Knowledge University

College of Science-DLMS- Level 4

L. 8 - (Subcutaneous mycosis)
Medical mycology(2023/2024)

Dr. Salah M. Saleem

Dr.Salah M.Saleem 2023/2024 1

 3-Subcutaneous inf.

• Subcutaneous mycoses are fungal infections of the dermis, subcutaneous

tissue, and bone. Causative organisms reside in the soil and decaying or
live vegetation . (Source of infections)
•
• Epidemiology
• Subcutaneous fungal infections are almost always acquired through
traumatic lacerations or puncture wounds. Sporotrichosis, for example, is
often acquired from the prick of a thorn.
• As expected, these infections are more common in individuals who have
frequent contact with soil and vegetation and wear little protective
clothing.
• The subcutaneous mycoses are not transmissible from human to human
under ordinary conditions.
• Attention / Look above for the characteristics of subcutaneous mycosis.

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 Subcutaneous inf. cont. https://
www.slideshare.net/arjun_3535/sporotrichosis-chromoblatomycosis

• There are (3)disease related to Subcutaneous inf.

• 1. Sporotrichosis:
• This infection, characterized by:
• (1) a granulomatous ulcer at the puncture site,
• (2) may produce secondary lesions along the draining lymphatics .

The causative organism, Sporothrix schenckii, is a dimorphic fungus that

exhibits the yeast form in infected tissue and the mycelial form upon
laboratory culture. In most patients, the disease is self-limiting, but may
persist in a chronic form.

Oral itraconazole is the drug of choice.

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 Subcutaneous inf. cont.
• 2. Chromomycosis (also called chromoblastomycosis):
• http://medcomhk.com/hkdvb/pdf/200206-07.pdf
• This infection is characterized by warty nodules that
spread slowly along the lymphatics and develop crusty
abscesses . Pathogens causing this mycosis include
several species of pigmented soil fungi, for example,
Phialophora and Cladosporium, and the infection is
most commonly seen in the tropics. Treatment is difficult.
• Surgical removal of small lesions is effective, but must be
performed cautiously and with wide margins to prevent
dissemination.
• More advanced stages of the disease are
treated with itraconazole and terbinafine.

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 Subcutaneous inf. cont.
https://www.who.int/buruli/mycetoma/en/

• 3. Mycetoma (Madura foot):

• Mycetoma appears as a localized abscess, usually
on the feet, that discharges pus, serum, and blood
through sinuses (in this usage, sinus means
“abnormal channel or cavity”). The infection can
spread to the underlying bone and results in
crippling deformities . The pathogenic agents are
various soil fungi or actinomycetes ,depending on
the climate of the geographic area.

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 Madura cont.

• The most common site of occurrence is foot

(approximately 70% cases), which explains the
synonym “Madura foot”.
Hand is the next most common site. Repeated minor trauma or
penetrating injury provides a portal of entry for the organism.
Infection
can be caused by true fungi in 40% cases where it is known as
eumycetoma and by filamentous bacteria of order actinomycetes
(actinomycetoma) in 60% cases.
Therapy of these two groups is entirely (fully) different, thereby
necessitating the need to differentiate between -the two in cases
of patients presenting with Madura foot.
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 Subcutaneous inf. cont.

• Most common are Madurella grisea and

Actinomadura madurae.
Mycetomas appear similar to the lesions of
chromomycosis, but the defining characteristic of
mycetoma is the presence of colored grains, composed
of compacted hyphae, in the exudate.
The color of the grains (black, white, red, or yellow) is
characteristic of the causative organism and,
therefore, useful in identifying the particular
pathogen. There is no effective chemotherapy for
fungal mycetoma;
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 Madur mycosis cont.
• Diagnosis requires laboratory evaluation of a biopsy, or small tissue
sample, of the infected area.
• The treatment for mycetoma includes antibiotics or antifungal
medication, depending on which type of microbe is causing it, and
surgery is sometimes needed to cut away the infected tissue.
Wearing shoes might help prevent mycetoma.

• Mycetoma affects people of all ages and is more common in men.

This disease primarily affects poorer people in rural regions of
Africa, Latin America, and Asia that are located near Earth’s equator
and have dry climate
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 Questions

• Q1/ Define subcutaneous mycosis and give their

characteristics.
• Q2/ What are the types of subcutaneous mycosis?
• Q3/ Define Madura mycosis.
• Q4/ Explain the treatment of Madura.
• Q5/ Chromoblastomycosis, why it named so? Which fungi
caused this disease?

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