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SubQ and Cutaneous Fungal Infections (Cutaneous Mycoses (Dermatophytes …

- - - - Arthroderma genus
        (environmental form)
        
        :star: Most common pediatric dermatophyte infection worldwide :star:
        
        Microsporum
        
        M. canis
        
        ID: Micro & Macroconidia (asexual spores observed in LAB ONLY:!: on culture - not in vivo)
        
        Mycelium after several days
        
        :cat:
        
        Adult = subclinical carriers
        
        Kittens = symptomatic
        
        :dog:
        
        Puppies = symptomatic
        
        Tinea Corporis (torso)
        
        Annular scaley plaques & vesicles
        
        Dx:
        
        Fluoresce under Wood's light :bulb:
        
        Trichophyton
        
        T. rubrum
        :star2:Most common dermatophyte in humans :star2:
        
        Tinea Barbae (beard)
        
        Affects hair & skin of beard & neck regions
        :man::skin-tone-2:
        
        Erythema
        
        Scaling
        
        Pustules
        
        Highly inflammatory
        
        :star::star:
        
        T. Tonsurans
        
        :star: MCC (US) :star:
        
        Tinea Capitis (scalp)
        
        Childhood disease - :notebook: school children
        
        Spontaneously resolves at PUBERTY
        
        Black Dot Ringworm (hair breaks off)
        
        Alopecia
        
        Kerion (boggy inflammation)
        
        :warning:Scarring & permanent alopecia possible
        
        1 more item...
        
        ECTOthrix Infection
        Outside hair shaft
        
        Microsporum
        
        Trichophyton
        
        ENDOthrix Infection
        Inside hair shaft
        
        Trichophyton
        
        T. mentagrophytes
        :star:2nd most common dermatophyte in humans
        
        Microconidia
        
        Tinea Manus (hand)
        
        Palms, finger webs
        
        ONE hand usually
        
        Assoc. Tinea Pedis
        
        Scaling & Erethma
        EX: dishwasher - hands always wet
      - Epidermophyton
        
        E. floccosum
        
        Tinea Cruris (groin)
        "JOCK ITCH"
        MEN :male_sign:
        
        Candida
        
        Elderly pts esp.
        
        Intense puritis
        
        Pain possible
        
        RF:
        
        DM, obesity, excess perspiration
        
        Direct & indirect contact w/ fomites (towels, clothing, bedding)
        
        Tinea Pedis (foot)
        
        ADULTS in USA
        
        Toe webs & soles
        
        Scaling & peeling
        
        Erythema
        
        Vesicles
        
        Puritis (initially)
        
        :mans_shoe: Linked to shoe use :athletic_shoe:
        :!!: Most Prevalent Dermatophytosis :!!:
        
        Tinea Unguium (nails)
        (Onychomycosis)
        
        ADULT MALES :male_sign: (shoes, boots)
        
        Can spread to genital region
      - :explode:Infection via CONTACT w/ Arthroconidia (main infective stage - fragmented)
      - Human Infection S&S:
        
        Lesions inflamed at edges w/ a central clearing
        
        Hair loss w/ puritis, not debilitating
        
        Disseminated disease poss in HIV pts
    - - :star: 10% KOH or lactophenol cotton blue to see Arthroconidia & Hyphae in tissue (FASTEST)
      - Culture on:
        
        Sabouraud agar
        OR
        
        Dermatophyte Test Medium (DTM)
        
        (At room temp, mature in 1-4 wks)
        SLOW GROWER
        
        Can STAIN DTM --> Red color change in 3 days
    - - Person 2 Person
      - Fomite
    - - Zoophilic
        Animal :arrow_right: Humans
      - Anthrophophilic
        Human Transmission
      - Geophilic
        Soil :arrow_right: Humans
    - - 1. ANTIFUNGAL AGENTS: Target ergosterol in CM (toxic in humans)
        
        Amphotericin B
        
        Nystatin
        
        Tolnaftate
        
        Griseofulvin (oral)
        
        Terbinafine (ORAL, blocks sterol synthesis)
        
        Any "-AZOLE" (including yeast infection cream)
        
        Intraconazole - PULSE DOSING (1 week on, 3 weeks off to avoid LIVER toxicity)
        
        Undecylenic acid (fatty acid) OTC, NOT effective
        
        :warning: Topical treatments not very effective. ORAL admin. preferred.
        
        :worried: COMPLICATIONS OF EXCESSIVE TREATMENT:
        Dermatophytid
        
        Dermal reaction to fungal antigens
        
        Hypersensitivity at distal site
        
        Lesions devoid of organisms - can't isolate
        
        Most common in Tinea Pedis :keycap_star:
      - 2. Spray Shoes:
        
        Benzalkonium chloride
        :warning: will NOT work for topical treatment
        
        Use for surface disinfectant
      - 3. Laser treament
      - 4. Remove toenail completely
    - - Avoid SPORES:
        
        Arthroconidia SHEDS from skin & hair
        
        Vacuum
        
        Bleach
        
        Benzalkonium chloride
        
        Detergents
  - - - "Sun spots"
        
        HYPO-pigmentation
        
        Tyrosinase inhibitors interfere w/ melanin production
        
        HYPER-pigmentation
        
        Induces enlargment of melanosomes
        
        Malassezia furfur
        
        (Lipophillic yeast)
        
        Unbranched hyphae & spherical cells
        
        Yeast-like colony (lipophillic yeast)
        
        Depigmented maculae
        
        Tropics :palm_tree:
        
        Young adults
        
        :PILL: Treatment - TOPICAL:
        
        Selenium (Selsun Blue shampoo)
        
        Miconazole
    - - Brown skin lesions
        
        Palms of hands affected
        
        Hortaea werneckii
        
        :pill: Treatment - TOPICAL:
        
        Iodine or azole creams
        
        Tropics & subtropics :palm_tree:
        
        Young children & young adults
        
        Female :female_sign:
- - - - Lymphocutaneous Sporotrichosis
        Abscess, Nodules or Ulcers form along lymphatics
        
        Chronic Granulomas & Necrosis