Overlay-TitleSlide.png Fungal skin infections M. Nečas, H. Charvátová I. dermatovenerologická klinika FN u sv. Anny, LF MU Brno http://selectsmarthealth.com/skin-fungus/ Overlay-ContentSlides.png Skin infection —Bacterial —Fungal —Viral Overlay-ContentSlides.png Fungi imperfecti —Dermatophytes — —Yeasts /candida, cryptococcus/ — —Dimorphic fungi (deep fungal inf.) — —Oportunic fungi (aspergillus aj.) Overlay-ContentSlides.png Fungi - mycetes Ø100 thousand of species, ubiquitary ØAerobic organisms ØDo not manufacture chlorophyll Ø — classes: Zygomycetes — Ascomycetes — Basidiomycetes — — Deuteromycetes (fungi imperfecti) — (pathogenic for human) — — Overlay-ContentSlides.png nomenclature —Mycosis = any fungal infection, — incl. Yeast, deep mycosis — > —Tinea = dermatophytoses — — > — —Trichofytia, epidermophytia, microsporia Overlay-ContentSlides.png I. Dermatophytoses —Antropophilic: T.rubrum,T. interdigitale — fungi T. tonsurans,T. schoenleinii — Microsporon audouinii — Epidermphyton floccosum — —Zoophilic : T. verrucosum, mentagrophytes, equinum — Microsporon canis, persicolor, nanum — —Geophilic: T. ajelloi, terrestre — Microsporon gypseum — — Overlay-ContentSlides.png Tinea pedis —C. agens: Trichophyton rubrum — —clinical variants : interdigital — hyperkeratotic — dyshidrotic Overlay-ContentSlides.png interdigital tinea lg326_1 Overlay-ContentSlides.png hyperkeratotic tinea mykozy 016 Tinea unguium-onychomycosis —C.agens: — T. rubrum — T. interdigitale — — Epidermophyton — floccosum — mykozy 033 Overlay-ContentSlides.png Tinea unguium-onychomycosis mykozy 030 Overlay-ContentSlides.png Tinea unguium-onychomycosis mykozy 032 Overlay-ContentSlides.png Tinea unguium-onychomycosis mykozy 034 Overlay-ContentSlides.png Tinea unguium-onychomycosis mykozy 037 Tinea inguinalis —C. agens: E. floccosum,T. rubrum,T. interdigitale mykozy 014 Overlay-ContentSlides.png Tinea inguinalis mykozy 015 Overlay-ContentSlides.png Tinea manum —etiol: T. rubrum — T. interdigitale — E. floccosum —---------------------------------- — T. verrucosum — —forms: hyperkeratotic — dyshidrotic — erythemosquamous Overlay-ContentSlides.png Tinea manum-dyshidrotic form mykozy 018 Overlay-ContentSlides.png Tinea manum erythemosquamous form mykozy 017 Tinea corporis — —T. verrucosum —T. mentagrophytes —M. canis —----------------------- —T. rubrum —E.floccosum mykozy 021 Overlay-ContentSlides.png Tinea corporis -superficial mykozy 022 Overlay-ContentSlides.png Tinea corporis - erythemosquamous mykozy 023 Overlay-ContentSlides.png Tinea corporis erythemovesiculous mykozy 020 Overlay-ContentSlides.png Tinea corporis - deep —T. verrucosum —T. mentagrophytes mykozy 019 Tinea faciei —M. canis —T. verrucosum —T. mentagrophytes — —Ddg: atop. dermatitis — seborrhoic — dermatitis — CDE mykozy 024 syccosis barbae Overlay-ContentSlides.png Tinea capitis —C.agens: Trichophyton (ecto/endothrix ) — growth along the hair — Microsoporon (ectothrix) — invasion of the hair — —clinical variants: superficial — (non-inflammatory) — deep (inflammatory) - Kerion Celsi — favus Overlay-ContentSlides.png Tinea capitis - superficial mykozy 025 Overlay-ContentSlides.png Tinea capitis - deep mykozy 026 Overlay-ContentSlides.png Tinea capitis - deep mykozy 027 Overlay-ContentSlides.png Tinea capitis - favus —C.agens: Trichophyton Schoenleinii — —Most often in children, very rare in W. and C. Europe —Occurence in Middle East region —Scutulum (little shield) – yellowish dish-like crusts —mixture of hyfi and spores, smells like a mouse urine —Rarely trunk and nails affected Overlay-ContentSlides.png Tinea capitis - favus mykozy 028 Tinea barbae (syccosis barbae parasitaria) —C.agens: — T. verrucosum — M. canis —Clinical picture: — folliculitis, — infiltrates, nodules —Ddg: syccosis barbae — nonparasitaria — (staphylogenes) — mykozy 029 Pityriasis versicolor —Causative agens – Malassezia furfur —dimorfism of malasezia yeasts: able form both — hyfi and round/oval yeasts —Lipophilic, utilize human lipids —Component part of the normal residential