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Overview

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hyaline. Phaeo/dematiaceous. others. Subcutaneous mycoses (M4.1) ... Eumycetoma (dematiaceous and hyaline) Madurella mycetomatis. Pseudallescheria boydii ... – PowerPoint PPT presentation

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Title: Overview


1
Overview
  • Superficial
  • Tinea versicolour
  • Tinea nigra
  • Black and white piedra
  • Cutaneous
  • Subcutaneous
  • Systemic
  • opportunistic

onychomycosis
2
Fungi by the Tristram scheme
3
Subcutaneous mycoses (M4.1)
  • Subcutaneous tissue (beyond just skin)
  • Aetiology - is diverse / environmental
  • Organisms of low innate pathogenicity
  • traumatic implantation, chronic, non
    transmissible.
  • Pathology
  • May be a non specific foreign body reaction
  • May be a distinct clinical / microbial entity

4
Subcutaneous mycoses (M4.1a)
  • Sporotrichosis
  • Distinct disease with Sporothrix schenkii.
  • Chromoblastomycosis
  • Distinct disease with various dematiaceous fungi
    AND specific tissue fungal morphology.
  • Mycetoma
  • Eumycotic and actinomycotic
  • Specific clinical presentation.
  • Phaeohyphomycosis
  • Brown hyphae in tissue

5
Sporotrichosis (M4.2)
  • Sporothrix schenkii - dematiaceous/dimorphic
  • Reservoir - soil, decaying vegetation, worldwide
    distribution
  • Transmission
  • Traumatic implantation, occupational
  • Clinical
  • Subcutaneous nodules
  • Suppuration, ulceration and drainage
  • Spread down lymphatic course.

6
Laboratory diagnosis (M4.3)
  • Direct microscopy
  • Poor sensitivity. Sparse yeast cells, asteroid
    body
  • Culture
  • Good yield and grows on most media
  • Room temp for isolation (37oC is slower)
  • Identification
  • A white to grey mold becoming moist
  • Hyaline hyphae, mixed hyaline/demat conidia
  • Need in vitro conversion to yeast

7
Chromoblastomycosis (M4.4)
  • Classified by presence of fungal tissue form AND
    clinical presentation, NOT aetiology
  • Aetiology - any dematiaceous fungi
  • e.g Cladosporium, Fonsecaea, Phialophora
  • NOT all subcutaneous infections with these
    organisms are chromoblastomycosis

8
Chrmoblastomycosis (M4.4b)
  • Tissue form is SCLEROTIC body
  • Dematiaceous thick walled yeast cell
  • Non budding, but multiplane septation

9
Chromoblastomycosis (M4.5)
  • Reservoir and transmission
  • Traumatic implantation from decaying vegetation,
    but chronicity dictates that it is uncommon in
    developed countries.
  • Clinical presentation is distinctive
  • Hyperkeratosis and hyperplasia
  • Tumour like warty cauiliflower growths
  • Very slow progression
  • Uncommon in children (? time or immune)
  • Treatment - antifungals / surgery / heat

10
Chromo - diagnosis (M4.6)
  • Direct microscopy
  • Sclerotic bodies (usually easily seen)
  • Occasional hyphae
  • Culture
  • Will grow on most media (some are cyclo R)
  • Slow growing (4-6 wks)
  • Dark velvety colonies (similar)
  • Contamination can be a problem

11
Chromo - diagnosis (M4.6b)
  • Identification
  • Sclerotic cells are identical
  • NO dimorphism in vitro
  • Complex and variable conidiation
  • Hyphael elements are clearly dematiaceous

12
Mycetoma (M4.7)
  • Terminology
  • Eumycetoma if fungal, actinomycetoma if caused by
    an actinomycete.
  • Characterised by
  • Swollen tumour like body sites with internal
    lesions.
  • Draining sinuses, granule formation.
  • Epidemiology
  • Traumatic implantation, non contagious

13
Mycetoma (M4.8)
  • Clinical features
  • Variable incubation period.
  • Swelling hard and painless
  • Local spread to contiguous tissue
  • Eventual sinus formation and drainage
  • Location of lesions linked to exposure
  • Male to female is 31
  • Therapy is poor for eumycotic but slightly better
    for actinomycotic.

14
Mycetoma (M4.9)
  • Eumycetoma (dematiaceous and hyaline)
  • Madurella mycetomatis
  • Pseudallescheria boydii
  • Fusarium
  • Exophiala jeanselmii
  • Actinomycotic (aerobic actinomycetes)
  • Actinomadura, Streptomyces, Nocardia
  • Actinomycetoma Actinomyces israelii, ANO2 and
    endogenous

15
Laboratory diagnosis (M4.10)
  • Recover granules black, red, white
  • Squash prep microscopy
  • 2-6um fungal, lt0.5 actinomycetes
  • Culture to cover all
  • Use selective for fungi plus selective for
    actinomycetes, but NOT both.
  • Dont forget Actinomyces

16
Identification of Actinomycetes (M4.11)
  • Blood agar, BHI agar, sabs variable
  • Typical colonial and microscopic morphology to
    group
  • Identification to genus by partial acid fastness,
    but speciation is difficult.

17
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18
Summary
  • Subcutaneous mycoses
  • Sporotrichosis
  • Chromoblastomycosis
  • Mycetoma
  • Eumycotic
  • Actinomycotic
  • Actinomycosis
  • Phaeohyphomycosis
  • Hyalohyphomycosis
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