Bacterial & Fungal skin, Soft Bacterial & Fungal skin, Soft Tissue & Muscle infectionsTissue & Muscle infections

For Second Year Medical For Second Year Medical StudentsStudents

Prof. Dr Asem ShehabiProf. Dr Asem Shehabi

Infections of Skin & Soft TissuesInfections of Skin & Soft Tissues

Infections depends upon the Layers of Skin & Soft Infections depends upon the Layers of Skin & Soft Tissues involved ( epidermis, dermis, subcutis, Tissues involved ( epidermis, dermis, subcutis, muscle).. Infections may involve one or several skin muscle).. Infections may involve one or several skin layers.layers.

Skin InfectionsSkin Infections are associated with: are associated with: swelling ,tenderness, warm skin, blisters, ulceration, swelling ,tenderness, warm skin, blisters, ulceration, fever headache.. Rarely systemic disease..septicemia.fever headache.. Rarely systemic disease..septicemia.

Few Normal Few Normal Bacteria & YeastBacteria & Yeast species species live in hair live in hair follicles- Skinfollicles- Skin .. .. maymay cause inflammation of cause inflammation of Hair Hair follicles follicles .. folliculitis, Abscess formation ( Boils).. .. folliculitis, Abscess formation ( Boils)..

Type of Skin Infection-1Type of Skin Infection-1

Skin infectionSkin infection increased by presence of minor skin increased by presence of minor skin injuries, abrasions.. Increase production injuries, abrasions.. Increase production Androgenic Androgenic HormonesHormones after Puberty.. Increase activities after Puberty.. Increase activities Sebaceous ducts..Sebaceous ducts.. secretionsecretion SebumSebum (Fatty Acid+ (Fatty Acid+ Peptides) Increase keratin & skin desquamation .Peptides) Increase keratin & skin desquamation .

Acne vulgaris Acne vulgaris is the most common skin disorder that is the most common skin disorder that affects more Jung male adults than females..Mostly affects more Jung male adults than females..Mostly face.. less other body parts due to face.. less other body parts due to accumulation of oil accumulation of oil sebaceoussebaceous glandsglands & dead tissues.& dead tissues.

Causative Agent: Causative Agent: AnaerobicAnaerobic Propionibacteria acnesPropionibacteria acnes , , gram+ve small bacilli excrete Enzymes.. split sebum .. gram+ve small bacilli excrete Enzymes.. split sebum .. cause mild to severe forms inflammation. cause mild to severe forms inflammation.

PityrosporumPityrosporum folliculitis is a condition where folliculitis is a condition where the yeast invades hair follicles and causes an the yeast invades hair follicles and causes an

itchy, Acne-like eruption caused by itchy, Acne-like eruption caused by P.acneP.acne

Common Normal Skin Flora & PathogensCommon Normal Skin Flora & Pathogens

Staphylococci, hemolytic StreptococciStaphylococci, hemolytic Streptococci ( ( Group AGroup A) ) Micrococci,Micrococci, Propionibacteria , AcinetobacterPropionibacteria , Acinetobacter

Pityrosporum and other YeastsPityrosporum and other Yeasts..Candida species...Candida species.

S. aureusS. aureus :: coagulase+ve.. Various Enterotoxins & coagulase+ve.. Various Enterotoxins & enzymes( Coagulase, DNAse, hyaluronidase), skin enzymes( Coagulase, DNAse, hyaluronidase), skin infections is the most common & important cause of infections is the most common & important cause of human Skin diseases. human Skin diseases.

About 15-40 per cent of healthy humans are healthy About 15-40 per cent of healthy humans are healthy carriers of carriers of S. aureus S. aureus ....nose ornose or skin..feces. skin..feces.

S.epidermidisS.epidermidis is also common in skin..less virulent.. is also common in skin..less virulent.. No toxins ..opportunistic pathogen..No toxins ..opportunistic pathogen..

