotics, pregnancy, malignancy.
Oral thrush: whitish patches, removal erythem. base
Angular stomatitis: whitish patches, soreness
Intertrigo: (inguinal, axilla, under the breasts) erythematous patches, satellite papules and pustules
Erosio interdigitale: eroded patch affects the webs

investigations

Swab or scrapping for microscope exam yeasts
Culture

Treatment

● Correction of underlying pred. factor
● Topical azoles
● Nystatin or amphotericin
● Fluconazole, itraconazole

21



Clinical findings ?
Interdigital erythema, fissuring and maceration
Diagnosis ?
Interdigital (Flexural) Candidiasis

Oral thrush

Angular stomatitis

Intertriginous candidiasis

Pityriasis versicolor

Affects young adults, hot humid climate
Pityrosporum orbiculare, Keratinophilic and lipophilic.
Brownish or hypopigmented round patches, with fine scales
Upper trunk, upper arms, neck.
Tend to recur.

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Pityriasis versicolor

Brownish patches
with branny scales
on the upper trunk

Pityriasis versicolor

investigations

Usually it is a clinical diagnosis
Scrapping.
Wood’s light lemon yellow


treatment
Topical: azoles: *ketoconazole shampoo
* other azole creams

selenium sulphide shampoo
● Systemic : fluconazole, ketoconazole,
itraconazole

Antifungal therapy

* Imidazoles: clotrimazole, miconazole
econazole, ketoconazole.
topical broad spectrum
* Triazoles: itraconazole, fluconazole
systemic broad spectrum
* griseofulvin: systemic…dermatophytes
* nystatin: topical and systemic..candidiasis

Summary

T. pedis: interdigital scaling; diffuse scaling or bullae
T. unguium: yellow free edge proximal invasion with darkening. Onycholysis.
T. cruris and corporis: eryth. Scaly. With active boarder.
T. capitis: patchy hair loss with inflamm.


Summary
Oral thrush: whitish patches
Angular stomatitis: whitish patches, soreness
Intertrigo: erythematous patches, satellite papules and pustules
Erosio interdigitale: eroded patch
Pityriasis versicolor:Brownish or hypopigmented round patches, with fine scales