Fungal Infections Overview

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Questions and Answers

What is the most common type of Tinea Manuum?

Dyshidrotic type

Inflammatory vesicular type

Eczematous type

Non inflammatory squamous type (correct)

Tinea Pedis is the most common fungal infection worldwide.

True

Name one method of prevention for Tinea Pedis.

Keeping toes dry

The chronic intertriginous type of Tinea Pedis commonly affects the __________ toe webs.

3rd & 4th Signup and view all the answers

Match the types of Tinea Pedis with their descriptions:

Chronic intertriginous type = Fissuring and scaling between toes Chronic papulosquamous type = Moccasin-like scaling over soles Vesicular type = Small vesicles on instep Acute ulcerative type = Maceration and secondary infections Signup and view all the answers

Which of the following is a characteristic of Tinea Cruris?

Erythematous advancing annular rash Signup and view all the answers

Nummular eczema is a type of Tinea.

False Signup and view all the answers

What demographic is most commonly affected by Tinea Pedis?

Adult males Signup and view all the answers

Which of the following is NOT a predisposing factor for fungal infections?

High socioeconomic status Signup and view all the answers

Tinea Pedis is also known as Athlete's foot.

True Signup and view all the answers

Name one genera of fungi that is associated with superficial fungal infections.

Microsporum Signup and view all the answers

Tinea __________ is commonly known as ringworm of the scalp.

Capitis Signup and view all the answers

Match the type of Tinea with its description:

Tinea Barbae = Ringworm of beard and moustache area Tinea Corporis = Dermatophyte infection of body skin Tinea Faciei = Dermatophyte infection on the non-bearded face Tinea Pedis = Ringworm of the foot Signup and view all the answers

Which variety of Tinea Capitis is characterized by a painful, boggy swelling?

Kerion Signup and view all the answers

Tinea Corporis lesions typically have a clear center with hyperpigmentation.

True Signup and view all the answers

What is the common symptom of Tinea Faciei?

Burning and itching Signup and view all the answers

The type of Tinea that begins early in life with a yellow cup-shaped crust is called Tinea __________.

Favus Signup and view all the answers

Which type of Onychomycosis is the most common?

Distal and lateral subungual Onychomycosis Signup and view all the answers

What is the most common population at risk for Tinea Capitis?

Children Signup and view all the answers

Proximal Subungual Onychomycosis is the most common type of fungal nail infection.

False Signup and view all the answers

What is the primary etiology of Distal and lateral subungual Onychomycosis?

T.rubrum Signup and view all the answers

Onychomycosis is responsible for ____% of all nail diseases.

20 Signup and view all the answers

Which treatment is NOT recommended for Onychomycosis?

Acetaminophen Signup and view all the answers

Match the following clinical types of Onychomycosis with their descriptions:

<ol> <li>Distal and lateral subungual Onychomycosis = A. 90% of fungal nail infections</li> <li>Proximal Subungual Onychomycosis = B. Whitish-brownish area on the nail</li> <li>White Superficial Onychomycosis = C. Well circumscribed powdery white patches</li> <li>Total Dystrophic Onychomycosis = D. Complete nail dystrophy or thickening</li> </ol> Signup and view all the answers

White Superficial Onychomycosis can be easily scraped away.

True Signup and view all the answers

How long should treatment for toenail Onychomycosis generally continue?

6 months Signup and view all the answers

Which of the following is a causative organism of candidiasis?

Candida albicans Signup and view all the answers

Oral thrush typically appears as a green, moss-like layer on the tongue.

False Signup and view all the answers

What is the primary symptom of vulvovaginitis caused by candidiasis?

Itching and soreness with a thick, creamy white discharge Signup and view all the answers

_________ is the etiologic agent of pityriasis versicolor.

Malassezia furfur Signup and view all the answers

Which examination method shows yellow fluorescence for diagnosing pityriasis versicolor?

Wood’s Lamp examination Signup and view all the answers

Match the type of candidiasis with its description:

Oral thrush = Creamy white pseudomembrane on mucosa Vulvovaginitis = Itching and thick creamy discharge Balanoposthitis = Papules on the glans penis Chronic paronychia = Swelling and pus around nail fold Signup and view all the answers

Griseofulvin is effective in treating pityriasis versicolor.

