Sub Cutaneus mycosis.pdf

Sub Cutaneus Mycoses Sub Cutaneus Mycoses: mycotic disease that involve under skin tissues and include: Mycetoma. Sporotrichosis. Chromoblastomycosis Mycetoma Madura foot Mycetoma (Madura foot) Definition: is a clinical syndrome of localized, deforming, swollen l...

Sub Cutaneus Mycoses Sub Cutaneus Mycoses: mycotic disease that involve under skin tissues and include: Mycetoma. Sporotrichosis. Chromoblastomycosis Mycetoma Madura foot Mycetoma (Madura foot) Definition: is a clinical syndrome of localized, deforming, swollen lesions, exudative abscess, involving cutaneous and sub cutaneous tissues like as bone Causes: Actinobacteria Fungi Actinobacteria: a group of bacteria with filamentous morphology such as: Actinomyces israeli Actinomadura madurae Nocardia asteroides N.otitidis caviarum N.brasiliensis Streptomyces somaliensis Except of A israaeli that is a normal flora of nose , mouth and vagina the other one exist in soil and plants Fungi Pseudallescheria boydii Madurella mycetomatis Madurella grisea Aspergillus spp Acremonium spp. Fusarium spp. and some another fungi that live and exist in soil and plants Environmental niches Soil Plants devices Etiological types Actinomycotic Mycetoma Eumycotic Mycetoma Mode of transmission Cutaneous inoculation of micro organism by each trauma like as Pin, thorn, thistle injury lead to transmission and after that infection Ecology: mycetoma has a world wild distribution with different frequency High frequency in tropical area India, Sudan, Mexico Low frequency in sub tropical area: Iran Epidemiology: Employment: Farmer, Gardener Age: All age groups are sensitive to infection Sex: Both sex groups are sensitive to infection but acquired in high frequency in male due to her jobs Clinical manifestation: Incubation period is long time from 6 months to 10 years A tense nodule: small, painless, subcut swelling. Abscess: with multiple sinus tracts, the tracts may remain open for long time, heal and then reopen with produce pus and sometimes granule or grain( small and hard particles from 300 micron to 5 mm or more in size with different color white, yellow, pink, red, brown or black) Edema and disfiguration  Metastasis to joints and bone But not to nerves and muscle Local involvement Anatomic site of infection Pedal mycetoma: the lesion are only in sole area (pedal area) Extra pedal mycetoma: another part of body like as leg, trunk, arm, back and … Laboratorial Diagnosis Sampling from pus, exudates and granule Preparing the smear with KOH or PAS staining from grains. Actinomycotic grains includes tin branched filaments with about 1 mic diameter Eumycotic grains includes septate mycellia Culture: on S, Sc and BHI Treatment Amphotricine-B, Itraconazole for Eumycotic Mycetoma Dapsone +StrptOmycin for ACtinomycotic mycetoma Sporotrichosis Rose Syndrome Sporotrichosis Definition: Cutaneus, Subcutaneus lesions with or without Lymphatic infection. Cause: Sporothrix schenkii this fungus exist in soil and plants ,it is a dimorphic fungi mycelial phase in 25C and yeast phase in 37C, skin injury contact with contamination sources lead to transmission of fungal elements to under skin tissues (connective tissues). Mode of transmission Pin, Thorne, Thistle trauma Insect bite Dog and Parrot bite Fishing hook injury Fish skin injury Cat scratch Epidemiology Endemic in tropical : Mexico & Brazil Sporadic in subtropical area: Iran (south area) Employment: Farmer, Gardener Age: All age groups are sensitive to infection Sex: Both sex groups are sensitive to infection but acquired in high frequency in male due to her jobs Clinical Types Fixed cutaneus Spo. Lympho cutaneus Spo. Muco cutaneus Spo. Extra cutaneus Spo. (disseminated) Fixed cutaneus Spo.:in endemic area has high frequency with clinical signs such as Single lesion Ulcerative, Necrotized, Exudates No lymphatic involvement Tolerate to drugs The commonest sites of infection are the face, neck ,trunk and sometimes legs Lymphocutaneus Spo.: up to 75% of all cases is this form of disease with average time IP period about 3 weeks Sub cutaneus motile Nodules Sporotrichotic Chancre (necrotic lesion) Anthrax like ulcer Lymphadenopathy: Lymphadenitis, Lymphangitis in chronic disease Muco cutaneus Spo. This type has rare frequency The lesion is Erythematous, ulcerative with pus at first and became grannulomatous and papillomatous. Regional lymph nodes become hard and enlarged Mouth, Nose, Throat and Larynx involvement were seen Extra cutaneus Spo. It is rare and almost all cases have history of prior skin lesion Disseminated to 1-Bone 2-Eye 3-Lungs 4-Any organs Respiratory tract: Pneumonia , Acute bronchitis, Adenopathy. Laboratorial Diagnosis Sampling: pus, exudate biopsy materials Direct smear: Yeast bodies, asteroid bodies Culture: In 37°C, oval , cigarette form In 25°C, Roset shaped Conidia Treatment Iodine solution (orally) + Milk or water Iodine (injection) Amphotricine- B Imidazoles Chromoblastomycosis Dematiaceus infection Chromoblastomycosis Definition: Subcutaneous infection, Verrucoid, compact Lesions Causes: Dematiaceus fungi Fonsecae compactum Fonsecae pedrosoi Phialophora verrucosa Cladosporium carrioni Clinical Manifestation Papule and Nodule Verrucoid and rough lesions. Dissemination to organs : Brain Laboratorial Diagnosis Direct Examination: Smear with KOH method from scrapings and biopsies shows the Sclerotic bodies Culture: Dark mycelia and high pigmented spores in chains or clusters. Treatment Amphotricine-B Imidazoles