Medical Mycology

Prof. Dr. Nadeem A. Ramadan

2020-2021
Definitions:
What is Mycology? Mycology is the study of fungi and their multiple
functions in nature.
What are Fungi: Fungi are eukaryotic organisms that do not contain
chlorophyll, but have cell walls (chitin), filamentous structures, and
produce spores.
These organisms grow as saprophytes and decompose dead organic
matter as pathogens of plants, animals, humans, and in food spoilage
and as producers of secondary metabolites, there are between
100,000 to 200,000 species depending on how they are classified.
About 300 species are presently known to be pathogenic for the
human. Mycology (from Greek term μύκης (mykes, mukos)
"Mushroom" and logy "science"
History of Mycology:
Mycology is a relatively new science that became systematic after the
development of the microscope in the 16th century.
*Fungal spores were first observed by Giambattista Della Porta in
1588, *The seminal work in the development of mycology is
considered to be the publication of Pier Antonio Micheli's 1729
work Nova plantarum genera. Micheli not only observed spores but
also showed that, under the proper conditions, they could be induced
into growing into the same species of fungi from which they
originated.
*Extending the use of the binomial system of nomenclature introduced
by Carl Linnaeus in Species Plantarum.
*Hendrik Persoon (1761–1836) established the first classification of
mushrooms with such skill to be considered a founder of modern
mycology.
*Elias Magnus Fries (1794–1878) further elaborated the classification
of fungi, using spore color and various microscopic characteristics,
methods still used by taxonomists today.
*Anton de Bary(1861)established modern mycology; he studied slime
molds, rusts and late blight of potato diseases.
*Berfield(1875) studied smut disease and he used copper sulfate to
control plant diseases caused by fungi.
* Robert Koch (1843-1910) the first one who discovered artificial
medium to isolate and growth fungi. The 20th century has seen a
modernization of mycology.
The taxonomy of the Kingdom Fungi is evolving and is controversial.
Formerly based on light microscopic morphology, studies of
ultrastructure, biochemistry and molecular biology provide new evidence
on which to base taxonomic positions.
Taxonomy: Organisms do not divide itself but Scientists are divided
into groups for the following reasons:
1. Give scientific names to the organisms in a scientific manner
universally recognized and described in different groups.
2. Know the natural relationship between these organisms and
between other organisms in different groups.
Based on available information, The organisms divided into five (5) kingdoms, depending
on (Whattaker ,et al, 1969).
A-Degree of complexity of body:
1. Unicellular , 2. Multicellular
B-Feed method:
1-Photosynthesis, 2. Absorption, 3. Ingestion digestion
Kingdom Fungi
Characteristic of fungi:
1-Fungi are eukaryotic organisms means they have true nucleus which are enclosed in membranes
2-They are non-vascular organisms.They do not have vascular system.Xylem and Phloem are abse
3-Fungi have cell walls . They reproduce by means of spores. There are sexual and asexual spores
Sexual spores are Oospores,Zygospores, Ascospores, Basidiospores, and Asexual spores are
Sporangiospores, Aplanospores, Zoospores, Conidia, etc.
4-Depending on the species and conditions both sexual and asexual spores may be produced.
5-They are typically non-motile.
6-Fungi exhibit the phenomenon of alteration of generation.They have both haploid and diploid
stage.
7-Fungi are achlorophyllous, which means they lack the chlorophyll pigments present in the
chloroplasts in plant cells and which are necessary for photosynthesis.
8-The vegetative body of the fungi may be unicellular or composed of microscopic threads called
hyphae.,Hyphae can grow and form a network called a mycelium.
9-Yeasts are unicellular fungi that do not produce hyphae.
10-The structure of cell wall is similar to plants but chemically the fungi cell wall are composed
of chitin
11-Optimum temperature of growth for most saprophytic fungi is 20-30°C while (30-37)°C for
parasitic fungi.
12-Growth rate of fungi is slower than that of bacteria.
13-Reproduction in fungi is both by sexual and asexual means.
14-Sexual state is referred to as teleomorph (fruiting body), asexual state is referred to as
anamorph (mold like).
15-Reproduction occurs by both asexual (Axamorph) and sexual (Teliomorph) mode:Asexual
methods18-Pheromone is a chemical substance produced by fungi, which leads to the
sexual reproduction between male and female fungi cells.
16-Some fungi are macroscopic and can be seen by naked eyes. Mold or mushrooms are
examples of macroscopic form of fungi.
17-In 1991, a landmark paper estimated that there are 1.5 million fungi on the Earth.
18-Only about 300 species of fungi are infectious to human.
Examples: Candida albicans, Aspergillus, Blastomyces, Coccidioides , Cryptococcus
neoformans, Histoplasma, Pneumocystis spp. etc.
Importance of Fungi:
1-Fungi are the agents responsible for much of the disintegration of
organic matter and such they affect us directly by destroying food,
fabrics, leather and other consumer goods manufactured from
materials subject to fungal attack.
2-They are the basis of a number of industrial processes involving
fermentation, such as making of bread example:
Saccharomyces cerevisiae, wines, beers, and the fermentation of
cacao, bean and the preparation of certain cheeses.
3-Production of many organic acids of some drugs such as Ergotamine,
