2. FUNGAL INFECTIONS
■ Fungal infections are also called as Mycoses
■ Mycoses are of 2 well defined groups
1. Systemic mycoses
2.Superficial mycoses
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3. SYSTEMIC MYCOSES
■ Sporadic distribution is very common in some areas and not common in
other areas.
■ Soil inhabiting saprophytes causes systemic mycoses
■ They can adapt to the internal environment of the host by lungs,which
is a common route.
■ The infection can be found by skins test or immunological procedures.
■ Body produces gaint cells/walling off
■ Lesions are detected by autopsy/X-ray.
Eg: Histoplasmosis,sporotrichosis,Blastomycosis,Coccidiodomycosis,
Cryptococcosis,Paracoccidiodomycoses
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4. OPPURTUNISTIC FUNGAL INFECTIONS
■ These are the new type of systemic infections which occurs due to
overuse of immunosuppressive agents, antibiotics, steroids,
cytotoxins,Infra red radiations.
Eg: Systemic candidiasis,Aspergillosis
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5. SUPERFICIAL MYCOSES
Superficial mycoses is of 2 types.
1.Cutaneous superficial mycoses
2.Subcutaneous superficial mycoses
Cutaneous infections are most common compared to subcutaneous
infection.
Cutaneous infection occurs in keratinized epidermis and epidermal
appendages like hair ,nail etc..,
Eg:Trichophyton infection,Microsporum infection,Tinea infections
(Hand,groin,beard,scalp,nails)
Subcutaneous infection involves skin as well as subcutaneous tissue.
Eg: Chromomycoses,sporotrichosis,Mycetoma,Lobomycoses
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6. FUNGAL INFECTIONS-REACTIONS
■ Tissue actions of fungal diseases shows different response
and it varies widely depends on type of organism involved.
■ That reactions include severe inflammation followed by scar
formation,Keloid formation(projections).
■ A uniform acute pyogenic(formation of pus) takes
place,granuloma with ceseations & fibro caseous ,pulmonary
granuloma.
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7. ANTIFUNGALAGENTS
■ Drugs used in the treatment of various types of fungal
infections(mycoses) are called as antifungal agents.
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8. CHEMICAL CLASSIFICATION
Antifungal agents are classified based on their chemical structure:
1.Azoles- Clotrimazole,Miconazole,Ketoconazole
2.Allyl amines and related compounds- Naftifine,Tolnaftate
3.Fatty acids and its derivatives-Zinc propionate,Sodium caprylate
4.Phenols and its derivatives- Haloprogin,Cyclopirox olamine
5.Nucleosides- Flucytosine
6.Anti-fungal antibiotics-Natamycin,Amphoterecin-B,Nystatin,Candicidin
7.Other antifungal antibiotics- Griseofulvin
8.Miscellaneous antifungal agents- Acrisorcin
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9. CLOTRIMAZOLE
Uses: Topically it is used in the treatment of tinea pedes,T.cruris,
T.capitis & cutaneous candidiasis.
It is also used for vulvo vaginal candidiasis.
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11. KETOCONAZOLE
Uses: Ketoconazole is a broad spectrum imidazole antifungal agent
Used to treat systemic fungal infections like
candidiasis,Coccidiodomycoses,Histoplasmosis,Blastomycoses,Chromomycose
s.
To treat cutaneous dermatophytic infections.
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Acetyl Piperazine Phenyl
Dichlorophenyl
Imidazole
Dioxalan
15. SODIUM CAPRYLATE
Uses: It is used topically to treat superficial dermatomycoses caused by
Candida albicans,Trycophytan ,Mycosporum,Epidermophyton species.
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17. CYCLOPIROX
Uses: Broad spectrum antifungal agent for topical use.
In the treatment of cutaneous candidiasis,tinea corporis,Tinea cruris
infections.
It is a second line agent for the treatment of
onyochomycoses(Ringworm of nails)
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18. FLUCYTOSINE
Uses: Narrow spectrum antifungal agent
To treat serious systemic infections caused by susceptible strains of
candida and cryptococcus species.
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19. NATAMYCIN
Uses: In the treatment of fungal conjunctivitis
To treat Blepharitis(Inflammation of eyelids)
To treat Keratitis(Inflammation of cornea)
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20. AMPHOTERECIN-B
Uses: Parentral amphotericin-B is used for the treatment of severe
potentially life threatening fungal infections including coccidiodomycoses,
Histoplasmoses,North American Blastomycoses & Aspergillosis.
Topically it is used to treat cutaneous and mucocutaneous mycoses
caused by candida albicans.
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21. NYSTATIN
Uses: For the treatment of local and GIT Candida infections caused by
candida albicans and other candida species.
To control vaginal candidiasis.
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23. GRISEOFULVIN
Uses: For the treatment of ringworm and fungal infections on the hair, nails & feet caused
by various species of fungi.
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25. MOA OF AZOLES
■ Azoles are fungicidal at high concentrations.
■ They are fungistatic at low concentrations.
■ Fungicidal effect is due to the damage of cell-membrane with the loss of essential
cellular components such as K+ and amino acids.
■ Fungistatic effect is due to the inhibition of membrane bound enzymes such as
cytP-450 involved in the fungal sterol biosynthesis particularly lanosterol 14α-
demethylase.
■ This enzyme is essential for the biosynthesis of ergosterol,the principle sterol
component of fungal cell membrane.
■ Lanosterol 14α-demethylase is also required for the biosynthesis of
Cholesterol.
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27. MOA OF ALLYLAMINES
■ Tolnaftate,Naftifine drugs interfere with early step of
ergosterol biosynthesis namely epoxidation of squalene by
Squalene epoxidase.
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28. MOA OF FATTY ACIDS & PHENOLS
■ Seabum ,an acid in and on the skin is a natural antifungal
agent.Fatty acid like seabum when applied to the infected
area acts as antifungal agents.Salts of fatty acids are also
fungicidal.
Eg: Zinc propionate,Sodium caprylate
■ They interfere with cell-membrane integrity and function in
susceptible fungi.
Eg: Haloprogin,Cyclopirox
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29. MOA OF NUCLEOSIDES
■ 5-Fluoro cytosine undergoes deamination to form 5-Fluro uracil.
■ 5-Fluoro uracil converts to 5-Fluoro uridine monophosphate,then diphosphate,triphosphate
and enters into RNA (by formation of faulty RNA) or blocks the synthesis of DNA causes cell-
death.
5-Fluoro cytosine 5-Fluoro cytosine 5-Fluoro uracil
5-Fluoro uridine diphosphate 5-Fluoro uridine monophosphate
5-Fluoro uridine triphosphate RNA(Faulty) Cell-death
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Active
transport
(Out of cell) (Inside of cell)
30. MOA OF ANTIFUNGALANTIBIOTICS
■ These drugs penetrate the fungal cell-membrane becoz of their three
dimensional shape.
■ After penetrating into the cell membrane they act as false membrane
components and binds with ergosterol causing membrane disruption
and loss of cellular constituents especially potassium ions.
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31. MOA OF GRISEOFULVIN
■ Griseofulvin is a mitotic spindle poison.
■ It arrests the cell-division in metaphase.
■ It binds with tubulin dimer which is required for microtubule formation.
■ Then shows selective toxicity to fungi and causes cell-death
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