Mycological and parasitical infections

1
Mycological and parasitical infections

• Gkalpakiotis Spyridon MD,PhD Dermatovenereology
  department of Third Faculty of Medicine, Charles
  University,Prague

2

• Fungal diseases are called generally diseases
  caused by fungal infection
• Skin and adnexa caused by fungal infections are
  dermatomycoses
• Fungi are aerobic organisms, form cell wall in
  the living organic material and form colonies
• Unlike bacteria, have a nucleus

3
Origin of skin mycoses

• 1/
• 2/
• 3/

• dermatophytes

yeast
Oportunic micromycetes
4
Origin of skin mycoses

• 1/
• 2/
• 3/

• dermatophytic

antropofilní
zoofilní
geofilní
yeast
oportunní mikromycety
5
Origin of skin mycoses

• 1/

• dermatophytes

antropofilní
zoofilní
geofilní
Trichophyton rubrum Trichophyton
interdigitale Epidermophyton floccosum
6
Origin of skin mycoses

• 1/

• dermatophytes

antropofilní
zoofilní
geofilní
Microsporum canis Trichophyton mentagrophytes
7
Origin of skin mycoses

• 1/

• dermatophytes

antropofilní
zoofilní
geofilní
Microsporum gypseum Trichophyton terrestre
8
Way of transmission
Sport /closed shoes
Sprchy Bazény sauny
Koberce v hotelích
Vypujcené boty, prezuvky
Nástroje na pedikúru manikúru
Hrebeny, kartáce
Pacienti s poruchami metabolismu
Iatrogenní vliny /kortikosteroidy ATB,imunosupresi
va
Pacienti s poruchami imunity
9
Way of transmission
Shower Pool Sauna
Sport /uzavrená obuv
Koberce v hotelích
Vypujcené boty, prezuvky
Nástroje na pedikúru manikúru
Hrebeny, kartáce
Pacienti s poruchami metabolismu
Iatrogenní vliny /kortikosteroidy ATB,imunosupresi
va
Pacienti s poruchami imunity
10
Way of transmission
Carpets in hotel
Sport /uzavrená obuv
Sprchy Bazény sauny
Vypujcené boty, prezuvky
Nástroje na pedikúru manikúru
Hrebeny, kartáce
Pacienti s poruchami metabolismu
Iatrogenní vliny /kortikosteroidy ATB,imunosupresi
va
Pacienti s poruchami imunity
11
Way of transmission
Sport /uzavrená obuv
Sprchy Bazény sauny
Koberce v hotelích
Lented shoes
Nástroje na pedikúru manikúru
Hrebeny, kartáce
Pacienti s poruchami metabolismu
Iatrogenní vliny /kortikosteroidy ATB,imunosupresi
va
Pacienti s poruchami imunity
12
Way of transmission
Sport /uzavrená obuv
Sprchy Bazény sauny
Koberce v hotelích
Tools for pedicure and manicure
Vypujcené boty, prezuvky
Hrebeny, kartáce
Pacienti s poruchami metabolismu
Iatrogenní vliny /kortikosteroidy ATB,imunosupresi
va
Pacienti s poruchami imunity
13
Way of transmission
Sport /uzavrená obuv
Sprchy Bazény sauny
Koberce v hotelích
Hair brush
Vypujcené boty, prezuvky
Nástroje na pedikúru manikúru
Pacienti s poruchami metabolismu
Iatrogenní vliny /kortikosteroidy ATB,imunosupresi
va
Pacienti s poruchami imunity
14
Way of transmission
Sport /uzavrená obuv
Sprchy Bazény sauny
Koberce v hotelích
Vypujcené boty, prezuvky
Nástroje na pedikúru manikúru
Hrebeny, kartáce
Iatrogenní vliny /kortikosteroidy ATB,imunosupresi
va
Pacienti s poruchami metabolismu
Pacienti s poruchami imunity
15
Way of transmission
Sport /uzavrená obuv
Sprchy Bazény sauny
Koberce v hotelích
Vypujcené boty, prezuvky
Nástroje na pedikúru manikúru
Hrebeny, kartáce
Pacienti with immunodeficiency
Iatrogenní vliny /kortikosteroidy ATB,imunosupresi
va
Pacienti s poruchami metabolismu
16
Dermatomykózy