False Signup and view all the answers

What treatment options are recommended for candidiasis?

Topical antifungals such as Clotrimazole and Miconazole or oral medications like Itraconazole and Fluconazole Signup and view all the answers

What is the primary etiology of Proximal Subungual Onychomycosis?

T. rubrum Signup and view all the answers

Distal and lateral subungual Onychomycosis accounts for 90% of all fungal nail infections.

True Signup and view all the answers

What is a clinical sign of Proximal Subungual Onychomycosis?

Whitish-brownish area on proximal part of nail Signup and view all the answers

Onychomycosis is responsible for ___% of all nail diseases.

20 Signup and view all the answers

Match the following treatment options with their types:

Terbinafine = Systemic Treatment Ciclopirox = Topical Treatment Fluconazole = Systemic Treatment Amorolfine = Topical Treatment Signup and view all the answers

How long should treatment for fingernail Onychomycosis be continued?

3 months Signup and view all the answers

White Superficial Onychomycosis is characterized by well-circumscribed patches that cannot be scraped away.

False Signup and view all the answers

What is the least common variant of Onychomycosis?

Proximal Subungual Onychomycosis Signup and view all the answers

Which of these organisms is NOT a causative agent of candidiasis?

Malassezia furfur Signup and view all the answers

Vulvovaginitis caused by candidiasis is characterized by a thin, watery discharge.

False Signup and view all the answers

What is a common site of infection for oral thrush in immunocompromised patients?

Tongue Signup and view all the answers

Chronic paronychia involves swelling of the nail fold along with __________ and discharge of pus.

pain Signup and view all the answers

Match the type of candidiasis with its description:

Oral thrush = Creamy, curd-like pseudomembrane Vulvovaginitis = Itching with thick, creamy discharge Balanoposthitis = Tiny papules on the glans penis Intertrigo = Erythema in skin folds Signup and view all the answers

What is the primary treatment for pityriasis versicolor?

Fluconazole 400mg single dose Signup and view all the answers

Angular cheilitis is soreness located at the college of the mouth.

False Signup and view all the answers

What is the method of examination that shows yellow fluorescence for diagnosing pityriasis versicolor?

Wood's Lamp examination Signup and view all the answers

Which type of Tinea Pedis is characterized by fissuring, scaling, or maceration of the toes?

Chronic intertriginous type Signup and view all the answers

Tinea Cruris is the medical term for a dermatophytic infection affecting the groins.

True Signup and view all the answers

Name one of the two main clinical forms of Tinea Manuum.

Non inflammatory squamous form or Inflammatory vesicular form Signup and view all the answers

Tinea _________ is commonly known as Athlete's foot.

Pedis Signup and view all the answers

Match the following types of Tinea Pedis with their descriptions:

Chronic intertriginous type = Commonly presents with fissuring and scaling between toes Chronic papulosquamous type = Causes patchy scaling over soles Vesicular type = Introduces small vesicles on the instep Acute ulcerative variant = Leads to maceration and ulceration of soles Signup and view all the answers

Which of the following best describes the inflammation associated with Tinea Cruris?

Intense and inflamed Signup and view all the answers

Wearing closed shoes can help prevent Tinea Pedis.

False Signup and view all the answers

What is the most common demographic affected by Tinea Pedis?

Adult males Signup and view all the answers

Which of the following is a predisposing factor for fungal infections?

Malnourishment Signup and view all the answers

Tinea Barbae is commonly seen in adult females.

False Signup and view all the answers

What is the common name for Tinea Corporis?

ringworm of the body Signup and view all the answers

Tinea __________ is characterized by yellow, cup-shaped crusts called scutulum.

Favus Signup and view all the answers

Match the type of Tinea with its description:

Tinea Capitis = Dermatophyte infection of the scalp Tinea Pedis = Athlete's foot Tinea Corporis = Dermatophyte infection of the body Tinea Faciei = Dermatophyte infection of the face Signup and view all the answers

What variety of Tinea Capitis is marked by a painful, boggy swelling?