Cortisone, and some Vitamin preparations, and are responsible for
the manufacture of a number of Antibiotics, Penicillin and
Cephalosporin.
4- Some of them are good for human consumption such as Agaricus
bisporus - edible mushroom, and single cell proteins.
5-Many fungi are particularly important in the decomposition of plant
debris because of their ability to utilize cellulose such as Xylaria.
6- Use it as important research tools in cytologists, Geneticists, and
biochemists such as Neurospora.
7- They cause a majority of known plant diseases such as Botrytis, and
many diseases of animals and humans such as Fusarium.
During the time period between 1941 - 1973, the number of reported
deaths in the U.S. due to scarlet fever, typhoid, whooping cough,
diphtheria, dysentery and malaria decreased from 10,165 cases to 107;
but the reported deaths due to mycoses during the same time period,
increased from 324 to 530.
Principles of living fungi
Living mode of fungi:
In nature fungi obtain their food either by infecting living organisms as parasites or
by attacking dead organic matter as saprobes, many also form symbiotic relationships
with higher plants as in mycorrhiza (and with blue-green algae as in lichens.
Cultivation of fungi:
Fungi which we can be cultivated them on nutrient media are (saprobes and
facultative parasites), and those fungi cultivate on different culture media such as
1.Natural media: They are planting extract such as wheat extract , potato extract, carrot
and others vegetable extract , also we can use fruit to prepare this kind of media.
2. Synthetic media: The main compositions of this medium are certain chemicals and
some salts such as Czapek`s Dox Medium .
3. Semi-synthetic media: they are mixed of two kinds of media (natural and synthetic)
such as Potato Dextrose Media. These threetypes of culture media are liquid so we
can be solidified them by adding (1.5 – 2.0 %) agar.
Optimum conditions suitable for fungal growth :
1. Temperature:
Fungi are living in the wide range of temperature and according to it, fungi classified in to :
A. Mesophilic fungi:The range is (10–40ºC) and the optimum is(25–35ºC).
B. Psychrophilic fungi: The range is (5–25ºC) and the optimum is (15ºC).
C. Thermophilic fungi:The range is (20– 50ºC) and the optimum is (40ºC).
2. Light: In some species, the pigment melanin may play a role in extracting energy from
ionizing radiation, such as gamma radiation. This form of "radiotrophic" growth has been
described for only a few species, the effects on growth rates are small, and the underlying
biophysical and biochemical processes are not well known.
3-Aeration: All fungi prefer living in aerobic condition.
4- Hydrogen Ion concentration: pH: (acidic).
5. Humidity:
A) Some fungi are water mold.
B) Some fungi need some water for growth.
C) Some fungi are capable of growth in near-dry condition.
What are the important elements for fungal growth?
1. Carbon sources: (carbohydrates) such as monosugar (glucose and
fructose) or di sugar such as sucrose and maltose and multi-sugar
such as starch.
2. Nitrogen sources:
A. Organic source: such as Amino acids and peptone.
B. Inorganic source: such as nitrate and ammonia. The salts are
added according to fungi requirements. A. Macro elements:
which add in large quantities such as Na, Mg, k, Zn. B.
Microelements: which add in trace quantities such as Sc, Mn.
Morphology of fungi:
When fungi are grown on the suitable medium, produce long, branching
filaments, those called -Mold-. Each filament is called hyphae.
Hyphae are long, slender transparent, wall filled or lined with a large of
protoplasm varying in thickness.
Generally 3-10 microns in diameter. If hyphae have the cross wall, the
fungus is said to be septate- if not -aseptate-(coenocytic hyphae).
Aseptate (or coenocytic) and septate hyphae
The presence or absence of these cross wall can be important in
differentiating between certain classes. Hyphae may become
divided into a chain of cells by the formation of septa (septum).
As the hyphae continue to growth and branched a mat of growth
called mycelium.
The part of growth which projects above the surface of the substrate
called aerial mycelium- which holds the spores.
The part which penetrates into the substrate and absorbs food is known
as vegetative mycelium.
The mycelium of parasitic fungi grows either by spreading between the
cells or penetrating into them.
The mycelium of fungus generally beings as a short-germ-tube
emerging from a germinating spore.
Fungal colony tend to be circular in outline on solid medium, while the
mycelium has a tendency to grow more or less equally in all
directions from the central point, and to develop colony- you can
observe this by growing certain fungi on liquid and solid media.
A: Somatic phase (Soma): Fungi can be classified into four groups
according to their morphology:
1- Mold – Mould-: Which grow as branching filaments - hyphae - and
produce the mycelium, while in slime molds the somatic phase grows
as Plasmodium.
2- Yeast: are eukaryotic, single-celled microorganisms (Unicellular cells)
which appear as round cells, do not form spores but reproduce by
budding of the parent cells. This process of budding results in the
production of two cells. Most are the single-celled structure with
thick cell wall such as Cryptococcus neoformans. Note: The word
"yeast" comes from Old English gist, cyst, and from the Indo-
European root yes-, meaning "boil", "foam", or "bubble.
3- Yeast-like fungi: Also reproduce by
budding and grow as non-branching
filament-pseudohyphae- such as
Candida albicans.

