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== Introduction<br>  ==
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==General==
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Dermatophytes are pigmented, saprophytic organisms called Phaeohyphomycetes and were previously called 'Fungi Imperfecti'. The two main species of veterinary interest are ''Microsporum'' and ''Trichophton ''and these are found worldwide.<br>
[[Image: Trichophyton mentagrophytes dog.jpg|200px|thumb|right|''Trichophyton mentagrophytes'' in a dog - Courtesy of Bristol BioMed Image Archive]]
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*Pigmented, saprophytic organisms called '''Phaeohyphomycetes'''
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They are usually secondary invaders and are able to penetrate all layers of [[Skin - Anatomy & Physiology|skin]], but are generally restricted to the keratin layer and its appendages.&nbsp;Therefore the condition is most often seen in subcuticular or cutaneous sites. A lack of tolerance to body temperature and antifungal activity in serum and body fluids prevent the fungi invading subcutaneously. Secondary invasion by Staphylococcus aureus and Staphylococcus intermedius are common and cause pustules in the hair follicles. Epidermal hyperplasia then follows with inflammation.<br>
**Previously called 'Fungi Imperfecti'
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*The two main species of veterinary interest are ''Microsporum'' and ''Trichophton''
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Dermatophytes are transmitted by direct or indirect contact e.g. on brushes, fomites etc. Signs vary in severity, but immunuocompromised hosts may develop systemic infections.
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*Worldwide
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There are certain types of dermatophytes: Microsporum is zoophilic and so parasites of animals, Trichophyton is geophilic and inhabits soil but will also parasitise animals. Epidermophyton is anthropophilic and so is a parasite of people. <br>
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*They are usually secondary invaders
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Microsporum canis is the most common dermatophyte to infect small animals and will be the cause of&nbsp; 90% of feline infections and 60% of canine infections. Trichophyton mentagrophytes affects around 30% of daogs, especially Terrier breeds. Trichophyton verrucosum causes most cases in cattle and sheep and Trichophyton equinum is the commonest cause in horses.<br>
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*Able to penetrate all layers of [[Skin - Anatomy & Physiology|skin]], but are generally restricted to the keratin layer and its appendages
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<br>
**Therefore, most often seen in subcuticular or cutaneous sites
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**Lack of tolerance to body temperature and antifungal activity in serum and body fluids prevent the fungi invading subcutaneously
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*Transmitted by direct or indirect contact
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== Signalment<br>  ==
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*Immunuocompromised hosts may develop systemic infections
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The condition is common in many species, with certain strains affecting certain species more commonly. Hot, humid environments predisposes to infection and young animals tend to be more commonly effected. The condition is more common in housed animals, rather than animals turned out to pasture and the highest incidence of the disease occurs during the winter months. It may resolve spontaneously in the spring and summer.<br>
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*''Microsporum'' - zoophilic
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<br>
**Parasites of animals
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*''Trichophyton'' - geophilic
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== Clinical Signs<br>  ==
**Inhabits soil
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*''Epidermophyton'' - anthropophilic
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There will be a presence of circular or irregular lesions (dependent on infectant organism) and these may coalesce. There will be scaly and crusty patches and alopecia in these areas due to broken hair shafts and hairs lost from inflammed regions of skin. Follicular papules and pustules will also be present. There will be a peripheral red ring (rignworm) due to dead fungi in areas of inflammation at centre of lesions and viable fungi peripherally. There is usually a varying degree of pruritus. <br>
**Parasites of people
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*Common in many species, especially cats
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<br>
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*Hot, humid environment predisposes to infection
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== Diagnosis<br>  ==
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*More common in young animals
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Clinical signs are characteristic of the disease. Wood's Lamp can be used. Here, UV light is shined onto th lesion and it will fluoresce 50% if Microsporum fungi are present. Therefore it is a good diagnostic tool in small animals but is not incredibly reliable. Ifnot fluoresence, it does not mean there is no dermatophytes or no Microsporum.
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*Produce proteolytic enzymes to penetrate surface lipid
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Samples can be taken and examined in 10-20% KOH for the presence of hyphae or arthrospores. Lactophenol Cotton Blue enhances visualisation. One may see, septate hyphae or spores in the stratum corneum, keratin layers and in hair follicles. Perifolliculitis, folliculitis or furunculosis, epidermal hyperplasia and intracorneal microabscesses may also be seen.
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*Fungal hyphae invade keratin -> break into arthrospores
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Sabouraud's Dextrose agar containing cyclohexamide and chloramphenicol can be used to culture the dermatophyte at room temperature for a month. <br>  
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*Phaeohyphomycosis:
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A biopsy can also be taken and examined histologically. Signs will include epidermal hyperplasia (hyperkeratosis, parakeratosis, acanthosis) and inflammation
**Occurs sporadically in cats, horses, cattle, fish, reptiles, amphibians, birds, and rarely in dogs 
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**Examples include:  ''Exophiala'' sp., ''Phialophora'' sp., ''Pseudomicrodochium'' sp., ''Bipolaris'' sp., ''Moniella'' sp., ''Cladosporium'' sp., ''Wangiella'' sp., ''Curvularia'' spp., ''Exserohilum'' sp., ''Alternaria'' sp., ''Staphylotrichum'' sp., and ''Xylohypha'' sp 
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**Culture is necessary for definitive diagnosis
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==Pathogenesis==
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<br>
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*Epidermal hyperplasia ([[Skin Glossary - Pathology|hyperkeratosis, parakeratosis, acanthosis]]) and [[:Category:Inflammation|inflammation]]
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== Treatment  ==
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*Superficial perivascular dermatitis -> exocytosis (migration through epidermal layers) -> intracorneal microabscesses
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The affected animal should be isolated and precautions should be taken to prevent human infection, such as wearing gloves. Hair should be clipped around the skin lesions.<br>  
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*Exocytosis -> folliculitis -> furunculosis
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[[Antifungal Drugs#Griseofluvin|Griseofulvin]] is the best method of systemic treatment, however it can be expensive and prolonged oral treatment may be required. Griseofulvin is no longer licensed for small animals but has been used for many years with useful results. Typical dose is 25-50 mg/kg in divided doses for 2 weeks after clinical and mycological cure. Griseofulvin is teratogenic and contra-indicated in pregnancy. Haematological side effects have been reported, including neutropenia in FIV-positive cats. Owners handling tablets must wear gloves. <br>
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*Highly variable lesions
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Itraconazole is now licensed for cats in the U.K. (Itrafungol, Janssen). The manufacturers suggest 3 cycles of therapy, one week on, one week off, reflecting the lipophilic properties of the drug that leads to its persistence in the stratum corneum. Laboratory infection models of M. canis infection in kittens have shown that griseofulvin and itraconazole have comparable efficacy. <br>
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*Normal -> eruptive nodular -> [[Dermatophytic Pseudomycetoma|pseudomycetoma]] -> onychomycosis
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Apply topical therapy. Topical therapy alone is unlikely to shorten the course of disease because the agents do not penetrate into infected hairs. However, it does assist in removal of surface organisms and reduces environmental contamination. Enilconazole (Imaverol) is licensed for use in dogs and should be applied every three days, in conjunction with systemic therapy. Fatal idiosyncratic reactions have been reported in cats treated with enilconazole. A miconazole + chlorhexidine shampoo (Malaseb, VetXX) is helpful in cats and dogs, and is licensed in the former species for use in conjunction with griseofulvin. <br>
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*Secondary invasion by ''[[Staphylococcus aureus]]'' and [[:Category:Staphylococcus species|''Staphylococcus intermedius'']] are common and cause pustules in the hair follicles
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Monitor treatment by repeat cultures
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*Grossly:
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<br>
**Circular or irregular lesion, may coalesce
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**Scaly to crusty patches
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**Alopecia due to broken hair shafts and hairs lost from inflammed follicles
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**Follicular papules and pustules
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**Peripheral red ring ('''ringworm''') due to dead fungi in areas of [[:Category:Inflammation|inflammation]] at centre of lesions and viable fungi peripherally
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*More common in housed animals, rather than animals turned out to pasture
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== Further Links ==
 