Clinical features commonly staphylococci:Clinical features commonly staphylococci: Folliculitis / FurunclesFolliculitis / Furuncles .. Hair follicular-based papules

and pustules.. Erythematous lesions.. affect All ages.

Skin InfectionsSkin Infections

Staphylococci skin infections Staphylococci skin infections S. epidermidisS. epidermidis.. .. normal inhabitants of the skin normal inhabitants of the skin

surface.. but Less Pathogenic. Most its infections surface.. but Less Pathogenic. Most its infections occur in normal individuals.. Dry Skin.. Injury.. but occur in normal individuals.. Dry Skin.. Injury.. but underlying illness increase the risk of infection.. underlying illness increase the risk of infection.. Infants.. compromised patients.Infants.. compromised patients.

S.aureusS.aureus is more associated with serious skin is more associated with serious skin infection due to release of 2 important toxins..not all infection due to release of 2 important toxins..not all strainsstrains

1-Toxic Schlock Syndrome1-Toxic Schlock Syndrome:: TSST-1(Enterotoxin) TSST-1(Enterotoxin) Super antigens activate T-lymphocytes..Cytokines, Super antigens activate T-lymphocytes..Cytokines, caused by localized-systemic infectioncaused by localized-systemic infection.. .. Rash & Skin Rash & Skin Desquamation may be associated with sepsis, high Desquamation may be associated with sepsis, high fever,fever, multi-organ failure.. kidney failure.. can be fatal.multi-organ failure.. kidney failure.. can be fatal.

2-Scalded Skin Syndrome2-Scalded Skin Syndrome:: Epidermolytic Epidermolytic/ / Exfoliative Exfoliative

Toxins (A,B).. Minor skin lesion.. Destruction skin Toxins (A,B).. Minor skin lesion.. Destruction skin intercellular connection.. Large blisters containing intercellular connection.. Large blisters containing Fluid .. Skin scaling.. Painful.. Common in small Fluid .. Skin scaling.. Painful.. Common in small children.. Develop specific antitoxins..general massive children.. Develop specific antitoxins..general massive inflammatory response.. rarely causes kidney inflammatory response.. rarely causes kidney failure ..failure ..Shock.. Death without antibiotic treatment .

Staphylococci Staphylococci are becoming increasingly resistant to are becoming increasingly resistant to many commonly used antibiotics including:many commonly used antibiotics including:

Penicillins-Cephalospoins.. Methicillin & flucloxacillin , Penicillins-Cephalospoins.. Methicillin & flucloxacillin , Augmentin (amoxycillin + clavulonic acid) .. B-Augmentin (amoxycillin + clavulonic acid) .. B-lactamase-resistant penicillins.. Other antibioticslactamase-resistant penicillins.. Other antibiotics

Worldwide Spread Worldwide Spread Methicillin resistance Methicillin resistance ((MRSA)..MRSA).. 20-90% ..in Jordan about 60% clinical isolates (2004)20-90% ..in Jordan about 60% clinical isolates (2004)

Diagnosis &Treatment of staphylococcal Diagnosis &Treatment of staphylococcal infectionsinfections

Lab DiagnosisLab Diagnosis of staphylococcal infectionsof staphylococcal infections should be should be confirmed by: culture, gram-stain, positive cocci, +ve confirmed by: culture, gram-stain, positive cocci, +ve catalase , coagulase test .catalase , coagulase test .

Effective treatment ForEffective treatment For MRSAMRSA .. Vancomycin, .. Vancomycin, Teicoplanin, Imipenem, Fusidic acidTeicoplanin, Imipenem, Fusidic acid

DrainageDrainage of pus collections before treatment of pus collections before treatment Surgical removal Surgical removal (debridement(debridement)) of dead tissue of dead tissue

