Subcutaneous Mycosis

Subcutaneous Mycosis

Mycetoma (Maduromycosis = Madura Foot)

• Chronic granulomatous lesion of

subcutaneous tissues characterized by
swelling, sinus formation & suppuration.
• Post-traumatic chronic infection
• Common in tropical climates
 Mycetoma
Causes

• Bacterial (Actinomycotic Mycetoma)

o Actinomyces, Nocardia & Streptomyces

o The granules contain very fine delicate

filaments

o Usually has one sinus tract

 Mycetoma

• Fungal (Eumycotic Mycetoma)

• Saprophytic fungi like Madurella (soil organism)

• Granules contain large coarse septate hyphae

• Usually the lesion has many sinus openings

• Causative agents
• Madurella mycetomatis
• Pseudallescheria boydii
• Acremonium
• Aspergillus
 Mycetoma

Clinical findings

Site(s)
• Feet, lower extremities, hands

Findings
• Abscess formation
• Draining sinuses containing granules
• Deformities
Mycetoma

Lab Diagnosis
• Characteristics of the granule & colony
morphology are used for identification

KOH Preparation
• Bacterial : Fine branching filaments
• Fungal : Coarse septated hyphae
 Mycetoma
Treatment
• Bacterial
o Antibiotics usually penicillin
• Fungal
o Itraconazole or
o Amphotericin B
 Amputation of the affected part may
be needed
 Subcutaneous Mycosis
Sporotrichosis
• Chronic infection involving cutaneous,
subcutaneous and lymphatic tissues
• Frequently encountered in gardeners
Causative Agent
Sporothrix schenckii
• A dimorphic fungus living in soil & on
vegetation
• Spores introduced into puncture wounds
(thorn pricks)
 Sporotrichosis

Symptoms
o A chronic ulcer at wound site
o Ulcerating nodules along the lymphatic
drainage
o Enlarged draining LN
o Systemic dissemination to:
o Bones, joints, meninges
 Sporotrichosis

• Treatment
• Cutaneous infection
 Topical potassium iodide

• Disseminated infection
 Amphotericin B
 Itraconazole
 CHROMOBLASTOMYCOSIS
• Posttraumatic chronic infection of
subcutaneous tissue
• Papules  cauliflower-like lesions on
lower extremities
• Causative agents
1. Fonsecaea
2. Phialophora
3. Cladosporium
 LOBOMYCOSIS
Causative Agent
• Loboa loboi
• Multiple budding yeast cells forming short chains

• Chronic, subcutaneous, progressive infection

• Traumatic inoculation of the fungus
• Hard, painless nodules on extremities
• Ulcerative lesions
• Lesions resemble those of chromoblastomycosis
mycetoma and carcinoma
 RHINOSPOROIDOSIS

Causative agent
Rhinosporidium seeberi
• Has not been cultured in vitro on artificial media

• Chronic infection in divers

• Polypoid masses at nasal mucosa, conjunctiva,
genitalia and rectum
• Seropurulent discharge from nasal lesions