Kerion Signup and view all the answers

Black Dot is a non-inflammatory type of Tinea Capitis.

False Signup and view all the answers

In which demographic is Tinea Capitis most commonly seen?

children Signup and view all the answers

HIV and diabetes are examples of __________ factors that can predispose individuals to fungal infections.

immunosuppressive Signup and view all the answers

Match the Tinea description with correct type:

Tinea Corporis = Annular lesions with clear center Tinea Manuum = Infection of the hands Tinea Cruris = Infection of the groin Tinea Pedis = Athlete's foot Signup and view all the answers

Study Notes

Fungal Infections

Fungal infections are common, affecting 20-25% of the world population.
Predisposing factors include tropical climates, manual labor, low socioeconomic status, profuse sweating, friction with clothes, malnutrition, and immunosuppression.
Fungal infections can be classified as superficial or deep.

Superficial Infections

Superficial fungal infections are caused by dermatophytes, specifically Microsporum, Trichophyton, and Epidermophyton.
Superficial fungal infections can affect different parts of the body:
- Tinea Capitis (Scalp Ringworm): Invasion of the hair shaft by dermatophytes, mainly seen in children.
  - There are 4 varieties:
    - Gray Patch (Ectothrix): non-inflammatory, caused by Microsporum spp, characterized by patches of partial hair loss with dull, grey, easily pluckable hairs.
    - Black Dot (Endothrix): characterized by brittle hair shafts, broken-off hairs with black dots, minimal inflammation, and green fluorescence under Wood's Lamp examination.
    - Kerion: inflammatory, painful, boggy swelling with purulent discharge, vesicles, pustules, thick crusting, matting of hair, lymphadenopathy, secondary bacterial infection, and scarring.
    - Favus: inflammatory, begins early in life, characterized by yellow, cup-shaped crusts (scutula), mousy odor, matted hair, and extensive patchy hair loss with cicatricial alopecia.
- Tinea Barbae (Barber's Itch): Ringworm of the beard and moustache area, mainly affecting adult males.
- Tinea Faciei: Dermatophyte infection of the non-bearded area of the face, characterized by burning, itching, photosensitivity, erythematous scaly patches, raised borders, and hypopigmented or brown central areas.
- Tinea Corporis: Dermatophyte infection of the skin excluding the scalp, beard, face, hands, feet, and groin.
- Tinea Manuum (Ringworm of the Palms): Common in adults, particularly males, with two main types:
  - Non-inflammatory squamous form: most common, characterized by hyperkeratosis of palms and fingers, accentuation of flexural creases, and association with hyperhidrosis.
  - Inflammatory vesicular/dyshidrotic/eczematous form: uncommon in temperate climates, characterized by vesicles mainly on the palms, itchiness, and spontaneous healing.
- Tinea Pedis (Athlete's Foot): Dermatophyte infection of the feet, most common fungal infection worldwide, affecting 30-70% of the population in developed countries.
  - Four types:
    - Chronic intertriginous: most common, characterized by fissuring, scaling, and maceration between the 3rd and 4th toes.
    - Chronic papulosquamous: inflammatory, patchy scaling over the soles.
    - Vesicular/vesiculobullous: small vesicles/vesiculopustules on the instep and mid anterior plantar surface with scaling.
    - Acute ulcerative: maceration, weeping, and ulceration of the soles with secondary infections possible.
- Tinea Cruris (Dhobi's Itch, Jock Itch): Dermatophytic infection of the groins, characterized by itching, sharply demarcated erythematous annular skin rash extending from the groins to the thighs.
- Onychomycosis: Infection of the nail caused by fungus, common infection affecting 20% of all nail diseases, characterized by dirty, dull, dry, pitted, ridged, split, discolored, thick, uneven nails with subungual hyperkeratosis.
  - Four types:
    - Distal and lateral subungual onychomycosis: most common, starts distally and moves proximally.
    - Proximal subungual onychomycosis: least common, characterized by whitish-brownish area on the proximal part of the nail, can be an early indicator of HIV infection.
    - White superficial onychomycosis: 2nd most common, characterized by well-circumscribed powdery white patches on the nail plate.
    - Total dystrophic onychomycosis: characterized by complete destruction of the nail plate.

