Subcutaneous Mycoses

Subcutaneous Mycoses

• normally resides in the soil/ vegetation

• traumatic inoculation
• granulomatous lesions
• generally slow growing
• may become systemic infection
 Sporothrix schenckii

• sporotrichosis
• thermally dimorphic
• lives on vegetation
• may grow as mold-ambient temp.
• may grow as budding yeast – tissues
(35-37*c)
• may involve lymphatics and lymphnodes
 Morphology and Identification

• appears as blackish and shiny –young

colony
• wrinkled and fussy with age
• produce branching septate hyphae with
small conidia
• thermally dimorphic
• may elicit delayed skin reaction on
infected individuals ( sporotrichin)
Conidia skin (trauma) Granulomatous
nodules

May involve necrotic

lymphatics ulcerative
lesions
abscesses
• may mimic pulmonary tuberculosis
• fixed sporotrichosis- Mexico
• generally involve little systemic
illnesses
• dissemination –usual among immuno-
compromised individuals
 Diagnostic and Laboratory Tests

• biopsy
• microscopic examination-use of stains
• culture-Sabourauds agar
• serology
 Treatment

• self limited- some cases

• saturated solution of K iodide in milk
• itraconazole and other azoles
• amphotericin B-systemic infection
 Epidemiology

• worldwide
• 75% among males
(exposure? X- link?)
• occupational risk
(farmers, forest rangers)
 Prevention

• minimize accidental inocculation

• use of fungicides
 Chromoblastomycoses

• chromomycoses
• traumatic inocculation
• 5 recognized fungal agents
• chronic, slow granulomatous lesions
• hyperplasia of the epidermal tissues
 5 Fungal Elements

• Phialophora verrucosa
• Fonsecaea pedrosoi
• Fonsecaea compacta
• Rhinocladiella aquaspersa
• Cladosporium carrionii
 Morphology and Identification

• colonies are compact, deep brown to

black
• each agent is identified by their modes
of conidiation
 Phaeohyphomycosis

 characterized by the presence

of darkly pigmented septate hyphae
in tissue
 Solitary capsulated cyst , sinusitis,
brain abscesses
 Some common causes of subcutaneous
phaeohyphomycotic lesions
• Exophiala jeanselmei

• Phialophora richardsiae

• Bipolaris spicifera

• Wangiella dermatitidis
• Can be differentiated from
other fungi by the melanin in
their cell walls
• Itraconazole or flucytosine
is the drug of choice
 Mycetoma

 chronic subcutaneous infection

 Induced by traumatic inoculation
 saprophytic fungi or actinomycetous
bacteria
 commonly found in the soil
 Clinical Features

• Local swelling

• Interconnecting, often draining sinuses that contain

granules
• Actinomycetoma- caused by actinomycete

• Eumycetoma- caused by fungus (Madura foot,

maduromycosis)
• Clinical features are similar
• Actinomycetomas are more
invasive, spreading from the
subcutaneous tissue to the
underlying muscles
 Fungal agents of Mycetoma

• Pseudallescheria boydii

• Madurella mycetomatis

• Madurella grisea

• Exophiala jeanselmei

• Acremonium falciforme
 Pathogenesis and Clinical
Features

• Traumatic inoculation

• Commonly involve the feet, lower extremities , hands

and exposed areas
• Abscess formation, granulomas, and the formation of
draining sinuses
 Diagnosis

• Culture of granules from pus, biopsy materials

 Treatment

• Surgical debridement

• Excision

• chemotherapy
 Treatment –given in long
periods

• P. boydii- topical nystatin/miconazole

• Madurella infection-itraconazole, ketoconazole, ampho

B
• E. jeanselmei- flucytosine
Good Afternoon