SUPERFICIAL

■Malassezia furfurDISEASE CAUSED Pityriasis versicolor

a.k.a Tinea versicolor, Tinea Flava, Dermatomycosis furfurcea, “liver spots”CHARACTERISTICS OF DISEASE

Chronic, asymptomatic fungal infection of the stratum corneum Hyperpigmented macules or patchesIncrease in melanosome size but not in numberFolliculitisSepsis

FACTOR Excessive sweatingCOMMON SITES Chest, upper back, shoulder, upper arms, abdomen

⊠ hair shafts and nailsDIAGNOSIS KOH mount

Branching septate hyphae Spaghetti and meatballs

Wood’s light Yellow fluorescence

Culture White to creamy

Saboraud’s agarTREATMENT Ketoconazole

OTHERS With very high recurrence rate■Malassezia pachydermatitis

DISEASE CAUSED Psoriasis, mycosis fungoides, febrile systemic syndrome (neonates)SITE Otitis externa of dogs

urine, CSF, blood, vaginal, eye & ear discharge, tracheal aspirate -also reported in patients receiving IV lipid hyperalimentation (esp. neonates)

■Malassezia sympodialisSITE Scalp of AIDS patients with Tinea capitis

■Pidea hortaiDISEASE CAUSED Black piedra (tropics and subtropics)CHARACTERISTICS OF DISEASE

Infected hair: rough, sandy, or granularNodules:hard, fusiform, firmly attached to hair shaft

COMMON SITES Scalp hairhair follicles, cortex of hair⊠

DIAGNOSIS KOH mount Tightly packed, regularly arranged, thick-walled cells, dichotomously branching,

dematiaceous hyphae 8 ascopores

Culture Compact, dark-brown to black, conical with short aerial hyphae Grow slowly on Saboraud’s agar

TREATMENT Topical medicationShaving and cutting

OTHERS Males=femalesCommon in regular swimmers

■Trichosporon beigeliiDISEASE CAUSED White piedra (temperate)CHARACTERISTICS OF DISEASE

infected hair:softer, mucilaginous, white and to light brownnodules

:adherentCOMMON SITES Facial and genital hair

hair follicles⊠DIAGNOSIS KOH mount

Softer, less adherent, not as discrete Transparent, greenish, irregular sheath Blastospores and arthrospores

Culture Smooth, highly-wrinkled or radially folded, yeast-like, cream-colored Grow moderately Hyaline septate hyphae with many arthrospores

TREATMENT Topical medicationShaving and cutting

OTHERS Low incidence in black variety

■Cladosporium werneckii or Exophiala werneckiiDISEASE CAUSED Tinea nigra

a.k.a. Keratomycosis nigricans Palmaris, cladosporiosis epidermica, pityriasis nigra, microsporis nigra

CHARACTERISTICS OF DISEASE

Chronic, superficial (upper layers of stratum corneum), asymptomatic, fungal infectionDark patch on the palm with well-defined, irregular margin “stained appearance”Occ. Pruritus and scaling⊠erythema, induration

FACTOR Hyperhydrotic patientsCOMMON SITES PalmsDIAGNOSIS KOH mount

Sinous, dematiaceous branching septate hyphae and elongated budding cellsSaboraud’s agar

Shiny, moist, yeastlike dirty white to brown covered with masses of conidia and budding cells

Turn black in 2-3 weeksTREATMENT Ketoconazole

OTHERS Tropical diseaseMale:female 1:3Common under 20Misdiagnosed as melanomaLow recurrence rate

■Histoplasma capsulatum and Fusarium solaniDISEASE CAUSED Mycotic keratitis (Keratomycosis)CHARACTERISTICS OF DISEASE

Fungal infection of the corneaTrauma leading to inoculums of eyesRaised cornea ulcers with occasional satellite lesions, plaques, or hypopyon

COMMON SITES CorneaDIAGNOSIS Demonstration of Hyphae

Corneal scrapings Surgical specimens

Saboraud’s agar and Enriched mediumPotato dextrose Agar

Cottonlike, white, turning pink-vioolet or brown at the center with ageLactophenol cotton blue

Microconidia with fusiform or oval shape extending gtom delicate lateral phialides Macroconidia are fusiform with appearance of sickle and have 3-5 septae

CUTANEOUSETIOLOGY: Dermatophytes -keratophilic fungi

CLINICAL MANIFESTATION: Tinea or Ringworm ANAMORPHIC STATES:

MICROSPORUM – skin and hair TROCHOPHYTON – all (skin, hair, and nails)EPIDERMOPHYTON – skin and nail

TELEOMORPHIC STATE of Microsporum and Trichophyton is genus Arthroderma

DIAGNOSIS ◉Culture (SDA with cycloheximide, chloramphenicol)