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*Highest incidence of disease during the winter
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**May resolve spontaneously in the spring and summer
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==Histology==
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*Perifolliculitis, folliculitis or furunculosis
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*Epidermal hyperplasia
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*Intracorneal microabscesses
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*Septate hyphae or spores may be found in stratum corneum and keratin of hair follicles
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==Diagnosis==
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*Wood's Lamp
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**UV light
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**Florourescence if fungi present
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*Samples can be examined in 10-20% KOH for the presence of hyphae or arthrospores
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**Lactophenol Cotton Blue enhances visualisation
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*Sabouraud's Dextrose agar containing cyclohexamide and [[Chloramphenicol|chloramphenicol]] at room temperature for a month for culture
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*Dermatophyte Test Medium
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**Saubouraud's Dextrose agar with phenol red indicator
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**Medium changes from yellow to red if fungi present
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==Treatment==
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*Isolation of infected animal
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*Precautions should be taken to prevent human infection
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*[[Antifungal Drugs#Griseofluvin|Griseofulvin]] best method of treatment
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**Expensive
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**Oral dosage
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**Prolonged treatment required
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*Whitfield's ointment
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**Salicylic and benzoic acid
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*Other treatments:
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**Aqueous lime sulphur topically for dogs
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**Iodine
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**[[Antibiotics|Antibiotics]]
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**[[Antifungal Drugs#Polyene Antifungals|Natamycin]] antifungal
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**[[Antifungal Drugs#The Azoles|Imidiazole]] derivatives
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==Further Links==
      
*[[Antifungal Drugs]]
 
*[[Antifungal Drugs]]
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==Image Gallery==
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== Image Gallery ==
    
{| align="center"
 
