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MIKOSIS SUPERFISIAL
DERMATOFITOSIS
MIKOSIS SUBKUTAN
Dr.Sofyan Lubis
Departemen Mikrobiologi
Fak.Kedokteran USU
2008
Pendahuluan
When fungi do pass the resistance barriers of
the human body and establish infections, the
infections are classified according to the tissue
levels initially colonized
Superficial mycoses
Cutaneous mycoses (Dermatophytoses )
Subcutaneous mycoses
Systemic mycoses
Opportunistic mycoses
Levels of Invasion
Superficial Mycoses
There are a number of fungi capable of infecting
various superficial structure, including hair, nails,
stratum corneum of the skin, the cornea, and the
lining of the external ear canal
1http://www.mycology.adelaide.edu.au/Mycoses/Superficial/Malassezia_infections/index.html
Culture of Malassezia furfur on Dixon's agar
(contains glycerol mono-oleate)
Tinea Nigra (palmaris)
Infeksi superfisial, paling sering di telapak
tangan coyy
disebabkan oleh black yeast (rasis bah!)
Phaeoannellomyces werneckii (Exophiala
werneckii)
Lesinya umumnya berwarna gelap, non-
scaling macules dan asimptomatik
Paling sering di daerah tropis atau semitropis
Amerika bagian tengah atau selatan, Africa,
dan Asia
Typical brown to black, non-scaling macules
on the palmar aspect of the hands.
Note there is no inflammatory reaction.2
http://www.mycology.adelaide.edu.au/Mycoses/Superficial/Tinea_nigra/index.ht
Fungal keratitis
Ini adalah infeksi di permukaan kornea
yang biasanya diikuti dengan cedera
mata
Jamur yang terlibat :
Fusarium solani,
Aspergillus fumigatus,
Candida albicans,
and several other genera of filamentous
fungi
Fungal otitis externa
infeksi jamur pada kanal
auditory externa
Fungal otitis externa
Disebabkan oleh beberapa spesies
dari Aspergillus (paling sering
A.niger), tapi Candida albicans juga
mampu menginfeksi daerah ini.
Gejala yang utama adalah gatal dan
terasa penuh di telinga
BLACK PIEDRA
Infeksi jamur pada rambut kepala
Agen Etiologi: Piedraia hortae
sering di daerah tropis
Temuan klinis: Discrete, keras,
nodules cokelat gelap hingga hitam
di rambut
BLACK PIEDRA
Micr. hifa septate berpigmen,
dan ascus ( pl.asci )
Unicellular dan fusiform
ascospores dengan polar
filament(s)
Culture: koloni dengan warna cokelat
kehitaman
Treatm.: Topical salicylic acid, azol
creams
Piedraia hortae
WHITE PIEDRA
Infeksi jamur pada wajah, axila dan
rambut daerah genital
Agen etiologi: Trichosporon
beigelii
Sering di daerah tropis dan
temperate
WHITE PIEDRA
Clinical findings: Soft, nodules putih
kekuningan yang melekat dengan
longgar di rambut (loosely
attached)
Micr.: Intertwined septate hyphae,
blasto- and arthroconidia
Culture: Soft, creamy colonies
Treatm.: Shaving, azoles
White piedra
Black piedra
Conidia of Phaeoannellomyces werneckii
Cutaneous mycoses
Dermatophytosis
Cutaneous candidiasis
Dermatophytosis
Dermatophytosis (tinea or ringworm)
adalah infeksi struktur yang berkeratin,
termasuk kuku, batang rambut, &
stratum corneum di kulit, oleh
organisme yang disebut dermatophytes
;
Trichophyton
Epidermophyton keratophilic
Microsporum
Fungi in Cutaneous
Mycoses
Trichophyton Microsporum Epidermophyton
(TRI) (SHair) ( SNails)
3 http://www.mycology.adelaide.edu.au/Mycoses/Cutaneous/Dermatophytosis/index.html
Tinea capitis
Tinea pedis
Tinea Capitis (scalp ringworm)
Three main patterns of hair invasion
Endothrix infections, in which arthrospores
are formed within hair shaft
Ectothrix infections, in which sporulation
occurs outside the hair
Favic, in which the hyphae do not survive
well in hair keratin and cause encrustation
or scutula around the hair follicle
KOH mount of infected hairs showing KOH mount of an infected hair showing an
ectothrix invasion by M. gypseum. 3 endothrix invasion caused by T. tonsurans3
SUBCUTANEOUS MYCOSES
Sporotrichosis
Chromoblastomycosis
Eumycotic Mycetoma
Entomophthoramycosis
Phaeohyphomycosis
Rhinosporidiosis
Lobomycosis
SPOROTRICHOSIS
General features
Chronic inf. involving cutaneous,
subcutaneous and lymphatic tissue
Frequently encountered in
gardeners ,florists
May develop in otherwise healthy
individuals
Most common in Mexico, endemic in
Brasil
SPOROTRICHOSIS
Causative agent
Sporothrix schenkii
Thermally dimorphic
Natural habitat: soil
37C: Round/cigar-shaped yeast cells
25C: Septate hyphae, rosette-like
clusters of conidia at the tips of the
conidiophores
SPOROTRICHOSIS
Pathogenesis & Clinical Findings
Sporothrix schenkii - dematiaceous/dimorphic
Reservoir - soil, decaying vegetation, worldwide
distribution
Transmission
Traumatic implantation, occupational disease
Clinical
Subcutaneous nodules
Suppuration, ulceration and drainage
Spread down lymphatic course.
