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**[[Superficial Mycoses]](#bookmark=id.pdhbgc5bybef) Nondermatophytic** **Name** **General Features** **Lab** **Clinical** **Tinea/Pityriasis Versicolor** - - - - - - - - - - - - - - - - - - - **Tinea nigra** - - - - - - - -...

**[[Superficial Mycoses]](#bookmark=id.pdhbgc5bybef) Nondermatophytic** **Name** **General Features** **Lab** **Clinical** **Tinea/Pityriasis Versicolor** - - - - - - - - - - - - - - - - - - - **Tinea nigra** - - - - - - - - - - - - - - - - - - - - - - **Black Piedra** - - - - - - - - - - - - - - - - - - - - - - **White piedra** - - - - - - - - - - - - - - - - - - - - - - +-----------------+-----------------+-----------------+-----------------+ | [**[Cutaneous & | | | | | Subcutaneous | | | | | Mycoses]{.under | | | | | line}**](#bookm | | | | | ark=id.v29pj57i | | | | | 004x) | | | | +=================+=================+=================+=================+ | **Name** | **General | **Lab** | **Clinical** | | | Features** | | | +-----------------+-----------------+-----------------+-----------------+ | **Genus | - - - - | - - - - | - - | | *Dermatophytes* | - - | - | | | ** | | | - - - - | | | - - - | - | - - - - | | | - | | | | | | - - - | | | | - - - | | - - - | | | - - | - - - | - - | | | | | | | | - | | - - - | | | | | - | | | | | | | | | | - - | | | | | | | | | | - - - | | | | | - | | | | | | | | | | - - - | | | | | - | | | | | | | | | | - | | | | | | | | | | - - - - | | | | | - - | +-----------------+-----------------+-----------------+-----------------+ | ***Microsporum* | - - | - - - - | | | ** | | - - | | +-----------------+-----------------+-----------------+-----------------+ | ***Trichophyton | - | - - - - | | | *** | | - - | | | | | | | | | | - - - - | | | | | - | | +-----------------+-----------------+-----------------+-----------------+ | ***Epidermophyt | - - - | - - - | | | on*** | | | | | | - | - | | +-----------------+-----------------+-----------------+-----------------+ | **Candidiasis** | - - - | - - | - - - | | | | | | | | | - | | +-----------------+-----------------+-----------------+-----------------+ | **Dermatomycosi | - | - | - | | s** | | | | +-----------------+-----------------+-----------------+-----------------+ +-----------+-----------+-----------+-----------+-----------+-----------+ | [**[Syste | | | | | | | mic]{.und | | | | | | | erline}** | | | | | | | [ | | | | | | | **Mycoses | | | | | | | **]{.unde | | | | | | | rline}](# | | | | | | | bookmark= | | | | | | | id.iyuzgj | | | | | | | 80piy1) | | | | | | | | | | | | | |  | | | | | | +===========+===========+===========+===========+===========+===========+ | **Name** | **Etiolog | **Pathoge | **Diagnos | **Clinica | **Treatme | | | ic | nesis | is** | l | nt** | | | agents** | & | | Manifesta | | | | | Transmiss | | tions** | | | | | ion** | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | | | Saprobic | | | | | | | phase: | | | | | | | | | | | | | | Parasitic | | | | | | | phase: | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ +-----------+-----------+-----------+-----------+-----------+-----------+ | **Opportu | | | | | | | nistic | | | | | | | Mycoses** | | | | | | +===========+===========+===========+===========+===========+===========+ | **Name** | **Causati | **Transmi | **Lab | **Clinica | **Treatme | | | ve | ssion** | diagnosis | l | nt** | | | agent** | | ** | Manifesta | | | | | | | tions** | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Candidias | *Candida | | [Type of | Balanitis | **Mucocut | | is | albicans | | specimens | | aneous | | | =* thick | | ]{.underl | Vaginitis | candidias | | | walled | | ine}: | | is:** | | | chlamydos | | | Endophtha | | | | pores, | | swabs, | lmitis | Topical | | | yeast | | spinal | | nystatin, | | | form for | | fluid, | Esophagit | ointments | | | colonizat | | exudates, | is | , | | | ion | | urine, | | creams | | | of | | blood | Endocardi | | | | surfaces, | | scraping | tis | Fluconazo | | | dissemina | | from | | le | | | tion | | superfici | Flexural | | | | to host | | al | candidias | Oral | | | tissues | | lesions | is | ketoconaz | | | | | | | ole | | | Pseudohyp | | 1. | Systemic | | | | hae | | | candidias | **Systemi | | | for | | - | is | c | | | motility | | | | candidias | | | and | | 2. 3. 4 | Candidemi | is** | | | nutrient | |. | a | | | | scavengin | | | (bloodstr | Echinocan | | | g | | | eam | dins | | | | | | infection | -(*Candid | | | Hyphae - | | | s) | a | | | lysis of | | | | glabrata | | | neutrophi | | | | and | | | ls | | | | krusei*) | | | and | | | | | | | macrophag | | | | - - - | | | es, | | | | | | | entry | | | | | | | into | | | | Fluconazo | | | mucosal | | | | le | | | cell | | | | | | | layers | | | | Amphoteri | | | | | | | cin | | | Phenotypi | | | | B with | | | c | | | | oral | | | switching | | | | flucytosi | | | , | | | | ne | | | from | | | | -(*Candid | | | smooth | | | | a | | | white | | | | glabrata | | | colony to | | | | and | | | unicellul | | | | krusei*) | | | ar | | | | | | | yeast | | | | Preventio | | | cells | | | | n: | | | | | | | avoid | | | Multidrug | | | | catheter | | | resistant | | | | use and | | | *Candida | | | | broad | | | auris -* | | | | spectrum | | | bloodstre | | | | antibioti | | | am | | | | cs | | | infection | | | | | | | s | | | | | | | | | | | | | | *Candida | | | | | | | glabrata* | | | | | | | as yeast | | | | | | | cells *-* | | | | | | | second | | | | | | | most | | | | | | | common | | | | | | | cause of | | | | | | | dissemina | | | | | | | ted | | | | | | | candida | | | | | | | infection | | | | | | | s | | | | | | | | | | | | | | Only in | | | | | | | yeast | | | | | | | form | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Cryptococ | *Cryptoco | No human | [Type of | Asymptoma | Amphoteri | | cosis | ccus | to human | specimens | tic | cin | | | neoforman | transmiss | ]{.underl | in | B and | | | s. | ion | ine}: | immunocom | flucytosi | | | -* | | Spinal | ptent | ne | | | capsular | 1. 