SUBCUTANEOUS MYCOSES

- Involves the dermis, subcutaneous tissue, and sometimes the muscle fascia

Overview of the Subcutaneous Mycoses

Mycoses Most Common Causative Agent Appearance of Direct Lymphatic
Site Lesion Microscopy Involvement
Sporotrichosis Upper and lower Sporothrix schenckii Painless, smooth Asteroid bodies Spreads along
limbs nodules lymphatic
Ulcers channels
Chromoblastomycosis Lower Limbs Phialophora Verrucoid/ warty Sclerotic bodies Possible
verrucosa crusted nodules,
Fonsecaea pedrosoi, micro-abscesses

Minor:
Cladosporium
carrionii
Fonsecaea compacta
Mycetoma Lower Limbs Pseudoallescheria Tumefaction, Granules No
boydii draining sinuses Localized
Exophiala jeanselmei
Rhinosporidiosis Mucous Rhinosporidium Granuloma Spherule Possible
membranes seeberi containing
endospores
Nasal mucosa,
tonsils, or
external
structure of the
eyes
Phaeohyphomycosis Any Area Any dematiaceous Diverse No specific Possible
fungi symptoms elements
Wangiella
dermatitidis
Xylohypha bantiana

1. Sporotrichosis
- Other names: “Rose gardener’s disease”
- Causative agent: Sporothrix schenckii
- Reservoir: Soil, vegetable debris, moist wood, wood pulp, and sphagnum moss
- Mode of transmission: Traumatic implantation
- Risk factors:
o Gardening and working with soil
o “Rose gardener’s disease” : Infection due to contact with the sphagnum moss used to mulch roses and other
plants
- Characteristic lesion: Ulcers and smooth, painless nodules
o Painless nodule  ulceration  tissue becomes necrotic  Lymphatic involvement/ Bone and joint
involvement
- Common involved site: Upper and lower limbs
- Forms:
o Cutaneous sporotrichosis
 Most common primary infection
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  Skin; formation of a painless nodule which later develops to fluid-discharging fluids
oLymphocutaneous sporotrichosis
 Primary infection  Dissemination to lymph nodes
o Osteoarticular sporotrichosis
 Primary infection  Bone/ joint involvement  arthritis
o Pulmonary sporotrichosis
 Relatively rare
 Occurs via inhalation of Spororthrix schenckii spores
 Pneumonia-like: Hemoptysis, Coughing, Chest pain
- Laboratory Diagnosis:
o Dimorphic fungi
Direct Microscopy Asteroid bodies
Star-shaped, with rays of EOSINOPHILIC MATERIAL radiating from CENTRAL
YEASTLIKE CELL
Yeastlike cell: Basophilic, 3 to 5 micrometers
Eosinophilic material: Complex of antigenic material from the fungus and antibody protein
from the host cell
Culture Media Modified SDA, Modified SDA with antimicrobials,
BHIA with blood for the isolation of the yeast form
Macroscopic Molds:
Morphology Young colonies: Cream to white, glabrous texture
Develop dark pigment with age
Typical mature colonies are flat, leathery to velvety, and black with a black reverse pigment
Yeast:
White, beige, or tan yeast-like colonies resembling that of Candida albicans
Microscopic Molds:
Morphology Hyphae: Hyaline, septate thin, and delicate; Parallel strands in ropelike fashion
Conidiophores: Arise at right angles to the hyphae; Vesicles are denticulate (tooth-like)
Conidia: 2 types
a. Hyaline, oval to pyriform, daisy-like or rosette pattern
b. Dark brown and thick-walled, spherical to oval, found singly along the conidiophores
Yeast
Globose to fusiform or oval
Characterized as cigar-shaped, with a delicate point of attachment between the mother and the
daughter cell

2. Chromoblastomycosis
- Other names: Chromomycosis, Verrucous dermatitis
- Causative agents:
o Phialophora verrucosa
o Fonsecaea pedrosoi
o Minor agents:
 Cladosporium carrionii,
 Fonsecaea compacta
- Reservoir: Soil, wood and wood pulp, decaying vegetation
- Mode of transmission: Direct contact
- Characteristic lesion: Verrucoid and warty crusted nodules
o Scaly papules  warty, crusted nodules  ulceration & more elevated (cauliflower-like appearance)
- Common involved site: Lower limbs

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 - Laboratory Diagnosis:
o Direct Microscopy: Sclerotic Bodies
o Types of anamorphic conidiation:
 Cladosporium-type
 Septate hyphae of various sized (often short)
 Conidia:
o Produced in a “treelike” fashion
o Long chains (12-15) of oval, smooth-walled blastoconidia
 Phialophora- type
 Classic phialides are vase-shaped (rounded bases that narrows into the neck)
 Vase-shaped phialides flare to form a colarrette (lip)
 Conidia
o Oval/ elliptical
o Tend to cluster around the tip of the phialide
 Rhinocladiella-type
 Conidiophores of varying sizes and lengths that are slightly swollen at the distal ends
 Conidia
o Approximates the rosettes produced by Sporothrix but are bigger and coarser
o Produces sympodially (conidia develops in zigzag rachis) on short dentricles
around the tip of the conidiophores

