Mycological and parasitical infections Gkalpakiotis Spyridon MD,PhD Dermatovenereology department of Third Faculty of Medicine, Charles University,Prague

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

Oportunic micromycetes Origin of skin mycoses 1/ 2/ 3/ dermatophytes yeast Oportunic micromycetes

oportunní mikromycety Origin of skin mycoses 1/ 2/ 3/ dermatophytic antropofilní zoofilní geofilní yeast oportunní mikromycety

Origin of skin mycoses dermatophytes 1/ antropofilní zoofilní geofilní Trichophyton rubrum Trichophyton interdigitale Epidermophyton floccosum

Origin of skin mycoses dermatophytes 1/ antropofilní zoofilní geofilní Microsporum canis Trichophyton mentagrophytes

Origin of skin mycoses dermatophytes 1/ antropofilní zoofilní geofilní Microsporum gypseum Trichophyton terrestre

Way of transmission Sport /closed shoes Sprchy Bazény sauny Koberce v hotelích Vypůjčené boty, přezůvky Nástroje na pedikúru manikúru Hřebeny, kartáče Pacienti s poruchami metabolismu Iatrogenní vliny /kortikosteroidy ATB,imunosupresiva Pacienti s poruchami imunity

Way of transmission Shower Pool Sport Sauna Koberce v hotelích /uzavřená obuv Koberce v hotelích Vypůjčené boty, přezůvky Nástroje na pedikúru manikúru Hřebeny, kartáče Pacienti s poruchami metabolismu Iatrogenní vliny /kortikosteroidy ATB,imunosupresiva Pacienti s poruchami imunity

Way of transmission Carpets in hotel Sprchy Sport Bazény /uzavřená obuv Sprchy Bazény sauny Vypůjčené boty, přezůvky Nástroje na pedikúru manikúru Hřebeny, kartáče Pacienti s poruchami metabolismu Iatrogenní vliny /kortikosteroidy ATB,imunosupresiva Pacienti s poruchami imunity

Way of transmission Sprchy Sport Bazény Koberce v hotelích /uzavřená obuv Sprchy Bazény sauny Koberce v hotelích Lented shoes Nástroje na pedikúru manikúru Hřebeny, kartáče Pacienti s poruchami metabolismu Iatrogenní vliny /kortikosteroidy ATB,imunosupresiva Pacienti s poruchami imunity

Way of transmission Sprchy Sport Bazény Koberce v hotelích /uzavřená obuv Sprchy Bazény sauny Koberce v hotelích Tools for pedicure and manicure Vypůjčené boty, přezůvky Hřebeny, kartáče Pacienti s poruchami metabolismu Iatrogenní vliny /kortikosteroidy ATB,imunosupresiva Pacienti s poruchami imunity

Way of transmission Sprchy Sport Bazény Koberce v hotelích /uzavřená obuv Sprchy Bazény sauny Koberce v hotelích Hair brush Vypůjčené boty, přezůvky Nástroje na pedikúru manikúru Pacienti s poruchami metabolismu Iatrogenní vliny /kortikosteroidy ATB,imunosupresiva Pacienti s poruchami imunity

Way of transmission Sprchy Sport Bazény Koberce v hotelích /uzavřená obuv Sprchy Bazény sauny Koberce v hotelích Vypůjčené boty, přezůvky Nástroje na pedikúru manikúru Hřebeny, kartáče Iatrogenní vliny /kortikosteroidy ATB,imunosupresiva Pacienti s poruchami metabolismu Pacienti s poruchami imunity

Way of transmission Sprchy Sport Bazény Koberce v hotelích /uzavřená obuv Sprchy Bazény sauny Koberce v hotelích Vypůjčené boty, přezůvky Nástroje na pedikúru manikúru Hřebeny, kartáče Pacienti with immunodeficiency Iatrogenní vliny /kortikosteroidy ATB,imunosupresiva Pacienti s poruchami metabolismu

