MICROBIOLOGY 2 (8:30-9:30) SUPERFICIAL MYCOSES Other names Malassezia furfur Exophiala werneckii DISEASES Skin: -Pityriasis vesicolor / Tinea

ea vesicolor -Pityriasis folliculitis Scalp: Seborrhoic dermatitis / dandruff Systemic Infection Pityriasis vesicolor / Tinea vesicolor Hyperpigmentation/Hypopigmentation of skin >> lesion are well demarcated (white, pink, brownish) >>fawn colored macules are the most predominant: --Trunk and upper arms >>rare: neck & face Pityriasis folliculitis >>follicular papules & pustules --back, chest, upper arms --sometimes; the neck seldom on face >>itchy & often appear after sun exposure Seborrhoic dermatitis / dandruff >>changes in quantity & composition of sebum ---increase in wax esters ---shift from TG to shorter fatty acid chain ---increase alkalinity of skin ---external local factor such as occlusion >>Clin mx: --erythema & scaling in areas w/ a rich supply of sebaceous gland >scalp, face, eyebrows, ears & upper trunk --lesion are covered w/ greasy scales Phaeoannellomyces werneckii Cladosporum werneckii Piedraia hortae **ascomycetous fungus **common on central america & southeast asia BLACK PIEDRA >>affect hair shaft >>young adult-age of 20 >>epidemic in families >>chronic fungal infxn Clin mx: --does not penetrate on hair follicle Nodules: >>hard, fusiform, firmly, attached, to hair shaft --scalp hair: rough, sandy --infected hair: hard black nodules on the hair shaft Trichosporon beigelii

**worldwide,tropical and subtropical WHITE PIEDRA >>superficial cosmetic fungal infxn of the hair shaft >>affect scalp, axilla, fascial & genital hair >>affect most of the young adult Nodules: >>mucilaginous white follicle not affected, irregular, soft, white, or light brown nodules firmly adhering to the hair >>1.0-1.5mm in length >>no pathological changes are elicited

Tinea Nigra >>chronic superficial fungal infxn of the palms >>Brown to black macules (palmar & plantar & other skin surface) >>well defined dark patch w/ irregular margin, 1-5 cm in diameter on palm stained appearance Lesion: >>Non-inflammatory & nonscaling >>both tropical & temperate zone >>usually <20 y/o; female (3:1) >>predisposing factor: excessive sweating

--itching is common in the scalp Laboratory Dx clinical specimen Direct Mc:

skin scrapings -margins/dandruff 10% KOH (w/ PI or CW) >>cluster of thick-walled round budding yeast like cells >>short angular hyphal forms >>yeast cells (3-7 um) >>* spaghetti and meatball appearance >>for systemic infection >>stimulate growth by natural oils or other fatty substance >>Sabouraud's Dextrose Agar or sheep blood agar containing ACTI-DIONE >>DIXONS AGAR containing glycerol monooleate broad-shaped buds currently no commercially available serology 1. Topical agent: imidazole & ketoconazole shampoo 2. Oral tx: ketoconazole, itraconazole 3. Alternative: Zinc pyrithione shampoo selenium sulfide lotion propylene glycol 50% skin hyper/hypopigmentation spaghetti and meatball appearance require oil and FA for growth Yeast Tropic skin, hands & feet Dark macules

skin scrapings -margins/border 10% KOH (w/ PI or CW)

affected hair w/ black nodules 10% KOH (w/ PI or CW) darkly pigmented nodule in the hair shaft nodule: pigmented nodule containing asci 10% KOH (w/ PI or CW)

Culture

primary isolation media: SDA Colony: mucoid, yeast-like & shiny black(young yeast) abundant aerial mycelium

primary isolation media >>culture are dark, brown black take @ 2-3 weeks to appear.

primary isolation media >>white yellowish /deep cream colored >>smooth wrinkled, velvety, dull colonies w/ mycelial fringe

Microscopic Appearance Treatment

pigmented brown to dark dematiaceous septate hyphal element; 2 yeast cell sulfur soap, SSA, azoles topical tx: whitfield ointment (benzoic acid compound) Imidazole agent-2x a day non-scaling lesion Stained appearance PDF:excessive sweating Mold Temperate Chest, arms & back altered hypo/hyperpigmentation

thick part: fungal cells cemented together thin part: hyphal element shave / cut the hair short **terbinafine --dose 250 a day for 6 wks. shave topical: imidazole agent

Key feature

nodule: black & hard feature: barrel shape -Arthoconidia

nodule: mucilaginous,soft,white feature: blastoconidia

morphology geography area appearance

Moldy tropical hair shaft in the scalp

iSmayli (+_-)