(necrosis) (necrosis) Removal of Removal of foreign bodiesforeign bodies (stitches) that may be a (stitches) that may be a

focus of persisting infection focus of persisting infection Treating underlying skin disease..Prevent repeat Treating underlying skin disease..Prevent repeat

infection..No Vaccine availableinfection..No Vaccine available

Streptococcal Skin Infections-1Streptococcal Skin Infections-1 Streptococcus pyogenes Streptococcus pyogenes / B-H-Group A) / B-H-Group A) ....Major Major

virulence factors: M-Protein, Hemolysin O & S, virulence factors: M-Protein, Hemolysin O & S, Streptokinase (Fibrinolysin-digest Fibrin & Proteins in Streptokinase (Fibrinolysin-digest Fibrin & Proteins in Plasma), Streptodornase (DNAse) Plasma), Streptodornase (DNAse) Erythrogenic-Erythrogenic-pyogenic exotoxins,Toxic Shock Syndrome toxinpyogenic exotoxins,Toxic Shock Syndrome toxin

Cellulites/Cellulites/ Erysipelas Erysipelas : Acute Rapidly Spreading : Acute Rapidly Spreading Infection in skin & Subcutaneous tissues..Following.. Infection in skin & Subcutaneous tissues..Following.. Wounds, Burns.. Highly Communicable..Massive Wounds, Burns.. Highly Communicable..Massive Edema, Lymphatic's inflammation..Children. Edema, Lymphatic's inflammation..Children. ImpetigImpetigoo:: Pyoderma Superficial Layers Skin.. Epidermis, Pyoderma Superficial Layers Skin.. Epidermis, Blisters, Children.. Highly Communicable..followed Blisters, Children.. Highly Communicable..followed Streptococcus Sore Throat or rarely Streptococcus Sore Throat or rarely S. aureus S. aureus wound wound infection.infection.

2/2/

– Scarlet fever: Scarlet fever: Following Group A Strept. Sore throat Following Group A Strept. Sore throat infection..infection.. Erythematous skin rash due to releaseErythematous skin rash due to release Erythrogenic ToxinErythrogenic Toxin.. Strawberry tong.. small .. Strawberry tong.. small children.. permanent immunitychildren.. permanent immunity

- Necrotizing fasciitis Necrotizing fasciitis : Few strains group A , Minor : Few strains group A , Minor

trauma, Invasive infection, trauma, Invasive infection, pyogenic exotoxinspyogenic exotoxins, , Subcutaneous tissues & Fascia, Rapid spread Subcutaneous tissues & Fascia, Rapid spread necrosis..Sever tissue damage..Pain, Fever, Sever necrosis..Sever tissue damage..Pain, Fever, Sever systemic illness.. Fatal without Rapid Antibiotic systemic illness.. Fatal without Rapid Antibiotic TreatmentTreatment

- Streptococcal Toxic Shock SyndromeStreptococcal Toxic Shock Syndrome::

pyrogenic toxin pyrogenic toxin //superantigensuperantigens/TSS, Infected s/TSS, Infected Trauma, Bacteremia, Respiratory & Multi Organ Trauma, Bacteremia, Respiratory & Multi Organ Failure.. 30% Death.Failure.. 30% Death.

Skin rash - Scarlet FeverSkin rash - Scarlet Fever

B-H-StreptococciB-H-Streptococci

Diagnosis & TreatmentDiagnosis & Treatment

Culture on blood, Culture on blood, B-Hemolytic reactionB-Hemolytic reaction, Gram-+ve , Gram-+ve cocci in chain, catalase-ve, Bacitracin-Susceptiblecocci in chain, catalase-ve, Bacitracin-Susceptible

SerotypingSerotyping should used to confirm group of should used to confirm group of streptococcal infection.. A, B, C etc. using antisera streptococcal infection.. A, B, C etc. using antisera against group-specific cell wall carbohydrate –against group-specific cell wall carbohydrate –Antigens (Lancefield classification)Antigens (Lancefield classification)

Penicillin is the drug of choicePenicillin is the drug of choice.. All Group A .. All Group A streptococci are very sensitive to penicillin. streptococci are very sensitive to penicillin.