Macroconidia: large and multicellular Microconidia: small and unicellular

Spiral hyphae, chlamydospores, nodular bodies, racquet hyphae, and chandeliersASEXUAL STATE OF SELECTED DERMATOPHYTES

◉KOH 10% (skin), 20% (hair) except:

CLASSIFICATION OF DERMATOPHYTES ACCORDING TO ECOLOGICAL NICHE

GENERAL CHARACTERISTICS OF MACROCONIDIA AND MICROCONIDIA OF DERMATOPHYTES

■Trichophyton schoenleiniiDisease caused FavusCharacteristics of disease Infected hair

:with waxy mass of hyphal elements (scutulum)Factor Hyperhydrotic patientsCommon sites PalmsDiagnosis Microscopic exam

Degenerated hyphal elements coursing throughout the hairshaft

Treatment Azoles -interfere with cytochrome p450Griseofulvin -fungistatic, affects microtubular system-oral route

Others: Tinea capitis with erythematous edge Tinea corporis part of the rtorso Tinea mannum hand with abrasions, prutirus, very

itchy Tinea cruris jock itch, inguinal, pubic and perennial Tinea pedis athlete’s foot, crackling of skin but

moist inner Tinea favus also affects hair follicles causing

hairlossSUBCUTANEOUS☀ individual ■Sporothrix schenckii

DISEASE CAUSED SporotrichosisGardener’s disease (spores on thorns)

CHARACTERISTICS OF DISEASE

Form granuloma-like filled with inflammatory cellsLymphocutaneousChronicFixed

COMMON SITES cutaneous, subcutaneous and lymphaticsDIAGNOSIS KOH

Cigar-shaped bodiesCulture

@37: white greeny colonies @25: brown to black moulds-hyphal elements with microspores (infectious)

TREATMENT Potassium Iodide (KI)-oralItraconazole

OTHERS Most common

■Loboa loboiDISEASE CAUSED Lobomycosis

Kelloidal blastomycosisCHARACTERISTICS OF DISEASE

Small, hard, subcutaneous nodulesPainless but may become verrucous and ulcerative

FACTORCOMMON SITES Extremeties, face and ear

⊠ lymph nodesDIAGNOSIS KOH mount

Skin scrapings, biopsies, exudates Large yeast cells with multiple buds and form 3-4 short chains

TREATMENT DOC: Sulfa drugsSurgery

■Entomophthora coronataDISEASE CAUSED RhinoentomophthoromycosisCHARACTERISTICS OF DISEASE

Hard, subcutaneous nodules large disfurging tissue mass

FACTORCOMMON SITES Nasal mucosa

⊠ blood vesselsDIAGNOSIS Biopsy

numerous branching hyphaeTREATMENT Surgery

KIAmphotericin B

■Rhonosporidium seeberiDISEASE CAUSED RhinosporidiosisCHARACTERISTICS OF DISEASE

chronicpolyploidy masses(pedunculated) in the nasal mucosacompromised respiration due to polypssporangia

COMMON SITES nose, nasopharynx, soft palate, occ. genitalsother mucocutaneous sites: conjunctiva, genitalia, rectum

DIAGNOSIS KOH or HP sporangia

TREATMENT SurgeryDapsone

OTHERS Stimulate proliferation of epithelial cells

■Phycomycosis☀several■ Dematiaceous fungi

Fonsecae Phialophora Cladosporium

• Most common: F. pedrosoi

DISEASE CAUSED ChromomycosisCHARACTERISTICS OF DISEASE

Slow development of verrucous, cutaneous vegetationsVerrucous cauliflower-like lesionsSystemic invasion is rare

COMMON SITES Lower extremetiesDIAGNOSIS Biopsy

KOH Sclerotic bodies

TREATMENT Excision (early stages)Amphotericin B (late)FluocytosineItraconazole

OTHERS Temperate and tropicalCaused by traumatic implantation

■ Dematiaceous fungi Exophiala Wangiella Cladosporium Phialophora

DISEASE CAUSED PhaeohyphomycosisCHARACTERISTICS OF DISEASE

Subcutaneous cysts -suually solitary, discrete, firm, non-tenderCutaneous and systemicBrain abcess with deep-tissue invasion

COMMON SITESDIAGNOSIS KOH or HP

Brown septate hyphae

TREATMENT Excision (early stages)Amphotericin B (late)FluocytosineItraconazole

OTHERS Caused by traumatic implantation

■ Actinomycotic Actinomadura Nocardia Streptomyces

granules: contain very fine, delicate hyphae Eumycotic Actinomycetes:

Eumycetes Allescheria Madurella Phialophora,

granules: contain large, coarse, septate hyphaeDISEASE CAUSED MycetomaCHARACTERISTICS OF DISEASE

