MICROBIOLOGY LECTURE M4 – Subcutaneous Mycoses

Lecture and Notes by Dr. Magat/Dr. Pascual

USTMED ’07 Sec C – AsM

SUBCUTANEOUS MYCOSES

MYCOSES
• SYSTEMIC
• SUPERFICIAL
• SUBCUTANEOUS
• OPPORTUNISTIC LABORATORY DIAGNOSIS
• MISCELLANEOUS
• KOH mount
SUBCUTANEOUS MYCOSES o (look for = ‘cigar-shaped’ bodies)
• Sporotrichosis TREATMENT
• Lobomycosis
• Rhinoentomophthoromycosis • Potassium iodine (oral)
• Mycetoma* • Itraconazole
• Chromomycosis*
• Phaeohyphomycosis*
LOBOMYCOSIS
• Rhinosporidiosis*
o *sometimes classified under Miscellaneous - Due to: Loboa loboi
- Endemic area: Amazon River basin
GENERALITIES
- Predisposition: mostly adults, almost all males
(?exposure?hormonal)
• Acquired through the skin or subcutaneous tissue by
- Clinical manifestation: small, hard, SQ nodules of
traumatic inoculation extremities, face & ear
• Resulting sequela/e – depends on the pathogenecity of - Lesions: painless, but may become verrucous &
the fungus & host defenses ulcerative
• Usually confined to subcutaneous tissues
LABORATORY DIAGNOSIS
• Two Types: depending on the number of infecting
organisms • KOH mount
1. Sporotrichosis, Rhinosporidiosis, o ( skin scrapings, biopsies, exudates)
Rhinoentomophthoromycosis, Phycomycosis = o Look for : large yeast cells with multiple buds
are due to individual fungi & characteristically form short chains
2. Chromomycosis, Phaeohypomycosis, Mycetoma = o NB: buds & parent cells – same size (vs. P.
are due to several species of fungi braziliensis)

PATHOLOGY
SPOROTRICHOSIS
• Lymph nodes – not involved
• Definition: a chronic infection of the cutaneous, SQ • Infection – chronic & progressive
tissue & lymphatics • Etiologic agent has not been cultured, only maintained
• Caused by: Sporothrix schenckii in laboratory animals
• Synonym: Gardener’s disease
TREATMENT
• Distribution: worldwide
• Predisposition: all ages, 75% males (? Sex-linked or • DOC: Sulfa drugs
increased exposure) • other mx: surgery
• Seen more on agricultural workers
• Highest incidence: Mexico (also Central America &
Brazil) RHINOENTOMOPHTHOROMYCOSIS
• Infection most pronounced: debilitated & malnourished
- A rare infection of the nasal mucosa
persons
- Caused by: Entomophthora coronata
CLINICAL MANIFESTATION - Confined to: India, Africa, Southeast Asia
- Predisposition: 80% males
• Lymphocutaneous – one lesion but with eventual - Clinical manifestation: hard, SQ nodules developing in
involvement of lymphatics (75% of all cases) the nasal area  large disfiguring tissue mass
• Chronic – multiple SQ nodules
LABORATORY DIAGNOSIS
• Fixed – has only one lesion, restricted & less progressive,
but waxes & wanes • Biopsy
o look for numerous branching hyphae (NB.
blood vessels not invaded)
• Serology:
o ID (highly sensitive & specific)

TREATMENT

• surgery
• KI
Sporotrichosis Arm
Sporotrichosis Tissue • Amphotericin B

Sporothrix schenckii
MYCETOMA

- Synonyms: Madura foot, Maduromycosis

- Clinical features: local tumefaction & interconnecting,
often draining sinuses that contain granules
- Granules: micro-colonies of fungi embedded in the
tissue
- Etiology : Actinomycotic or Eumycotic Actinomycetes:
o Actinomadura, Nocardia, Streptomyces, etc.
  granules: contain very fine, delicate
hyphae
o Eumycetes: Allescheria, Madurella,
Phialophora, etc.
 granules: contain large, coarse,
septate hyphae

EPIDEMIOLOGY
Chromoblastomycosis
• Most commonly found: Central & South America, Africa,
Leg
India
• Most often involved: feet, lower extremities, hands,
exposed areas

LABORATORY DIAGNOSIS

• Laboratory Diagnosis: Histopath or KOH granules:

o Color LABORATORY DIAGNOSIS
o Size
• biopsy or KOH
o Texture
o hyaline or pigmented hyphae TREATMENT

TREATMENT • early stages – excision

• late stages – Ampho B
• Amphotericin B • Fluocytosine
• Ketoconazole • Itraconazole
• Topical Nystatin
• Fluocytosine
• Debridement
PHAEOHYPHOMYCOSIS

Mycetoma Foot - Due to: dematiaceous fungi

- Clinical form: SQ cysts – usually solitary, discrete, firm,
non-tender
- Deep tissue invasion may occur
o eg. brain abscess (frontal-most common)
- Caused by: traumatic implantation
- Agents responsible: Exophiala, Wangiella,
Cladosporium, Phialophora, etc.

CLINICAL MANIFESTATION
Mycetoma
Granules from mycetoma pedis, • cutaneous & systemic
Gridley stain
LABORATORY DIAGNOSIS

• Histopath or KOH (look for: brown, septate hyphae)

TREATMENT

• Treatment: (same with Chromomycosis)

CHROMOMYCOSIS

- Due to: dematiaceous fungi RHINOSPORIDIOSIS

- Caused by: traumatic implantation
- Characterized by: slow development of verrucous,
cutaneous vegetations
- Usual site: lower extremities
EPIDEMIOLOGY
• Distribution: temperate & tropical areas
• Etiologic agents: Fonsecae, Phialophora, Cladosporium
• Most common: F. pedrosoi
- Definition: a chronic infection, characterized by the
development of polypoid masses in the nasal mucosa
- Most commonly affected areas: nose, nasopharynx,
soft palate, occasionally, the genitals
- 90% of cases: India & Sri-Lanka
- 90% males (children & young adults)
- Etiology: Rhinosporidium seeberi (stimulate
proliferation of epithelial cells)

CLINICAL MANIFESTATION CLNIICAL MANIFESTATIONS:

• Clinical presentation: verrucous cauliflower-like lesions, • other muco-cutaneous sites: conjunctiva, genitalia,
developing after several years rectum
• Systemic invasion: rare • respiration may be compromised (nasal polyp)
• sporangia may be grossly visible

LABORATORY DIAGNOSIS

• Histopath or KOH
o (look for = sporangia)

TREATMENT

• Surgery
• Dapsone ( for preventing relapse)

Chromoblastomycosis
Sclerotic bodies
 Rhinosporidiosis Tissue

-fin-

spne

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