Medical Mycology

193 Pages·1987·4.02 MB·English

by  Professor Dr. med. Siegfried Nolting, Professor Dr. med. Klaus Fegeler (auth.)

S. Nolting K. Fegeler
Medical
Mycology
With 74 Figures
Springer-Verlag Berlin Heidelberg New York
London Paris Tokyo
Professor Dr. med. Siegfried Nolting Professor Dr. med. Klaus Fegeler
Abteilung fUr Dermatomikrobiologie Niedergelassener Hautarzt
Hautklinik der Westfalischen HarsewinkelstraBe 21122
Wilhelms-Universitiit 4400 Munster (Westf.)
von-Esmarch-StraBe 56 Federal Republic of Germany
4400 Munster (Westf.)
Federal Republic of Germany
Translation of the third German Edition
Translated by:
Dora Wirth Languages Ltd
85 Campden Street
Kensington, London W8 7EN
Great Britain
In English-speaking countries the products mentioned in this book are registered under
different trademarks; only those trademarks which are registered in Germany are given
herein.
Translation of "Medizinische Mykologie", 3. Aufiage,
K1iniktaschenbiicher, 1987
ISBN-13: 978-3-540-17606-0 e-ISBN-13: 978-3-642-72553-1
DOl: 10.1007/978-3-642-72553-1
Library of Congress Cataloging in Publication Data
Nolting, S. (Siegfried) Medical mycology. Translation of: Medizinische Mykologie.
3. Aufi. 1987. Bibliography: p. Includes index. 1. Mycoses. 2. Medical mycology.
I. Fegeler, K. (Klaus), 1943- . II. Title. [DNLM: 1. Fungi. 2. Mycoses. WC 450
N798mJ RC117.N65131987 616.9'69 87-9501
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© Springer-Verlag Berlin Heidelberg 1987
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Preface to the Third German Edition
The increasing interest in medical mycology and greater mycological
awareness of doctors in all fields have made it necessary to prepare a
third updated edition after only two years. In addition, there were
urgent questions being asked by people on problems that we consid
ered mycological. The changes include additions to the general text
and the figure legends and important innovations in therapy.
The well-meant criticism and technical suggestions were taken into
consideration to a high degree. We would like to thank all our read
ers and critics.
s.
Miinster, December 1986 Nolting
K.Fegeler
v
Table of Contents
1 Introduction . . . . . . . . . . . . . . 1
1.1 Taxonomy of the Fungi ..... . 3
1.2 The General Importance of Fungi 4
1.3 Disorders Caused by Fungi . . . . 5
1.4 Definition and Nomenclature ... 7
1.5 Diagnosis ....... . 10
1.6 Collection of Samples . . . . . . .. 10
1.7 Direct Preparations .. . 12
1.8 Fungal Cultures .... . 13
1.9 Dermatomycoses . . . 17
2 Dermatophytoses . . 18
2.1 Microsporosis .. . 18
2.1.1 Epidemiology .. . 19
2.1.2 Clinical Picture . . . 19
2.1.3 Pathology ..... . 20
2.1.4 Examination under Wood's Light . 23
2.1.5 Microscopic Findings and Cultures . 23
2.1.6 Differential Diagnosis . . . . . . . . . . . . . 24
2.1.7 Treatment ................... . 25
2.2 Disorders Caused by Trichophyton spp. . . . 25
2.2.1 Favus ........... . 25
2.2.2 Deep Trichophytosis . . . . . 27
2.2.3 Superficial Trichophytosis . . 31
2.2.4 Follicular Trichophytosis .. . . . . . . . 31
2.2.5 Microscopic Examination and Culture of
Trichophyton spp. . . . 32
2.2.6 Treatment . . . . . . . . . . . . . . . . . . . . . . . . .. 34
VII
2.3 Cutaneous Dermatophytoses . . . . . . . . . 34
2.3.1 Ringworm of the Body - Tinea Corporis ... 36
2.3.2 Ringworm of the Groin - Tinea Inguinalis . . 36
2.3.3 Ringworm of the Hand - Tinea Manuum . 37
2.3.4 Ringworm of the Foot - Tinea Pedis .. 38
2.4 Onychomycosis - Mycosis of the Nails. 44
2.4.1 Clinical Picture ..... 46
2.4.2 Differential Diagnosis . . . . . . . . . . 47
2.4.3 Treatment.................. 48
2.5 Microscopic Examination and Culture . 50
2.6 Immunological Reactions 51
2.6.1 Mycid-Dermatophytid ........ . 53
3 Yeast Infections . . . . . 55
3.1 Candidosis . . . . . . . 56
3.1.1 Cutaneous Candidos is . 61
3.1.2 Candida Paronychia and Candida Onychomycosis 64
3.1.3 Other Sites .. . . . . . . . . . . . . . . 65
3.1.4 Candidosis of the Mucous Membranes. 66
3.1.5 Deep Candidosis . . . . . . . . . . . . 74
3.1.6 Chronic Mucocutaneous Candidos is . 80
3.1.7 Candida Granuloma . 84
3.1.8 Candida Sepsis . 86
3.1.9 AIDS ........ . 87
3.1.10 Candidid ...... . 88
3.1.11 Treatment of Candida Infections 89
3.1.12 Conclusions .. 90
3.2 Cryptococcosis. 91
3.2.1 Clinical Picture. 91
3.2.2 Organisms 92
3.2.3 Diagnosis.... 93
3.2.4 Treatment.... 93
3.3 Rhodotorulosis . 94
3.3.1 Clinical Picture. 94
3.3.2 Organisms 94
3.3.3 Diagnosis .. 94
3.3.4 Treatment .. 95
3.4 Torulopsosis 95
VIII
3.4.1 Clinical Picture . 95
3.4.2 Organisms 95
