University:
American Career College
Course:
NURS115 | Intermediate Medical
Academic year:

2021
Views:

306

Pages:

60
Author:

olianesmcq

Fungal Infections 2 Fungal Infections: • These infections are divided to 4 groups: • Superficial mycoses Cutaneous mycoses Or “Dermatophytosis” Subcutaneous mycoses Systemic mycoses (Deep mycoses) 3 Superficial mycoses • The causative agents invade to just epidermis 4 Superficial Mycoses • Tinea versicolor (Pityriasis versicolor) • Pityrosporosis (Seborrheic dermatitis) • Tinea nigra • Piedra • Otomycosis • Erythrasma • Trichomycosis are bacterial diseases.(clinical signs). 5 Tinea versicolor Or: Pityriasis versicolor 6 Definition • A chronic, recurrent, macular, (as hypopigmentation or hyperpigmentation macules) of the stratum corneum.  Caused by: Malassezia species (lipophilic yeasts).  Most common species are:  Malassezia globosa (according to the new reports)  Malassezia furfur ( formerly) 7 Taxonomy Malassezia spp. belong to the Basidiomycota 8 Clinical manifestation  Macular, sharply marginated, very slightly raised and furfuraceous.  Popular form: is seen on seborrheic areas of trunk. 9 10 Risk factors including:  Excessive Sweating / hyperhidrosis Emotional stress  Warm climate  Poor hygiene  Long term use of antibiotics  Long term use of corticosteroids (under this condition cell turnover of the epithelium is slowed)   Other immunocompromised states  11 Tinea versicolor • Macular, • sharply marginated, • very slightly raised and furfuraceous 12 Tinea versicolor 13 Tinea versicolor Tinea versicolor 15 Tinea versicolor 16 Pityriasis versicolor in a man and electron micrograph of his skin showing round Malassezia yeasts. 17 Mycological Diagnosis • In macroscopic observation • The most lesions produce goldish-yellow fluorescence under Wood's light. • Direct smear: is done by KOH 10-20% • Microscopic result: yeasts and hyphae, • or spaghetti and meat ball form 18 Malassezia species Microscopic result: yeasts and hyphae with giemsa staining 19 Malassezia species Staining with methylene blue 20 Treatment Whitfield cream (keratolitic) selenium sulfide (shampoo) Clotrimazole and Miconazole (ointment or cream) 21 Other clinical manifestation • An uncommon variant is Folliculitis • Malassezia species, may grow in large numbers in hair follicles and sebaceous glands (usually on trunk). • with erythematous papules and pustules 22 Pustules on skin 23 Malassezia folliculitis Other clinical manifestation • Malassezia species associated seborrheic blepharitis 25 Other clinical conditions • Malassezia species associated to onychomycosis, and otitis • Malassezia species ( especially Malassezia furfur) are recognized as a cause of catheter-acquired sepsis in adults and especially neonates receiving prolonged courses of intravascular lipid. 26 Dandruff Oily scalp scale 27 Pityrosporosis (Seborrheic dermatitis)  Definition: Seborrheic dermatitis Pityrosporosis is a chronic superficial infection with scales on the trunk (Seborrheic dermatitis) or on scalp (dandruff).  Causes: Malassezia globosa,  Malassezia furfur .  Clinical manifestation: 28 Dandruff scales on scalp 29 Mycological Diagnosis  Direct examination:  Skin scrapping from seborrheric lesions should be done.  staining with methylene blue show large numbers of oval budding cells (bottle form). 30 Treatment  Selenium sulfide (shampoo)  Ketoconazole (ointment) or shampoo  Pyrithione zinc (shampoo) 31 Otomycosis • Otomycosis is a fungal ear infection, a superficial mycotic infection of the outer ear canal. • Clinical manifestation: • It is more common in tropical countries. 32 outer ear canal 33 Epidemiology • Factors that predispose to otitis externa include absence of cerumen, high humidity, increased temperature and local trauma - usually from use of cotton swabs or hearing aids. • Eczema • About 1 in 8 of otitis external infections is fungal in origin. 