4- Dimorphic fungi: They grow as yeast form in tissue when incubated

at 37ºC in vitro, but when incubated
at 22ºC grow as mycelium form.
This group of fungi has two phases
of growth –Dimorphic such as
-Histoplasma capsulatum;
Blastomyces dermatitidis.
Molds growing on solid medium Yeast
Classification of Fungi
Kingdom Fungi are classified based on different modes. The different
classification of fungi is as follows:
Based on Mode of nutrition
On the basis of nutrition, kingdom fungi can be classified into 3 groups.
1-Saprophytic fungi– The fungi obtain their nutrition by feeding on dead
organic substances. Examples: Rhizopus, Penicillium and Aspergillus.
2-Parasitic fungi –The fungi obtain their nutrition by living on other living
organisms (plants or animals) and absorb nutrients from their host. Examples:
Taphrina and Puccinia.
3-Symbiotic–These fungi live by having an interdependent relationship
association with other species in which both are mutually benefited. Examples:
Lichens and mycorrhiza. Lichens are the symbiotic association between
algae and fungi. Here both algae and fungi are mutually benefited as fungi
provide shelter for algae and in reverse algae synthesis carbohydrates for fungi.
Based on Spore Formation
Kingdom Fungi are classified into the following based on the formation of spores:
Zygomycetes :
1-These are formed by the fusion of two
different cells.
2-The sexual spores are known as
zygospores while the asexual spores are
known as sporangiospores.
3-The hyphae are without the septa.