SPOROTRICHOSIS
Diagnosis
Samples: Aspiration fluid, pus, biopsy
I. Microscopic examination :
. Direct microscopic examination (KOH), .
. Histopathological examination with
Gomori methenamine silver stain
II.Culture
III.Serology :Yeast agglutination test
IV. Sporotrichin skin test
Direct microscopy
Poor sensitivity. Sparse yeast cells, asteroid body
Culture
Good yield and grows on most media
Room temp for isolation (37oC is slower)
Identification
A white to grey mold becoming moist
Hyaline hyphae, mixed hyaline/dematiaceous conidia
Need in vitro conversion to yeast
SPOROTRICHOSIS
Treatment
Spontaneous healing is possible.
Conidia forming
a rosette-like
Sporothrix schenckii
Yeast form
Round, oval and
fusiform budding
yeast cells of
various sizes 2-3 x
3-10 m
Cigar-bodied
370C on BHI agar
Sporothrix schenckii
Sporotrichosis
Subcutaneous, pulmonary sporotrichosis
Scattered worldwide
Cutaneous
sporotrichosis
Sporotrichosis
CHROMOBLASTOMYCOSIS
General features
Reservoir and transmission
Traumatic implantation from decaying vegetation, but
chronicity dictates that it is uncommon in developed
countries.
Clinical presentation is distinctive
Hyperkeratosis and hyperplasia
Tumour like warty cauiliflower growths
Very slow progression
Uncommon in children (? time or immune)
Treatment - antifungals / surgery / heat
Chromoblastomycosis
Classified by presence of fungal tissue form AND
clinical presentation, NOT aetiology
No dimorphism in vitro
Chromoblastomycosis
# TROPHOCYTE
# SPORANGIA
RHINOSPORIDIOSIS
Treatment
Ethylstilbamidine
Surgery
(Local injection)
Rhinosporidiosis
Lobomycosis
Syn. Keloidal Blastomycosis
Central and South America
Keloidal plaques +/- sinuses
In ear, may resemble cauliflower ear
Dolphins may harbor this infection
Therapy :: Excision, Amphotericin B
usually unsuccessful
LOBOMYCOSIS
Pathogenesis & Clinical features
Chronic, subcutaneous, progressive inf.
Traumatic inoculation of the fungus
Natural infection : in dolphins
Hard, painless nodules on extremities,
face and ear
Verrucous / ulcerative lesions
Lesions mimic those of chromoblasto-
mycosis, mycetoma, Carcinoma.
LOBOMYCOSIS
Causative agent
Loboa loboi ( Lacazia loboi )
Multiple budding yeast cells
Forming short chains
Asteroid body
Clofazimine
Amphotericin B
Sulphonamides
Entomophtoramycosis
Subcutaneous zygomycosis
Caused by entomophthorale
Basidiobolus coronatus : Basidiobolomycosis
Conidiobolus ranarum : Conidiobolomycosis
Entomophthoramycosis
Candidiasis of skin, mucous
membranes and nails
Predisposing factors
Infancy, pregnancy, old age
Disorders of immune function, e.g., leukemia,
corticosteroid therapy
Chemotherapy, e.g., immunosuppressive,
antibiotic
Endocrine disease, e.g., diabetes mellitus
Carcinoma
Candidiasis of skin, mucous
membranes and nails
Oropharyngeal candidiasis: including thrush,
glossitis, stomatitis, and angular cheilitis ( perleche )
Candidiasis of skin, mucous
membranes and nails
Cutaneous cadidiasis : including
intertrigo, diaper candidiasis,
paronychia and onychomycosis
Candidiasis of skin, mucous
membranes and nails