Patients with penicillin allergy may be given Patients with penicillin allergy may be given Erythromycin.. Azithromycin..Erythromycin.. Azithromycin..

Less Common Bacterial Skin InfectionsLess Common Bacterial Skin Infections N.gonorrhoeaN.gonorrhoea....Salmonella typhi or paratyphSalmonella typhi or paratyph i.. i..

General Skin rash..Rosa spotsGeneral Skin rash..Rosa spots Soft chancre /chancroid Soft chancre /chancroid : : Haemophilus Haemophilus

ducreyiducreyi..Gram-ve bacilli, STD.. Painful Skin Ulcer.. ..Gram-ve bacilli, STD.. Painful Skin Ulcer.. Extra Genitalia .. Common in Tropical Region.Extra Genitalia .. Common in Tropical Region.

SyphilisSyphilis:: Treponema pallidumTreponema pallidum.. Genital ulcers.... Genital ulcers.. MeningococemiaMeningococemia:: N. meningitidis N. meningitidis.. Sepsis, Skin rash .. Sepsis, Skin rash

& hemorrhage..Thrombosis& hemorrhage..Thrombosis Rickettsia diseasesRickettsia diseases: Small intracellular bacteria : Small intracellular bacteria

human, human, R. prowazeki R. prowazeki (Typhus), (Typhus), R. rickettsii R. rickettsii (Spotted (Spotted fever).. Transmitted by body lice.. systemic diseasesfever).. Transmitted by body lice.. systemic diseases

Pseudomonas aeruginosa Pseudomonas aeruginosa : Wound infections, Burns: Wound infections, Burns

/2/2 Bacillus anthracisBacillus anthracis.... Cutaneous Black Lesions.. Clostridium perfingens Clostridium perfingens and other sp.and other sp. : Necrotizing : Necrotizing

Fasciitis.. Myonecrosis, Cellulitis, tissues putrefaction, Fasciitis.. Myonecrosis, Cellulitis, tissues putrefaction, gas production/ Gas gangrene.. Surgical/Traumatic gas production/ Gas gangrene.. Surgical/Traumatic wound.. Skin- Subcutaneous (Mixed Infection).. wound.. Skin- Subcutaneous (Mixed Infection).. Specific Enzymes & ExotoxinsSpecific Enzymes & Exotoxins

Borrelia BurgdorferiBorrelia Burgdorferi :: Lyme disease Lyme disease .. Transmitted .. Transmitted by Tick/ Insect bites.. Incub. 1-3 weeks.. Annular by Tick/ Insect bites.. Incub. 1-3 weeks.. Annular Rash.. Chronic Skin Lesion.. Cardiac & Neurological Rash.. Chronic Skin Lesion.. Cardiac & Neurological Abnormality.. Arthritis.. Endemic USA, China, JapanAbnormality.. Arthritis.. Endemic USA, China, Japan

Bartonella speciesBartonella species: G-ve bacilli Bartonellosis : G-ve bacilli Bartonellosis Cat Cat Scratch Fever..Scratch Fever..followed Cat scratch or bite..Skin followed Cat scratch or bite..Skin lesions.. Subacute regional lymphadenitis..Septicemia. lesions.. Subacute regional lymphadenitis..Septicemia.

Tuberculosis-Leprosy-1Tuberculosis-Leprosy-1

Cutaneous TuberculosisCutaneous Tuberculosis (TB).. Cutaneous TB is a (TB).. Cutaneous TB is a relatively uncommon form of extra-pulmonary TB.. relatively uncommon form of extra-pulmonary TB..

Rare M. tuberculosisRare M. tuberculosis.. Common .. Common M. marinum-M. marinum-ulceransulcerans.. Low Temperature..Water.. Skin Lesions.. .. Low Temperature..Water.. Skin Lesions.. Chronic cutaneous ulcer.. Small granulomas Follow Chronic cutaneous ulcer.. Small granulomas Follow skin injury..Trauma.skin injury..Trauma.

