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Superficial mycoses

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Publié le

Superficial candidiasis
Pityriasis versiclour(tinea versicolor)
White piedra
Black piedra
Mycotic keratitis

Publié dans : Santé & Médecine
  • Great book! I'm on the second week and seeing definite improvement on my yeast infection symptoms. I must also note that the texture of my skin became very soft and consistent. I completely agree with many of your arguments in the book especially those about conventional methods for treating Yeast Infection. I wanted to let you know that I feel so fine you have no idea. I am not so tired all the time and I feel very energetic. The rashes on my neck and on the right side of my nose have also cleared up. I wish you all the health and happiness in the world and thanks so much for helping me. I really appreciate your time and efforts to assist me. ♣♣♣ http://ishbv.com/index7/pdf
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  • For years, I was plagued by chronic yeast infections, including but not limited to: rashes, weight gain, insomnia, acne, constipation, chronic fatigue, depression, sensitivity to chemicals, you name it. After following your program, I had made a significant progress. My thrush, acne and rashes had vanished. My skin had almost completely cleared up. I hadn�t looked that good in 15 years. I felt rejuvenated, energized, happier and so much healthier... ★★★ http://ishbv.com/index7/pdf
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  • Hello, I'm 45 and have battled with severe Yeast Infection for the last nine years. A month and a half ago, I stumbled across your Yeast Infection No More program. I had my doubts and didn't think it was the right program for my Yeast Infection or if it was going to work at all, but I did order it because I'll do anything to rid myself of this crippling condition. Over 3 week period, I have seen an improvement that I had never experienced with any other conventional or so called natural treatment. The non-stop vaginal itching and burning have stopped. My skin looks significantly better and I slowly got rid of the psoriasis on my right elbow that I had for years. I can now save the money that I would have wasted on drugs like Monistat and Diflucan. Your suggestions have kept my vaginal yeast infections as well as the other candida related symptoms at bay incredibly well! I also lost about 15 lbs! I am feeling so healthy, too. ➤➤ https://tinyurl.com/y3flbeje
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  • Holistic Candida Secrets, Eliminate Yeast Infection Fast. Candida cure e-book reveals all ◆◆◆ http://scamcb.com/index7/pdf
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  • I am 31 years old and have had severe Yeast Infection for over 8 years. I have been suffering (yes! really suffering for so long) and I have indeed tried every over-the-counter and prescription that you could think of to treat this horrible disease. My wife also suffered from moderate Yeast Infection for years and we both started your Yeast Infection No More system about 4 months ago and I am so excited to report that we are both free from Yeast Infection. Both of us! For the first time ever. The symptoms are gone...completely! And the overall feeling is unbelievable. Thank you for your help... ▲▲▲ https://tinyurl.com/y4uu6uch
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Superficial mycoses

