Student Copy Subcutaneous Mycoses_copy.pdf

Subcutaneous Mycoses Angeli Abegail Q. Naranja, MIH  Subcutaneous Mycoses neglected tropical disease, most common among populations that are socially and economically marginalized in tropical and subtropical areas. Subcutaneous tissue/ Hypodermis ar...

Subcutaneous Mycoses Angeli Abegail Q. Naranja, MIH  Subcutaneous Mycoses neglected tropical disease, most common among populations that are socially and economically marginalized in tropical and subtropical areas. Subcutaneous tissue/ Hypodermis area Caused by a break in the skin Native to the soil and allowing the fungus to enter: Agricultural workers Fascia decaying vegetation Percutaneous, Implantation Foresters Sometimes lymphatic & Trauma by thorns, sharp Gardeners involvement surface (wood/ concrete) Insect stings and bites Sporothrix brasiliensis (cat bite) Subcutaneous Site of Causative agents Appearance of Appearance in Lymphatic Mycoses infection lesion Direct microscopy involvements 01 Upper & Exophiala jeanselmei Solitary Darkly pigmented Rare lower Exophila (formerly Wangiella) nodular/cystic hyphae or yeast- extremities dermatitidis lesions like cells Cladophialophora (formerly Xylohypha) bantiana 02 Lower Eumycetoma: Madurella chronic Granules None extremities mycetomatis granulomatous Scedosporium (formerly infection Pseudallescheria) boydii Tumefaction E. jeanselmei 03 Upper Sporothrix schenckii Suppurate, Asteroid bodies Yes limbs ulcerate and draining nodular lesions 04 Lower Cladophialophora (formerly verrucoid Sclerotic bodies None extremities Cladosporium)carionii (wartlike) Phialophora verrucosa crusted Fonsecaea pedrosoi nodules  01 Phaeohyphomycosis infection caused by dematiaceous saprobes among immunocompromised hosts Invasion of the skin, lungs, and brain 1. Subcutaneous phaeohyphomycosis 2. Paranasal sinus phaeohyphomycosis 3. Cerebral phaeohyphomycosis (CNS)  Exophiala jeanselmei Exophiala (formerly Wangiella) Cladophialophora complex dermatitidis (formerly Xylohypha) bantiana Molecular methods will only Involved in brain, lung (cystic Cerebral phaeohyphomycosis determine the specifics species fibrosis), eyes Causes mycetoma and phaeohyphomycosis Conidia is seen in CMA/ PDA Macroscopic Surface: velvety brown Young:Yeast like mucoid black, shiny Obverse: velvety olive black/ green black/ skin like Mature: Velvety olive gray/black gray/brown Reverse: black Reverse: black Reverse: black Microscopic Oval conidia and gather in Septate branching hyphae Cladosporium type. Long clusters Conidia: small, ovoid, smooth walls chains of 35-40. Tree like Exophiala jeanselmei complex Exophiala (formerly Wangiella) Cladophialophora (formerly, dermatitidis Xylohypha) bantiana  02 Mycetoma Skin and subcutaneous tissue Chronic :Muscle, fascia and Bone Causative agents: 01. __________: actinomycota (Nocardia, Actinomadura and Streptomyces) 02. __________: eumycota (Madurella mycetomatis, Pseudallescheria boydii, E. jeanselmei)  Madurella mycetomatis Scedosporium( formerly E. jeanselmei Pseudallescheria) boydii Macroscopic Smooth /folded /glabrous Young: White and fluffy /powdery from white to Mature: Wooly brown gray to black yellowish brown Reverse: gray to black Reverse: dark brown Teleomorph( sexual): Cleistothecia Microscopic ____: septate hyphae with Cleistotheca: dark brown to black globes chlamydoconidia like spores with thick walls ____: phialides that bear round Anamorph: simple, long/short conidia conidiophores Madurella mycetomatis Scedosporium( formerly Pseudoallescheria) boydii CMA SDA  03 Sporotrichosis MOT: puncture by contaminate plant material (wood splinters, thorns, sphagnum moss, hay) Microscopic: Asteroid bodies (Star Shapes with rays of eosinophilic material radiating from central yeast like cell  Sporothrix schenckii Macroscop Macroscopic: Dimorphic ic 25-30C Young: orange gray colony; Mature: Moist, wrinkled, leathery to salt-peppery brown 35-37C: Cream/Tan, smooth yeast like Microscopi Mold: flowerette/ daisy like/ rosette pattern conidia in clusters, hyphae: ropelike c Yeast: Globose/ fusiform/ oval, cigar shaped  04 Chromoblastomycosis Early (L) and late (R) stage of chromoblastomycosis infection.  Cladophialophora Phialophora verrucosa Fonsecaea pedrosoi (formerly Cladosporum)carionii Macroscopic Velvety dull gray, grey green/ Dark greenish brown to black Dark green, gray/ black with purplish brown with a close matlike olive to silvery velvety mycelium Reverse: black gray mycelium Reverse: black Microscopic Long branching chain Hyphae: brown, branched and Hyphae: septate, branched, conidiophore spectate brown, conidia are dark Philalide: vase shaped with Conidiophores: asterisk like flared cuplike collarette conidia Cladophialophora (formerly Phialophora verrucosa Fonsecaea pedrosoi Cladosporum)carionii  Prevention 1. Wear protective clothing 3. Proper wound care by (gloves, long sleeves, boots, cleaning wounds and closed toe footwear) in seeking care in deep wounds gardening, farming and forestry 4. Good hygiene 2. Avoid barefoot in areas with soil and organic matter 5. Recognize high risk environments  Specimen: Skin scrapings from lesions or a skin Diagnosis biopsy Microscopy: Examination through direct microscopy with a potassium hydroxide (KOH) Histopathology: Examination of a skin biopsy can find the presence of pigmented fungal cells in the dermis. Culture and molecular diagnosis: Helpful in Excised mycetoma showing a draining confirming the diagnosis. sinus containing black grains X-ray or ultrasound may be used to assess damage to muscle and bone  Treatment Chromoblastomycosis Terbinafine, Itraconazole, voriconazole, posaconazole Skin sporotrichosis Supersaturated potassium iodide Mycetoma (SSKI) for several months Actinomycetoma: antibiotics Eumycetoma: long term antifungal medicine Lung or Surgery/amputation disseminated sporotrichosis Phaeohyphomycosis at least a year of antifungal medication, including intravenous amphotericin B Combination of antifungal therapy (itraconazole, medicine and oral itraconazole ketoconazole, or terbinafine) and surgery  Got questions?