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SUBCUTANEOUS MYCOSES

SUBCUTANEOUS MYCOSES. By. Dr. Emad AbdElhameed Morad. Lecturer of Medical Microbiology and Immunology. Chromoblastomycosis. Causative fungus. Chromoblastomycosis is caused by five fungi which are: 1- Phialophora verrucosa 2- Cladophialophora carrionii 3- Rhinocladiella aquaspersa

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SUBCUTANEOUS MYCOSES

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  1. SUBCUTANEOUS MYCOSES By Dr. Emad AbdElhameed Morad Lecturer of Medical Microbiology and Immunology

  2. Chromoblastomycosis

  3. Causative fungus • Chromoblastomycosis is caused by five fungi which are: 1- Phialophora verrucosa 2- Cladophialophora carrionii 3- Rhinocladiella aquaspersa 4- Fonsecaea pedrosoi 5- Fonsecaea compacta • All of these fungi reside in soil and vegetation. • All of these fungi are transmitted by traumatic inoculation.

  4. All of these fungi are dematiaceous fungi. • Dematiaceous fungi are fungi which have melanin in their cell walls. • All of these fungi in tissues appear the same producing spherical copper colored cells (4 – 12 µm in diameter) called sclerotic bodies that divide by transverse septation producing clusters of four to eight cells. • These fungi are differentiated only according to the mode of conidiation.

  5. Pathogenesis and clinical picture • Fungi are introduced in the skin by traumatic inoculation of the exposed areas such as legs or feet. • Infection is slow and will induce hyperplasia of the epidermal tissues. • Over months to years, the lesion becomes verrucous with extension along the draining lymphatics. • Then, cauliflower nodules with crusting abscesses finally cover the lesion. • Dissemination is rare. • Fibrosis of lymphatic channels may occur leading to lymphatic obstruction and elephantiasis.

  6. Chronic verrucous chromoblastomycosis

  7. Laboratory diagnosis • Specimen:scrapings or biopsies from the lesion. • Direct microscopic examination: • Skin scrapings should be examined using KOH 10% and Parker ink or calcofluor white stains. • Detection of is diagnostic of chromoblastomycosis regardless of the fungus. • Tissue biopsies should be stained by H&E / PAS / Grocott’s methenamine silver stains. • Tissue sections reveal AND sclerotic bodies granuloma extensive hyperplasia of the dermal tissue

  8. Sclerotic bodies

  9. Culture: • Culture is done on SDA with antibiotics at 25 degree (colonies are olivaceous black with a suede-like surface). • Slide culture is done to identify the fungus based on the morphology of conidia.

  10. Treatment • Surgical excision with wide margin is the therapy for small lesions . • For larger lesions, we use flucytosine or itraconazole. • Relapse is common

  11. Phaehyphomycosis

  12. Phaehyphomycosis is a term applied to infections characterized by the presence of darkly pigmented septate hyphae in tissues (dematiaceous fungi). • Phaehyphomycosis is caused by over 100 species of dematiaceous fungi. • The clinical forms vary from phaehyphomycotic cyst in the subcutaneous tissues to sinusitis and brain abscesses.

  13. GOOD LUCK

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