What is the rumor against recurrent fungal infections??

The    frequent cases of relapse which are mistaken for resistance are due to   the ambient local factors. Clinical resistance  is a wrong term as in vitro resistance    is rare    is probably due to the interplay of the fungal species and the host immune response. Your Questions answered:

.9 What are the local factors??? :--Local factors  that favor dermatophyte  infection include sweating  occlusion   occupational exposure  geographic  location high  humidity     .

A problem to think about intelligence of our ancestors!!!!  In India a common cause for   persistence  is the type of clothing  : Cause : A  in India Change of clothing pattern: We have   moved from cotton to denim the latter    being     a preferred  cloth of the Western  world   suited for  their   cold climate. In our climate this prevents evaporation of sweat and thus    does not let the skin breathe . In our  practice almost  all such patients have   recurrences. Cause : B in India :-use of   leather shoes : the other  observation is that the use of   leather shoes predisposes to tinea   Pedis. Tinea   Pedis is  rarely seen a villager who   usually works   barefooted .  having tinea Pedis though the well heeled usually      have tinea Pedis and commonly  onychomycosis both   being causes of relapse.

Q. 1: What are dermatophytes??  How one can  classify the  CLASSIFICATION OF DERMATOPHYTES i.e. fungus which have affinity for skin only??

Mode of transmission  :What may be source of fungus???  Dynamics of spread of Fungus to a healthy men/ women ??:--1) Anthropophilic : Person  to person  transmission  by fomites and by direct contact( so onwards please make a point to invite to count money as U receive at your chamber to avoid  Anthropophilic  contaminating of Fungus) .

2) Zoophilic : Animal   to human transmission by direct contact  or by fomites. FROM PETS TO WOMEN

3) Geophilic : Originating  in soil. Wives of agricultural men & women who works at  feild .

Q. 2  :Which fungi have a protracted course??  The  importance    of this is that zoophilic species would mount a  severe inflammatory reaction and thus clear early     whereas   the anthrophilic species (Person  to person  transmission  by fomites by direct contact )  would mount a milder reaction and thus would   lead to a more persistent  infection However these groups  are not    sharply  demarcated as geophilic species may infect animals . In vivo dermatophytes   grow only  on or within   keratinized structures  and as such  involves the following 

Q. 3:- Sites of Fungal infestations  site 1 is  epidermis :--Epidermal  fungal infection ??? dermatopytosis;   Tinea facie, tinea    corporis  , tinea cruris , tinea manus  , tinea Pedis

Q. 4: Sites of Fungal infestations :: nail apparatus  :: Are U a surgeon??  :Fungus will love you most ::  : Know about Dermatophytoses of nail apparatus  in details  as  your fungus is less likely to response to common agents . Why??  U  frequently wash your hands with soap/ alkalis:- Tinea unguium   

Q. 5: Sites of Fungal infestations:  Nail infestations:-Onychomycosis is a more inclusive term including   nail infections caused by  dermatophytes  yeasts  and molds.

Q. 6 :- Dermatophytoses of hair and hair follicle  Tinea   capitis  dermatophytic  folliculitis   Majocchi granuloma tinea  barbae.

 Q. 7 :--Pathogenesis of fungal infections : Why & when ???

Ans:-The     pathogenesis of dermatophytosis has    three main  aspects which  determine   its course. This includes the A) host response   B) barrier   function and C) load of  the fungi . The    frequent cases of relapse which are mistaken for resistance are due to   the ambient local factors.  Clinical resistance is a wrong term as in vitro resistance    is rare    is probably due to the interplay of the fungal species and the host immune response. Thus it is meaningless to prolong the duration of anti fungals  or even combine and add   oral azoles to the therapy as that is not a solution when microbiological resistance  is not an issue as is the case.

Q.8:--Why all women don’t suffer from Fungal infections of Vulva and adjoining  skin??  ::: Steps on pathogenesis of fungal infestations?? Ans: Dermatophytes synthesize    keratinases that digest  keratin and sustain existence  of fungi in keratinized structures ,.  Dermatophytes that initiate     little  inflammatory response are better able   to establish  chronic infection.   Organisms  such as  Microsporum canis cause an acute   infection associated   with a brisk inflammatory     response and thus lead  to spontaneous resolution.

In some individuals    infection   seems  to involve the dermis    as in kerion and Majocchi   granuloma however it should be noted   that it is the inflammation which is extending  to the dermis and not the infection  as the fungus is present  only in stratum corneum fuly keratinized hair    shaft  nail plate    or keratinized  nail  bed Mannans  in the cell walls of dermatophytes   have    immune inhibitory    effects. In T rubrum the mannans may also decrease   epidermal proliferation thereby  decreasing  the likelihood  of the fungus being   sloughed off prior to invasion . This mechanism is though   to contribute   to the chronicity of infections caused  by T rubrum.

Q How beneficial is sebum???? The  severity  of clinical  disease is also  affected by several  host factors. Sebum has an inhibitory  effect on dermatophytes and the degree of disease activity may be related to the number    and activity   of sebaceous glands  in a particular body    region.  Breaks in the skin barrier or macerated skin encourage     dermatophyte invasion and increased   susceptibility   may be inherited or related    to the competency  of the  immune  system. Once deramtophytes   have invaded and begun to proliferate in the skin several mechanisms  aid in   limiting the infection to keratinized  tissue. These include the preference of dermatophytes for the cooler  temperature at the skin  surface   serum factors that inhibit  dermatophyte  growth    and the host  immune system.

Cell mediated immunity and antimicrobial activity of polymorphonuclear leukocytes restrict  dermatophyte   pathogencity. Host factors    that  facilitate   dermatophyte   infections include   atopy  topical and systemic   glucocorticoids  ichthyosis collagen   vascular disease.

What factors control  the clinical  presentation of dermatophytoses  ?? It depends   on several   factors. Site of  infection immunologic response of the host and  species   of fungus.