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Subcutaneous Mycoses

Subcutaneous mycoses presentation

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43 views26 pages

Subcutaneous Mycoses

Subcutaneous mycoses presentation

Uploaded by

aysheralkali97
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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STUDENTS’ LECTURE NOTES

Subcutaneous Mycoses

Dr. Muhammad Getso


Department of Medical Microbiology and Parasitology, College of
health Sciences, Bayero University, Kano – Nigeria.
Synopsis
• Introduction
• Mycetoma
• Sporotichosis
• Chromoblastomycosis
• Phaeohyphomycosis
• Lobomycosis
Introduction
• Subcutaneous mycoses is a group of chronic,
localized fungal infections of skin and
subcutaneous tissue following traumatic
implantation of the aetiologic agent(s).

• The causative fungi are usually soil saprophytes of


regional epidemiology

• Their ability to adapt to the tissue environment and


elicit disease is extremely variable.
Mycetoma (fungus tumors)
• Is a slowly progressive, chronic, granulomatous, skin
and subcutaneous infection.

• They can be eumycotic mycetoma (caused by the TRUE


fungi) OR actinomycetoma.

• They frequently invade contiguous tissue, particularly


the bone.

• Diagnosis of the etiologic agent is essential for patient


management because the prognosis and therapy differs.
Epidemiology
Distribution: World-wide but most common in bare-
footed populations living in tropical or subtropical
regions.

Mycetoma reported cases in 2013

The lancet; (2016) Vol 16:1


Common etiologic agents
Eumycetoma Actinomycetoma
• Madurella mycetomatis • Actinomadura madurae
• Madurella grisea • Actinomadura pelletieri
• Pseudallescheria boydii • Nocardia braziliansis
• Aspergillus nidulans • Streptomyces somaliensis
Clinical manifestation
– tumefaction - swelling
– granules - a variety of colors (white, brown, yellow, black,
etc.).
– draining sinus tracts
– Contiguous spreads

• Laboratory Diagnosis
– High index of clinical suspicion
– DE: Characteristic granules crushed on slide + 10% KOH to
observe hyphal materials ± septation, cement-like
materials
– Grams stain: GP branching filaments of actinomycetes
• Culture
– Grains cultured on SDA and BHA or BA @ 25oC and
37oC
• Biopsy and Histology
• Others : X-ray, CT or MRI

• Treatment
– Ketoconazole
– Itraconazole
– Amp B
– Antibiotics: Dapson, Amikacin, Rifampin
• Surgical excision and debridement of localized
lesion
Sporotrichosis
• Chronic pyogranulomatous fungal infection of
skin and subcutaneous tissue which may show
lymphatic spread.
• AKA: Rose Gardener’s (Rose Picker’s) disease

• Etiology: Sporothrix schenkii (dimorphic)


Epidemiology

Historical frequency of papers in


sporotrichosis by years (Source: Pubmed)

World distribution of reported cases of sporotrichosis


Clinical Manifestation
i. Lymphocutaneous sporotrichosis
ii. Fixed cutaneous sporotrichosis
iii. Muco-cutaneos sporotrichosis
iv. Disseminated sprotrichosis
v. Pulmonary sporotrichosis
Lab Diagnosis
• Specimen: pus, exudates, swab, curate

• DE:
– Wet mount :10% KOH
– Gram stain: GP irregularly stained budding yeast cells
– Calcoflour stain: Scanty yeast cells
– Histology + PAS, H&E, GMS: Cigar-shaped yeast cells,
sprotichoid/asteroid body , Giant cells
• Culture:
o 2 set of SDA and BHIA or BA @ 25oC and 37oC
o 25oC: Delicate septate mycelia with apical tear drop conidia
o 37oC: spherical or cigar-shaped budding cells
Treatment:
•Saturated Solution of Potassium Iodide (SSKI)
•Itraconazole
•Amp B
Chromoblastomycosis
• A chronic, localized infection of subcutaneous tissues
caused by several species of dematiaceous (black
pigmented) fungi.

• Common etiologic agents

– Fonsecaea pedrosoi
– F. compacta
– Cladosporium carrionii
– Phialophora verrucosa
– Rhinocladiella aquaspersa
Epidemiology

• Distribution: worldwide with higher prevalence


in humid tropical and subtropical climate areas
of America, Asia and Africa

cmr.asm.org Vol 30:1 (2017)


Clinical Manifestation
• Warty nodular lesions limited to subcut tissue,
usually with superimposed bacterial infection
(crust formation).
• Secondary lymphedema-elephantiasis, SCC
Lab Diagnosis
• Specimen: Scraped crusts, Pus, biopsy/curate specimen

• DE: 10% KOH- long brown, branching hyphae

• Histology: Sclerotic bodies in clinical samples

• Culture:
– SDA ± antibiotic @ 25oC and 37oC
(Dark olivatious to black colonies)

• PCR: Species identification


Treatment
• Antifungals
• Itraconazole ± 5FC
• Terbinafine, Amp B
• Nonpharmacological treatments
– Curettage
– electrocoagulation,
– cryosurgery
Phaeohyphomycosis
• Phaeohyphomycosis is a heterogeneous group
of mycoses caused by dark-walled
(dematiaceous) fungi

• Common Etiologic agents


o Exophiala spp.
o Bipolaris spp.
o Curvularia spp.
o Pleurophomopsis spp.
o Phaeoacremonium spp.
o Alternaria spp.
Epidemiology
• Distribution: found in all climates, but more
common in tropical climates.

• There has been a recent rise in cases among


immunosuppressed patients with HIV/AIDS,
transplant and diabetic patients
Clinical Manifestation
• Cutaneous
phaeohyphomycosis

• Subcutaneous
phaeohyphomycosis

• Invasive and cerebral


phaeohyphomycosis
(Cladophilophora bantiana)

• Paranasal sinus
phaeohyphomycosis
Subcutaneous Phaeohyphomycosis
• Following local trauma or inoculation with foreign
material, patients develop a slow-growing solitary lesion
(generally a cyst or a nodule, or possibly a plaque or
abscess).

• Lesion usually located


on the extremities
Lab Diagnosis
• Specimen: Depend on site involved

• DE: 10% KOH- darkly pigmented, septate hyphae

• Histology: darkly pigmented, septate hyphae and


pseudohyphae, yeast-like cells

• Culture:
– SDA ± antibiotic @ 25oC and 37oC
(Dark olivatious to black colonies)

• PCR: Species identification


Treatment
• Combination of antifungals
(itraconazole, ketoconazole, or terbinafine) with
surgery.
• Exophiala spp. strains tend to be resistant to
fluconazole.
• Disseminated infections are treated with
amphotericin B

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