• tinea superf.,profunda
• kandidózy
• Pityriasis versicolor

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Dermatophytes

• It feeds on keratin, so attack - skin, hair
  and nails
• Each dermatophytes can cause various forms
  of infection, known as tinea

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Tinea pedis

• It affects mostly men, interdigital spaces of
  middle age, 10-30 of the population
• Etiology Trichophyton rubrum, Trichophyton interd
  igitale
• Clinical formsInterdigital - flushed skin with
  exfoliation, then macerated, whitish, thickened, w
  ith the formation of cracks, itching. Complication
  s - bacterial infection

19
Tinea pedis

• Clinical formsHyperkeratotic - asymptomatic, and
   affects mainly the soles of the
  feet often crosses borders. The skin
  is thickened, desquamated, cracksAcute dyshidroti
  cká - less frequent, small itchy blisters
  that brakes and forms erosions

20
Tinea pedis

• Diagnosis clinical picture, mycological examinati
  on
• Dif.dg the hyperkeratotic forms
  - atopic dermatitis, palmoplantar psoriasis, eczem
  a,hyperkeratotic                at dishydrotické 
  forms - atopic, contact, dishydrotic eczema 

21
Tinea inguinalis

• Dermatophytic groin disease
• Etiology Trichophyton rubrum, interdigitale, Epid
  ermophyton floccosum
• Itchy erythematous lesion, which
  slowly expands into peripherals raised, red,
  from the surrounding skin sharply
  defined rim, consisting of papules, vesicles and p
  ustules in the center gradually fades

22
Tinea inguinalis

• Diagnosis The typical clinical picture, mycologic
  al examination
• Dif.dg Candida infections erythrasma,
  contact dermatitis, inverse psoriasis

23
Tinea manus

• Uncommon dermatophytic infection of the hand
• Etiology almost exclusively secondary disease, oc
  curs when leg infection
• Clinical picture mostly one sided. 
• Hyperkeratotic form - peeling, pronounced
  inpalmar grooves    Dyshidrotic - itchy blisters

24
Tinea manus

• Diagnóza mykologické vyšetrení
• Dif.dg atopický ekzém, kontaktní dermatitida,
  dyshidrotický ekzém, psoriáza.

25
Tinea barbae

• Dermatophytic infection at the bearded part
  of face and neck
• It affects persons coming into contact with
  sick animals. T.mentagrophytes (rodents), Trichopy
  ton verrucosum (cattle) and domestic animals
  Microsporum canis

26
Tinea barbae

• The beard formes follicular erythematous papulopus
  tules up to nodular lesions and
  abscesses with purulent secretion,
  sometimes lymphadenitis. Beards easily released.
• Diagnosis Microscopic examination and cultureDif
  .dg folliculitis, actinomycosis, TB

27
Tinea capitis

• Dermatophytic condition the scalp,
  eyebrows and eyelashes, more children
• Etiology Trichopyton and Microsporum.Microsporum
   infection causes type ektotrix (on the surface
  of the hair), Trichophyton infection type  ektotri
  x and endotrix (inside the hair).

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Tinea capitisKerion celsi

• T.verrucosum, T.mentagrophytes
• Strongly red exfoliating lesion formed papules, pu
  stules and more confluent and mutually communicati
  ng purulent lesions

29
Tinea capitisMikrosporie

• Noninflammatiory tinea capitis.
  M.canis,M.audouinii.
• Oval alopetic lesions with exfoliations and
  brocken hairs

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Tinea capitisFavus

• Trichophyton schoenleinii
• In Central Europe it is rare, affecting children
• The disease is characterized by the formation so
  called skutul, which are yellowish lesions
  formating near the mouth of the hair follicle the
  hair encircling the stem, merging into
  larger areas, leading to cicatricial
• alopecia 

31
Tinea capitis

• Diagnóza mykologické vyšetrení
• Dif.dg. ostatní formy alopecie, seboroicka
  dermatitida, lupus erytematodes, folikulitida

32
Tinea unguium(Onychomycosis)

• Onychomycosis has a wider meaning
  (dermatophytes  yeast)
• Fungal nail plate infections 
• T.rubrum (85), T.interdigitale, E.floccosum 
• of the yeast genus Candida.Predisposing factors
  disorders of circulation, neuropathy, diabetes,
  injury

33
Onychomycosis

• Diagnóza klinický obraz, mykologické vyšetrení
• Dif.dg dystrofické nehty, psoriáza