Leprosy:Leprosy: Chronic bacterial infectionChronic bacterial infection caused by caused by M. lepraeM. leprae.. .. ItIt primarily affects cold body sites primarily affects cold body sites skin, skin,

mucous membranes.. peripheral nervesmucous membranes.. peripheral nerves .. ..nose, ears, nose, ears, eye lids and testes.eye lids and testes.

characterized by characterized by multiple skin lesions multiple skin lesions accompanied accompanied first by sensation loss/ anesthesia.. sensory loss in the first by sensation loss/ anesthesia.. sensory loss in the affected areas, toes, finger tipsaffected areas, toes, finger tips, , tissuetissue destructions.destructions.

Leprosy-2Leprosy-2

Leprosy-3Leprosy-33/3/

LebrosyLebrosy can affect people of all races around the world. can affect people of all races around the world. However, it is most common in warm, wet areas in the However, it is most common in warm, wet areas in the tropics and subtropics.tropics and subtropics.

In most cases, it is spread through In most cases, it is spread through long-term contactlong-term contact with a person who has the disease but has not been with a person who has the disease but has not been treated.treated.

Most people will never develop the disease even if Most people will never develop the disease even if they are exposed to the bacteria.. have they are exposed to the bacteria.. have

a natural immunity to leprosy.a natural immunity to leprosy. Worldwide prevalence is reported to be around Worldwide prevalence is reported to be around 5.5 million5.5 million, ,

with 80% of these cases found in 5 countries: India, with 80% of these cases found in 5 countries: India, Indonesia, Myanmar, Brazil and Nigeria.Indonesia, Myanmar, Brazil and Nigeria.

Clinical Leprosy-4Clinical Leprosy-4

Infection incubation period range from 6 months - 40 Infection incubation period range from 6 months - 40 years or longer. usually begins in the extremitiesyears or longer. usually begins in the extremities

Leprosy formsLeprosy forms depend on the person's immune depend on the person's immune response to the infection.response to the infection.

There are several forms of leprosy:There are several forms of leprosy: Tuberculoid formTuberculoid form.... Mild FormMild Form.... Few AF Bacilli, Few AF Bacilli,

Lepromin skin test +ve, Presence nerve sensationLepromin skin test +ve, Presence nerve sensation lepromatous type lepromatous type Severe form.. Numerous Acid-fast Severe form.. Numerous Acid-fast

bacilli, Loss nerve sensation.. Lepromin skin test -vebacilli, Loss nerve sensation.. Lepromin skin test -ve

Diagnosis & TreatmentDiagnosis & Treatment Lab DiagnosisLab Diagnosis: A skin biopsy may show : A skin biopsy may show

characteristic granulomas (mixed inflammatory cell characteristic granulomas (mixed inflammatory cell infiltrate in the deeper layers of the skin, the dermis) infiltrate in the deeper layers of the skin, the dermis) with involvement of the nerves. with involvement of the nerves.

Presence Acid fast bacilli.. number of bacilli visible Presence Acid fast bacilli.. number of bacilli visible depending on the type of leprosy.. depending on the type of leprosy.. No Culture.. No No Culture.. No Protected Vaccine availableProtected Vaccine available.. BCG may help & .. BCG may help & reduce the severity of diseasereduce the severity of disease

Treatment:Treatment: Dapsone, Rifampin, Clofazimine. Life-long Dapsone, Rifampin, Clofazimine. Life-long Treatment ..No Cure but Less Tissue Damage and Treatment ..No Cure but Less Tissue Damage and Spread of Infection.Spread of Infection.

Common Fungal Skin Infection-1Common Fungal Skin Infection-1

Superficial & Cutaneous MycosisSuperficial & Cutaneous Mycosis: : Invade only dead Invade only dead tissues of the skin.. keratinized body tissues.. Skin, tissues of the skin.. keratinized body tissues.. Skin, Hair, Nails. causes skin peeling, redness, itching, Hair, Nails. causes skin peeling, redness, itching, burning.. less blisters and sores. burning.. less blisters and sores.