{| align="center"
|<gallery>Image:Dermatophyte arthrospore hair root.jpg|<center><p>'''Dermatophyte arthrospores on a hair root'''</p><sup>Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</sup></center>
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|-
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| <gallery>Image:Dermatophyte arthrospore hair root.jpg|<center><p>'''Dermatophyte arthrospores on a hair root'''</p><sup>Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</sup></center>
 
Image:Dermatophyte mycelium in skin.jpg|<center><p>'''Dermatophytosis mycelium in skin'''</p><sup>Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</sup></center>
 
Image:Dermatophyte mycelium in skin.jpg|<center><p>'''Dermatophytosis mycelium in skin'''</p><sup>Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</sup></center>
 
Image:Dermatophyte skin KOH.jpg|<center><p>'''Dermatophyte in skin using a KOH mount'''</p><sup>Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</sup></center>
 
Image:Dermatophyte skin KOH.jpg|<center><p>'''Dermatophyte in skin using a KOH mount'''</p><sup>Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</sup></center>
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|}
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[[Image: Microsporum canis lesions.jpg|100px|thumb|right|<small><center>''Microsporum canis'' alopecia and scaling lesions (Courtesy of Bristol BioMed Image Archive)</center></small>]]
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[[Image:Microsporum canis lesions.jpg|thumb|right|100px|<small><center><i>Microsporum canis</i> alopecia and scaling lesions (Courtesy of Bristol BioMed Image Archive)</center></small>]] [[Image:Ringworm dog.jpg|thumb|right|100px|<small><center>Ringworm in a dog (Courtesy of Bristol BioMed Image Archive)</center></small>]] [[Image:Trichophyton mentagrophytes dog.jpg|thumb|right|100px|<small><center>Trichophyton mentagrophytes in a dog (Courtesy of Bristol BioMed Image Archive)</center></small>]]
[[Image: Ringworm dog.jpg|100px|thumb|right|<small><center>Ringworm in a dog (Courtesy of Bristol BioMed Image Archive)</center></small>]]
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[[Image: Trichophyton mentagrophytes dog.jpg|100px|thumb|right|<small><center>Trichophyton mentagrophytes in a dog (Courtesy of Bristol BioMed Image Archive)</center></small>]]
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<br>
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== Test yourself with the Dermatophytosis Flashcards  ==
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[[Dermatophytosis - Flashcards|Dermatophytosis Flashcards]]  
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*Caused by [[Fungi|dermatophytes]]
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<br>
**''Microsporum'' - zoophilic
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**''Trichophyton'' - geophilic
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**''Epidermophyton'' - anthropophilic
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*Common in many species, especially cats
  −
*Hot, humid environment predisposes and viable fungi peripherally
  −
*More common in young animals
  −
*Produce proteolytic enzymes to penetrate surface lipid
  −
*Fungal hyphae invade keratin -> break into arthrospores
  −
*Epidermal hyperplasia ([[Skin Glossary - Pathology|hyperkeratosis, parakeratosis, acanthosis]]) and inflammation
  −
*Superficial perivascular dermatitis -> exocytosis (migration through epidermal layers) -> intracorneal microabscesses
  −
*Exocytosis -> folliculitis -> furunculosis
  −
*Highly variable lesions
  −
*Normal -> eruptive nodular -> pseudomycetoma -> onychomycosis
  −
*Grossly:
  −
**Circular or irregular lesion, may coalesce
  −
**Scaly to crusty patches
  −
**Alopecia due to broken hair shafts and hairs lost from inflammed follicles
  −
**Follicular papules and pustules
  −
**Peripheral red ring ('''ringworm''') due to dead fungi in areas of inflammation at centre of lesions and viable fungi peripherally
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*Microscopically:
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**Perifolliculitis, folliculitis or furunculosis
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**Epidermal hyperplasia
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**Intracorneal microabscesses
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**Septate hyphae or spores may be found in stratum corneum and keratin of hair follicles
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==Test yourself with the Dermatophytosis Flashcards==
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== References<br> ==
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[[Dermatophytosis_-_Flashcards|Dermatophytosis Flashcards]]
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Foster, A, and Foll, C. (2003) BSAVA small animal dermatology (second edition) British Small Animal Veterinary Association<br>Merck &amp; Co (2008) The Merck Veterinary Manual (Eighth Edition) Merial<br>Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier. <br>Quinn, P.J., Markey, B.K., Carter, M.E., Donnelly, W.J., Leonard, F.C. (2007) Veterinary Microbiology and Microbial Disease Blackwell Publishing<br>Radostits, O.M, Arundel, J.H, and Gay, C.C. (2000) Veterinary Medicine: a textbook of the diseases of cattle, sheep, pigs, goats and horses Elsevier Health Sciences<br>Tilley, L.P. and Smith, F.W.K.(2004)The 5-minute Veterinary Consult (Third edition) Lippincott, Williams &amp; Wilkins. <br>
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<br>
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[[Category:To_Do_-_Clinical]]
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[[Category:To_Do_-_Review]] [[Category:Dermatological_Diseases_-_Dog]] [[Category:Cutaneous_Mycoses]]
[[Category:Dermatological Diseases - Dog]]
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[[Category:Cutaneous Mycoses]]
 
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