SUBCUTANEOUS MYCOSES LOBOMYCOSIS

 Sporotrichosis - Due to: Loboa loboi

 Lobomycosis - Endemic area: Amazon River basin
 Rhinoentomophthoromycosis - Predisposition: mostly adults, almost all males
 Mycetoma* (?exposure?hormonal)
 Chromomycosis* - Clinical manifestation: small, hard, SQ nodules of
 Phaeohyphomycosis* extremities, face & ear
 Rhinosporidiosis* - Lesions: painless, but may become verrucous &
o *sometimes classified under Miscellaneous ulcerative

LABORATORY DIAGNOSIS
GENERALITIES

 Acquired through the skin or subcutaneous tissue by  KOH mount

traumatic inoculation o ( skin scrapings, biopsies, exudates)
o Look for : large yeast cells with multiple buds
 Resulting sequela/e – depends on the pathogenecity of
& characteristically form short chains
the fungus & host defenses
o NB: buds & parent cells – same size (vs. P.
 Usually confined to subcutaneous tissues
braziliensis)
 Two Types: depending on the number of infecting
organisms PATHOLOGY
1. Sporotrichosis, Rhinosporidiosis,
Rhinoentomophthoromycosis, Phycomycosis =  Lymph nodes – not involved
are due to individual fungi  Infection – chronic & progressive
2. Chromomycosis, Phaeohypomycosis, Mycetoma =  Etiologic agent has not been cultured, only maintained
are due to several species of fungi in laboratory animals

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

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.
Sporothrix schenckii  granules: contain very fine, delicate
hyphae
o Eumycetes: Allescheria, Madurella,
Phialophora, etc.
 granules: contain large, coarse,
septate hyphae

EPIDEMIOLOGY

 Most commonly found: Central & South America, Africa,

India
 Most often involved: feet, lower extremities, hands,
exposed areas

LABORATORY DIAGNOSIS

 Laboratory Diagnosis: Histopath or KOH granules:

o Color
o Size
o Texture
LABORATORY DIAGNOSIS o hyaline or pigmented hyphae

 KOH mount TREATMENT

o (look for = ‘cigar-shaped’ bodies)
 Amphotericin B
TREATMENT  Ketoconazole
 Topical Nystatin
 Potassium iodine (oral)  Fluocytosine
 Itraconazole  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

Chromoblastomycosis
Leg

LABORATORY DIAGNOSIS

 biopsy or KOH

TREATMENT

 early stages – excision

 late stages – Ampho B
 Fluocytosine
 Itraconazole