SUBCUTANEOUS MYCOSES

Note: Transcription is based from the manual and the transcribers notes

SUBCUTANEOUS MYCOSES involvement (multiple nodules, cord-

Chronic, localized infections of the skin and like nodules)
subcutaneous tissue following traumatic Fixed cutaneous type
implantation of etiologic agent Disseminated type poor prognosis
Rare, exotic, under the skin Pulmonary type rare; resemble TB
Insidious cause LABORATORY DIAGNOSIS
MOT: accidental puncture o Microscopic examination
Causative fungi are all soil saprophytes of Thermo dimorphic
regional epidemiology; soil and vegetation Tissue phase budding yeast cell
saprophytes (decaying organic material) CIGAR BODY
Considered as occupational hazard Mold phase microconidia DAISY-
Lesions are deeply rooted Difficult to treat LIKE or ROSETTE
some require surgical intervention o Culture
Patients are not immunocompromised early: moist; whitish, not cottony
Tx: systemic antifungals, surgical excision Older: more vegetative cell; whitish
filamentous becoming brownish
Mold: SDA with cycloheximide
Disease Etiologic Agent Yeast: BHIA
o Histopathology
Sporotrichosis Sporothrix schenkii
Inflammation: central area with
Chromoblastomycosis Phialophora
acute suppuration
Cladosporum
Organism: fluorescent technique
Fonseca
o Serology
Mycotic Mycetoma Pseudallescheria
Precipitation test
Madurella
TREATMENT
Exophiala
o Oral potassium iodide (MOA: unknown)
Acremonium
o Amphotericin B for extracutaneous forms
Rhinosporidiosis Rhinosporidium seeberi
o Antimicrobial therapy for secondary
Lobomycosis Loboa loboi
bacterial infection

SPOROTRICHOSIS CHROMOCYTOSIS
Etiologic agent: Sporothrix schenkii Etiologic agent:
Rose handlers disease o Phialophora verrucosa most common
Chronic infection with involvement of adjacent o Cladosporum cerrionii
lymphatics, subcutaneous nodules, ulcers o Fonseca pedrosol
(painless chanre sporotrichotic chanre), o Fonseca compactum
suppuration Chromoblastomycosis, chromomycosis
Nodular with suppuration and ulceration Verrucous dermatitis
Common in tropical or temperate region Common in temperate countries
Dimorphic DEMATACEOUS FUNGI melanin-like pigment
o Yeast/Tissue phase: budding yeast (black, rubbery)
(asteroid body) cigar body
Dimorphic
o Mold phase: rosette microconidia (at the
o Yeast/Tissue phase: sclerotic bodies, Medlar
tip)
bodies, brown bodies, fission bodies,
CLINICAL MANIFESTATION cannot distinguish the species
o Forms: o Mold phase: fine hyphae and various types
Lymphotcutaneous type most of sporulation; distinguishes the species
common; skin and lymphatic channel

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 SUBCUTANEOUS MYCOSES

Note: Transcription is based from the manual and the transcribers notes

CLINICAL MANIFESTATIONS Earlier involvement of bone

o Chromoblastomycosis o Eumycotic mycetoma
Verrucous, warty nodules TRUE FUNGI
Progress, vegetate and take a Causative agents
cauliflower-like appearance Madurella
o Phaeohyphomycosis Pseudallescheria
Solitary encapsulated cyst Exiophiala
phaeohyphomycotic cyst Leptoshaeria
LABORTORY DIAGNOSIS Curvularia
o 3 types of sporulation Fusarium
Phialophora FLASK-SHAPED Lesion: chronic granulomatous lesion involving
phialides the foot, characterized by multiple draining
Cladosporium branching sinus tracts; granules are seen in the discharge
conidiophores, with CHAINS of LABORTORY DIAGNOSIS
conidia o Demonstration of granules in the discharge
Acrotheca CLUB-SHAPED TREATMENT
conidiophores with conidia arising at o Surgical amputation
lateral sides; Fonseca o Amphotericin B
TREATMENT o Antibiotics (if actinomycotic form)
o Surgical removal
o Amphotericin B + 5 fluorocytosine
LOBOMYCOSIS
Etiologic agent: Loboa loboi
MYCETOMA Lobos disease
Etiologic agent: species of true higher fungi Keloidal blastomycosis
Madura foot Found in Mexico and southwards of Central
Maduramycosis Brazil
Only lesion where granules can be seen from CLINICAL MANIFESTATIONS
the discharge o Rare, progressive disease of the skin and
Triad of mycetoma subcutaneous tissue
o Draining sinuses o Lesions vary in appearance according to the
o Abscess duration of infection
o Granules o Sites: limb and face
Lesion: abscess, granulomata and draining o No discomfort
sinuses, tumefaction o Early stage: single nodule 1cm
Incubation period: years o Late stage: elevated and keloidal with
CLINICAL MANIFESTATION satellite lesion
o Actinomycotic mycetoma LABORATORY DIAGNOSIS
Filamentous BACTERIA masquerading o Direct microscopic examination
like fungi o KOH chain of yeast cell
Causative agents (NASA) TREATMENT: Surgical excision
Nocardia
Actinomadura RHINOSPORIDIOSIS
Streptomyces Etiologic agent: Rhinosporidium seeberi
Actinomycetes Common in India and Sri Lanka
bacterial infection Males from rural areas with frequent contact
fine threads of bacilli with freshwater pools
IP shorter than 5 years CLINICAL MANIFESTATIONS

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 SUBCUTANEOUS MYCOSES

Note: Transcription is based from the manual and the transcribers notes

o Chronic granulomatous disease of the

mucocutaneous tissue (eyes, oral cavity)
o Large polyps or wart-like lesions dangling
pedunculated with stalk
o Most commonly affected area: NOSE
Pedunculated
Extrude from nostril
Large pink to red cauliflower-like
masses
o Conjunctiva of the eyes
Unilateral
May be pedunculated
o Anus, vagina, and ears (rare)
o Cutaneous lesion extension from
infected mucosa
o Source: unknown
LABORATORY DIAGNOSIS
o Host tissue
Large sporangia (spherules) <350 cm
Thick cell wall (5cm)
Numerous spores inside (6-7um)
o Direct microscopic examination
Sporangia may be seen with eyes
KOH
H&E
o Cannot be cultured
TREATMENT
o surgical excision

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