Subcutaneous mycoses.pptx
Transcript of Subcutaneous mycoses.pptx
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Subcutaneous mycoses
By Dr. kajumbula
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General features of Subcutaneous
mycoses
• un!al infections in"ol"in!
– the dermis
– Subcutaneous tissue
–
#djacent bone
• Mainly in tropics and subtropics
• $esult from traumatic implantations ofsaprobic fun!i from soil into subcutaneoustissue
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Mycetoma
• Chronic !ranulomatous infection in"ol"in!: – Skin
– Subcutaneous tissue
– ascia – Bone
• May be caused by: – un!i %&umycetoma'
– #ctinomycetes %#ctinomycetoma'
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Mycetoma
• #ctinomycetoma: – Caused by (lamentous bacteria
• Actinomyces israelii
• Norcardia
• Actinomadura
– Actinomyces spp are )ora in the mouth
and colon
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Mycetoma
• &umycetoma: – Caused by a ran!e of moulds
• Madurella
• Leptosphaeria
• Pseudallescheria
• Phiallophora verrucosa
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Mycetoma•
Infection follo*s traumatic implantation of or!anisms
• Minor cellular de(cits could ha"e a role in the de"elopmentof the disease: – &stablishment of disease has only been accomplished in athymic
nude mice• Pro!esterone + &stro!ens could be protecti"e % Male: emale
ratio is ,:-'
• Patholo!ical features:
– ocali/ed s*ollen lesions *ith multiple drainin! sinuses – Patholo!y consists of abscesses containin! !rains in association
*ith !ranulomatous in)ammation and (brosis
– 0he !rains are composed of compacted colonies of the or!anisms%masses of mycelial fun!i or bacterial (laments'
– 0he color of the !rains is often indicati"e of the causati"e or!anism
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Mycetoma
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Mycetoma
• aboratory dia!nosis: – Specimens: Pus1 biopsy materials
– Contain "isible !rains *hose color may beindicati"e of etiolo!ic a!ent:• Black: un!al 2 Madurella spp1 eptoshaeria1
Phialophora "errucosa
•
Pale !rains %*hite to yello*': Pseudoallescheria1#sper!illus
• 3ello* 2 Bro*n 2 4sually bacterial %#ctinomycetoma'
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Mycetoma
• aboratory dia!nosis: – Bacterial5fun!al elements may be
demonstrated in:• 678 preparations
• Gram stain
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Chromoblastomycosis
• Chronic locali/ed infection of skinand subcutaneous tissue
• Characteri/ed by "errucous %*artylesions' lesions mostly on the limbs
• 7ccur mainly in the tropics
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Chromoblastomycosis
• Causati"e a!ents are dematecious%Dark *alled' moulds: – onsecae pedrosoi %Most common'
– onseca compacta
– Phialophora "errucosa
– Cladophiola carrioni
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Chromoblastomycosis
• Infection follo*s traumatic implantation offun!us into the skin
•
Patholo!y consists of chronic suppurati"e and!ranulomatous in)ammation: – Pseudoepitheliomatous hyperplasia of the dermis
– Microabscesses in the epidermis and dermis
–
Granulomas *ith !iant cells and epitheliod cells inthe dermis
– 8allmark of the disease: Scelerotic5Copper coinbodies 2 dark bro*n thick *alled fun!al cells insideor outside macropha!es
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Chromoblastomycosis
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Chromoblastomycosis
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Subcutaneousphaeohyphomycosis• Phaeohyphomycosis are dark *alled fun!i %also referred to
as dematecious fun!i'
• 7ther than chromoblastomycosis
• Cause indolent lesions of skin and subcutaneous lesionthat start as a sin!le red noduley on the e9tremities.
• May e9tend to the brain1 can occur in theimmunosuppressed patient.
• &9amples of or!anisms include: – Bipolaris, Exophiala, Exserohilum, Phialophora, and Wangiella
are particularly common.
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obomycosis %obos disease1
keloidal blastomycosis'
• # chronic skin infection most commonly a;ictin! the indi!enouspeople of the #ma/on re!ions of Columbia and Bra/il.
• 0he etiolo!ic %Lacazia loboi has ne"er been isolated in culture1 buthas been sho*n to be closely related to Paracoccidioides
brasiliensis
• < 0he fun!us remains con(ned to the skin1 pro!ressin! slo*ly o"erdecades.
• esions are typically nodules or keloidal pla=ues that are red1 hard1and shiny associated *ith (brosis and a !ranulomatous reaction onhistolo!y nodules or keloidal pla=ues that are red1 hard1 and shinyassociated *ith (brosis and a !ranulomatous reaction on histolo!y
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obomycosis
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Conidiobolomycosis
• #n subcutaneous mycosis
• Characteri/ed by a chronic !ranulomatous in)ammation
•
Caused by !onidiobolus species
• $estricted to the nasal submucosa
• Characteri/ed by polyps or palpable restricted subcutaneous
masses
• Presents as nasal obstruction1 draina!e and sinus pain
• Subcutaneous nodules de"elop in the nasal and perinasal
re!ions.
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Conidiobolomycosis
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Basidoibolomycosis