Ascomycetes:
1-They are also called as sac fungi.
2-They can be coprophilous, decomposers,
parasitic or saprophytic.
3-The sexual spores are called ascospores.
4-Asexual reproduction occurs by conidiospores.
Example - Saccharomyces
Basidiomycetes:
1-Mushrooms are the most commonly found basidiomycetes and mostly live as parasites.
2-Sexual reproduction occurs by
basidiospores.
3-Asexual reproduction occurs
by conidia, budding or fragmentation.
Agaricus

Deuteromycetes :
1-They are otherwise called imperfect
fungi, as they do not follow the regular
reproduction cycle as the other fungi.
2-They do not reproduce sexually.
3-Asexual reproduction occurs by conidia.
Example – Trichoderma.
Reproduction of fungi:
Reproduction is the formation of new individuals having all the characteristics
typical of the species. Two general types of reproduction are recognized:
Sexual and asexual. Asexual reproduction sometimes called somatic or vegetative,
does not involve the union of nuclei sex cells or sex organs. Sexual reproduction, on
the other hand, is characterized by the union of two nuclei. In the formation of
reproductive organs, either sexual or asexual, the entire thallus may be converted
into one or more reproductive structure, so that somatic and reproductive phases do
not occur together in the same individual, fungi that follow this pattern are called
(Holocarpic). In the maturity of fungi, however, the reproductive organs arise from
only a portion of the thallus, while the remainder continuous its normal somatic
activities, the fungi in this category are called (Eucarpic). Asexual Reproduction In
general, asexual reproduction is more important for the propagation of the species
because it results in the production of numerous individuals, and particularly since
the asexual cycle is usually repeated several times during the season, whereas the
sexual stage of many fungi is produced only once a year.
The asexual methods of reproduction commonly found in fungi may be summarized
as follows:
1) Fragmentation:
Each fragment growing into a new individual. Some fungi employ fragmentation of
hyphae as a normal means of propagation. The hyphae may break up into their
component cells that behave as the spore. These spores are known as arthrospores.
If the cells become enveloped in a thick wall before the separation from each other
from other hyphal cells, they are often called chlamydospores. Fragmentation may
also occur accidentally by the tearing off parts of the mycelium through external
forces. Such pits of mycelium under favorable conditions will start a new employ
mycelia fragmentation to keep fungal cultures growing on artificial media by
transferring a bit of mycelium to fresh media and thus starting a new colony.
2) Simple fission of somatic cells into daughter cells:
Fission, the simple splitting of a cell into two daughter cells by constriction and
formation of a cell wall, is characteristic of a number of simple organisms including
some yeast.
 3) Budding of somatic cell or spores:
Each bud producing a new individual. As the bud is formed, the nucleus of the
parent cell divides and one daughter nucleus migrates into the bud. The bud
increases in size while still attached to the parent cell and eventually breaks
off and form a new individual, example Saccharomyces.

4) Spore formation (vegetative reproduction):

