MEDICALLY IMPORTANT

FUNGI

INTRODUCTION
Fungi are a diverse group of sacrophytic and parasitic
eukaryotic organisms
Kingdom: Mycota
Of 100,000 fungal species only 100 have pathogenic
potential for humans, only a few account for clinically
important infections
Mycoses : Human Fungal Diseases
Fungal spores may be important as human allergenic
agents

INTRODUCTION
MYCOSES
CUTANEOUS: limited to the dermis
SUBCUTANEOUS : when infection penetrates
significantly beneath the skin
SYSTEMIC : when the infection is deep within the body
or disseminated to internal organs

PATHOGENIC FUNGI

TRUE
PATHOGENS

OPPORTUNISTIC
PATHOGENS

TRUE PATHOGENS
Cutaneous infective agents

Subcutaneous infective agents

Epidermophyton species
Microsporum species
Trichophyton species

Actinomadura madurae
Cladosporium
Madurella grisea
Phialophora
Sporothrix schenckii

Systemic infective agents

Blastomyces dermatitidis
Coccidioides immitis
Histoplasma capsulatum
Paracoccidioides brasiliensis

OPPORTUNISTIC PATHOGENS

Absidia corymbifera
Aspergillus fumigatus
Candida albicans
Crytococcus neoformans
Pneumocystis carinii
Rhizomucor pusillus
Rhizopus oryzae (R.arrhizus)

CLASSIFICATION OF FUNGI

CLASSIFICATION OF FUNGI
Depends on :
Characteristic Structures
Habitats
Modes of Growth
Modes of Reproduction

Cell Wall and Membrane

Composed mainly of chitin rather than peptidoglycan
(bacteria)-so unaffected by antibiotics
Chitin: consists of a polymer of N-acetylglucosamine
Fungal Membrane contains ergosterol rather than
cholesterol found in mammalian cells, use in antifungal
agents such as amphotericin which binds to
ergosterolpores that disrupts membrane function
cell death

Cell Membrane
The imidazole antifungal drugs
( clotrimazole, ketoconazole, miconazole) and the
triazole antifungal agents (fluconazole , itraconazole)
interact with the C-14 -demethylase to block
demethylation of lansterol to ergosterol, vital
component of cell membrane and disruption of it`s
synthesis results in death

HABITAT
All fungi are heterotrophs ( their require some form of
organic carbon for growth)
They depend on transport of soluble nutrients across
their cell membrane
To do this they secrete degradative enzymes
( proteases etc) into their immediate environment,
therefore they live on dead organic material
So Natural Habitat : is soil or water containing decaying
organic matter

MODES OF FUNGAL GROWTH

FILAMENTOUS
MOLDS

UNICELLULAR
YEASTS

However there are some dimorphic fungi ( they switch between these
Two forms depending on their environment)

Filamentous (mold-like) Fungi

Thallus (vegetitive body)
mass of threads with
many branches
resembling cotton ball
Mass: mycelium
Threads: hyphae, tubular
cells that in some fungi
are divided into segments
septate whereas in other
fungi the hyphae are
uninterrupted by
crosswalls-nonseptate
Grow by branching and
tip elongation

YEAST like FUNGI

These fungi exist as
populations of single ,
unconnected , spheroid cells,
not unlike many bacteria,
although they are sometimes
10 times larger than a typical
bacterial cell
Yeasts reproduce by budding
Some fungal species
particularly those that cause
systemic infection exist as
dimorphic fungi

REPRODUCTION

SPORULATION
The principle way in which fungi reproduce and spread
within the environment
Fungal spores are metabolically dormant, protected
cells, released by the mycelium in enormous numbers
Borne by the air or water to new sites , where they
germinate and establish new colonies
Spores can be generate sexually or asexually

ASEXUAL SPORULATION
(MITOSIS)

Colour of a particular fungus seen on bread, culture plate is due to the

Conidia, easly airborne and disseminated

SEXUAL SPORULATION
meiosis

Relatively rare compared to asexual sporulation, and spore shape often

Used as a method of identification

SEXUAL SPORULATION
meiosis

Relatively rare compared to asexual sporulation, and spore shape often

Used as a method of identification

Superficial
. . .. .. . ..
Mycoses

Superficial Mycoses and

Dermatophytosis
Predisposing factors:
humidity
Immunosuppression
Poor hygiene
Affects the epidermal area with
strong affinity to keratin

Superficial Mycoses
Causative agents:

