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Chapter 121 : , , , and Agents of Superficial Mycoses

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Abstract:

The etiologic agents of dermatophytosis are classified, along with some nonpathogenic relatives, in the anamorphic genera , , and . The recorded connections between the teleomorphic (sexual) and anamorphic (asexual) states of the dermatophytes as well as the dermatophytoids are discussed in this chapter. As part of the ongoing molecular revolution in biology, fungal taxonomy is ever more strongly influenced by one's greatly increased understanding of population genetics. The chapter retains a relatively cautious approach to the ongoing debates in this area and synonymizes traditionally recognized species primarily when there is unequivocal, multigene molecular evidence that they are not supported at the species level. Dermatophytes are keratinophilic fungi that are capable of invading the keratinous tissues of living animals. They are grouped into three categories based on host preference and natural habitat. Infections with geophilic dermatophytes involve transmission of soil-borne inoculum to humans or other mammals. At present, the great majority of dermatophytes are identified phenotypically. Identification is often based on (i) colony characteristics in pure culture on sabouraud glucose agar (SGA) and (ii) microscopic morphology. Dermatophytes can in principle be tested for susceptibility to antifungal drugs using the Clinical and Laboratory Standards Institute (CLSI) M38-A3 standard procedure for molds. In the superficial mycoses, the causative fungi colonize the cornified layers of the epidermis or the suprafollicular portion of the hair. There is little tissue damage, and lack in cellular response from the host.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121

Key Concept Ranking

Fungal Infections
0.46131083
Trichophyton rubrum
0.42732558
Restriction Fragment Length Polymorphism
0.42421108
Trichophyton mentagrophytes
0.42151165
0.46131083
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Image of FIGURE 1
FIGURE 1

Dermatophyte hyphae in skin scraping. NaOH mount. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 2
FIGURE 2

ectothrix type of hair invasion. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 3
FIGURE 3

endothrix type of hair invasion. Magnification, ×1,000.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 4
FIGURE 4

Hair infected by from a patient with favus. Magnification, ×1,000.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 5
FIGURE 5

Smooth-walled macroconidia of . Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 6
FIGURE 6

Macroconidia and microconidia of complex on SGA with 5% NaCl. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 7
FIGURE 7

Smooth-walled macroconidia of Afro-Asiatic type from primary isolate on SGA. Magnification, ×1,000.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 8
FIGURE 8

FIGURE 8 Long, narrow macroconidium and clavate to pyriform microconidia of . Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 9
FIGURE 9

Clavate macroconidium, microconidia, and intermediate conidia of . Phase contrast; magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 10
FIGURE 10

Microconidia with typical refractile cytoplasm of . Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 11
FIGURE 11

Characteristic chlamydospores produced by or BCP-milk solids-yeast extract agar. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 12
FIGURE 12

Macroconidia of on SGA. Note the absence of microconidia. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 13
FIGURE 13

Macroconidia of on SGA with 3% NaCl. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 14
FIGURE 14

Macroconidia of with rough thick walls. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 15
FIGURE 15

Macroconidia of showing thick walls and pseudosepta. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 16
FIGURE 16

Macroconidia of . Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 17
FIGURE 17

Rough-walled macroconidium of on SGA with 3% NaCl. Magnification, ×1,000.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 18
FIGURE 18

(a) complex: “nodular” variant of (formerly ), SGA, 12 days, showing typical bright yellow pigmentation. (b) complex: granular, zoophilic type (mating tester strain of ), 14 days. (c) SGA, 10 days, surface showing cottony white mycelium. (d) SGA, 10 days, reverse showing typical red pigment. (e) , SGA, 14 days, surface showing low velvety texture, mixed white and brownish mycelium. (f) SGA, 14 days, reverse showing mixture of mahogany red-brown and sulfur yellow coloration. (g) SGA, 10 days, relatively flat colony showing pale striate margin and yellowish pigment near colony center. (h) Brown filaments of in NaOH mount of scraping from tinea nigra. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 19
FIGURE 19

in skin scrapings from a lesion of tinea versicolor (Kane's stain). Magnification, ×1,000.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 20
FIGURE 20

Culture of on Littman oxgall agar overlaid with olive oil.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 21
FIGURE 21

Microscopic appearance of yeast cells on Littman oxgall overlaid with olive oil. Magnification, ×400.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 22
FIGURE 22

Black piedra nodules on scalp hair. NaOH mount. Magnification, ×100.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 23
FIGURE 23

White piedra nodule on hair from the groin. Magnification, ×1,000.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Image of FIGURE 24
FIGURE 24

Arthroconidia from a crushed nodule of white piedra. Magnification, ×1,0

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
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Tables

Generic image for table
TABLE 1

Important characteristics of clinically isolated dermatophytes and dermatophytoids

Common.

Uncommon but likely to be seen by large labs in Americas and Europe.

Unlikely to be seen except in region where endemic or proficiency test or soil isolation experiment.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
Generic image for table
TABLE 2

Grouping of dermatophytes on the basis of host preference and natural habitat

Normally nonpathogenic, soil-associated dermatophytoids such as and are not included in this table.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
Generic image for table
TABLE 3

Hair invasion by dermatophytes on the human host

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
Generic image for table
TABLE 4

Dermatophyte nutritional response as elucidated by agars

Only the growth responses for organisms with growth factor requirements and the selected organisms that must be most closely compared with them are included in this table. The numbers in the table body indicate the relative degree of growth according to traditional 1+ to 4+ visually approximated scale: 0, no growth; 1, slight growth, strongly nutrient deprived colony morphology (very sparse, subsurface colonial growth only or colony diameter strongly reduced compared to Sabouraud agar control); 2, partially stimulated growth but still significantly suppressed compared to that of the control; 4, growth comparable to that of the control (the table includes no 3+ reactions); v, variable. Blank spaces in the table indicate growth responses that are not customarily examined but that are insignificantly different from control growth responses on Sabouraud agar.

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121
Generic image for table
TABLE 5

Sequence of procedures for phenotypic identification of dermatophytes in pure culture

It may be necessary to incubate cultures on brain-heart infusion agar or BCPMSG to ensure absence of antibiotic-resistant bacterial contamination before proceeding to step 4. Procedures are adapted from Weitzman and colleagues ( ) and Kane et al. ( ).

Citation: Summerbell R. 2011. , , , and Agents of Superficial Mycoses , p 1919-1942. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch121

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