Treatment of Dermatophyte Infections

Topical Treatment: Bifonazole, Oxiconazole, Clotrimazole, Miconazole, Butenafine, Terbinafine, available in lotions, creams, powders, and gels.
Systemic Treatment: Griseofulvin, Fluconazole, Terbinafine, Itraconazole.
Duration of Treatment:
- Tinea capitis: 6 weeks
- Tinea faciei: 4 weeks
- Tinea cruris: 2-4 weeks
- Tinea corporis: 4-6 weeks
- Tinea manuum/pedis: 6-8 weeks

Treatment of Onychomycosis

Topical Treatment: 8% Ciclopirox olamine lotions, Amorolfine lacquer.
Systemic Treatment: Same treatment as for dermatophyte infections for 3 months (fingernails) or 6 months (toenails), Pulse Therapy with Terbinafine or Itraconazole can be considered.

Treatment Principles for Fungal infections

Dermatophytosis takes 3-4 weeks to resolve with complete treatment, including one week beyond apparent cure.
Good hygiene, proper clothing, and treatment of predisposing factors are crucial.
Onychomycosis requires 3-6 months of treatment with 4 weeks beyond apparent cure.

Candidiasis

Causative organism: Candida albicans, Candida tropicalis, Candida pseudotropicalis.
Sites of affection: mucous membranes, skin, nails.
Mucosal Candidiasis:
- Oral Thrush: creamy, curd-like white pseudomembrane on an erythematous base in immunocompetent patients, affecting cheeks, gums or palate; in immunocompromised patients, it can affect the tongue and extend to the pharynx or esophagus.
- Angular Cheilitis (Angular Stomatitis/Perleche): soreness at the angles of the mouth.
- Vulvovaginitis (Vulvovaginal Thrush): itching, soreness, thick creamy white discharge.
- Balanoposthitis: tiny papules on the glans penis after intercourse evolving into white pustules or vesicles, radial fissures on glans penis in diabetics, vulvovaginitis in conjugal partner.
Flexural Candidiasis (Intertrigo): Erythema and maceration in folds, axilla, groins, webspaces, and napkin rash (pustules with irregular borders and satellite lesions).
Candidiasis of Nail:
- Chronic Paronychia: swelling of the nail fold with pain and discharge of pus.
- Onychomycosis: Destruction of the nail plate.

Treatment of Candidiasis:

Treat predisposing factors, including poor hygiene, diabetes, AIDS, and conjugal infections.
Topical Treatment: Clotrimazole, Miconazole, Ciclopirox olamine.
Oral Treatment: Itraconazole, Fluconazole.

Pityriasis Versicolor

Etiologic agent: Malassezia furfur.
Common among youth with genetic predisposition and familial occurrence.
Characterized by multiple, discrete, fawn, brown, grey, or hypopigmented macules, pinhead-sized to large sheets of discolouration.
Typically affecting seborrheic areas, upper half of the body: trunk, arms, neck, abdomen.

Investigations for Pityriasis Versicolor:

Wood's Lamp examination: Yellow fluorescence.
KOH preparation: spaghetti and meatball appearance (coarse mycelium, fragmented to short filaments with spherical, thick-walled yeasts).

Treatment of Pityriasis Versicolor:

Topical Treatment: Clotrimazole, Miconazole, Bifonazole, Oxiconazole, Butenafine, Terbinafine, Selenium sulfide, Sodium thiosulphate.
Oral Treatment: Fluconazole (single dose). Griseofulvin is not effective.

Fungal Infections

Fungal infections are a common type of infection, affecting 20-25% of the world's population.
Predisposing factors for fungal infections include tropical climates, manual labor populations, low socioeconomic status, profuse sweating, friction with clothes, synthetic innerwear, malnourishment, and immunosuppression.
Immunosuppression can be caused by HIV, congenital immunodeficiencies, corticosteroid use, immunosuppressive drugs, and diabetes.