Malassezia furfur
Exophiala werneckii
Trichosporon beigelii
Piedraia hortae

Malassezia furfur
lipophilic yeast
Found as a normal flora on the
skin
Diseases :
Pityriasis versicolor
Pityriasis folliculitis
Seborrhoeic dermatitis;
Dandruff
Systemic infection

Major Clinical
Manifestation:
Hyper- or hypopigmented of
the skin.
Lesions are well-demarcated
(white, pink or brownish)
Fawn-colored macules are the
most common presentation
Trunk and upper arms

Pityriasis folliculitis
follicular papules and
pustules
back, chest and upper arms
sometimes the neck,
seldom the face
Itchy and often appear after
sun exposure

Seborrhoeic dermatitis
changes in quantity and
composition of sebum
increase in wax esters
shift from triglycerides to
shorter fatty acid chains
increase in alkalinity of skin
external local factors such as
occlusion

Clinical manifestations:
erythema and scaling in areas
with a rich supply of
sebaceous glands
scalp, face, eyebrows, ears
and upper trunk
Lesions are covered with
greasy scales
Itching is common in the scalp

29

Systemic Infection (M. furfur)

common among infants as
catheter acquired
Intravenous infusions of
lipid
Pneumonia results from
emboli from the infected IV
catheter

Laboratory Diagnosis
Clinical material/Specimen:
Skin scrapings
blood
indwelling catheter tips

Laboratory Diagnosis
1. Direct Microscopy
10% KOH (glycerol w/ Parker
ink or Calcofluor white)
clusters of thick-walled
round budding yeast-like
cells
short angular hyphal forms
Yeast cells (3-7um)

Spaghetti and meatballs

Spaghetti and meatballs

KOH w/
PI

GMS

Laboratory Diagnosis
2. Culture
For systemic infection
Stimulate growth by natural
oils or other fatty
substances
Sabouraud's dextrose agar
or Sheep blood agar
containing Acti-Dione
Dixon's agar containing
36

Malassezia
furfur

Colonies of Malassezia furfur on

Dixon's agar. A specialized isolation

Laboratory Diagnosis
Microscopic apperances:
Broad-based buds
The collarettes of the
phialides appear as distinct
dark rings separation the
mother & daughter cells
currently no commercially
available Serology

Management and Treatment:

1. topical agent: imidazole
.Ketoconazole shampoo
2. Oral treatment :
ketoconazole
: itraconazole
3. Alternative: zinc pyrithione
shampoo
selenium sulfide lotion
propylene glycol 50% in
water twice daily

Helpful Features
White discoloration of skin
or light brown discoloration
Spaghetti and meatballs

Oil and FA requirement

Exophiala wernekii
Phaeoannellomyces
werneckii
Cladosporum
werneckii
common saprophytic
fungus
soil, compost, humus and

Exophiala werneckii
Disease:

Tinea nigra

Chronic superficial fungal

infection of the palms
brown to black macules
(palmar and plantar and
other surfaces of the skin)
Well-defined dark patch
with irregular margin, 1-5
cm in diameter on palm;
stained appearance

Exophiala werneckii

Tinea nigra

Lesions: non-inflammatory and

non-scaling
Both tropics and temperate
zones
Usually <20 y/o; > females
(3:1)
Predisposing factor: excessive
sweating

Laboratory Diagnosis
Clinical Material: Skin scrapings
1. Direct Microscopy:
10% KOH and Parker ink;
calcofluor white mounts.
2. Culture:
Primary isolation media
Sabouraud's dextrose agar

 pigmented brown to dark

(dematiaceous)
septate hyphal elements
2-celled yeast cells

Exophiala
werneckii

Initially colonies are mucoid, yeastlike and shiny black. (young yeast)
Abundant aerial mycelia and become
velvety, dark olivaceous in colour.

