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Questions and Answers
What is a characteristic of abscesses with multiple sinus tracts?
What is a characteristic of abscesses with multiple sinus tracts?
Which site of infection is referred to as pedal mycetoma?
Which site of infection is referred to as pedal mycetoma?
What are the main antifungal treatments for eumycotic mycetoma?
What are the main antifungal treatments for eumycotic mycetoma?
What is the mode of transmission for sporotrichosis?
What is the mode of transmission for sporotrichosis?
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Which group is at high risk for acquiring sporotrichosis?
Which group is at high risk for acquiring sporotrichosis?
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Which of the following conditions is classified under subcutaneous mycoses?
Which of the following conditions is classified under subcutaneous mycoses?
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What is the primary mode of transmission for mycetoma?
What is the primary mode of transmission for mycetoma?
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Which of the following groups of organisms are NOT known to cause mycetoma?
Which of the following groups of organisms are NOT known to cause mycetoma?
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In which geographical areas is mycetoma known to occur with a high frequency?
In which geographical areas is mycetoma known to occur with a high frequency?
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Which of the following is true regarding the clinical manifestation of mycetoma?
Which of the following is true regarding the clinical manifestation of mycetoma?
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Which clinical signs are associated with fixed cutaneous sporotrichosis?
Which clinical signs are associated with fixed cutaneous sporotrichosis?
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What characterizes lymphocutaneous sporotrichosis?
What characterizes lymphocutaneous sporotrichosis?
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Which site is commonly affected by fixed cutaneous sporotrichosis?
Which site is commonly affected by fixed cutaneous sporotrichosis?
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What is a notable feature of muco-cutaneous sporotrichosis?
What is a notable feature of muco-cutaneous sporotrichosis?
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Which of the following statements about the treatment of sporotrichosis is true?
Which of the following statements about the treatment of sporotrichosis is true?
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Chromoblastomycosis is primarily caused by which types of fungi?
Chromoblastomycosis is primarily caused by which types of fungi?
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What is a common laboratory diagnosis method for chromoblastomycosis?
What is a common laboratory diagnosis method for chromoblastomycosis?
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What distinguishes extra cutaneous sporotrichosis from other forms?
What distinguishes extra cutaneous sporotrichosis from other forms?
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Study Notes
Subcutaneous Mycoses
- Include diseases involving under skin tissues: Mycetoma, Sporotrichosis, Chromoblastomycosis.
Mycetoma (Madura Foot)
- Clinical syndrome characterized by localized, deforming, swollen lesions and exudative abscesses.
- Affects cutaneous and subcutaneous tissues and can involve bone.
- Caused by a combination of Actinobacteria and fungi.
Actinobacteria
- Filamentous bacteria associated with mycetoma include:
- Actinomyces israelii (normal flora)
- Actinomadura madurae
- Nocardia species (N. asteroides, N. otitidis-caviarum, N. brasiliensis)
- Streptomyces somaliensis
- Most exist in soil and plants except A. israelii.
Fungi
- Key fungi involved in mycetoma:
- Pseudallescheria boydii
- Madurella mycetomatis
- Madurella grisea
- Aspergillus species
- Acremonium species
- Fusarium species
- Primarily found in soil and plants.
Environmental Niches
- Commonly found in soil, plants, and certain devices.
Etiological Types of Mycetoma
- Actinomycotic Mycetoma: Caused by Actinobacteria.
- Eumycotic Mycetoma: Caused by fungi.
Mode of Transmission
- Transmission occurs through cutaneous inoculation after trauma (e.g., pin, thorn, thistle injuries).
Ecology and Epidemiology
- Distributed worldwide; higher frequency in tropical regions (e.g., India, Sudan, Mexico) and lower in subtropical areas (e.g., Iran).
- Affects all age groups, with a higher incidence in males, especially in farming and gardening occupations.
Clinical Manifestations
- Long incubation period (6 months to 10 years).
- Presenting symptoms include:
- Tense nodules and abscesses with multiple sinus tracts.
- Granules may be produced, varying in size and color.
- Edema, disfigurement, and potential metastasis to joints or bone (not nerves/muscles).
Anatomic Sites of Infection
- Pedal mycetoma: Lesions localized to the foot.
- Extrapedal mycetoma: Involvement in areas such as the leg, trunk, or arm.
Laboratorial Diagnosis
- Sample pus, exudate, or granules for analysis.
- Smearing with KOH or PAS staining highlights:
- Actinomycotic grains (branched filaments) versus Eumycotic grains (septate mycelia).
- Culturing on selective media (S, Sc, BHI).
Treatment
- Eumycotic Mycetoma: Amphotricine-B, Itraconazole.
- Actinomycotic Mycetoma: Dapsone combined with Streptomycin.
Sporotrichosis (Rose Syndrome)
- Caused by the dimorphic fungus Sporothrix schenckii, typically found in soil and plants.
Mode of Transmission
- Common injuries facilitating transmission include:
- Pin, thorn, thistle trauma, and bites from animals (dogs, parrots, cats).
Epidemiology
- Endemic in tropical areas (Mexico and Brazil), sporadic in subtropical regions (Iran).
- Affects all ages, with a higher frequency among males due to occupational exposure.
Clinical Types
- Fixed cutaneous sporotrichosis: Single painless lesions without lymphatic involvement.
- Lymphocutaneous sporotrichosis: Subcutaneous nodules and ulcerative lesions with lymphadenopathy.
- Muco cutaneous sporotrichosis: Rare with involvement in oral and nasal areas.
- Extra cutaneous sporotrichosis: Dissemination to bones, eyes, and lungs, typically after prior skin lesions.
Laboratorial Diagnosis
- Sampling of pus, exudates, or biopsy materials.
- Direct smears reveal yeast bodies, asteroid bodies; cultures differ based on temperature.
Treatment
- Iodine solutions (oral and injectable), Amphotricine-B, Imidazoles.
Chromoblastomycosis
- A subcutaneous infection leading to verrucoid, compact lesions caused by dematiaceous fungi such as Fonsecae and Cladosporium species.
Clinical Manifestation
- Papules and nodules that can develop into verrucoid lesions.
Laboratorial Diagnosis
- Direct examination via smear with KOH shows sclerotic bodies.
- Cultures reveal dark mycelia and pigmented spores.
Treatment
- Amphotricine-B, Imidazoles.
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Description
Explore the various subcutaneous mycoses, including mycetoma, sporotrichosis, and chromoblastomycosis. This quiz delves into the clinical syndrome known as Madura foot, its characteristics, causes, and the role of Actinobacteria and fungi in these infections.