34
Tinea corporis

• Infection of the trunk and limbs
• All species of dermatophytes
• Annular lesions, the periphery is
  spreading, elevated rim of papulopustules,
  desquamation

35
Tinea corporis

• Diagnóza klinický obraz, mykologické vyšetrení
• Dif.dg. erythema chronicum migrans, psoriasis,
  numulární ekzém, pityriasis rosea

36
Candidosis

• Infections caused by fungi of the
  genus Candida, mainly affects the intertriginous
  localization of the skin and mucous membranes.
• Often in diabetic patients, immunosuprimised, afte
  r use of systemic antibiotics, corticosteroids, cy
  totoxic agents.
• Clinical picture     Candidiasis DU, Angulo infe
  ctiosi, genital candidiasis, intertriginous,interd
  igitalis, Candida Paronychia, chronic mucocutaneou
  s candidiasis

37
Oral candidosis

• Soor ( akutní pseudomembranózní forma)
• Confluent whitish deposits on the buccal mucosa an
  d tongue, can be easily wiped off

38
Anguli infectiosi

• Painful reddened, cracked mouth corners of the
  mouth sometimes with a whitish coating
• Infants, patients with dental prostheses

39
Genital candidosis

• Vulvovaginitis thick whitish discharge, itching, 
  redness of the genital
• Balanitis, balanoposthitis erythematous bearings,
   whitish coating

40
Intertriginous candidosis

• Red, moist areas on the periphery
  of the collar scales, sometimes pustulesGroin, ab
  domen algae, under the breastsItching, burning

41
Candidosis interdigitalis

• In 3rd interdigital space,  erosion occurs with a
  whitish collar scales at the periphery ( people
  working in the wet - cleaning ladies, cooks)

42
Paronychia kandidová

• Bolestivé, zdurelé, zarudlé nehtové valy.

43
Chronic mucocutaneous candidosis

• Infections of the skin, mucous membranes and
  nails affecting immunosuprimised
  and immunodeficient individuals
• Erythematous hyperkeratotic bearings

44
Candidosis

• Microscopic examination and culture on agar Sabour
  adove during 48h.When recidives and
  atypical manifestations need to look for
  possible internalconnection (diabetes mellitus, im
  munodeficiency, etc.)Dif.dg contact dermatitis,
  inverse psoriasis, other fungal infections

45
Other mycotic infections

• Pityriasis versicolor
• Often superficial infection
• Hot a wet supports the infection
• Etiology Malassezia furfur ( before known as
  Pityrosporum ovale)

46
Pityriasis versicolor

• Diagnosis Clinical picture, microscopic examinati
  on, yellow fluorosence in Wood's light
• Dif.dg seborh.dermatitida, Pityriasis rosea
  Gibert, Vitiligo, postzánetlivé hypopigmentace

47
Pityrosporum folliculitis

• Inflammatory diseases of hair follicles caused by
  the organism Malassezia furfur
• Immunosuprimised persons
• Clinics itchy, follicular-bound,
  red papules and acne-like papulopustuly
• Mycological examination, negative bacteriological 
  examination

48
Therapy dermatomycoses

• - local
• - systemic

49
Therapy of dermatomycoses

• - local
• - systemic

Nonspecific antimycotics
Specific antimycotics
50
Non specific

• - jod solutions / Jodisol/ Betadine
• - coal tar, sulfur
• - urea
• Salicylic acid

51
Specific antimycotics

• 1/ polyen antimycotics
• - nystatin / Fungicidin ung/
• - natamycin/ Pimafucin , Pimafucort
• krém, ung/

52
Specific antimycotics

• 2/ azole antimykotics
• -bifonazol /Mycospor/
• - ekonazol / Pevaryl/
• - klotrimazol /Canesten, Canifug, Clotrimazol,
  Imazol , Imazol Plus, Imacort/
• - oxiconazol / Myfungar/
• - ketokonazol / Nizoral/
• - flutrimazol /Micetal/

53
Specific antimycotics

• 3/allylamin antimykotics
• - naftifin / Exoderil /
• - terbinafin / Lamisil/
• 4/pyridin antimykotics
• - cyklopiroxolamin / Batrafen/
• 5/ morfolin antimykotics
• - amarolfin / Loceryl /

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systemic antimycotics

• - Lamisil / terbinafin/
• - Sporanox, Prokanazol / itraconazol/
• - Diflucan /fluconazol/
• - Nizoral / ketokonazol/