3.4.3 Diagnosis ... 96
3.4.4 Treatment ... 96
3.5 Trichosporosis 96
3.5.1 Clinical Picture . 96
3.5.2 Organisms 96
3.5.3 Diagnosis .. 97
3.5.4 Treatment .. 97
3.6 Geotrichosis 97
3.6.1 Clinical Picture . 98
3.6.2 Organisms 98
3.6.3 Diagnosis .... 98
3.6.4 Treatment .... 98
3.7 Pityriasis Versicolor 99
3.7.1 Clinical Picture . 100
3.7.2 Organisms 101
3.7.3 Diagnosis. 101
3.7.4 Treatment. 102
4 Mycoses Caused by Molds 104
4.1 Aspergillosis .. 105
4.1.1 Clinical Picture . 105
4.2 Scopulariopsosis 106
4.3 Cladosporiosis 108
4.4 Chrysosporiosis 108
4.5 Cephalosporiosis . 108
4.6 Fusariomycosis . . 109
4.7 Verticilliosis. . . . 109
4.8 Penicilliosis (Penicillosis) 109
4.9 Maduromycosis 110
4.10 Chromomycosis 110
5 Deep Mycoses. . ............... 112
5.1 Endomycoses (Candidosis, Cryptococcosis) 114
5.1.1 Mucormycosis ............ 114
5.1.2 Sporotrichosis ............ 115
5.2 Systemic Mycoses in the Strict Sense 116
IX
5.2.1 North American Blastomycosis . 117
5.2.2 Histoplasmosis . . . . . . 118
5.2.3 Coccidioidomycosis . . . 118
5.2.4 Paracoccidioidomycosis . 119
6 Diseases Resembling Mycosis - Saphrophytic Mycoses . 121
6.1 Erythrasma . . . . . . . 121
6.1.1 Clinical Picture .... 121
6.1.2 Differential Diagnosis 122
6.1.3 Organisms 122
6.1.4 Diagnosis ....... 122
6.1.5 Treatment ....... 123
6.2 Trichomycosis Axillaris, Formerly Trichomycosis
Palmellina ...... 123
6.2.1 Clinical Picture . . . . 123
6.2.2 Differential Diagnosis 124
6.2.3 Organisms 124
6.2.4 Diagnosis. 125
6.2.5 Treatment. 125
...........
7 Fungal Allergies - Allergic Mycoses . 126
8 Treatment ......... 131
8.1 Nonspecific Treatment .. 133
8.1.1 Disinfectants/A ntiseptics 133
8.1.2 Moist Treatments . . . . . 135
8.1.3 Solutions of Dyes. . . . . 136
8.1.4 Preparations for the Treatment of Eczema 137
8.2 Specific Antifungal Agents for Systemic Use. 143
8.2.1 Amphotericin B 143
8.2.2 Flucytosine . . . . . . 145
8.2.3 Griseofulvin ..... 146
8.2.4 Imidazole Derivatives 148
8.2.5 Natamycin ...... 151
8.2.6 Nystatin ........ 151
8.3 Specific Topical Agents 152
8.3.1 Antifungal Agents Effective Against Dermatophytes 154
X
8.3.2 Combinations of Antifungal Agents and Corticosteroids
Effective Against Dermatophytes ............. 155
8.3.3 Preparations Effective Against Yeasts .......... 156
8.3.4 Combinations of Antifungal Agents and Corticosteroids
Effective Against Yeasts . . . . . . . . . . . . . . . . 158
8.3.5 Broad-Spectrum Antifungal Agents. . . . . . . . . . 159
8.3.6 Topical Agents for the Treatment of Erythrasma and
Trichomycosis Axillaris 159
8.4 Adjuvant Treatments: . . . . . . . . . 160
9 Prophylaxis Against Fungal Infections. 163
9.1 Prevention of Recurrences . . . . . . 163
9.2 Elimination of Predisposing Factors 164
9.3 Preventing Exposure. . . . . . . . . 164
10 Glossary . . 165
11 References. 172
12 Subject Index 177
XI
1 Introduction
Fungal diseases take up a considerable and steadily increasing part
of the time of general practitioners. We hear and read of the inexor
able advance of fungi and of the growing threat they pose to man.
Whilst it is unlikely that this generalisation can be applied to all fun
gal diseases, it is nevertheless time that we learned to form an accu
rate estimate of the risks posed by these pathogens. Any reference
made nowadays to the growing importance of fungal infections ref
ers primarily to the mycoses, i. e. diseases caused by parasitic
fungi.
Knowledge of the mycoses is no less important to general practitio
ners than knowledge of the diseases caused by bacteria or viruses. At
first sight, this branch of microbiology no doubt seems extraordinari
ly complex. In order not to add to the uncertainty of those wishing to
find out more about mycology, we shall do our best neither to pre
sent them with a multitude of confusing terms nor to remind them
continually of the inadequacy of their measures but rather to aid
them in the diagnosis, treatment and prevention of fungal dis
eases.
Mycology is undoubtedly the oldest branch of microbiology. As
early as 1836, before the discovery of bacteria, Remark observed a
network of filaments in the crusts produced by favus although he
probably did not at that time recognise the mycelia as the cause of
the disease. The term dermatomycosis was in fact introduced by Vir
chow although the importance of mycology was not appreciated
until it received its vital impetus from the work of Sabouraud.
Mycology as a science is now almost 150 years old and although
many problems have been solved, especially in the last few years,
new questions constantly arise, many of which have not yet been
1