The most common method of asexual reproduction in fungi is by means of
spores. Spores vary in color from hyaline through green, yellow, orange, red,
brown to black; in size from minute to large; in shape from globose through
oval, oblong, needle-shaped to helical; in number of cell, from one to many;
in the arrangement of cells; and in the way in which the spores them-self is
borne.
Some fungi produce only one type of spore, whereas other produce as
many as four types. Fungal spores produced asexually are either borne in
sporangia (sporangium) and then are called Sporangiospores as in
Rhizopus and Mucor, or are produced at the tips or sides of hyphae in
various ways and are then called conidia (conidium) as in Aspergillus
spp. Sporangiospores may be motile or non- motile.
In simpler fungi, the Sporangiospores are usually motile and are called
zoospores if non- motile are called aplanospores. Fungal zoospores are
equipped with one or two flagella (flagellum). There are at least two
types of flagella in the fungi: The whiplash and tinsel.
The flagella in fungi are differing in position, types, and number.
Sexual reproduction:
Sexual reproduction in fungi as in other living organisms involves the
union of two compatible nuclei. The process of sexual reproduction
typically consist of three distinct phases:
1. Plasmogamy: a union of two protoplasts brings the nuclei to close
together within the same cell.
2. Karyogamy: The fusion of the two nuclei brought together by
plasmogamy.
3. Mitosis: The reduction of chromosomes number to the half.
Karyogamy follows plasmogamy almost immediately in many of the
simpler fungi. In the more complex fungi, however, those two
processes are separated in time and space, with plasmogamy resulting
in a binucleate cell containing one nucleus from each parent. Such
pair of nuclei we call a (Dikaryon).
The sex organs of fungi are called gametangia (gametangium),
these may form differentiated sex cell called gametes or may
contain instead one or more gamete nuclei.
We use the terms (isogametangia and isogametes) to designated
gametangia and gametes that are morphologically
indistinguishable; we use (heterogametangia and heterogametes)
to designate male and female gametangium and gamete that are
morphologically different, in the latter case, the male gametangium
is called the ( antheridium) and the female is called the
(Oogonium).
We now list the various methods by which compatible nuclei are
brought together in the process of plasmogamy.
These methods are often referred to as methods of sexual
reproduction. Fungi employ five general methods to bring
compatible nuclei together for fusion. These methods are:
1. Planogametic copulation: Planogametic copulation involves
the fusion of two naked motile gametes (planogametes) as in
Allomyces.
2. Gametangial contact:
Here gametes are not released from gametangia, instead of male and
female gametangia come in close contact with help of fertilization tube.
Then one or more male nuclei migrate into the female gametangium.
The gametangia never fuse or lose their identity during the sexual act.
Male gametangium is called antheridium and female gametangium
called Oogonium (Ascogonium in Ascomycota ) Example: Albugo,
Aspergillus, Pythium.
3. Gametangial copulation: the entire content of two
compatible gametangia fuse each other The gametangia come in
close contact, the wall at the point of contact dissolves and their
contents mix each other Then karyogamy is
established.Example Zygomycota.
4. Spermatization: In some higher fungi sex organs are completely
absent Here the sexual process is accomplished by minute spores like
spermatia and specialized (receptive) hyphae acting as male and female
structures respectively spermatia are carried by air, water or insect to the
receptive hyphae. Spermatia attached to the trichogyne of receptive
hyphae and migrate into the cytoplasm.
5. Somatogamy. In this method, sex organs are not formed and
two vegetative cells or vegetative hyphae take over the sexual
function and fuse together advanced fungal groups such as
Morchella, Peziza, Agaricus.
Lecture (2)
Pathogenesis of fungi (Mycoses):
Most fungi are saprophytic or parasitic to plants and are adapted to their natural environment.
Infection in humans is a chance event, occurring only when conditions are favorable. Except for
few fungi such as the dimorphic fungi that cause systemic mycoses and dermatophytes, which are
primary pathogens, the rest are only opportunistic pathogens. The human body is a hostile
environment and offers great resistance to fungal invasion. Most fungi are saprophytic and their
enzymatic pathways function more efficiently at the redox potential of non-living substrates than
at the relatively more reduced state of living metabolizing tissue. Some fungi such as Candida
and Malasezzia have adapted to the human environment and exist as commensals.
Host defense factors:
• Physical barriers, such as skin and mucous membranes
• The fatty acid content of the skin
• The pH of the skin, mucosal surfaces, and body fluids
• Epithelial cell turnover
• Normal flora
• Chemical barriers, such as secretions, serum factors
• Most fungi are mesophilic and cannot grow at 37oC.
• Natural Effector Cells (polymorphonuclear leucocytes) and the Professional
Factors predisposing to fungal infections:
• Prolonged antibiotic therapy, • Underlying disease (HIV infection, cancer, diabetes,
etc.) , • Age ,• Surgical procedures,• Immunosuppressive drugs,• Irradiation therapy, •
Indwelling catheters,• Obesity ,• Drug addiction ,• Transplants, • Occupation
Classification mycoses:
1-Superficial Mycoses
These are superficial cosmetic fungal infections of the skin or hair shaft. No living
tissue is invaded and there is no cellular response from the host. Essentially no
pathological changes are elicited.
These infections are often so Disease Causative Incidence