Local tumefaction and interconnecting often draining sinuses that contain granules

COMMON SITES feet, lower extremities, hands, exposed areas

DIAGNOSIS KOH or HP granules Color Size Texture hyaline or pigmented hyphae

TREATMENT Amphotericin BKetoconazoleTopical NystatinFluocytosineDebridement

OTHERS Common In Central and South America, Africa, India

SYSTEMIC■Blastomyces dermatitides

DISEASE CAUSED Blastomycosisa.k.a. Gilchrist’s disease, North America Blastomycosis

CHARACTERISTICS OF DISEASE

Similar to PTBSuppurative and granulomatous lesionsSkin lesionsPulmonary-mimic TBSystemic:granulomatous lesions and abcesesCutaneous :crusty lesions, with well defined margins (verrucous borders) with microabcesses

DIAGNOSIS Body thick walled yeast cells with broad-based bud

Environment mycelia form with oval-shaped conidia on a laterally branching hyphae (infectious)

sputum, skin scrapingsm biopsy

TREATMENT Itroconazole-oral antifungal

OTHERS Soil-dweller fungiCommon in menvs. TB: Cons granules: tubercle bacilli surrounded by immunes cells solid lesion

■Paraccocidoides brasiliensisDISEASE CAUSED Paraccocidioidomycosis

a.ka. South American BlastomycosisCHARACTERISTICS OF DISEASE

Granulomatous disease Lymph node enlargement

COMMON SITES Skin, lymph nodes, mucous membranes, and internal organsGingival (loss of teeth)

DIAGNOSIS large yeast cells with multiple buds (Mariner’s wheel)-may be mistaken for Rhinosporidium

SDA white fluffy colonies

Gomori, LCBSerologic Tests (C’ fixation, immunodiffusion)@37

hyphal form with infectious spore

TREATMENT Itraconazole-oral antifungal

OTHERS Common in men 20-30 y/o

■Coccidiodes immitisDISEASE CAUSED CoccidiodomycosisCHARACTERISTICS OF DISEASE

Primary pulmonary- flu-like symptoms

Benign form- (+) skin test

- Lung cavitationDisseminated form

- Spread to internal organs- Precipitin titer diminish- Barrel-shaped infectious arthrospores

COMMON SITES Cutaneous or sucutaneousDIAGNOSIS Thick-walled sporangia or spherule containg multiple endospores

Culture Fluffy white colonies on micro will reveal barrel-shaped arthroconidia

Calcoflour white (also Silver Stain) Fluorescence due to fungal wall

skin, sputum, other tissuesTREATMENT Ampothericin B

-oral antifungalOTHERS Highest risk race: Filipnos, African-Americans, Hispanics, Other asianas

Common in dark skinned individuals and men

■Histoplasma capsulatum Var. capsulatum Var. duboisii (birds) Var. farciminosum (horse)

DISEASE CAUSED Histoplasmosisa.k.a. Reticulo-endothelial cytomycosis, Cave disease, Spleunkers disease, Darling’s disease

CHARACTERISTICS OF DISEASE

Primary acute- flu-like or asymptomatic- (+) histoplasmin skin test

Chronic cavitary- cavitary lung lesion- destroy alveolar walls

Severe Disseminated- affect RES

COMMON SITESDIAGNOSIS Non encapsulated intracellular yeast cells

-may be mistaken with Leishmania spp.Culture

Whte fluffy coloniesMicroscopy

Microconidia: tuberculate Macroocnidia @25: mistaken for mariner’s wheel

@35-37: yeast formHistoplasmin skin testPrecipitin TestCfAb titer

TREATMENT Itraconazole

OTHERS Thrives in bird and bat droppingsMOA: inhalation of microconidia

■Histoplasma capsulatum var duboisii (birds)DISEASE CAUSED African HistoplasmosisCOMMON SITES Skin, lymph node, bone

Rare pulmonaryDIAGNOSIS Large yeast cells inside giant cells

Same mycelia formTREATMENT Itraconazole

OPPURTUNISTIC

■Candida albicansDISEASE CAUSED CandidiasisCHARACTERISTICS OF DISEASE

SUPERFICIAL--infection of the skin, hair, nails and mucous membranesa. cutaneous infection b. chronic mucocutaneous infectionc. onychomycosis -involves the fingernails due to frequent exposure to water (laundry women, cannery workers etc)d. oropharyngeal infection -occurs in infants, patients with diabetes mellitus, those receiving broad spectrum antibiotics, and those with HIV infectione. vulvovaginitis -occurs most commonly in postpubertal women who have DM, have been taking antibacterial drugs, are in the third trimester of pregnancy, or are sexually active -vaginal discharge, which may be curd-like, itching, burning, and dyspareunia are the most common symptomsf. keratitis g. conjunctivitis