Superficial Cutaneous Fungal Infections

Superficial cutaneous fungal infections are caused by three genera: Microsporum, Trichophyton, and Epidermophyton.
These infections can be categorized by location on the body:
- Tinea Capitis (Scalp Ringworm): Invades the hair shaft, primarily affecting children, with boys demonstrating a higher prevalence than girls.
- Tinea Barbae (Barber's Itch): Affects the beard and moustache area in adult males, characterized by inflammatory papulopustules.
- Tinea Faciei: Dermatophyte infection of the non-bearded area of the face, often presents with burning, itching, and photosensitivity.
- Tinea Corporis: Infection of the skin excluding the scalp, beard, face, hands, feet, and groin. Presents with annular or polycyclic lesions, often with raised borders.
- Tinea Manuum (Ringworm of the Hand): Primarily affects adults, most commonly presenting as a non-inflammatory squamous form with hyperkeratosis and accentuation of flexural creases.
- Tinea Pedis (Athlete's Foot): The most common fungal infection worldwide, particularly affecting adult males. Presents with varying clinical types including intertriginous, papulosquamous, vesicular, and acute ulcerative variants.
- Tinea Cruris (Dhobi's Itch, Jock Itch): Dermatophytic infection of the groins, characterized by itching, a sharply demarcated erythematous rash, and variable scaling.
- Onychomycosis (Nail Fungus): Infection of the nails, frequently occurring in 20% of all nail diseases. Presents with various clinical types including distal and lateral subungual, proximal subungual, white superficial, and total dystrophic.

Tinea Capitis (Scalp Ringworm)

Tinea Capitis can present with varying lesions, ranging from subtle grey broken hairs with minimal scaling to severe, painful inflammatory masses.
Partial hair loss is common across all types.
There are four varieties of Tinea Capitis:
- Gray Patch (Ectothrix): Non-inflammatory type caused by Microsporum species, characterized by patches of partial hair loss and easily pluckable, dull grey hairs.
- Black Dot (Endothrix): Endothrix organisms cause brittle hair shafts, leading to black dots from broken off hairs. Inflammation is minimal, and a Wood's Lamp examination will reveal green fluorescence.
- Kerion: Inflammatory type with painful, boggy swelling, purulent discharge, vesicles, pustules, thick crusting, matted hair, lymphadenopathy, and secondary bacterial infection. Heals with scarring.
- Favus: Inflammatory type that begins early in life. Characterized by yellow, cup-shaped crusts (scutula), mousy odor, matted hair, and extensive patchy hair loss with cicatricial alopecia.

Tinea Barbae (Barber's Itch)

Affects the beard and moustache area, primarily affecting adult males.
The fungus invades coarse hairs, causing inflammatory papulopustules, seropurulent discharge, and easy hair epilation.
It can be difficult to differentiate from bacterial folliculitis, requiring confirmation through KOH mount.

Tinea Faciei

Dermatophyte infection of the non-bearded area of the face.
Presents with burning, itching, and photosensitivity.
Lesions appear as erythematous, scaly patches with raised borders and a central area of hypopigmentation or brown discoloration.
Often seen in immunocompromised patients.

Tinea Corporis

Infection of the skin excluding the scalp, beard, face, hands, feet, and groin.
The fungus enters the stratum corneum and spreads centrifugally.
Presents with annular or polycyclic lesions, often with raised borders and a clear, hyperpigmented center.
Concentric rings may be visible.

Tinea Manuum (Ringworm of the Hand )

Primarily affects adults, most commonly presenting as a non-inflammatory squamous form:
- Hyperkeratosis of palms and fingers
- Accentuation of flexural creases
- Association with hyperhidrosis
An inflammatory vesicular/dyshidrotic/eczematous form is uncommon in temperate climates, presenting with vesicles on the palms.

Tinea Pedis (Athlete's Foot)

The most common fungal infection worldwide, particularly affecting adult males.
Associated with wearing shoes and maceration.
Presents with four clinically accepted variants:
- Chronic intertriginous type: Fissuring, scaling, or maceration, commonly found in the lateral 3rd and 4th toe webs.
- Chronic papulosquamous type: Inflammation and patchy "mocassin-like" scaling over the soles.
- Vesicular or vesiculobullous type: Small vesicles/vesiculopustules on the instep and mid-anterior plantar surface, often associated with scaling.
- Acute ulcerative variant: Maceration, weeping, and ulceration of the soles, often complicated by secondary infections.