Malnourishment, poor hygiene, suppressed immunity Malnourishment, poor hygiene, suppressed immunity & warm moist climate may increase the incidence & warm moist climate may increase the incidence fungal skin infectionfungal skin infection

Dermatophytes:Dermatophytes: Trichopyhton, Microsporum, Trichopyhton, Microsporum, Epidermatophyton spp., Epidermatophyton spp., Yeast forms Yeast forms Piytrosporum, Piytrosporum, TrichosporonsTrichosporons ..present in hair follicles & skin folding. ..present in hair follicles & skin folding.

Transmission:Transmission: Usually from person to person or Usually from person to person or animal to person.. dust particles..common more with animal to person.. dust particles..common more with chronic skin disorders. chronic skin disorders.

Tinea CorporisTinea Corporis

Tinea pedis -Tinea capitis kerionTinea pedis -Tinea capitis kerion

Skin Fungal Infection-2Skin Fungal Infection-2 Tinea capitisTinea capitis:: Hair follicles, scalp circular patches.. Hair follicles, scalp circular patches..

Scaling,Scaling, Hair Loss..Children..Rare adults Hair Loss..Children..Rare adults Tinea corporisTinea corporis:: Skin annular-erythematic lesions, Skin annular-erythematic lesions,

Vesicles, Scaling.. Itching.. Rash.. All Ages.. Mostly Vesicles, Scaling.. Itching.. Rash.. All Ages.. Mostly caused by Dermatophytes ..rarely mixed with Yeastcaused by Dermatophytes ..rarely mixed with Yeast

Tinea pedisTinea pedis :: Red vesiclesRed vesicles.. .. Interdigital spaces, web Interdigital spaces, web lesions, Toes, Plantar surface.. Feet, Itching.. Chroniclesions, Toes, Plantar surface.. Feet, Itching.. Chronic lesions..Wearing tight shoes/socks, increased feet lesions..Wearing tight shoes/socks, increased feet sweating.. More in Adults than children.. Cased by all sweating.. More in Adults than children.. Cased by all Dermatophytes.Dermatophytes.

Tinea crurisTinea cruris: Pelvic area.. Groin.. Erythematic : Pelvic area.. Groin.. Erythematic Lesions, Itching, Chronic.. more common in male Lesions, Itching, Chronic.. more common in male young adults..mostly young adults..mostly Epidermophyton sppEpidermophyton spp

Skin Fungal Infection-3Skin Fungal Infection-3 Tina unguium Tina unguium ((Onychomycosis): Mostly caused by Onychomycosis): Mostly caused by

TrichophytonTrichophyton , ,MicrosporumMicrosporum.. less Candida..fingernails .. less Candida..fingernails & toenails. Nails become colorless/dark colored, & toenails. Nails become colorless/dark colored, thicken, disfigure and brittle..Diabetes thicken, disfigure and brittle..Diabetes

PsoriasisPsoriasis is a common skin disorder produces thick is a common skin disorder produces thick red plaques covered with silvery scales..can affect the red plaques covered with silvery scales..can affect the nails, scalp, skin and joints..not caused by fungus and nails, scalp, skin and joints..not caused by fungus and not transmitted to others. not transmitted to others.

EczemaEczema develops due to multiple immunological &  develops due to multiple immunological & other medical conditions.. Skin becomes inflamed or other medical conditions.. Skin becomes inflamed or irritated..No infectious agent involved.irritated..No infectious agent involved.

Aspergillus & Cryptococcus spp. Aspergillus & Cryptococcus spp. Rare cause localised Rare cause localised skin or nail.. skin or nail..

