Questions and Answers
What type of mycoses involve tissues under the skin?
Which of the following is NOT a cause of Mycetoma?
What is the primary mode of transmission for Mycetoma?
Which type of Mycetoma is caused by Actinobacteria?
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In which geographical areas is Mycetoma most frequently found?
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Which of the following is a treatment option for Eumycotic Mycetoma?
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What disease is caused by the fungus Sporothrix schenkii?
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Which of the following is NOT a mode of transmission for Sporotrichosis?
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In which area is Sporotrichosis endemic?
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What types of lesions are associated with Sporotrichosis?
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What are the clinical signs associated with Fixed cutaneous sporotrichosis?
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What is the average incubation period for Lymphocutaneous sporotrichosis?
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What type of lesions are commonly seen in Muco-cutaneous sporotrichosis?
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Which of the following is a common diagnostic method for Chromoblastomycosis?
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What is the primary cause of Chromoblastomycosis?
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Which treatment option is used for sporotrichosis?
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What is one of the common sites of infection for Fixed cutaneous sporotrichosis?
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What indicates a rare occurrence in Extra cutaneous sporotrichosis?
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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
This quiz covers subcutaneous mycoses, specifically focusing on conditions like mycetoma, sporotrichosis, and chromoblastomycosis. Understand the etiology, definitions, and significant characteristics of these mycotic diseases that affect the skin and underlying tissues.