2. | fluid, | or | in | | | serotypes | | tissue, | pneumonia | meningiti | | | : | | exudates, | producing | s | | | A, D, AD | | sputum, | lung | (Inductio | | | (highly | | blood, | nodules | n | | | virulent) | | urine | in | therapy) | | | | | | compromis | -\> 9 | | | Saprophyt | | 1. | ed | week | | | es | | | infection | consolida | | | in soil | |  | ous | fluconazo | | | ) | | | nodules | le | | | | | 2. | in | or | | | 2 | | | dissemina | itraconaz | | | varieties | | Difficult | ted | ole | | | : | | to | disease | | | | less | | different | | Treatment | | | pathogeni | | iate | Dissemina | with | | | c | | from | ted | fluconazo | | | *C. | | *Candida* | infection | le | | | gattii -* | | on SDA | (Cutaneou | in AIDS | | | B and C; | | | s, | patients | | | *neoforma | | \- | Mucocutan | for long | | | ns | | **Urease | eous, | term | | | -* | | positive* | Visceral | suppressi | | | serotype | | * | or | on | | | D | | for all | Cerebrome | of | | | | | species | ningal) | cryptococ | | | *C. var | | | | cal | | | grubii* | | Cyclohexa | Pustular, | meningiti | | | (serotype | | mide | nodular | s | | | A) | | inhibits | dissemina | (relapses | | | | | growth | ted | are | | | Basidiomy | | | | frequent) | | | cetous | | - | | | | | yeasts | | | | *C. | | | with | | 3. | | gattii* | | | large | | | | is less | | | **polysac | | | | responsiv | | | charide | | | | e | | | capsules* | | | | to | | | * | | | | antifunga | | | behind | | | | l | | | backgroun | | | | drugs | | | d | | | | than C. | | | of India | | | | neoforman | | | Ink, not | | | | s | | | dimorphic | | | | | | | | | | | No | | | Budding | | | | specific | | | cell, | | | | means of | | | polysacch | | | | preventio | | | aride | | | | n | | | capsule, | | | | | | | teleomorp | | | | | | | h | | | | | | | can grow | | | | | | | as | | | | | | | mycelia | | | | | | | in vitro | | | | | | | \> | | | | | | | Basidiosp | | | | | | | ore | | | | | | | chains, | | | | | | | Basidium | | | | | | | at | | | | | | | terminal | | | | | | | end of | | | | | | | hyphae | | | | | | | (37 | | | | | | | degrees) | | | | | | | enzyme | | | | | | | *laccase* | | | | | | | for | | | | | | | melanin | | | | | | | from | | | | | | | phenolic | | | | | | | substrate | | | | | | | s | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Aspergill | caused by | 1. | [Type of | Allergy | Aspergill | | osis | *Aspergil | | specimens | | oma | | | lus | 2. | :]{.under | Allergic | | | | flavus, | Ingestion | line} | bronchopu | - - - | | | fumigatus | (aflatoxi | sputum, | lmonary | | | | * | ns | respirato | aspergill | | | | (45 | can | ry | osis | Invasive | | | degrees | establish | samples | (ABPA) | aspergill | | | celsius)* | disease), | | | osis | | | , | | 1. | - - - | | | | clavatus, | 3. Direct | | | - - | | | niger, | inoculati | - - | | | | | terreus, | on | | Aspergill | Allergy | | | restrictu | (colonize |  | extrapulm | | | | ami* | wounds, | | onary | | | | | burns, | 2. | colonizat | | | | A | cornea, | | ion | | | | fumigatus | external | - | | | | | grows in | ear, or | | (Fungus | | | | wide | paranasal | 3. | ball) | | | | range of | sinuses) | | | | | | temperatu | | - - | | | | | res | For those | | | | | | 90% of | with | Lung | | | | | infection | neutropen | biospy is | | | | | s | ia, | the | | | | | | invade | prerequis | | | | | Produce | the lungs | ite | | | | | large | producing | test | | | | | amounts | hemoptysi | | | | | | of | s | | | | | | conidiosp | (lung is | | | | | | ores | the site | | | | | | | in 70% of | | | | | | Only in | patients) | | | | | | mold form | | | | | | | with true | Infection | | | | | | hyphae | of skin, | | | | | | (presence | eyes, | | | | | | of | ears, | | | | | | septation | "fungus | | | | | | s) | ball" | | | | | | | lungs, | | | | | | Germinati | allergic | | | | | | ng | bronchopu | | | | | | hyphae in | lmonary | | | | | | lumen and | aspergill | | | | | | blood | osis | | | | | | vessels | | | | | | | -\> | Rarely | | | | | | necrosis | pathogeni | | | | | | of | c | | | | | | lesions, | but | | | | | | infarctio | immosuppr | | | | | | n, | essed | | | | | | abscesses | individua | | | | | | | ls | | | | | | | are worst | | | | | | | affected | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Mucormyco | Caused by | 1. 2. 