Superficial fungi infection

Penyakit
etiologi
Pityriasis versicolor
Malassezia furfur

Manifestasi klinis
Hypo/hyperpigmentation
maculae, scaly, itchy

Tinea nigra

Exophiala werneckii

Asymptomatic, brown/black
lesion on palm, sole

Piedra

White(trichosporon
beigelli)
Black(piedraia hortae)
Epidermophyton
(skin, nail),
microsporum (skin,
hair), trichophyton
(skin, nail, hair)

White to brown soft

nodules, hair thickened
Black nodules,distal of hair
Infection on superficial
tissues with keratin
Central healing, raised
border, confluent
Tinea pedis, tinea unguium,
tinea cruris, tinea imbricata,
tinea imbricata, tinea
barbae

Dematomycoses

test
KOH 10%+scraping

treatment
Keratolyitic agent,
-azoles, selenium
sulfide
Keratolytic agent,
undecylenic acid,
imidazole

KOH 10% NaOH 10%

+scraping
Wood lamp yellow
green
Culture saboraud
agar

Keartolytic agent,
-azoles, selenium
sulfide, tolnaftate
Oral : griseofulvin,
ketoconazole,
terbinafine

Subcutaneous fungi infection

Penyakit
Sporotrichosis

etiologi
Sporothrix schenckii
saphrophytic

Manifestasi klinis
Ulcerative & necrosis,
multiple subcutaneous in
extremities

Chromoblatomycosis,
chromomycosis,
verrucous dermatitis

Phialophora
verrucosa
Fonsecaea pedrosoi

Wart like lesion,

granulomatous,
ulceration

test
KOH, FAT, HE : cigar
shaped asteroid
bodies
Saboraud agar
KOH : sclerotic bodies
biopsy

treatment
Itraconazole,
amphotericin B

Systemic antifungal
(flucytosine,
itraconazole)

Phaehypomycosis

Mycetoma

Fonsecaea compacta
Rhinocladiella
aquaspersa
Cladophialospora
carrionii
Exophiala jeanselmei
Phialospora
richardsiae
Bipolaris spicifera
Wangiella
dermatitidis
Alternaria spp. &
Curvularia spp.
Actinomycetes :
Nocardia braziliensis
Streptomyces
somaliensis
Actinomadura
madurae
Madura foot :
Pseudoallescheria
boydii
Madurella
mycetomatis
Madurella grisea
Exophiala jeanselmei
Acremonium
falciforme

Elephantiasis(lymphatic
blockage)

surgical

Subcutaneous cysts,
brain abscess

Chronic subcutaneous
infection
Madura foot :
granulomatous lesion in
tissue, suppuration,
abscess

Culture
Based on granules:

White
granules
P.boydii &
A.falciforme

Black
granules
M.grisea &
E.jeanselmei

Dark red
black
M.mycetomatis
In maduramycoses,
granules are hard,
consists of
intertwined hyphae;
in actinomycetoma:

Surgical excision
Actinomycetoma :
streptomycin,
cotrimoxazole,
dapsone
Maduromycosis :
itraconazole, -azole,
flucytosine,
amphotericin B

tissue and gram

(+)ve bacteria

Systemic fungi infection

Penyakit
Coccidiodomycosis

etiologi
Coccidiodes immitis
In soil per
inhalation
Coccidiodin, spherulin

Manifestasi klinis
Influenza like syndrome,
desert rheumatism,
hipersensitivity,
pulmonary disease,
extrapulmonary

test
Culture, microscopic
KOH, serology, skin
test : coccidiodin,
spherulin

Histoplasmosis

Histoplasma
capsulatum
In soil, avian habitats
per inhalation, by
lymphogen

Asymptomatic, fever,
cough, pulmonary
infiltrate, spread RES,
CNS, GI, adrenal gland

Blastomycosis

Blastomyces
dermatitidis
Per inhalation

Pulmonary blastomycosis,
spread hematogenous to
skin, bone, UG tract

Paracoccidiodomycosis

Paracoccidiodes
brasiliensis
Chlamydospores :
multiple budding
Per inhalation

Progressive pulmonary
disease spread skin,
mucocutaneus, liver,
adrenal

Microscopic :
tuberculated conidia
Sputum, urine, bone
marrow aspirates
Saboraud agar,
biopsy, skin test :
histoplasmin
Direct examination
microscope : broad
based budding yeast
Culture
Microscopic,
Culture
Biopsy
Skin test :
paracoccidiodin

treatment
Fluconazole,
ketoconazole,
itraconazole,
amphotericin B
Surgical resection of
pulmonary cvity
Itraconazole,
amphotericin B

Ketoconazole,
itraconazole,
amphotericin B
Amphotericin B,
itraconazole,
ketoconazole,
cotrimoxazole

Opportunistic fungi infection

Penyakit
Apergillosis

etiologi
A. fumigatus

mucormycosis

Rhizopus sp., Mucor

sp. , Absidia sp.

candidiasis

Candida albicans
NF skin, mucous
membrane,
pseudohyphae

cryptococcus

Cryptococcus
neoformans
Soil, bird droplings

Manifestasi klinis
Alergic
bronchopulmonary
aspergillosis : atopic
allergy, eosinophilia + IgE
Fungus ball aspergillosis
(aspergilloma)
colonization in sinuses,
lung, meatus acusticus
Invasive aspergillosis
seldom occur from lung
to adjacent organ
Sinusitis, pneumonia
spreading, rhinocerebral,
cutaneous
Cutaneous& mucosal
candidiasis oral thrush,
diaper rash, vulvovaginal
thrush, onychomycosis,
systemic candidiasis

test
Direct examination +
KOH
culture

treatment
Corticosteroid &
antifungal
(amphotericin B),
surgery

Direct examination +
KOH
culture
Direct
examination+KOH :
budding yeast +
pseudohiphae,
culture, serologic test

Antifungal, surgery

Chronic meningitis,
resemble brain tumor

Direct examination +
indian ink thick
capsule
Culture +
cycloheximide

Amphotericine B,
flucytosine,
fluconazole

Nystatin, gentian
violet 1%, flucytosine,
amphotericine B,
fluconazole
systemic infection