 Serology Not required for

diagnosis

Management & Treatment:

Sulfur soap, SSA, azoles
Topical treatment
Whitfield's ointment (benzoic
acid compound)
Imidazole agent twice a day
for 3-4 weeks
49

Piedraia hortae
ascomycetous fungus
common in Central and South
America and South-East Asia
Disease: Black piedra
Chronic fungal infection of
the hair shaft
mostly affects young adults
epidemics in families

Piedraia hortae
Black piedra
Clinical Manifestations:
Does not penetrate the hair follicle
Scalp hair: rough, sandy
Infected hairs: hard black nodules on
the shaft
Nodules: hard, fusiform, firmly
attached to hair shaft

Piedraia hortae
Black piedra
Clinical Manifestations:
Thick part: fungal cells cemented
together
Thin part: hyphal elements

Black piedra

Laboratory Diagnosis
Clinical Material:
hairs with hard black nodules
1. Direct Microscopy:
10% KOH w/ Parker ink;
calcofluor white
darkly pigmented nodules:
hair shaft
Nodules: pigmented center
containing asci

Laboratory Diagnosis
2. Culture:
primary isolation media
Colonies are dark,
brown-black
Take about
2-3 weeks to appear

Management and Treament:

shave or cut the hairs
short
Terbinafine
Dose: 250 mg a day for
6 weeks

Trichosporon beigelii
Worldwide, tropical or subtropical
regions
More in temperate zones
Disease: White piedra
superficial cosmetic fungal
infection of the hair shaft

Affects scalp, axilla, facial and

genital hair

Trichosporon beigelii
White piedra
Clinical Manifestations:
common in young adults
Nodules: mucilaginous, white,
follicles
not affected
irregular, soft, white or light
brown nodules firmly
adhering to the hairs
1.0 - 1.5 mm in length
no pathological changes are

White piedra

Laboratory Diagnosis
1. Direct Microscopy:
10% KOH and Parker ink;
calcofluor white

Laboratory Diagnosis
2. Culture:
primary isolation media
white or yellowish to deep
cream colored
smooth, wrinkled, velvety,
dull colonies with a
mycelial fringe.

Trichosporon beigelii

Serological test in not

Required
Management and
Treatment:
Shave the hairs
Topical: imidazole agent

Dermatophytes
(Cutaneous
mycoses)
- fungal infections involving the
dermis and its appendages
(hair follicles and nails)

o Dermatophytosis - "ringworm" disease

(mycotic infection) of the nails, hair, and/or
stratum corneum of the skin caused by
fungi called dermatophytes.
o Dermatomycosis - more general name
for any skin disease caused by a fungus.
- invasion of the cutaneous tissues by other
fungi.

THE SKIN PLANTS

Etiological agents are called dermatophytes "skin plants". Three important anamorphic
genera, (i.e., Microsporum, Trichophyton, and
Epidermophyton), are involved in ringworm.
Dermatophytes are keratinophilic - "keratin
loving". Keratin is a major protein found in
horns, hooves, nails, hair, and skin.
- use keratin as a source of nitrogen
Ringworm - disease called herpes' by the
Greeks, and by the Romans tinea' (which
means small insect larvae).

Dermatophytes
Common Causative agents:
a. Microsporum
- hair, skin, rarely nails
- children, rarely in adults
- spontaneous remission
b. Trichophyton
- hair, skin & nails
- both children & adults
- chronic.
c. Epidermophyton
- skin, nails, rarely hair
- adults, rarely children

Microsporum species
Microsporum gypseum
Microsporum canis

TRICHOPHYTON CLASSIFICATION

Epidermophyton species
Epidermophyton floccosum

Microsporum species
Microsporum gypseum
Microsporum canis

Microsporum species
Common features:
Colony:
Mycelium: white to buff
Underside: yellow to reddish brown

Microscopic
attached singly
thick walls & mature forms are echinulate
(spiny)
Spindle-shaped macroconidia
Septate hyaline hyphae

Microsporum gypseum complex

Teleomorphs are Arthroderma gypseum and A. incurvatum.
Produces abundant macroconidia brownish-yellow due to large
numbers macroconidia.
Surface of culture colony often is powdery in appearance.
Reverse of colony often appears ragged around edges.
Macroconidia usually have 4-6 septa or crosswalls, up to 40 m
long
Microconidia are smaller than in M. canis.
In lactophenol, water is extracted and can cause the macroconidia
walls to collapse. This is an artifact due to mounting media.
Macroconidia do not form on infected hair!

Microsporum gypseum

Microsporum canis
Teleomorph is an ascomycete called
Arthroderma otae.
Macroconidia are abundant, thick-walled
with many septa, up to 15. Macroconidia
are often hooked or curved at ends.
Microconidia are small and clavate
(club-shaped).

Microsporum canis
Teleomorph: Arthroderma otae

TRICHOPHYTON CLASSIFICATION

Infections by Dermatophytes
Severity of ringworm disease depends on
(1) strains or species of fungus involved
and (2) sensitivity of the host to a
particular pathogenic fungus.
More severe reactions occur when a
dermatophyte crosses non-host lines (e.g.,
from an animal species to man).