3 | | | | | sis/Zygom | saprophyt |. | | | | | ycosis/Ph | ic | | | | | | ycomycosi | fungi of | Prolifera | | | | | s | subphyla | te | | | | | | Mucoromyc | in walls | | | | | | otina | of blood | | | | | | and | vessel, | | | | | | Entomopht | cause | | | | | | horomycot | infarctio | | | | | | ina | n | | | | | | | and | | | | | | Not | necrosis | | | | | | dimorphic | distal to | | | | | | | blocked | | | | | | | vessels. | | | | | | | Does not | | | | | | | harm | | | | | | | immunocom | | | | | | | petent | | | | | | | but | | | | | | | infect | | | | | | | | | | | | | | [Patients | | | | | | | with iron | | | | | | | overload | | | | | | | are | | | | | | | susceptib | | | | | | | le | | | | | | | because | | | | | | | free iron | | | | | | | ]{.underl | | | | | | | ine} | | | | | | | | | | | | | | [helps | | | | | | | growth of | | | | | | | **mucoral | | | | | | | es** | | | | | | | in | | | | | | | vivo]{.un | | | | | | | derline} | | | | | | | | | | | | | | Patients | | | | | | | with | | | | | | | diabetes | | | | | | | ketoacido | | | | | | | sis | | | | | | | are | | | | | | | susceptib | | | | | | | le | | | | | | | to | | | | | | | developin | | | | | | | g | | | | | | | rhinocere | | | | | | | bral | | | | | | | mucormyco | | | | | | | sis | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ General Properties of Fungi & Laboratory Identification Methods =============================================================== +-----------------------------------------------------------------------+ | **General knowledge** | +=======================================================================+ | | +-----------------------------------------------------------------------+ | - - - - - - - - - - - | | | | - - - - - | | | | - - - | +-----------------------------------------------------------------------+ | **Some points to remember** | +-----------------------------------------------------------------------+ | - - | | | | - - - - - | | | | - - - - - - - | | | | - | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | **Yeast** | +=======================================================================+ | - - - - - - - | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | **Mold** | +=======================================================================+ | - | +-----------------------------------------------------------------------+ +-----------------------+-----------------------+-----------------------+ | **Dimorphic Fungi** | | | +=======================+=======================+=======================+ | - | | | +-----------------------+-----------------------+-----------------------+ | | **Saprophytic** | - | +-----------------------+-----------------------+-----------------------+ | | **Pathogenic/** | - | | | | | | | **parasitic form** | | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Fungal | | | | Reproduction** | | | +=======================+=======================+=======================+ |  | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | | | | | | - - - - - | | | | | | | | | | | | - - | | | +-----------------------+-----------------------+-----------------------+ | | **Conidia** | - - | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ | | **Sporangiospores** | - | +-----------------------+-----------------------+-----------------------+ | | **Classification of | | | | true fungi based on | | | | representation** | | +-----------------------+-----------------------+-----------------------+ | **Major Classes of | | | | Fungi** | | | +-----------------------+-----------------------+-----------------------+ | **Mucormycetes** | **Basidiomycetes** | **Pneumocystidomycete | | | | s** | | *Rhizopus, Mucor, | *Cryptococcus, | | | Basidiobolus* | Malasezzia, | *Pneumocystis | | | Trichosporon* | jirovecii* | +-----------------------+-----------------------+-----------------------+ | **Saccharomycetes** | **Eurotiomycetes** | | | | | | | *Candida, | *Dermatophytes, | | | Saccharomyces* | Blastomyces, | | | | Histoplasma, | | | | Aspergillus, | | | | Fusarium* | | +-----------------------+-----------------------+-----------------------+ +-----------------------------------------------------------------------+ | **Fungal Identification** | +=======================================================================+ | - - - - | | | | - - | | | | | | | | - - - | | | | | | | | - | | | | | | | | - - - - | | | | | | | | - | | | | | | | | - - - - | | | | | | | | - | | | | | | | | - - - - | | | |  | +-----------------------------------------------------------------------+ +-----------------------------------+-----------------------------------+ | **Mechanisms of Fungal Disease** | | +===================================+===================================+ | **1** | **Invasion** | | | | | | - | +-----------------------------------+-----------------------------------+ | **2** | **Allergic/Irritant reactions to | | | fungal products** | | | | | | - | +-----------------------------------+-----------------------------------+ | **3** | **Intoxication** | | | | | | - | +-----------------------------------+-----------------------------------+ | **4** | **Poisoning** | | | | | | - | +-----------------------------------+-----------------------------------+ | **How are fungal infections | | | diagnosed?** | | +-----------------------------------+-----------------------------------+ | - - - - | | +-----------------------------------+-----------------------------------+ +-----------------------+-----------------------+-----------------------+ | **Laboratory | | | | Diagnosis of | | | | Mycoses** | | | +=======================+=======================+=======================+ | - - - - - - | | | | - - | | | +-----------------------+-----------------------+-----------------------+ | | **Direct | - - | | | Examination** | | | | | - - - | | | | | | | | - - - - - | | | | | | | | - - - - - - | | | | - | | | | | | | | - - - - | +-----------------------+-----------------------+-----------------------+ | | **Culture** | - - - - | | | | | | | | - - - - - | +-----------------------+-----------------------+-----------------------+ | | **Initial observation | - - - | | | in