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Parasitic infections

• Scabies
• Pediculosis( lice )
• Pulicosis ( fleas)
• Cimicosis ( bed bugs )
• Trombidiasis ( autumn exanthema)
• Ixodidae ( tick-bite )
• Cercarial dermatitis
• Larva migrans

56
Scabies

• Scabies (syn. scabies)
• Itchy, portable, parasitic skin disease
• Sarcoptes scabies (make tunnels in the stratum
  corneum, leaving droppings and the females lay
  their eggs in them)
• direct contact
• The incubation period is 2-6 weeks
• Typical localization (interdigital spaces of
  hands, volar side of the wrist, elbow, axilla,
  areola, navel, genitals)

57
Scabies

• Papules in pairs, excoriation from scratching,
  urticarial lesions, burrows
• Generalized itching, especially at night!Scabies
  norvegica - extremely contagious form, face,
  neck, nails
• Scabies nodularis

58
Scabies

• Therapy
• Permethrin
• Precipitated sulphur 10-20, small children and
  pregnant 2,5
• Hygiene !!!
• Systemic treatment - ivermectin

59
Pediculosis

• Induce by lice - blood-sucking insects host every
  few hours, without food they die within a few
  daysPediculosis capitis (head lice)Phtirius
  pubis (pubic lice)Pediculus corporis (body lice)

60
Pediculosis

• Clinical manifestations are due to a reaction to
  the saliva or anticoagulant contained in the
  saliva, which penetrate into the dermis during
  sacking
• Maculopapular eruption hours to days after biting

61
Pediculosis capitis

• Most often type, affects mainly children of
  school age
• Poor personal hygiene and collective
• Scalp, rarely beard and hair genital
• Nits - gray-white oval that looks like dandruff,
  but they cling firmly to hair

62
Pediculosis pubis

• Especially areas with apocrne sweat glands, most
  commonly pubic, axillary and anogenital less,
  spaces with desne hair like eyebrows, eyelashes
  and scalp - rareAt the site of bite gray-blue
  spots (maculae coerulae) formed by hemoglobin
  degradation enzymes in the saliva of lice.

63
Pediculosis

• Diagnosis identification of lice or nits (or
  magnifying glass or microscope)
• Therapy Malathion, carbaryl and permethrin
  preparations. Lotions should remain on the scalp
  for 12hours and repeat after a week
• Nits can be removed by soaking the hair in warm
  water and use of a toothcomb
• hygiene measures

64
Pulicosis

• Caused fleas - Pulex irritans
• Hiding from the light in the crevices of
  furniture, the floor under the carpet
• Asymmetrically arranged, pruritic erythematous
  macular and urticarial lesions with petechiae in
  the center
• treatment is only symptomatic

65
Cimicosis

• Bedbugs preying on people - Cimex lectularius
• They hide from the light in tight places, they
  suck blood once a week and last for months
  without food
• Itchy wheals, which turn to papules, you can see
  hemorhagic center on the papule
• symptomatic therapy

66
Trombidiasis

• Caused by - Trombicula autumnalis, lives in the
  grass, in the bushes and when in contact with
  skin it sucks blood and spontaneously eliminates
• Pruritic dermatosis of late summer (August rash)
• Itchy red macular rash, within 24hrs papules and
  papulovesicles. Affecting areas in close contact
  with the skin garment, where the larvae collected
• symptomatic therapy

67
Ixodidae

• Tick ??- Ixodes ricinus
• Bite site we can fined erythematous papule
• Borreliosis, tick-borne encephalitis, ricktesiózy
• Therapy tick removal, disinfection, prevention

68
Cerkarial dermatitis

• Dermatitis caused by penetration of larvae
  (cercariae) of animal species (usuaaly birds) to
  damp skin, but in a few days die because man is
  not a suitable host
• Within a few minutes prickly sensations gradually
  macular erythema, and in a few hours - papules,
  vesicles, urticaria
• Treatment is symptomatic

69
Larva migrans

• Caused by the larvae of parasites in tropical
  regions
• Parasites of dogs and cats that enter uninvolved
  skin after direct contact with contaminated feces
  from the ground.
• Burrow in the lower layers of the epidermis -
  Rare affect other organs
• At the intersection intense itching, edema,
  papulovesicles - gradually elevate strip
• Therapy cryotherapy, albendazole p.o