Subcutaneous mycoses

By Dr. kajumbula

Major subcutaneous
mycoses
Include:
Chromoblastomycosis
Mycetoma
Sporotrichosis
Phaeohyphomycosis
Basidiobolomycosis
Conidiobolomycosis

General features of Subcutaneous

mycoses
Fungal infections involving
the dermis
Subcutaneous tissue
Adjacent bone

Mainly in tropics and subtropics

Result from traumatic implantations of
saprobic fungi from soil into subcutaneous
tissue

Mycetoma
Chronic granulomatous infection involving:
Skin
Subcutaneous tissue
Fascia
Bone

May be caused by:

Fungi (Eumycetoma)
Actinomycetes (Actinomycetoma)

Mycetoma
Actinomycetoma:
Caused by filamentous bacteria
Actinomyces israelii
Norcardia
Actinomadura

Actinomyces spp are flora in the mouth

and colon

Mycetoma
Eumycetoma:
Caused by a range of moulds

Madurella
Leptosphaeria
Pseudallescheria
Phiallophora verrucosa

Mycetoma
Infection follows traumatic implantation of organisms
Minor cellular deficits could have a role in the development
of the disease:
Establishment of disease has only been accomplished in athymic
nude mice

Progesterone & Estrogens could be protective ( Male: Female

ratio is 4:1)
Pathological features:
Localized swollen lesions with multiple draining sinuses
Pathology consists of abscesses containing grains in association
with granulomatous inflammation and fibrosis
The grains are composed of compacted colonies of the organisms
(masses of mycelial fungi or bacterial filaments)
The color of the grains is often indicative of the causative organism

Mycetoma

Mycetoma
Laboratory diagnosis:
Specimens: Pus, biopsy materials
Contain visible grains whose color may be
indicative of etiologic agent:
Black: Fungal Madurella spp, Leptoshaeria,
Phialophora verrucosa
Pale grains (white to yellow): Pseudoallescheria,
Aspergillus
Yellow Brown Usually bacterial (Actinomycetoma)

Mycetoma
Laboratory diagnosis:
Bacterial/fungal elements may be
demonstrated in:
KOH preparations
Gram stain

Chromoblastomycosis
Chronic localized infection of skin
and subcutaneous tissue
Characterized by verrucous (warty
lesions) lesions mostly on the limbs
Occur mainly in the tropics

Chromoblastomycosis
Causative agents are dematecious
(Dark walled) moulds:
Fonsecae pedrosoi (Most common)
Fonseca compacta
Phialophora verrucosa
Cladophiola carrioni

Chromoblastomycosis
Infection follows traumatic implantation of
fungus into the skin
Pathology consists of chronic suppurative and
granulomatous inflammation:
Pseudoepitheliomatous hyperplasia of the dermis
Microabscesses in the epidermis and dermis
Granulomas with giant cells and epitheliod cells in
the dermis
Hallmark of the disease: Scelerotic/Copper coin
bodies dark brown thick walled fungal cells inside
or outside macrophages

Chromoblastomycosis

Chromoblastomycosis

Chromoblastomycosis
Laboratory diagnosis:
Specimens:
Skin scrappings
Biopsy

Microscopy:
KOH preparations, H&E: Look for
characteristic scelerotic bodies

Culture on SDA

Subcutaneous
phaeohyphomycosis
Phaeohyphomycosis are dark walled fungi (also referred to
as dematecious fungi)
Other than chromoblastomycosis
Cause indolent lesions of skin and subcutaneous lesion
that start as a single red noduley on the extremities.
May extend to the brain, can occur in the
immunosuppressed patient.
Examples of organisms include:
Bipolaris, Exophiala, Exserohilum, Phialophora, and Wangiella
are particularly common.

Lobomycosis (Lobos disease,

keloidal blastomycosis)
A chronic skin infection most commonly afflicting the indigenous
people of the Amazon regions of Columbia and Brazil.
The etiologic (Lacazia loboi) has never been isolated in culture, but
has been shown to be closely related to Paracoccidioides
brasiliensis

The fungus remains confined to the skin, progressing slowly over

decades.
]

Lesions are typically nodules or keloidal plaques that are red, hard,
and shiny associated with fibrosis and a granulomatous reaction on
histology nodules or keloidal plaques that are red, hard, and shiny
associated with fibrosis and a granulomatous reaction on histology

Lobomycosis

Conidiobolomycosis
An subcutaneous mycosis
Characterized by a chronic granulomatous inflammation
Caused by Conidiobolus species
Restricted to the nasal submucosa
Characterized by polyps or palpable restricted subcutaneous
masses
Presents as nasal obstruction, drainage and sinus pain
Subcutaneous nodules develop in the nasal and perinasal
regions.

Conidiobolomycosis

Basidoibolomycosis