  1. 1. SUPERFICIAL MYCOSES KIMAIGA H.O MBChB (University of Nairobi)
  2. 2. Superficial Mycosis • Dermatotophytoses • Superficial candidiasis • Pityriasis versiclour(tinea versicolor) • White piedra • Black piedra • Otomycosis • Mycotic keratitis
  3. 3. Dermatophytoses • Diseases of superficial keratinized structures- nail, hair, skin • Filamentous/ Monomorphic fungi- Always in mould form • Pathogenic genera: • Trichophyton- Infect skin, hair and nails (Mneumonic Tri) • Microsporum - Infect hair and skin • Epidermophyton - Infect nails and skin • Classified as; • Anthrophillic - restricted to man • Zoophilic- in animals, inflammatory reaction in humans with contact with animals • Geophillic- from the soil, occasionally infects man and animals
  4. 4. Pathogenesis • Infection can be by direct or indirect transfer (fragment of keratin containing the infective particle) • No evidence of natural immunity • Factors that encourage invasion- increased environmental humidity and CO2 content • Resistance to infection is determined by • Production of inhibitory FAs (fatty acids) • Rate of epithelial cell turnover • T-cell mediated immunity • Unsaturated transferrin • Keratin affected by enzymatic digestion and mechanical pressure • Hyphae grow into newly differentiated keratin as it formed • Branching hyphae & may break up to arthroconnidia particularly in infected hair
  5. 5. • Species of fungi determine type of lesions: • Skin- dry scaling/ hyperkeratosis irritation, erythema, vesicles, pustules, ulceration • Nail- discolouration, thickened, raised • Scalp infection- scaling, hair loss, lesions (kerions)
  6. 6. “Id” reaction • An immunological allergic reaction to circulating fungal antigens • Patients with inflammatory infection develop a secondary rash known as dermatophytid (“id”) • Those with foot ringworm will have vesicular eczema on the hands • Those with scalp ringworm develop follicular rash on the trunk
  7. 7. Epidemiology/ Diseases • Common in tropics • Types: • Tinea corporis (smooth skin) • Tinea cruris (groin/ jock itch) • Tinea capitis (scalp) • Favus is more serious, often from animals and causes permanent hair loss • Tinea pedis (feet/athlete’s foot) - also candida species gram negative bacteria • Tinea unguium(nail plate) • Tinea barbae (beard) • Tinea manuum(palms) • Tinea faciale • NB: these are conditions not genera and species
  8. 8. Fungal
  9. 9. Fungal
  10. 10. Clinical Manifestations T. Corporis manifestations • Trichophyton species, microsporum species and epidermophyton floccosum • Frequently from a pet, infection from another body site, person to person • Scaly, itchy rash on trunk legs arm • Itching, dry, circular, scaling lesions • May be very large, affecting the back and chest • In AIDs patients- extensive or follicular forms • Usually zoophilic, occasionally geophillic
  11. 11. T. Capitis manifestations • Several tricophyton species, and microsporum species • Anthrophillic – easily transmissitted from child to child • Endemic in most African communities • Generally confined to prepubertal children • Diffuse or circumscribed areas of hair loss • Minimal scaling, hair broken at scalp level, leaving black swollen dot at hair follicle • Zoophilic • More inflammation, scaling and hair loss • Itchy inflammatory crusts cover lesion • In AIDs adult T. capitis may be seen
  12. 12. T. Pedis manifestations • Anthrophillic- T. rubrum, E. floccosum • Itchy, +/- pain, +/- erosions of web spaces • Severe erosion with greenish discoloration suggests pseudomonas
  13. 13. Onchomycosis • Toe nails usually • Usually together with sole or web space infection • Anthrophillic • Nail thickened & opaque, distal erosion of nail plate in chronic cases • T rubrum, T interdigtale, Fusorium spp., Acremonium spp.
  14. 14. T. Cruris • Skin of groin and pubic area • Anthrophillic- T rubrum, E floccosum • Usually from another body part • Highly contagious sharing towels e.t.c • One or more rapidly spreading erythematous lesions with central clearing on the inside of thighs, intense pruritus • Lesions with raised erythematous border and brown scaling • Infection may extend locally and spread to other body sites
  15. 15. Lab Diagnosis • Sample • Nail clippings • Skin scrapings (clean skin- 70% alcohol - ↓ bacterial flora) • Plucked hair collected in folded squares of black paper or card fastened with clip • Macroscopic exam (Wood’s lamp) • Detect fluorescence in infected hair, scalp lesions
  16. 16. • Direct microscopy • Microscopy of wet mounts of KOH preparations (10-30% KOH digestion 15 mins) • Look for hyphae or arthrospores • Calcofluor white- optical brightener under fluorescence microscope - enhances fungal elements • Microsporum fluoresces a bright yellow green (Wood’s lamp) • Direct microscopic exam of hair roots and skin softened with KOH shows hyphae, arthrospores and distinctive patterns of hair invasion • Arthroconidia retained in hair shaft - endothrix invasion- M. nanum, T. tonsurans • Arthroconidia on a sheath surrounding hair shaft - ectothrix invasion-M.canis, gypseum. T. verrucosum
  17. 17. Shaft of hair with KOH Skin scrapping with KOH
  18. 18. KOH preparation of hair KOH preparation of skin
  19. 19. Hyphae in skin:
  20. 20. • Culture • For isolation and ID of genus and species • On SDA for 10-14 days • Check for colonial morphology • Lactophenol blue staining on a portion of the colony • Look for micronidia and macronidia •Dermatophyte species produce 2 types of asexual spores: macroconidia & microconidia
  21. 21. Treatment • Topical therapy • Nonspecific – Whitfield’s ointment • Specific – Creams, lotions, shampoos •Azole derivatives- Clotrimazole, ketoconazole etc. • Oral antifungals if skin contact hurts– required for nail scalp and severe skin infection includes Griseofulvin, Terbinafine, Itraconazole, Fluconazole • Onchomycosis • Griseofulvin for 12-18 months-high relapse rates • Oral terbinafine or itraconazole
  22. 22. Prevention • Involves minimizing transmission from infected individuals especially through indirect spread from contaminated items
  23. 23. Pityriasis/ tinea versicolor • Caused by Malassezia furfur, normal skin flora • Usually in adults and less common in children • Common in roofing or construction workers in warm climate , exposed to sun, who are constantly wet and sweat hence infection can reoccur even after treatment. • Associated with immonusuppression due to organ transplantation. Not known association with AIDS
  24. 24. Presentation • Superficial infection of keratinized cells • Hypopigmented (in dark skin) or hyperpigmented (in light skin)spots on the chest and back • Coalesce with time to form confluent patches • Fungemia in premature infants on IV lipid supplements
  25. 25. Sebborhoeic dermatitis • Yeast found in large quanties in scales of dermatitis and in dandruff • AIDS patients –Early sign of CD suppresion but also commonly in health persons • Erythema and greasy scale- Eyebrows and eyelashes, scalp, nasolabial folds, behind ears, over sternum.
  26. 26. Lab diagnosis • Microscopy • Oval, budding yeast and short filaments • Culture • A lipid supplement is required in medium • Incubated at 32-340C • Small yello-creamed colonies develop within 1 week. Prevention • General cleanliness • Avoid sharing personal items- combs, towels, clothes
  27. 27. White piedra • Softwhite grayish nodules on hair shafts mainly axillae • Caused by a yeast – Trichosporum beigelii • Shaving off infected hairs is satisfactory treatment
  28. 28. Otomycosis • Chronic otitis externa • Patient has a lot of discomfort, itch on affected site • Aspergillus nigger is the most common species involved • Species isolated on SDA, sporulation after 2 days • Cleaning and topical therapy with azole derivatives
  29. 29. Mycotic keratitis • Fungal infections of the cornea • Can be secondary to injury or bacterial infections, use of steroids • Mainly caused by saprophytic moulds e.g. Aspergillus and Fusarium species