Common Dermatomycoses
Diseases:

Hairy areas:
Tinea capitis

Tinea barbae

Skin:
Tinea corpuris
Tinea cruris
Tinea manum Tinea pedis
Tinea fascie
Tinea imbricata

Nail:
Tinea ungium

Dermatophytosis of the skin

Clinical Manifestations:

ringworm
Papules to pustules with clear center and
active borders (peripheral pustules and
scaling), itchy,circinate and serpiginous with
inflammatory, vesicular, enlarging margins

Differential Diagnosis:
Psoriasis: dry and circinate borders
Ezcema: no clear center

Tinea or ringworm: basic lesion

Dermatophytosis (skin and nail)

Tinea fascie (face)
Tinea imbricata (subtype of Tinea
corpuris, concentric layers of lesions)
Tinea cruris (inguinal area)
Tinea pedis (interdigits of the feet)
Tinea manum (interdigits of the
hand)
Tinea ungium (fingernails)

Trichophyton species
The word "trichophyton" literally means "hair
plant".
Presence of macroconidia in cultures varies and
may not help in identification of cultures.
Most common species include:
Trichophyton mentagrophytes
T. rubrum
T. tonsurans
T. verrucosum
T. violaceum
T. schoenleinii
T. ajelloi (rare infects humans).

 ON SKIN: Scrapings from skin and nails

cannot distinguish species in this genus.
ON HAIR: Pattern of infection can help
distinguish etiologic or causal agent.
For Microsporum species - infections on hair
lead to a mosaic pattern of arthrospores.
For Trichophyton species - infections on hair
follow one of the 4 patterns.

 Ectothrix - more or less parallel rows of arthrospores

produced on surface of hair.

1. Small-spored ectothrix (arthrospores are <

5 mm in diameter) - caused by T.
mentagrophytes or T. rubrum (rare). Spores
are about the same size as those produced
by Aspergillus.
2. Large-spored ectothrix (arthrospores are 510 mm in diameter) - caused by T.
verrucosum.
Endothrix - growth inside hair shaft only!

3. "Black-dot" endothrix (hair stubs filled with

arthrospores) - caused by T. tonsurans or T.
violaceum.

4. "Favus hair" endothrix (honeycomb pattern of

damage seen on surface of hair shaft) - caused by T.

Trichophyton species
Common Features:
Colony:
Mycelia: Cream, buff to brown, granular to wrinkled
Underside: differ (brown to red)

Microscopic feature

Microconidia; oval- pyriform

attached singly, some in clusters
have smooth walls
Hyaline septate hyphae

Areas affected: hair, skin and nails

Tinea capitis (head, hair)

Clinical Manifestations:
Bald patches, moist, itchy, scaly
Papules to pustules
Friable hair
Differential Dx:
Alopecia: no scaling
Psoriasis: no loss of hair; silvery
scaling
Seborrheic dermatitis: diffuse hair
loss;
6-8 months old; pustular
Other hairy areas:Tinea barbei (beard)

Tinea capitis

Differential Diagnoses:
Alopecia areata

Differential Diagnoses:
Psoriasis

Differential Diagnoses:
Seborrheic keratosis

Tinea barbei

Tinea fascies

Tinea corporis

Tinea manum
(hand)

Tinea pedis
(feet)

Tinea imbricata

Tinea unguium

Epidermophyton species
Epidermophyton floccosum

Epidermophyton
floccosum
Only one
pathogenic species
in this genus.
Tinea unguium and
tinea cruris are
often caused by this
fungus.
/

Epidermophyton floccosum
Colony:
Mycelium: yellow green,
khaki; suede, gentle
folds; slow grower
Underside: green to
brown

Epidermophyton floccosum
Microscopic:
attached in multiples (2 4/group)
moderately thick , smooth walls
(beaver tails)
Clubbed-shaped, 2 5 cell
macroconidia
Septate,hyaline hyphae

Chlamydoconidia
Typically present particularly in

Dermatophytes

Epidermophyton floccosum
Areas affected: skin and nails
Disease: Tinea cruris or jock itch
Often start on the scrotum and spread to the groin as
dry, itchy lesions
Source of infection:

Sharing of linens, towels or clothes

Athletes, soldiers, ship crews

Other Forms
Superficial Mycoses
Keratomycosis
Onychomycosis
Cutaneous candidiasis