microflora of the skin — — — — — malassezia malassezia 2 Overlay-ContentSlides.png Pityriasis versicolor mykozy 011 Overlay-ContentSlides.png Pityriasis versicolor mykozy 012 Overlay-ContentSlides.png II. Yeast infections — yeasts: reproduce by budding —Candidosis: Cryptococcosis —Candida albicans —C.non albicans: glabrata — krusei — kefyr — parapsilosis — tropicalis Overlay-ContentSlides.png 1) oral candidosis – soor lg193_1 Overlay-ContentSlides.png 2) intertrigininous candidosis mykozy 035 Overlay-ContentSlides.png mykozy 036 Overlay-ContentSlides.png Candidosis interdigitalis errosiva lg146_1 3) vaginal candidosis (MOP VI) — 4) candidal balanitis — — lg585_1 Overlay-ContentSlides.png 5) paronychium, onychomycosis lg244_1 Deep fungal infections —Blastomycosis: blastomyces dermatitidis — skin, pulmonary, and disseminated variant —Histoplasmosis: H. capsulatum (american f.) — H.duboisii ( african form) — osteoarticular,lymphadenopathy,enteral, — skin: nodules, abscessses,ulcers —Lobomycosis: Loboa Loboi — tumoriform nodules — — th362_1 Deep fungal infections —Coccidiomycosis —Paracoccidiomycosis —Aspergillosis Sporotrichosis —Chromomycosis —Geotrichosis —Maduramycosis hluboká mykoza Diagnosis of fungal infections —1) Obtaining specimens – disinfection of the lesion with 70% — ethanol — scraping the scales from the border, — or hyperkeratotic material from — beneath the nail‘s free end — —2) Microscopic investigation: — - native preparation — (10-30% KOH,30min.-3h) — - possible to stain with — Parker‘s ink — —Branched septed fibres (hyphae) — — mykozy 008 Diagnosis of fungal infections —3) fluorescent microscopy — with blankophore – binds to chitin of the cell — wall of fungi mykozy 009 Overlay-ContentSlides.png Diagnosis of fungal infections —4) Wood‘s lamp (high pressure flash light lamp emittingd UV A 320-400 nm) — — UV investigation à fluorescence — —Pityriasis versicolor: yellow/orange —Mikrosporum: green —Favus: white/grey Overlay-ContentSlides.png Diagnosis of fungal infections —5) culture – on Sabouraud agar — —evaluation: after 3-5 days - yeasts (at 37 st C) — 2w rapidly growing f. - E. floccosum — 3w T.rubrum — 4w slowly growing - T.verucosum — —Only after 6 weeks if nt apears, the culture can —be concluded as negative — — — — Overlay-ContentSlides.png Diagnosis of fungal infections —Evaluation of the macromorphology — of the colonies —Manufacturing — of the microculture —Physiologic tests — - ureaze test … — - zymograms, — auxanograms.. — T Overlay-ContentSlides.png T.rubrum T Overlay-ContentSlides.png T.mentagrophytes T Overlay-ContentSlides.png T.tonsurans T Overlay-ContentSlides.png Epidermophyton floccosum E Overlay-ContentSlides.png M.audouinii M Overlay-ContentSlides.png Microsporon canis M Overlay-ContentSlides.png Microsporon Gypseum M Overlay-ContentSlides.png Diagnosis of fungal infections —5) histologic excamination with PAS staining (periodic acid Schiff) — mykozy 010 Overlay-ContentSlides.png Antifungal therapy —Antifungals: — — 1) polyenic — 2) azoles — 3) alylamines — 4) other Overlay-ContentSlides.png Antifungal therapy — systemic treatment - indications — —Deep fungal infections —Deep tinea capitis —Extensive onychomycosis —Recalcitrant superficial tinea — Overlay-ContentSlides.png Antifungal therapy —Parenteral application: — —1) Amphotericin B — systemic and deep fungal infections — intravenous appl., serious AE — —2) Voriconazole (VFEND) —3) Posakonazole (Nofaxil, Posatex) —4) Kaspofungine (Candidas) — — — — Overlay-ContentSlides.png Antifungal therapy —Oral application: — —1) fluconazole vaginal candidosis —2) ketokonazole yeast infection, dermatopytoses, — malassezia —3) itrakonazole yeast infection, dermatophytoses, — malassezia — onychomycosis: 3m/5m —4) terbinafine — onychomycosis: 6t/3m Overlay-ContentSlides.png Antifungal therapy — topical therapy: — —ekonazole - Pevaryl crm, pst —ketokonazole - Nizoral crm —clotrimazole - Canesten crm —oxikonazole – Myfungar crm. —terbinafin - Lamisil crm —cyklopiroxolamine – Batrafen crm, sol.