innocuous that patients are organisms

often unaware of their Pityriasis versicolor Malassezia spp. common
condition. (a lipophilic yeast)

Tinea nigra Hortaea werneckii rare

White piedra Trichosporon spp comman
A-Tinea Versicolor (pityriasis versicolor):
Malassezia species are basidiomycetous yeasts and form part of the normal skin
flora of humans and animals. The genus now includes 14 species of which 13 are
lipid dependent.
Clinical Manifestations
Pityriasis versicolor : This is a chronic, superficial fungal disease of the skin
characterised by well-demarcated white, pink, fawn, or brownish lesions, often
coalescing, and covered with thin furfuraceous scales. The colour varies according
to the normal pigmentation of the patient, exposure of the area to sunlight, and the
severity of the disease. Lesions occur
on the trunk, shoulders and arms, rarely
on the neck and face, and fluoresce
a pale greenish colour under Wood's
ultra-violet light. Young adults are
affected most often, but the disease
may occur in childhood and old age.
Laboratory Diagnosis:
1. Clinical Material: Skin scrapings from patients with superficial lesions, blood and indwelling catheter tips
from patients with suspected fungaemia.
2. Direct Microscopy:Skin scrapings taken from patients with Pityriasis versicolor stain rapidly when mounted
in 10% KOH, glycerol and Parker ink solution and show characteristic clusters of thick-walled round,
budding yeast-like cells and short angular hyphal forms up to 8um in diameter (ave. 4um diam.). These
microscopic features are diagnostic for Malassezia furfur and culture preparations are usually not necessary.
3. Culture: Culture is only necessary in cases of suspected fumgaemia. M. furfur is a lipophilic yeast;
therefore, natural oils or other fatty substances must stimulate in vitro growth. The most common method
used is to overlay Sabouraud's dextrose agar containing cycloheximide (actidione) with olive oil or
alternatively to use a more specialized media like Dixon's agar which contains glycerol.
4. Identification:
Microscopic evidence of unipolar, broad base budding yeast cells and special lipid requirements for growth
in culture are usually diagnostic.
Management:
The most appropriate antifungal treatment for pityriasis versicolor is to use a topical imidazole in a solution or
lathering preparation. Ketoconazole shampoo has proven to be very effective. Alternative treatments include
zinc pyrithione shampoo or selenium sulfide lotion applied daily for 10-14 days or the use of propylene glycol
50% in water twice daily for 14 days.
Causative agent: Malassezia furfur.
 B- Tinea nigra
A superficial fungal infection of skin characterised by brown to black macules which usually
occur on the palmar aspects of hands and occasionally the plantar and other surfaces of the skin.
World-wide distribution, but more common in tropical regions of Central and South America,
Africa, South-East Asia and Australia. The aetiological agent is Hortaea werneckii a common
saprophytic fungus believed to occur in soil, compost, humus and on wood in humid tropical and
sub-tropical regions.
Clinical Manifestations: Skin lesions are characterised by brown to black macules which
usually occur on the palmar aspects of hands and occasionally the plantar and other surfaces
of the skin. Lesions are non-inflammatory and non-scaling. Familial spread of infection has
also been reported.
Note: There is no inflammatory reaction.
Laboratory Diagnosis:
1. Clinical Material: Skin scrapings.
2. Direct Microscopy: Skin scrapings should be examined using 10% KOH and Parker ink or
calcofluor white mounts.
3. Culture : Clinical specimens should be inoculated onto primary isolation media, like
Sabouraud's dextrose agar.
4. Identification: Characteristic clinical, microscopic and culture features.
Causative agents: Hortaea werneckii