-a complication of the long-term use of corticosteroid eye drops -other risk factors are breaks in the corneal epithelium such as those caused by bullous keratopathy or corneal ulcers due to herpes simplex -findings include conjunctival erythema, cheesy discharge in the conjunctival sac, and progressive corneal ulceration

DEEPa. Local inoculation b. Esophagitis (candida esophagitis)c. Gastrointestinal candidiasisd. Urinary tract infection (includes “fungus ball of the ureter, cystitis, renal abscess, and pyelitise. Peritonitis – intra-abdominal abscessf. Respiratory Tract Candidiasis

HEMATOGENOUSLY DISSEMINATED (fever, DIC, shock)a. Candidemiab. Chronic disseminated (hepatosplenic) candidiasisc. Disseminated Candidiasis due to heroin abused. Suppurative phlebitise. Endocarditisf. Endophthalmitisg. Arthritis (Candida Arthritis)h. Osteomyelitis (Candida Osteomyelitis)i. Candida Endysphthalmitisj. CNS Candidiasis

COMMON SITESDIAGNOSIS Pseudohyphae (germ tube) or budding yeast cells within 24-28hrsTREATMENT Ampothericin B

OTHERS Most common cause of systemic mycosesInfect any organ systemBurn patients and IV frug users

Cryptococcus neoformans var neoformans and gatti■DISEASE CAUSED Cryptococcosis

a.k.a. Torulosis, European blastomycosis, Buss-Buschke diseaseCHARACTERISTICS OF DISEASE

AIDS (neoformans)*Gatti may infect those non-immunocompromisedPulmonary

- PneumoniaDisseminated

- Meningitis (other causes are also encapsulated except Meninggococcemia)COMMON SITES Respiratory tract and skin of healthy people

With affinity to nervous tissueDIAGNOSIS 10% KOH or India Ink

Encapsulated yeast cellsCulture

Urease (+) [like Proteus, Providencia, Morganella) Clean white to yellow brown colonies

SDA Does not require cyclohexamide, sensitive unlike candida which is resistant

HP Mucicarmine stain

Serologic (more sensitive and specific Cryptococcal Ag Latex Agglutination Test (CALA)

TREATMENT

OTHERS Source of fungineoformans: pigeon droppingsgatti: eucalyptus camaldulensis or red gum

Apergillus ■ fumigatus – most common for invasive and noninvasive flavus – 2nd most common from invasive niger – 3rd most common of invasive pulmonary

DISEASE CAUSED AspergillosisCHARACTERISTICS OF DISEASE

a) invasive lings to other organsb) noninvasive pulmonary*allergic bronchopulmonary-similar to asthma*aspergilloma- fungus balls (mass of hyphale elements in lungs)

COMMON SITESDIAGNOSIS hyphal form in sputum and expectorated mucus

: dichotomously branching septate hyphaeTREATMENT Removal of fungus ball and oral antifungal for invasive type

OTHERS Inhalation of spores (conidia)Airborne spores or through hosp supplies

Class Zygomycetes, order Mucorales■ - thermotolerant : Genus:

Rhizopus Rhizomucor Abdisia Cunninghamella Mucor Syncephalastrum

DISEASE CAUSED MucormycosisCHARACTERISTICS OF DISEASE

a) rhinocerebral-infect nasal mucosa and deeper tissues, sinuses, eye, bones and brain-presence of sporangiospores in nasal passages, invades blood vessels and able to cause necrosis and thrombosisb) thoracic - spores are lodged in the lungs (pulmonary) - acquired through inhalation of sporangiospores

COMMON SITESDIAGNOSIS Broad hyphae of uneven thickness, irregular branching, sparsely septatedTREATMENT Surgical removal of germinating fungi

Rapid administration od antifungal (Ampothericin B)OTHERS Syncephalastrum: medusa-like

Penicillin marneffei■

DISEASE CAUSED PenicillinosisCHARACTERISTICS OF DISEASE

Nonspecific manifestations

COMMON SITES Lymph node, lung, liver , skinDIAGNOSIS Biseriate, dichotomous held by a metula hyphal formTREATMENT Amphotericin B

OTHERS First isolated in bamboo ratsProduces an antibiotic

Pneumocystic carinii■

DISEASE CAUSED Pneumocystic pneumoniaCHARACTERISTICS OF DISEASE

Major cause of death in AIDS pariend

COMMON SITES Lymph node, lung, liver , skinDIAGNOSIS Thin-walled trophozoites and thick walled cyst

Produce fungal cell wall seen with calcoflour whiteTREATMENT Co-trimoxazole, Trimethoprim sulfamethoxsazole

-prophylactic antibioticPentamide-AIDS

OTHERS NewestNeutralization: CMI