Onychomycosis-PsoriasisOnychomycosis-Psoriasis

Skin Fungal Infection-3Skin Fungal Infection-3

Tinea Versicolor/PityriasisTinea Versicolor/Pityriasis:: Malassezia furfur / Malassezia furfur / Piytrosporum folliculitisPiytrosporum folliculitis.. Lipophilic .. Lipophilic Yeast ..difficult to culture in Labs. Part skin Yeast ..difficult to culture in Labs. Part skin flora.. Endogenous infection.. Skin Moist-Folded flora.. Endogenous infection.. Skin Moist-Folded Area.. Discoloration.. Red Spots.. Mostly Face-Area.. Discoloration.. Red Spots.. Mostly Face-Neck FingerNeck Finger Trunk..Mild..rarely Chronic, Stress Trunk..Mild..rarely Chronic, Stress conditions, UV-Light, Common in young adults.conditions, UV-Light, Common in young adults.

Head dundruffHead dundruff, Seborrheic dermatitis., Seborrheic dermatitis. White & Black PiedraWhite & Black Piedra..Trichosporon spp., Soft ..Trichosporon spp., Soft

to hard nodules. scalp hair & hair shaft , skin to hard nodules. scalp hair & hair shaft , skin face , any body part. face , any body part.

Yeat skin infectionYeat skin infection CandidasisCandidasis:: C. albicans, C. glabrata, C. tropicalis.. C. albicans, C. glabrata, C. tropicalis..

Other spp. Endogenous infection..moist folds of skin.. Other spp. Endogenous infection..moist folds of skin.. Lesions, finger nails, toenails, Finger webs.. Diabetes, Lesions, finger nails, toenails, Finger webs.. Diabetes, immuno-compromessed.. more common in Infant & immuno-compromessed.. more common in Infant & women.. Candida infections can look just like other women.. Candida infections can look just like other types of dermatitis /eczema or skin allergy. itching, types of dermatitis /eczema or skin allergy. itching, redness..infectionredness..infection

BlasmycosisBlasmycosis: Blastomyces dermatitidis & : Blastomyces dermatitidis & HistoplasmosisHistoplasmosis : Histoplasma capsulatum.. : Histoplasma capsulatum.. Dimorphic Fungi.. Soil ..Spore Inhalation.. Respiratory Dimorphic Fungi.. Soil ..Spore Inhalation.. Respiratory infection.. Systemic Infection.. Complications: Skin infection.. Systemic Infection.. Complications: Skin ulcerations/lesions Granulomas..causes severe ulcerations/lesions Granulomas..causes severe damages..common USA, Canadadamages..common USA, Canada

Tinea Pityrisis / versicolor Tinea Pityrisis / versicolor Seborrheic dermatitis Seborrheic dermatitis

Lab diagnosis-4Lab diagnosis-4 Direct microscopic examinationDirect microscopic examination of skin scales of skin scales

dissolved in a dissolved in a 10 % solution potassium hydroxide 10 % solution potassium hydroxide (KOH(KOH).. demonstrating the fungus as small ).. demonstrating the fungus as small Filaments / Filaments / Yeast like structures.Yeast like structures.

Culture:Culture: Sabouraud Dextrose agar, Incubation at Sabouraud Dextrose agar, Incubation at room temperature & 37 C for 2-6 Weeks. . Slow room temperature & 37 C for 2-6 Weeks. . Slow growth for Dermatophytes..Rapid growth Candida. growth for Dermatophytes..Rapid growth Candida.

ChromCandida agar.. used for rapid identification of ChromCandida agar.. used for rapid identification of common common Candida speciesCandida species..

TreatmentTreatment:: Most skin infections respond very well to Most skin infections respond very well to topical antifungaltopical antifungal drugs..Less systemic drugdrugs..Less systemic drug .. .. interact interact with Ergosterol ..causing Fungal Cell membrane with Ergosterol ..causing Fungal Cell membrane disruption.. disruption.. Imidazole drugsImidazole drugs ..miconazole, ..miconazole, clotrimazole, econazole, ketoconazole, fluconazole clotrimazole, econazole, ketoconazole, fluconazole