Fungal Infections Superficial fungal infections and Systemic fungal infections


Superficial fungal infections are caused by

  • numerousfungi that are capable of superficially invadingthe following:
  • ▪ Skin , Nail apparatus▪ ,Mucosal sites, Oropharynx•
  • Hair/hair follicles, Anogenitalia, Epidermis,
  • These fungi are commensural organisms thatfrequently colonize normal epithelium.
  • • Dermatophytes, Candida species, Malassezia species,
  • Infections can extend more deeply in the immunocompromisedhost.
  • Deeper, chronic cutaneous fungal infections canoccur after cutaneous inoculation.
  • ▪ Mycetoma, Chromomycosis, Sporotrichosis
Fungal Infections YH
Fungal Infections


Systemic fungal infections with cutaneous dissemination;

  • these infections occur most often inthe immunocompromised host.
  • ▪ Primary lung infection; can disseminate hematogenouslyto multiple organ systems, includingthe skin
  • Histoplasmosis.•
  • Cryptococcosis
  • • North American blastomycosis
  • • Coccidioidomycosis
  • Disseminated candidiasis commonly arises inthe GI tract.
  • • Penicillinosis
  • ▪ Primary gastrointestinal (GI) infection; neutropenichost


Etiology —

  • Three genera of dermatophytes:
  • Trichophyton
  • M icrosporum
  • E pidermophyton .
  • • More than 40 species are currently recognized;approximately 10 spp. are commoncauses of human infection.
  • • T. rubrum is the most common cause of epidermaldermatophytosis and onychomycosisin industrialized nations.

Under the microscope the fungi appear as rounded or budding forms or hyphae.

  • The budding forms are like yeast (round or oval buds).
  • The hyphae are molds( elongated rods).
  • Yeast-like fungi are Candida and Cryptococcus.
  • The mold like fungi are Aspergillus, Rhizopus, Ring worm fungi.
Dimorphic fungi IU
Fungal Infections Dimorphic fungi


Fungal Infections Dimorphic fungi (have 2 forms) – are

  • histoplasmo­sis,
  • blastomycosis,
  • sporotrichosis,
  • coccidiodomycosis.
Fungal Infections coccidiodomycosis
  • They are spherical but grow like molds (hyphae).
  • Candida grows like budding yeast called pseudo hyphae.
Candida growsIU
Fungal Infections Candida grows
  • Pneumocystis are also fungi.
  • Ring worm, Pityriasis versicolor, and Piedra infect the skin and its appendages.
  • Deep mycoses occurs by inhalation.
Fungal Infections K
Fungal Infections Ring worm, Pityriasis versicolor
  • Candida albicans is a normal commensal in the mouth but when the mucosa or skin is breached by disease, or surgery, or trauma, then infection occurs.
  • Aspergillus and Fusarium infect the host when immu­nologically compromised.

Diagnosis Fungal Infections

  • · Microscopic examination of smears or biopsy specimen.
  • · Fluorescence microscopy with calcofluor stain­ing is a sensitive technique for sputum, bron­chial lavage fluid, and pus.
cryptococci in CSIJ
India ink smear is used to detect Fungal Infections cryptococci in CSF
  • · India ink smear is used to detect cryptococci in CSF.
  • · Candida can be seen with Gram-positive stain­ing.
  • · Histopathology slides are stained with Gomori methenamine silver staining.
  • · Histoplasma is detected by nucleic acid hybrid­ization technique.



Fungal Infections UI
Fungal Infections cutaneous Candida, Tinea versicolor (pityri­asis) and ring worm


Imidazole and Triazoles

  • · Cutaneous applications are clotrimazole, ketoconazoleJ miconazole.
  • · For cutaneous Candida, Tinea versicolor (pityri­asis) and ring worm any of the above may be used.
  • .-1- Va inal formulations are miconazole, cIotrimazole.
  • · For vaginal candidiasis clotrimazole may be used.
  • For ring worm tolnaftate is used.
  • Salicylic acid is used for hyperkeratotic lesions of skin.
Systemic antifungals U
Fungal Infections Systemic antifungals
MANAGEMENT of Fungal Infection
  • Prevention
  • Apply powder containing imidazoles or tolnaftate to areas prone to fungal infectionafter bathing.

Topical antifungal

  • These preparations may be effective for treatment of dermatophytoses of skin butpreparations not for those of hair or nails .
  • Preparation is applied bid to involved area optimally for 4 weeks including at least1 week after lesions have cleared.
  • Apply at least 3 cm beyond advancing margin of lesion.These topical agents are comparable.
  • Differentiated by cost, base, vehicle, andantifungal activity.


  • Econazole (Spectazole)
  • Oxiconizole (Oxistat)
  • Sulconizole (Exelderm)
  • Sertaconazole (Ertaczo)Clotrimazole (Lotrimin, Mycelex)
  • Miconazole (Micatin)
  • Ketoconazole (Nizoral)


  • Naftifine (Naftin)
  • Terbinafine (Lamisil)


  • Tolnaftate (Tinactin)
  • Substituted pyridone
  • Ciclopirox olamine (Loprox)

Systemic antifungal agents

  • For infections of keratinized skin :
  • use if lesions are extensive or if infection hasfailed to respond to topical preparations.
  • Usually required for treatment of tinea capitis and tinea unguium.
  • Also may berequired for inflammatory tineas and hyperkeratotic moccasin-type tinea pedis.


  • 250-mg tablet.
  • Allylamine.
  • Most effective oral antidermophyte antifungal; lowefficacy against other fungi.


  • Itraconazole and ketoconazole
  • Itraconazole 100-mg capsules;
  • oral solution (10 mg/mL):Intravenous.


  • Needs acid gastricpH for dissolution of capsule.
  • Raises levels of digoxin and cyclosporine.


  • 100-, 150-, 200-mg tablets;
  • oral suspension (10 or 40 mg/mL);
  • 400 mg IV.


  • 200-mg tablets.
  • Needs acid gastric pH for dissolution of tablet.
  • Take with food orcola beverage; antacids and H2 blockers reduce absorption.
  • The mosthepatotoxic of azole drugs; hepatotoxicity occurs in an estimated one of every10,000–15,000 exposed persons

Griseofulvin Micronized:

  • 250- or 500-mg tablets;
  • 125 mg/teaspoon suspension.
  • Ultramicronized :
  • 165- or 330-mg tablets. Active only against dermatophytes;less effective than triazoles.

Fungal Infections Systemic antifungals

  • Griseofulvin for ring worms.
  • Terbinafine 250 mg  for onychomycosis (fun­gal nail infection) and ring worm.
  • Treatment is given for 3-6 months.
  • The Imidazoles and triazoles may be used for systemic use e.g. fluconazole, itraconazole for blastomycosis, histoplasmosis, aspergillosis.
  • Fluconazole penetrates CSF and other body flu­ids.
  • · It is useful in oropharyngeal and oesophageal candidiasis in adults.
  • Amphotericin B and fluconazole may be used for cryptococcal meningitis, in AIDS, and coccidiodal meningitis.


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