Dermatomykózy tinea superf.,profunda kandidózy Pityriasis versicolor

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

Tinea pedis It affects mostly men, interdigital spaces of middle age, 10-30% of the population Etiology: Trichophyton rubrum, Trichophyton interdigitale Clinical forms: Interdigital - flushed skin with exfoliation, then macerated, whitish, thickened, with the formation of cracks, itching. Complications - bacterial infection

Tinea pedis Clinical forms: Hyperkeratotic - asymptomatic, and affects mainly the soles of the feet often crosses borders. The skin is thickened, desquamated, cracks Acute dyshidrotická - less frequent, small itchy blisters that brakes and forms erosions

Tinea pedis Diagnosis: clinical picture, mycological examination Dif.dg: the hyperkeratotic forms - atopic dermatitis, palmoplantar psoriasis, eczema,hyperkeratotic                 at dishydrotické forms - atopic, contact, dishydrotic eczema 

Tinea inguinalis Dermatophytic groin disease Etiology: Trichophyton rubrum, interdigitale, Epidermophyton floccosum Itchy erythematous lesion, which slowly expands into peripherals raised, red, from the surrounding skin sharply defined rim, consisting of papules, vesicles and pustules in the center gradually fades

Tinea inguinalis Diagnosis: The typical clinical picture, mycological examination Dif.dg: Candida infections erythrasma, contact dermatitis, inverse psoriasis

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

Tinea manus Diagnóza: mykologické vyšetření Dif.dg: atopický ekzém, kontaktní dermatitida, dyshidrotický ekzém, psoriáza.

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

Tinea barbae The beard formes follicular erythematous papulopustules up to nodular lesions and abscesses with purulent secretion, sometimes lymphadenitis. Beards easily released. Diagnosis: Microscopic examination and culture Dif.dg: folliculitis, actinomycosis, TB

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  ektotrix and endotrix (inside the hair).

Tinea capitis Kerion celsi T.verrucosum, T.mentagrophytes Strongly red exfoliating lesion formed papules, pustules and more confluent and mutually communicating purulent lesions

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

Tinea capitis Favus 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 

Tinea capitis Diagnóza: mykologické vyšetření Dif.dg.: ostatní formy alopecie, seboroicka dermatitida, lupus erytematodes, folikulitida

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

Onychomycosis Diagnóza: klinický obraz, mykologické vyšetření Dif.dg: dystrofické nehty, psoriáza

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

Tinea corporis Diagnóza: klinický obraz, mykologické vyšetření Dif.dg.: erythema chronicum migrans, psoriasis, numulární ekzém, pityriasis rosea

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, after use of systemic antibiotics, corticosteroids, cytotoxic agents. Clinical picture:      Candidiasis DU, Angulo infectiosi, genital candidiasis, intertriginous,interdigitalis, Candida Paronychia, chronic mucocutaneous candidiasis

Oral candidosis Soor ( akutní pseudomembranózní forma) Confluent whitish deposits on the buccal mucosa and tongue, can be easily wiped off

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

Genital candidosis Vulvovaginitis: thick whitish discharge, itching, redness of the genital Balanitis, balanoposthitis: erythematous bearings, whitish coating

Intertriginous candidosis Red, moist areas on the periphery of the collar scales, sometimes pustules Groin, abdomen algae, under the breasts Itching, burning

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

Paronychia kandidová Bolestivé, zduřelé, zarudlé nehtové valy.

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

Candidosis Microscopic examination and culture on agar Sabouradově during 48h. When recidives and atypical manifestations need to look for possible internalconnection (diabetes mellitus, immunodeficiency, etc.) Dif.dg: contact dermatitis, inverse psoriasis, other fungal infections

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

Pityriasis versicolor Diagnosis: Clinical picture, microscopic examination, yellow fluorosence in Wood's light Dif.dg: seborh.dermatitida, Pityriasis rosea Gibert, Vitiligo, postzánětlivé hypopigmentace

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

Therapy dermatomycoses - local - systemic

Therapy of dermatomycoses - local - systemic Nonspecific antimycotics Specific antimycotics

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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