Tinea Cruris (Dhobi's Itch, Jock Itch):

Dermatophytic infection of the groins.
Characterized by itching and a sharply demarcated erythematous rash that advances in an annular pattern.
The rash extends from the groins to the thighs.
Scaling is variable and can mask inflammatory changes.
Vesiculation is rare.

Onychomycosis (Nail Fungus)

Infection of the nails, frequently occurring in 20% of all nail diseases.
Presents with a variety of clinical types:
- Distal and lateral subungual Onychomycosis: The most common type, caused by T.rubrum, affecting toe nails more than fingernails. The infection begins in the distal nailbed or lateral nailfold and moves proximally.
- Proximal Subungual Onychomycosis: Least common variant, caused by T.rubrum. The first sign is a whitish-brownish area on the proximal part of the nail. It can be an early indicator of HIV infection.
- White Superficial Onychomycosis: Second most common type. Well-circumscribed powdery white patches on the nail plate, easily scraped away, leaving a rough and friable nail surface.
- Total Dystrophic Onychomycosis: Characterized by involvement of the entire nail.

Candidiasis

Caused by Candida species, most commonly Candida albicans.
Affects mucous membranes, skin, and nails.
Mucosal candidiasis is common in immunocompromised patients, but also affects immunocompetent individuals.
- Oral thrush: Creamy, curd-like, white pseudomembrane on an erythematous base, affecting cheeks, gums, and palate.
- Angular cheilitis: Soreness at the angles of the mouth.
- Vulvovaginitis: Itching and soreness with a thick, creamy white discharge.
- Balanoposthitis: Tiny papules on the glans penis after intercourse, evolving into white pustules or vesicles that rupture.
Flexural candidiasis presents as erythema and maceration in skin folds, particularly in the axilla, groins, and webspaces.
Napkin rash presents with pustules, an irregular border, and satellite lesions.
Nail candidiasis presents as:
- Chronic paronychia: Swelling of the nailfold with pain and discharge of pus.
- Onychomycosis: Destruction of the nail plate.

Pityriasis Versicolor

Caused by Malassezia furfur.
Common among youth and associated with genetic predisposition and familial occurrence.
Presents with multiple, discrete, discolored macules that can be fawn, brown, grey, or hypopigmented.
Lesions range in size from pinhead-sized to large sheets of discoloration.
Affects seborrheic areas, particularly the upper half of the body, including the trunk, arms, neck, and abdomen.

Treatment

Topical Treatment:*
Dermatophyte Infections: Bifonazole, Oxiconazole, Clotrimazole, Miconazole, Butenafine, Terbinafine. Vehicles include lotions, creams, powders, and gels.
Onychomycosis: 8% Ciclopirox olamine lotions for local application.
Candidiasis: Clotrimazole, Miconazole, Ciclopirox olamine.
Pityriasis Versicolor: Clotrimazole, Miconazole, Bifonazole, Oxiconazole, Butenafine, Terbinafine, Selenium sulfide, Sodium thiosulphate.
Systemic Treatment:*
Dermatophyte Infections: Griseofulvin, Fluconazole, Terbinafine, Itraconazole.
Onychomycosis: Same medications as systemic dermatophyte treatments, for 3 months (fingernails) or 6 months (toenails).
Candidiasis: Itraconazole, Fluconazole.
Pityriasis Versicolor: Fluconazole, Griseofulvin is NOT effective.
Treatment Principles:*
Dermatophytoses require 3-4 weeks of treatment, extending 1 week beyond the apparent cure.
Proper hygiene, clothing, and avoidance of communal changing rooms and swimming baths is recommended.
Onychomycosis treatment is generally for 3-6 months, extending 4 weeks beyond the apparent cure.
Temporary relief should not be mistaken for cure.

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Description

Explore the various types of fungal infections, including superficial and deep infections. Learn about the common causes, predisposing factors, and specific conditions such as Tinea Capitis. This quiz delves into the dermatophytes responsible for these infections and their effects on different parts of the body.