34 Otomycosis agents • fungal ear infections are caused by: • Saprophytes, yeasts and dermatophytes • 90% of fungal infections involve Aspergillus spp. • Most fungal ear infections are caused by Aspergillus niger 35 Otomycosis • Mycelium and vesicle of Aspergillus spp. produced in the ear canal. 36 Otomycosis • There are nearly 60 different species of fungi that may be responsible for this infection. • Aspergillus fomigatus, Penicillium, Fusarium, Mucor, Rhizopus and Scopulariopsis. 37 Mycological Diagnosis for Otomycosis • Direct examination: • Discharge of the ears contain of fungal agents • If Aspergillus niger caused the ear infection: with Giemsa staining of discharge of ear : mycellium, vesicle and were seen. 38 Aspergillus niger 39 Treatment • Cleaning : Doctors can thoroughly clean the ears to remove discharge. • Ear drops Clotrimazole is an azole antifungal Another option is to use 5 percent aluminum acetate ear drops. • Topical medications Topical antifungal medications may recommend for otomycosis if the fungus is affecting the outside of the ear. Oral medications Some fungal infections such as Aspergillus may be resistant to the usual ear drops, and oral medications such as itraconazole may require. 41 Tinea nigra • Tinea nigra: is a superficial fungal infection that causes dark to brown macules with well defined borders. 42 Tinea nigra palms of the hands 43 Tinea nigra agent This infection is caused by Hortaea werneckii (Exophiala wernickii or:Phaeoannellomyces wernikii ) 44 Mycological Diagnosis for Tinea nigra • This is most rapidly achieved by direct microscopic examination of scrapings from the lesion with potassium hydroxide. On microscopic slides: • Brown septate branching hyphae and elongate budding cells are seen. 45 Treatment • Whitfield cream (keratolitic), • Terbinafine • Miconazole cream • Clotrimazole cream • Successful oral therapy has been reported with itraconazole. 46 Piedra • Black Piedra • forming hard black nodules on the shafts of the hairs (more often on scalp hairs). • The infected hair is rough, sandy or granular to the touch. • Black Piedra is caused by Piedra hortae an ascomycetous fungus • (Asci develop in these hard black nodules) 47 Black Piedra 48 Treatment • Treatment for black Piedra is cutting off all the hairs in the affected region. • Black piedra is treated by using oral terbinafine, and topical antifungals ketoconazole shampoo, 49 White Piedra • White Piedra is caused by Trichosporon beigelii is related to Basidiomycetes White Piedra is characterized by soft, white, yellow to light brown nodules 50 White Piedra 51 Treatment • • • • Treatment for white Piedra is cutting off all the hairs in the affected region. Use clotrimazole cream ketoconazole shampoo, Econazole or miconazole cream 52 Trichomycosis-axillaris and Erythrasma 53 Trichomycosis-axillaris Trichomycosis is a bacterial infection of the underarm hairs. In rare cases, this infection can also affect pubic hair. It should be called trichobacteriosis. 6/15/2020 54 Trichomycosis-axillaris Yellow, red, or black sweat Sweat stains on clothing Risk factors for developing trichomycosis are: •humidity •excessive underarm sweating •poor hygiene •obesity 55 Trichomycosis-axillaris Agent of trichomycosis-axillaris is Corynebacterium tenuis 56 Treatment  Cutting off all the hairs in the affected region.  Topical antibiotic preparations such as clindamycin or erythromycin also are effective. 57 • It's more commonly seen in warm or humid climates, and is usually caused by the bacteria • “Corynebacterium minutissimum”. 58 Erythrasma • The most common symptoms of erythrasma include pink, red, or brown skin patches with scales, and mildly itchy skin. 59 Erythrasma underarm Wood’s lamp skin examination. This lamp uses ultraviolet radiation to look at skin patches. Under this lamp, erythrasma will have a red or coral color. 60 Treatment • Choice drug is erythromycin • Cleaning the affected area with antibiotic soap, Use antibacterial solutions or creams on skin, such as clindamycin HCL solution, erythromycin cream,  Topical creams and solutions are usually used first.  Sometimes may need to try a combination of treatments. 61