studying fungal | | | | isolates** | - - - - | | | | | | | | - - - - | | | | | | | | - - - | +-----------------------+-----------------------+-----------------------+ | | **Germ tube test** | - - | +-----------------------+-----------------------+-----------------------+ | | **Antigen-antibody | - - - - - | | | tests** | | | | | - - - | +-----------------------+-----------------------+-----------------------+ | | **Biochemical tests** | - - - | +-----------------------+-----------------------+-----------------------+ | | **Detection of DNA or | - - | | | RNA** | | +-----------------------+-----------------------+-----------------------+ +-----------------------------------------------------------------------+ | **Antifungal mechanisms** | +=======================================================================+ | - - - - - - | | | | - - - - - - | | | | - - - - - - | | | | - - | | | | - | +-----------------------------------------------------------------------+ Superficial Mycoses =================== +-----------------------+-----------------------+-----------------------+ | **Superficial | | | | Mycoses** | | | +=======================+=======================+=======================+ | - - - - | | | +-----------------------+-----------------------+-----------------------+ | | **White** | - - | +-----------------------+-----------------------+-----------------------+ | | **Black** | - - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **1** | ***Tinea | | | | Versicolor*** | | +=======================+=======================+=======================+ | **General Features** | | | +-----------------------+-----------------------+-----------------------+ | - - - - - - | | | | - | | | | | | | | - | | | +-----------------------+-----------------------+-----------------------+ | **Epidemiology** | | | +-----------------------+-----------------------+-----------------------+ | - - - - | | | +-----------------------+-----------------------+-----------------------+ | **Clinical Features** | | | +-----------------------+-----------------------+-----------------------+ |  | | | +-----------------------+-----------------------+-----------------------+ | - - - - - - | | | | - | | | +-----------------------+-----------------------+-----------------------+ | | **Papules** | - - | | | | | | | | | | | | | | | | - - - | +-----------------------+-----------------------+-----------------------+ | | **Diagnosis** | - - - | | | | | | | |  | +-----------------------+-----------------------+-----------------------+ | **Treatment** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | +-----------------------+-----------------------+-----------------------+ | **Lab Diagnosis** | | | +-----------------------+-----------------------+-----------------------+ |  | | | +-----------------------+-----------------------+-----------------------+ | - - - - - - | | | | | | | | | | | | - - - - | | | | | | | | - - | | | +-----------------------+-----------------------+-----------------------+ | **Cultural and | | | | Microscopic | | | | Features** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | - - | | | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **2** | ***Tinea Nigra*** | | +=======================+=======================+=======================+ | **General Features** | | | +-----------------------+-----------------------+-----------------------+ | - - - - - | | | | | | | | - - - - | | | +-----------------------+-----------------------+-----------------------+ | **Distribution** | | | +-----------------------+-----------------------+-----------------------+ | - | | | +-----------------------+-----------------------+-----------------------+ | **Clinical Features** | | | +-----------------------+-----------------------+-----------------------+ |  | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | +-----------------------+-----------------------+-----------------------+ | **Treatment** | | | +-----------------------+-----------------------+-----------------------+ | - - | | | +-----------------------+-----------------------+-----------------------+ | **Lab Diagnosis** | | | +-----------------------+-----------------------+-----------------------+ | - | | | +-----------------------+-----------------------+-----------------------+ | | **Direct Microscopic | - - - - - | | | Examination** | | +-----------------------+-----------------------+-----------------------+ | **Cultural and | | | | Microscopic | | | | Features** | | | +-----------------------+-----------------------+-----------------------+ |  | | | +-----------------------+-----------------------+-----------------------+ | - - - - | | | +-----------------------+-----------------------+-----------------------+ | | **Culture** | - - - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **3** | ***Black Piedra*** | | +=======================+=======================+=======================+ | **General Features** | | | +-----------------------+-----------------------+-----------------------+ | - - - - | | | +-----------------------+-----------------------+-----------------------+ | **Distribution** | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | +-----------------------+-----------------------+-----------------------+ | **Treatment** | | | +-----------------------+-----------------------+-----------------------+ | - - - - - | | | +-----------------------+-----------------------+-----------------------+ | **Lab Diagnosis** | | | +-----------------------+-----------------------+-----------------------+ | | **DME** | - - - - | +-----------------------+-----------------------+-----------------------+ | | **Isolation** | - - - | +-----------------------+-----------------------+-----------------------+ | **Cultural and | | | | Microscopic | | | | Features** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | - | | | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **4** | ***White Piedra*** | | +=======================+=======================+=======================+ | **General Features** | | | +-----------------------+-----------------------+-----------------------+ | - - - - - - | | | | - | | | +-----------------------+-----------------------+-----------------------+ | **Distribution** | | | +-----------------------+-----------------------+-----------------------+ | - - | | | +-----------------------+-----------------------+-----------------------+ | **Cultural and | | | | Microscopic | | | | Features** | | | +-----------------------+-----------------------+-----------------------+ |  | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | +-----------------------+-----------------------+-----------------------+ | **Laboratory | | | | diagnosis** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **DME** | - - - - - | +-----------------------+-----------------------+-----------------------+ | | **Isolation** | - - | +-----------------------+-----------------------+-----------------------+ | - - | | | +-----------------------+-----------------------+-----------------------+ | **Treatment** | | | +-----------------------+-----------------------+-----------------------+ | - - - - | | | | | | | | - | | | +-----------------------+-----------------------+-----------------------+ | **Lab Diagnosis** | | | +-----------------------+-----------------------+-----------------------+ | | **DME** | - - - | +-----------------------+-----------------------+-----------------------+ | | **Isolation** | - - | +-----------------------+-----------------------+-----------------------+ Cutaneous & Subcutaneous Mycoses ================================ +-----------------+-----------------+-----------------+-----------------+ | **Cutaneous | | | | | Mycoses** | | | | +=================+=================+=================+=================+ | - - - | | | | +-----------------+-----------------+-----------------+-----------------+ | **Diseases | | | | | associated with | | | | | Cutaneous | | | | | Mycoses** | | | | +-----------------+-----------------+-----------------+-----------------+ | | **Dermatophytos | - - | | | | is** | | | | | | - - | | | | (Tinea/ringworm | | | | | ) | - | | +-----------------+-----------------+-----------------+-----------------+ | | | | | +-----------------+-----------------+-----------------+-----------------+ | | | | | +-----------------+-----------------+-----------------+-----------------+ | | | | | +-----------------+-----------------+-----------------+-----------------+ | | **Candidiasis** | - - - | | +-----------------+-----------------+-----------------+-----------------+ | | **Dermatomycosi | - - - | | | | s** | | | | | | - - | | | | | | | | | | - - | | +-----------------+-----------------+-----------------+-----------------+ +-----------------------+-----------------------+-----------------------+ | **Dermatophytes** | | | +=======================+=======================+=======================+ | **Ecology** | | | +-----------------------+-----------------------+-----------------------+ | | **Geophilic** | - - | | | | | | | |  | | | | | | | | Not definitive, not | | | | pigmented | +-----------------------+-----------------------+-----------------------+ | | **Zoophilic** | - - | | | | | | | | Hyphae in the middle | +-----------------------+-----------------------+-----------------------+ | | **Anthropophilic** | - - - - - | +-----------------------+-----------------------+-----------------------+ | - - - | | | | | | | | - - | | | +-----------------------+-----------------------+-----------------------+ | **Structural Basis of | | | | Identification for | | | | Dermatophytes** | | | +-----------------------+-----------------------+-----------------------+ |  | | | +-----------------------+-----------------------+-----------------------+ | - - - - - | | | +-----------------------+-----------------------+-----------------------+ | **Morphology of | | | | Dermatophytes** | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | | | | | | - - - - | | | | | | | | - - - | | | | | | | | - | | | +-----------------------+-----------------------+-----------------------+ +-----------------------------------+-----------------------------------+ | **3 Genera of Dermatophytes** | | +===================================+===================================+ | **1** | **Microsporum** | +-----------------------------------+-----------------------------------+ | | - - | +-----------------------------------+-----------------------------------+ | | **Morphology of Microsporum** | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | | - - | | | | | | - - | | | | | | - - | +-----------------------------------+-----------------------------------+ | | **Macroconidia & Microconidia** | +-----------------------------------+-----------------------------------+ | |  | +-----------------------------------+-----------------------------------+ | | - - - - | | | | | | - - - - | +-----------------------------------+-----------------------------------+ | **2** | **Trichophyton** | +-----------------------------------+-----------------------------------+ | |  | | | | | | *T. mentagrophytes* on SDA for 14 | | | days, 30℃ | | | | | | *SDA - microsporum on corn meal | | | agar* | +-----------------------------------+-----------------------------------+ | | **Morphology of Trichophyton** | +-----------------------------------+-----------------------------------+ | | - - - - | +-----------------------------------+-----------------------------------+ | | **Macroconidia** | +-----------------------------------+-----------------------------------+ | |  | +-----------------------------------+-----------------------------------+ | | - - - | +-----------------------------------+-----------------------------------+ | | **Microconidia** | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | | - - | | | | | | - - - - - | +-----------------------------------+-----------------------------------+ | **3** | **Epidermophyton** | +-----------------------------------+-----------------------------------+ | |  | +-----------------------------------+-----------------------------------+ | | - - | | | | | | - - - - | +-----------------------------------+-----------------------------------+ | | **Macroconidia** | +-----------------------------------+-----------------------------------+ | | LPCB dapat | +-----------------------------------+-----------------------------------+ | | - - - - | +-----------------------------------+-----------------------------------+ +-----------------------+-----------------------+-----------------------+ | **Clinical | | | | Manifestation of | | | | Dermatophytosis** | | | +=======================+=======================+=======================+ | | **Tinea capitis** | - - - - | | | | | | | | - - - | | | | | | | | - - | | | | | | | |  | +-----------------------+-----------------------+-----------------------+ | | **Tinea barbae** | - - | | | | | | | |  | +-----------------------+-----------------------+-----------------------+ | | **Tinea pedis** | - - - - - | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ | | **Tinea unguium | - - - - - | | | (Onychomycosis)** | | +-----------------------+-----------------------+-----------------------+ | | **Tinea corporis** | - - - | | | | | | | | - - | | | | | | | | - - | | | | | | | | - - | | | | | | | |  | +-----------------------+-----------------------+-----------------------+ | | **Tinea cruris** | - - - | +-----------------------+-----------------------+-----------------------+ | | **Tinea manus** | - | | | | | | | |  | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Lab diagnosis** | | | +=======================+=======================+=======================+ | - - - - | | | +-----------------------+-----------------------+-----------------------+ | | **Types of | - | | | specimens** | | +-----------------------+-----------------------+-----------------------+ | | **Culture** | - - | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ | **Dermatophyte test | | | | medium** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | +-----------------------+-----------------------+-----------------------+ | | **Soy peptone** | - | +-----------------------+-----------------------+-----------------------+ | | **Dextrose** | - | +-----------------------+-----------------------+-----------------------+ | | **Phenol red** | - | +-----------------------+-----------------------+-----------------------+ | | **Cycloheximide, | - - | | | chloramphenicol, | | | | gentamicin** | | +-----------------------+-----------------------+-----------------------+ | | **MSA** | - - | +-----------------------+-----------------------+-----------------------+ | **Trichophyton agar** | | | +-----------------------+-----------------------+-----------------------+ |  | | | +-----------------------+-----------------------+-----------------------+ | - - | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ +-----------------------------------------------------------------------+ | **Onychomycosis by non dermatophytic fungi** | +=======================================================================+ |  | +-----------------------------------------------------------------------+ | - - - - - | | | | - | +-----------------------------------------------------------------------+ +-----------------------+-----------------------+-----------------------+ | **Treatment** | | | +=======================+=======================+=======================+ | - - - | | | +-----------------------+-----------------------+-----------------------+ | | **Tinea capitis** | - - - | +-----------------------+-----------------------+-----------------------+ | | **Tinea corporis, | - | | | Tinea pedis** | | +-----------------------+-----------------------+-----------------------+ | | **Tinea unguium** | - - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Candidiasis/Candido | | | | sis** | | | +=======================+=======================+=======================+ | | | | +-----------------------+-----------------------+-----------------------+ | - - - - | | | | | | | | - | | | +-----------------------+-----------------------+-----------------------+ | **Predisposing | | | | factors** | | | +-----------------------+-----------------------+-----------------------+ | - - - - - | | | +-----------------------+-----------------------+-----------------------+ | ***Candida | | | | albicans*** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | - - - - - - | | | | - - | | | +-----------------------+-----------------------+-----------------------+ | | **Lab diagnosis** | - - - | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------------------------------------------------------+ | **Points to remember** | +=======================================================================+ | - - - - - | +-----------------------------------------------------------------------+ **Systemic/Endemic Mycoses** +-----------------------+-----------------------+-----------------------+ | **General | | | | Characteristics** | | | +=======================+=======================+=======================+ | **Physiological | | | | barriers** | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | +-----------------------+-----------------------+-----------------------+ | **Infection** | | | +-----------------------+-----------------------+-----------------------+ | - - - | | | | | | | | - - - | | | | | | | | - - | | | | | | | | | | | | | | | | - | | | | | | | | - - - - - - | | | | - | | | +-----------------------+-----------------------+-----------------------+ | | **Four genera** | - - - - | +-----------------------+-----------------------+-----------------------+ | **Epidemiology** | | | +-----------------------+-----------------------+-----------------------+ |  | | | +-----------------------+-----------------------+-----------------------+ | **Thermal | | | | dimorphism** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Natural habitat** | - - - | | | | | | | | - - | +-----------------------+-----------------------+-----------------------+ | | **Animal habitat** | - - | +-----------------------+-----------------------+-----------------------+ | **Summary** | | | +-----------------------+-----------------------+-----------------------+ | **Characteristics of | True pathogenic | | | fungus/disease** | infections | | +-----------------------+-----------------------+-----------------------+ | **Degree of | Well-developed | | | Virulence** | | | +-----------------------+-----------------------+-----------------------+ | **Conditions of | Immunocompetent or | | | Host** | immunocompromised | | | | (low or high | | | | resistance) | | +-----------------------+-----------------------+-----------------------+ | **Primary portal of | Upper respiratory | | | entry** | tract | | +-----------------------+-----------------------+-----------------------+ | **Nature of | Specific, primary | | | infection, form** | conidial | | +-----------------------+-----------------------+-----------------------+ | **Habitat of Fungus | Soil in endemic | | | and Location** | regions | | +-----------------------+-----------------------+-----------------------+ | **Thermal | Highly characteristic | | | dimorphism** | | | +-----------------------+-----------------------+-----------------------+ | **General | | | | Pathogenesis of | | | | Systemic Mycoses** | | | +-----------------------+-----------------------+-----------------------+ |  | | | | ===================== | | | | = | | | +-----------------------+-----------------------+-----------------------+ | **1** | **Production of | | | | spores: airborne | | | | inhalation of soil, | | | | bat/bird feces** | | +-----------------------+-----------------------+-----------------------+ | **2** | **Primary pulmonary | | | | infection (PPI)** | | | | | | | | - | | +-----------------------+-----------------------+-----------------------+ | **3** | **\*Dissemination of | | | | Infection: fungi | | | | infecting other | | | | sites** | | +-----------------------+-----------------------+-----------------------+ +-----------------+-----------------+-----------------+-----------------+ | **1** | ***Histoplasmos | | | | | is*** | | | +=================+=================+=================+=================+ | **General | | | | | characteristics | | | | | ** | | | | +-----------------+-----------------+-----------------+-----------------+ | - - - | | | | | | | | | | - - - | | | | +-----------------+-----------------+-----------------+-----------------+ | **Dimorphism** | | | | +-----------------+-----------------+-----------------+-----------------+ | - - | | | | +-----------------+-----------------+-----------------+-----------------+ | **Morphology** | | | | +-----------------+-----------------+-----------------+-----------------+ | - - - | | | | | | | | | |  | | | | +-----------------+-----------------+-----------------+-----------------+ | | **Microconidia* | - | | | | * | | | +-----------------+-----------------+-----------------+-----------------+ | | **Macroconidia* | - - - | | | | * | | | +-----------------+-----------------+-----------------+-----------------+ | **Infections | | | | | caused** | | | | +-----------------+-----------------+-----------------+-----------------+ | | **Chronic | - - | | | | Pulmonary** | | | +-----------------+-----------------+-----------------+-----------------+ | | **Chronic | - - - | | | | Cutaneous** | | | +-----------------+-----------------+-----------------+-----------------+ | | **Ocular | - - | | | | Histoplasmosis* | | | | | * | | | +-----------------+-----------------+-----------------+-----------------+ | | **Systemic | - - | | | | Histoplasmosis* | | | | | * | - | | +-----------------+-----------------+-----------------+-----------------+ | | **Reactivation* | - - - - | | | | * | | | +-----------------+-----------------+-----------------+-----------------+ | **Diagnosis** | | | | +-----------------+-----------------+-----------------+-----------------+ | | | | | +-----------------+-----------------+-----------------+-----------------+ | - - | | | | | | | | | | - - | | | | | | | | | | - - - | | | | +-----------------+-----------------+-----------------+-----------------+ | | **DME** | - | | +-----------------+-----------------+-----------------+-----------------+ | | **Culture** | | | +-----------------+-----------------+-----------------+-----------------+ | | | **SDA** | - | +-----------------+-----------------+-----------------+-----------------+ | | | **Blood agar | - | | | | plate** | | +-----------------+-----------------+-----------------+-----------------+ | | | **Chocolate | - | | | | agar** | | +-----------------+-----------------+-----------------+-----------------+ | | **Serologic** | - - | | +-----------------+-----------------+-----------------+-----------------+ | | **Skin** | - - | | +-----------------+-----------------+-----------------+-----------------+ | **Mode of | | | | | treatment** | | | | +-----------------+-----------------+-----------------+-----------------+ | | **Mode of | 1. 2. 3. 4. | | | | Treatment and | | | | | Prevention** | | | +-----------------+-----------------+-----------------+-----------------+ | **Mode of | | | | | transmission** | | | | +-----------------+-----------------+-----------------+-----------------+ | **1** | **PPI | | | | | Inhalation** | | | | | | | | | | - | | | +-----------------+-----------------+-----------------+-----------------+ | **2** | **Lymphatics | | | | | and Bloodstream | | | | | dissemination** | | | | | | | | | | - | | | +-----------------+-----------------+-----------------+-----------------+ | **3** | **Mimics | | | | | tuberculosis in | | | | | immunocompromis | | | | | ed | | | | | patients** | | | | | | | | | | - | | | +-----------------+-----------------+-----------------+-----------------+ +-----------------+-----------------+-----------------+-----------------+ | **2** | ***Coccidioidom | | | | | ycosis*** | | | +=================+=================+=================+=================+ | General Feature | | | | | s | | | | | =============== | | | | | = | | | | +-----------------+-----------------+-----------------+-----------------+ | - - | | | | | | | | | | - | | | | +-----------------+-----------------+-----------------+-----------------+ | Clinical Infect | | | | | ion | | | | | =============== | | | | | === | | | | +-----------------+-----------------+-----------------+-----------------+ | - - - | | | | +-----------------+-----------------+-----------------+-----------------+ | | **Pulmonary** | - - | | +-----------------+-----------------+-----------------+-----------------+ | | | **Chronic** | - - - - | | | | | | +-----------------+-----------------+-----------------+-----------------+ | | **Disseminated* | - - | | | | * | | | +-----------------+-----------------+-----------------+-----------------+ | | | **Erythema | - - | | | | nodosum** | | +-----------------+-----------------+-----------------+-----------------+ | Transmission an | | | | | d Pathogenesis | | | | | =============== | | | | | ============== | | | | +-----------------+-----------------+-----------------+-----------------+ |  | | | | +-----------------+-----------------+-----------------+-----------------+ | **1** | **Fungus in | | | | | soil** | | | +-----------------+-----------------+-----------------+-----------------+ | **2** | **Septation of | | | | | arthroconidia** | | | | | | | | | | - | | | +-----------------+-----------------+-----------------+-----------------+ | **3** | **Arthrospores | | | | | become | | | | | rounded** | | | +-----------------+-----------------+-----------------+-----------------+ | **4** | **Airborne | | | | | (inhaled) | | | | | lung** | | | +-----------------+-----------------+-----------------+-----------------+ | **5** | **Develop into | | | | | spherules** | | | | | | | | | | - - | | | +-----------------+-----------------+-----------------+-----------------+ | **6** | **Endospores | | | | | release can | | | | | form new | | | | | spherules** | | | | | | | | | | - | | | +-----------------+-----------------+-----------------+-----------------+ | Morphology | | | | | ========== | | | | +-----------------+-----------------+-----------------+-----------------+ |  | | | | +-----------------+-----------------+-----------------+-----------------+ | - - - | | | | | | | | | | - - - | | | | | | | | | | - - - - | | | | | | | | | +-----------------+-----------------+-----------------+-----------------+ | Laboratory Diag | | | | | nosis | | | | | =============== | | | | | ===== | | | | +-----------------+-----------------+-----------------+-----------------+ | | | | | +-----------------+-----------------+-----------------+-----------------+ | - | | | | +-----------------+-----------------+-----------------+-----------------+ | | **DME** | - | | +-----------------+-----------------+-----------------+-----------------+ | | **Culture** | - - | | +-----------------+-----------------+-----------------+-----------------+ | | **Serology** | - - - | | +-----------------+-----------------+-----------------+-----------------+ | | **Skin Test** | - | | +-----------------+-----------------+-----------------+-----------------+ | Treatment | | | | | ========= | | | | +-----------------+-----------------+-----------------+-----------------+ | - - | | | | +-----------------+-----------------+-----------------+-----------------+ +-----------------------+-----------------------+-----------------------+ | **3** | ***Paracoccidioidomyc | | | | osis*** |