o Cladosporium carrionii : Cladosporium-type conidiation

o Phialophora verrucosa : Phialophora-type conidiation
o Fonsecaea pedrosoi and Fonsecaea compacta: Commonly Rhinocladiella-type conidiation; Rarely
Cladosporium-type conidiation
Phialophora verrucosa
Direct Microscopy Sclerotic bodies (Medlar bodies)
Also called as “copper pennies”
Pleomorphic spherical brown forms, approximately 8 microns in diameter; Muriform septa
divide them into two or four cells
Culture Media Modified SDA, Modified SDA with antimicrobials
Macroscopic Olive green to black, with a gray-black to jet black reverse pigment. The surface is spreading and flat
Morphology with radial folds; Velvety texture. Colonies may be slightly embedded in the medium
Microscopic Hyphae: Brown pigment in unstained preparation, septate and branching
Morphology Conidiophores: Light-brown pigment
Phialophora-type conidiation

3. Mycetoma
- 2 types
o Actinomycotic mycetoma: Caused by filamentous bacteria
o Eumycotic mycetoma: Caused by fungi
Eumycotic Mycetoma
- Other name: Maduromycosis
- Causative agents:
o Pseudoallescheria boydii
o Exophiala jeanselmei
o Others:
 Madurella mycetomatis, Madurella grisea
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  Some saprobes: Aspergillus, Curvularia, Acremonium
- Reservoir: Soil, manure, rotting wood
- Mode of transmission: Traumatic implantation
- Characteristic lesion: Tumefaction, DRAINING SINUSES
o Pus contains GRANULES
- Common involved site: Lower limbs (MADURA FOOT but may also involve upper limbs
- Laboratory Diagnosis:
o Direct Microscopy:
 Wet Mount (NSS): Granules
 Small flecks of matter
 Made up of MICROCOLONIES OF THE CAUSATIVE AGENT &
PROTEINACEOUS MATERIALS from the host
o Culture is NOT NECESSARY and is used only for definitive diagnosis

Exophiala jeanselmei
Culture Media Modified SDA, Modified SDA with antimicrobials
Macroscopic Young colonies: Black yeast
Morphology Mature colonies: Olive-gray to brownish black with a jet-black reverse; velvety; dome-shaped, folding,
and spreading
Microscopic Young colonies: Black yeast cells
Morphology Mature:
Hyphae: Broad, septate, branched
Annellides: Conidiogenous cells, almost imperceptible on individual cells
Annelloconidia: Ellliptical to subglobose, hyaline

Pseudoallescheria boydii
Culture Media Modified SDA, Modified SDA with antimicrobials
PDA, PFA, 2% water agar or CMA enhances cleistotheca production
Macroscopic Young: White and fluffy
Morphology Mature: Brownish gray to black with woolly texture; gray to black reverse
Cleistotheca (Teleomorph)
Found at the periphery of the colony
Slighly submerged; Agar needs to be scrapped for microscopic preparation
Microscopic Teleomorph:
Morphology Cleistotheca:
Dark brown to black globes with thick walls
Walls are made up of two to three layers of septate hyphae that are interwoven
Anamorph:
Hyphae: Hyaline, septate, and may branch
Annellides: Conidiogenous cells, develops on the hyphae or erect annellophores
Annelloconidia: Subglobose to ovoid and colorless with truncate bases

4. Rhinosporidiosis
- Causative agent: Rhinosporidium seeberi
- Reservoir: Fish, aquatic insects
- Mode of transmission: Direct contact with contaminated water
- Characteristic lesion: GRANULOMA
- Common involved site: Mucous membranes
o Nose, Tonsils, Conjunctiva of the eye

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 - Laboratory Diagnosis:
o Direct Microscopy: SPHERULES
 Sac-like; Large with diameter of 300 microns
 Contains endospores
o Culture is NOT PERFORMED

5. Phaeohyphomycosis
- Causative agents:
o Wangiella (former Fonsecaea) dermatitidis
o Xylohypha bantiana
o Others: Cladosporium trichoides , Exophiala jeanselmei , Phialophora
- Rare infection caused by dematiaceous saprobes among immunocompromised hosts
- Invasion of the skin, lungs, and brain
- Laboratory Diagnosis
o Direct Microscopy: No specific element identified

Wangiella dermatitidis
Culture Media Modified SDA, Modified SDA with antimicrobials
Macroscopic Young: Yeast-like, mucoid, shiny, and black
Morphology Mature: Velvety but may become glabrous, olive gray to gray black with jet black reverse
Microscopic Young: Black, yeast-like cells
Morphology Mature:
Hyphae: Septate and branching, greenish brown
Phialides: Conidiogenous cells ; Develop laterally or terminally from hyphae
Conidia: Small, ovoid to globose, unicellular with smooth walls

Xylohypha bantiana
Culture Media Modified SDA, Modified SDA with antimicrobials
Macroscopic Young: Olive-gray to olive-brown with a dark gray to black reverse pigment
Morphology Mature: Obverse and reverse has dark gray or black color; velvety or cottony texture, typically flat
Microscopic Hyphae: Septate and maybe branched, broad with brown pigment
Morphology Conidiation: Cladosporium-type
Conidia: Long chains of 35 to 40; Produced acropetally (produced from the base toward the apex) in a
“treelike” fashion

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