subcutaneous mycoses.pptx

8/16/2019 Subcutaneous mycoses.pptx

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Subcutaneous mycoses

By Dr. kajumbula



General features of Subcutaneous

mycoses

• un!al infections in"ol"in!

– the dermis

– Subcutaneous tissue

–

#djacent bone

• Mainly in tropics and subtropics

• $esult from traumatic implantations ofsaprobic fun!i from soil into subcutaneoustissue



Mycetoma

• Chronic !ranulomatous infection in"ol"in!: – Skin

– Subcutaneous tissue

– ascia – Bone

• May be caused by: – un!i %&umycetoma'

– #ctinomycetes %#ctinomycetoma'



Mycetoma

• #ctinomycetoma: – Caused by (lamentous bacteria

• Actinomyces israelii

• Norcardia

• Actinomadura

– Actinomyces spp are )ora in the mouth

and colon



Mycetoma

• &umycetoma: – Caused by a ran!e of moulds

• Madurella

• Leptosphaeria

• Pseudallescheria

• Phiallophora verrucosa



Mycetoma•

Infection follo*s traumatic implantation of or!anisms

• Minor cellular de(cits could ha"e a role in the de"elopmentof the disease: – &stablishment of disease has only been accomplished in athymic

nude mice• Pro!esterone + &stro!ens could be protecti"e % Male: emale

ratio is ,:-'

• Patholo!ical features:

– ocali/ed s*ollen lesions *ith multiple drainin! sinuses – Patholo!y consists of abscesses containin! !rains in association

*ith !ranulomatous in)ammation and (brosis

– 0he !rains are composed of compacted colonies of the or!anisms%masses of mycelial fun!i or bacterial (laments'

– 0he color of the !rains is often indicati"e of the causati"e or!anism



Mycetoma



Mycetoma

• aboratory dia!nosis: – Specimens: Pus1 biopsy materials

– Contain "isible !rains *hose color may beindicati"e of etiolo!ic a!ent:• Black: un!al 2 Madurella spp1 eptoshaeria1

Phialophora "errucosa

•

Pale !rains %*hite to yello*': Pseudoallescheria1#sper!illus

• 3ello* 2 Bro*n 2 4sually bacterial %#ctinomycetoma'



Mycetoma

• aboratory dia!nosis: – Bacterial5fun!al elements may be

demonstrated in:• 678 preparations

• Gram stain



Chromoblastomycosis

• Chronic locali/ed infection of skinand subcutaneous tissue

• Characteri/ed by "errucous %*artylesions' lesions mostly on the limbs

• 7ccur mainly in the tropics



Chromoblastomycosis

• Causati"e a!ents are dematecious%Dark *alled' moulds: – onsecae pedrosoi %Most common'

– onseca compacta

– Phialophora "errucosa

– Cladophiola carrioni



Chromoblastomycosis

• Infection follo*s traumatic implantation offun!us into the skin

•

Patholo!y consists of chronic suppurati"e and!ranulomatous in)ammation: – Pseudoepitheliomatous hyperplasia of the dermis

– Microabscesses in the epidermis and dermis

–

Granulomas *ith !iant cells and epitheliod cells inthe dermis

– 8allmark of the disease: Scelerotic5Copper coinbodies 2 dark bro*n thick *alled fun!al cells insideor outside macropha!es



Chromoblastomycosis



Subcutaneousphaeohyphomycosis• Phaeohyphomycosis are dark *alled fun!i %also referred to

as dematecious fun!i'

• 7ther than chromoblastomycosis

• Cause indolent lesions of skin and subcutaneous lesionthat start as a sin!le red noduley on the e9tremities.

• May e9tend to the brain1 can occur in theimmunosuppressed patient.

• &9amples of or!anisms include: – Bipolaris, Exophiala, Exserohilum, Phialophora, and Wangiella

are particularly common.



obomycosis %obos disease1

keloidal blastomycosis'

• # chronic skin infection most commonly a;ictin! the indi!enouspeople of the #ma/on re!ions of Columbia and Bra/il.

• 0he etiolo!ic %Lacazia loboi has ne"er been isolated in culture1 buthas been sho*n to be closely related to Paracoccidioides

brasiliensis

• < 0he fun!us remains con(ned to the skin1 pro!ressin! slo*ly o"erdecades.

• esions are typically nodules or keloidal pla=ues that are red1 hard1and shiny associated *ith (brosis and a !ranulomatous reaction onhistolo!y nodules or keloidal pla=ues that are red1 hard1 and shinyassociated *ith (brosis and a !ranulomatous reaction on histolo!y



obomycosis



Conidiobolomycosis

• #n subcutaneous mycosis

• Characteri/ed by a chronic !ranulomatous in)ammation

•

Caused by !onidiobolus species

• $estricted to the nasal submucosa

• Characteri/ed by polyps or palpable restricted subcutaneous

masses

• Presents as nasal obstruction1 draina!e and sinus pain

• Subcutaneous nodules de"elop in the nasal and perinasal

re!ions.



Conidiobolomycosis



Basidoibolomycosis

subcutaneous mycoses.pptx

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