Subcutaneous Mycoses

 wide rang of fungal infections

 Characterized by lesion
 Usually associated with trauma
 Sporotrichosis
 Chromoblastomycosis
 Mycetoma
 Rhinosporidiosis
 Labiomycosis
 Common future
 Trauma at site of infection
 Thorn, splinter
 Infection occur at site prone to trauma
 Hand, arm
 Organisms usually found in soil
 Infections mimic subcutaneous bacterial
 Excision and amputation is frequently
employed
 Etiology and clinical syndroms
 Heterogeneous groups of fungi
 Low pathogenic potential
 found in soil
 Disease interplay between organism and
host response
 No underlying immunological defect
 Lymphocutaneous sporotrichosis
 Chronic infection
 Nodular and ulcerative lesions
 Drain at site of inoculation
 Causative agent
 Sporothrix schenkii
 Thermally dimorphic
 Natural habitat soil
 37°C: Round/cigar-shaped yeast cells
 25°C: Septate hyphae, rosette-like clusters of
conidia at the tips of the conidiophores
Pathogenesis & Clinical Findings
 Skin: Follows minor trauma
Nodule  ulcer necrosis
Skin/subcutaneous tissue
lymphatic channels lymph nodes
 Systemic dissemination: Bones,
joints, meninges
 Primary pulmonary: Chronic
alcoholics
 Laboratory Diagnosis
Samples: Aspiration fluid, pus, biopsy
I. Micro. Direct microscopic examination
(KOH), histopathological examination
(methenamine silver stain)
Yeast cells, asteroid body
II.Culture
III.Serology Yeast agglutination test
IV. Sporotrichin skin test (?)
 Treatment
 Spontaneous healing is possible.
 Cutaneous infection
 Potassium iodide (Topical/oral)
 Disseminated infection
 Amphotericin B
 Eumycotic MYCETOMA
(=Maduromycosis=Madura foot)
 General futures
 Posttraumatic chronic inf. of
subcutaneous tissue
 Common in tropical climates
 Causative agents
 Saprophytic fungi (Eumycetoma)
 Actinomyces (Actinomycetoma)
 MYCETOMA Causative agents
 Madurella mycetomatis
 Pseudallescheria boydii
 Acremonium
 Exophiala jeanselmei
 Leptosphaeria
 Aspergillus
 Actinomyces
 Clinical findings
 Site's
 Feet, lower extremities, hands
 Findings:
 Abscess formation, draining
 sinuses containing granules
 Deformities
 Dissemination
 Muscles and bones
 Laboratory Diagnosis
 Clinicalfindings are non-specific
 Identification of the infecting
fungus is difficult
 Characteristics of the granule,
colony morphology, and physiological
tests are used for identification
 Treatment
 Surgery
 Antifungal therapy
 Amphotericin B
 Flucytosine
 Topical nystatin
 Topical potassium iodide
 choice of treatment varies according to
the infecting fungus
 CHROMOBLASTOMYCOSIS
 General features
 Posttraumatic chronic inf. of
subcutaneous tissue
 Papules verrucous cauliflower-
like lesions on lower extremities
 Systemic invasion is very rare
 Causative agents
1. Fonsecaea
2. Phialophora
3. Cladosporium
 Pigmented (dematiaceous) fungi in soil
 Arrangement and shape of the spores
vary from one genus to other
Laboratory diagnosis

 Direct microscopic examination

(KOH)
 Sclerotic body
 Culture
 Sabouraud dextrose agar, 4-6 weeks,
37°C
 TREATMENT
 Surgery
 Antifungal therapy (susceptibility varies
depending on the genus)
 Amphotericin B
 Flucytosine
 Ketaconazole
 Heat