SUBCUTANEOUS MYCOSES Sevtap Arikan, MD

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SUBCUTANEOUS MYCOSES Sevtap Arikan, MD

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SUBCUTANEOUS MYCOSES Sevtap Arikan, MD. SUBCUTANEOUS MYCOSES. Sporotrichosis Chromoblastomycosis Mycetoma Rhinosporidiosis Lobomycosis. SPOROTRICHOSIS General features. Chronic inf. involving cutaneous, subcutaneous and lymphatic tissue Frequently encountered in gardeners - PowerPoint PPT Presentation

Transcript of SUBCUTANEOUS MYCOSES Sevtap Arikan, MD

Page 1: SUBCUTANEOUS MYCOSES Sevtap Arikan, MD

SUBCUTANEOUS MYCOSES

Sevtap Arikan, MD

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SUBCUTANEOUS MYCOSESSporotrichosisChromoblastomycosis MycetomaRhinosporidiosisLobomycosis

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SPOROTRICHOSISGeneral features

Chronic inf. involving cutaneous, subcutaneous and lymphatic tissue

Frequently encountered in gardeners May develop in otherwise healthy

individualsMost common in Mexico, endemic in

Brasil, Uruguay, South Africa

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SPOROTRICHOSISCausative agent

Sporothrix schenkiiThermally dimorphicNatural habitat: soil

37°C: Round/cigar-shaped yeast cells25°C: Septate hyphae, rosette-like clusters of conidia at the tips of the conidiophores

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SPOROTRICHOSISPathogenesis & Clinical FindingsSkin: Follows minor traumaNoduleulcer necrosisSkin/subcutaneous tissue lymphatic channels lymph nodes

Systemic dissemination: Bones, joints, meninges

Primary pulmonary: Chronic alcoholics

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SPOROTRICHOSISDiagnosisSamples: Aspiration fluid, pus, biopsyI. Micr. Direct microscopic examination

(KOH), histopathological examination (methenamine silver stain)Yeast cells, asteroid body

II.CultureIII.Serology Yeast agglutination testIV. Sporotrichin skin test (?)

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SPOROTRICHOSISTreatmentSpontaneous healing is

possible.

Cutaneous inf.: Potassium iodide (Topical/oral)

Disseminated inf.: Amphotericin B

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CHROMOBLASTOMYCOSISGeneral features

Posttraumatic chronic inf. of subcutaneous tissue

Papules verrucous cauliflower-like lesions on lower extremities

Systemic invasion is very rare

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CHROMOBLASTOMYCOSISCausative agents1. Fonsecaea 2. Phialophora 3. Cladosporium

Pigmented (dematiaceous) fungi in soil Arrangement and shape of the spores vary from one

genus to other

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CHROMOBLASTOMYCOSISDiagnosis

Direct microscopic examination (KOH)Sclerotic body

CultureSabouraud dextrose agar, 4-6 weeks, 37°C

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CHROMOBLASTOMYCOSISTREATMENTSurgeryAntifungal therapy (susceptibility

varies depending on the genus)Amphotericin BFlucytosineKetoconazole

Heat

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MYCETOMA(=Maduromycosis=Madura foot)

Posttraumatic chronic inf. of subcutaneous tissue

Common in tropical climates Causative agents

Saprophytic fungi (Eumycetoma)Actinomyces (Actinomycetoma)

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MYCETOMACausative agentsMadurella mycetomatis Pseudallescheria boydiiAcremonium Exophiala jeanselmeiLeptosphaeriaAspergillusActinomyces

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MYCETOMAClinical findings

Site(s): Feet, lower extremities, hands

Findings: Abscess formation, draining sinuses containing granules Deformities

Dissemination: Muscles and bones

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MYCETOMADiagnosis

Clinical findings are nonspecific

Identification of the infecting fungus is difficult

Characteristics of the granule, colony morphology, and physiological tests are used for identification

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EUMYCETOMATreatment

SurgeryAntifungal therapy

Amphotericin BFlucytosineTopical nystatin Topical potassium iodide(choice of treatment varies according to the infecting fungus)

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RHINOSPORIDIOSISGeneral & Clinical featuresChronic inf.In diversPolypoid masses at nasal mucosa,

conjunctiva, genitalia and rectumSeropurulent discharge from nasal

lesions

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RHINOSPORIDIOSISCausative agent

Rhinosporidium seeberiNatural reservoir: fish, aquatic

insects Spherules filled with endospores (in

tissue) Has not been cultured in vitro on

artificial media

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RHINOSPORIDIOSISTreatmentSurgery

Ethylstilbamidine(Local injection)

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LOBOMYCOSISPathogenesis & Clinical features

Chronic, subcutaneous, progressive inf. Traumatic inoculation of the fungusNatural inf.: in dolphinsHard, painless nodules on extremities,

face and earVerrucous / ulcerative lesionsLesions mimic those of

chromoblastomycosis, mycetoma and carcinoma

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LOBOMYCOSISCausative agent

Loboa loboiMultiple budding yeast cells

forming short chains Asteroid body

Has not been cultured in vitro on artificial media

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LOBOMYCOSISTreatment

Surgery

ClofazimineAmphotericin BSulphonamides