Management:
Usually, topical treatment with Whitfield's ointment (benzoic acid compound) or an
imidazole agent twice a day for 3-4 weeks is effective.
C-White piedra,
White piedra is a superficial cosmetic fungal infection of the hair shaft caused
by Trichosporon. Infected hairs develop soft greyish-white nodules along the shaft.
Essentially no pathological changes are elicited. White piedra is found worldwide,
but is most common in tropical or subtropical regions.
Trichosporon species are a minor component of normal skin flora, and are
widely distributed in nature. They are regularly associated with the soft nodules of
white piedra, and have been involved in a variety of opportunistic infections in the
immunosuppressed patient. Disseminated infections are often fulminate and
widespread, with lesions occurring in the liver, spleen, lungs and gastrointestinal
tract. Infections in non-immunosuppressed patients include endophthalmitis after
surgical extraction of cataracts, endocarditis usually following insertion of
prosthetic cardiac valves, peritonitis in patients on continuous ambulatory peritoneal
dialysis (CAPD), and intravenous drug abuse.
Clinical Manifestations:
Infections are usually localised to the axilla or scalp but may also be seen on facial
hairs and sometimes pubic hair. White piedra is common in young adults. The
presence of irregular, soft, white or light brown nodules, 1.0-1.5 mm in length,
firmly adhering to the hairs is characteristic of white piedra.
Laboratory Diagnosis:
1. Clinical Material: Epilated hairs with white soft nodules present on the shaft.
2. Direct Microscopy: Hairs should be examined using 10% KOH and Parker ink or
calcofluor white mounts. Look for irregular, soft, white or light brown nodules,
1.0-1.5 mm in length,
firmly adhering to the hairs.
3. Culture: Hair fragments should be implanted onto primary isolation media, like
Sabouraud's dextrose agar. Colonies of Trichosporon spp. are white or
yellowish to deep cream colored, smooth, wrinkled, velvety, dull colonies with
a mycelial fringe.
4. Identification: Characteristic clinical, microscopic and culture features.
Causative agents: Trichosporon spp. Six species are of clinical significance ( T.
dermatis,T. domesticum, T. faecale, ).

Management: Shaving the hairs is the simplest method of treatment. Topical

application of an imidazole agent may be used to prevent reinfection.
D-Black piedra :
is a superficial fungal infection of the hair shaft caused by Piedra hortae, an
ascomycetous fungus forming hard black nodules on the shafts of the scalp, beard,
moustache and pubic hair. It is common in Central and South America and South-East
Asia.
Clinical Manifestations:
Infections are usually localised to the scalp but may also be seen on hairs of the
beard, moustache and pubic hair. Black piedra mostly affects young adults and epidemics
in families have been reported following the sharing of combs and hairbrushes. Infected
hairs generally have a number of hard black nodules on the shaft.
Laboratory Diagnosis:
1.Clinical Material : Epilated hairs with hard black nodules present on shaft.
2. Direct Microscopy: Hairs should be examined using 10% KOH and Parker ink or
calcofluor white. Look for darkly pigmented nodules that may partially or
completely surround the hair shaft. Nodules are made up of a mass of pigmented
with a stroma-like Centre containing asci.
3. Culture: Hair fragments should be implanted onto primary
isolation media, like Sabouraud's dextrose agar. Colonies of Piedra
hortae are dark, brown-black and take about 2-3 weeks to appear.
4. Identification:Characteristic clinical, microscopic and culture
features.
Causative Agents : Piedra hortae
Management:
The usual treatment is to shave or cut the hairs short, but this is
often not considered acceptable, particularly by women. In-
vitro susceptibility tests have shown that Piedra hortae is sensitive
to terbinafine and it has been successfully used.