Cutaneous and Subcutaneous Mycoses PART 3

Question 2

SUBCUTANEOUS MYCOSES:

Answer 2

a. Mycetoma
b. Chromoblastomycosis
c. Phaeohyphomycosis
d. Sporotrichosis

Question 3

chronic granulomatous infection that usually involves the lower extremities

Answer 3

Mycetoma
Subcutaneous Mycoses

Question 4

infection is characterized by swelling, purplish discoloration, tumor-like deformities of the subcutaneous tissue, and multiple sinus tracts that drain purulent material containing
yellow, white, red, or black granules called grains

Answer 4

Mycetoma
Subcutaneous Mycoses

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• The infection gradually progresses to involve the bone, muscle, or other contiguous tissue and ultimately requires amputation in
  most progressive case

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Mycetoma
Subcutaneous Mycoses

Question 6

Mycetomas usually are seen among people living in

Answer 6

tropical
and subtropical regions

Question 7

The organisms associated with mycetoma are saprophytic and commonly found in soil, standing water, and sewage. Humans acquire infections through traumatic implantation of
the organism into the skin and subcutaneous tissues

Answer 7

Mycetoma
Subcutaneous Mycoses

Question 8

Mycetoma Subcutaneous Mycoses
- Two types:

Answer 8

1 Actinomycotic (bacterial) mycetomas
2 Eumycotic (fungal) mycetomas

Question 9

caused by the aerobic actinomycetes, including
Nocardia, Actinomadura, and Streptomyces spp.

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Actinomycotic (bacterial) mycetomas

Question 10

• Caused by a heterogeneous group of fungi that have septate hyphae
• Subcategorized as white grain mycetomas or black grain mycetomas

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Eumycotic (fungal) mycetomas

Question 11

is the most common fungal agent
associated with mycetoma

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Madurella mycetomatis

Question 12

Direct examination of clinical specimens from patients with a eumycotic mycetoma or phaeohyphomycosis demonstrates

Answer 12

yellowish brown, septate to moniliform
hyphae (string of beads), with or without budding yeast cells present

Question 13

White Grain Mycetoma

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Scedosporium spp
Acremonium spp

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grow rapidly (5 to 10 days) on common laboratory media. Initial growth begins as a white, fluffy colony that changes in several weeks to a brownish gray (the so-called mousy gray) colony; the reverse of the colony progresses from tan to dark brown.

Answer 14

Scedosporium spp

Question 15

cause mycetomas, such as Acremonium falciforme, grow slowly and produce gray colonies.

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Acremonium spp

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Black Grain Mycetoma

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Madurella spp.
E. jeanselmei
Curvularia spp
T. grisea

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appear yeastlike and darkly pigmented (olive to black) but in time develop a velvety appearance with the production of aerial
hyphae.

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E. jeanselmei

Question 18

vary from white (during the early phases of growth) to olive-brown; a brown
diffusible pigment is characteristic of this fungus.

Answer 18

Madurella spp

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produce a fluffy or downy, olive-gray
to black colony, and growth is rapid.

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Curvularia spp.

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forms slow-growing, velvety colonies that
appear smooth or radially furrowed and dark gray or olive-brown to black. The reverse side of the colonies appears black. The hyphae are septate and nonsporulating.

Answer 20

T. grisea

Question 21

-a chronic fungal infection acquired through traumatic inoculation of an organism, primarily into the skin and subcutaneous tissue
- characterized by the development of a papule at the site of the traumatic insult that slowly enlarges to form warty or tumorlike lesions characterized as resembling cauliflower
capable of spreading through the lymphatic system

Answer 21

Chromoblastomycosis
Subcutaneous Mycoses

Question 22

The lesions usually are confined to the feet and legs but may involve the head, face, neck, and other body surfaces

Answer 22

Chromoblastomycosis
Subcutaneous Mycoses

Question 23

Histologic examination of the lesion reveals characteristic sclerotic bodies which are copper-colored, septate cells that appear to be dividing by binary fission and resemble copper
pennies.

Answer 23

Chromoblastomycosis
Subcutaneous Mycoses

Question 24

Infections cause hyperplasia of the epidermal layer of the skin, which may be mistaken for squamous cell carcinoma

Answer 24

Chromoblastomycosis
Subcutaneous Mycoses

Question 25

Chromoblastomycosis is widely distributed, but most cases occur in the ___ of the world

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tropical and subtropical areas

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The fungi most often associated with chromoblastomycosis include

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Cladophialophora carrionii, Fonsecaea monophora and pedrosoi Phialophora verrucosa

Question 27

Scrapings from crusted lesions added to 10% KOH show muriform cells (aggregation of dark brown cells that resemble stones in a stonewall) or sclerotic bodies, which are rounded, brown, 4 to 10 μm in diameter, and have fission planes. They resemble copper pennies

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Laboratory Diagnosis Chromoblastomycosis

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Laboratory Diagnosis Chromoblastomycosis - includes species that produce long chains of budding, often fusiform, conidia (blastoconidia) that have a dark septal scar.

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Cladosporium

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Laboratory Diagnosis Chromoblastomycosis includes species that produce short, flask-shaped to tubular phialides, each with a well-developed collarette - Produce colonies that are wooly and olive-brown to brownish gray; some strains may appear to have concentric zones of color

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Phialophora

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ncludes organisms that exhibit a mixed type of sporulation produces a distinct Fonsecaea-type conidiophore, may also produce a Rhinocladiella-type sporulation

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Fonsecaea

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Cladophialophora type of sporulation with long chains of elliptical conidia (2 to 3 μm × 4 to 5 μm) borne from erect, tall, branching conidiophores

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Cladophialophora (C. carrionii)

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produces phialides, each with a distinct cup- or flask-shaped collarette

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P. verrucosa

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produces phialides with a flattened collarette. Conidia are produced endogenously and occur in clusters at the tip of the phialide

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P. richardsiae

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Conidial heads with sympodial arrangement of conidia are seen, with primary conidia giving rise to secondary conidia

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Fonsecaea spp

Question 35

a general term used to describe any infection caused by a dematiaceous organism

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Phaeohyphomycosis Subcutaneous Mycoses

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Includes molds; brownish, yeastlike cells; pseudohyphae; and hyphae

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Phaeohyphomycosis Subcutaneous Mycoses

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These infections may be subcutaneous, localized, or systemic .Include phaeohyphomycotic cysts, progressive soft tissue infection, brain abscess, sinusitis, endocarditis, mycotic keratitis, pulmonary infection, and systemic infection

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Phaeohyphomycosis Subcutaneous Mycoses

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Symptoms often include headache, neurologic manifestations, and seizure

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Phaeohyphomycosis Subcutaneous Mycoses

Question 39

Phaeohyphomycosis Subcutaneous Mycoses - The most common fungal isolates associated with neurologic manifestations include

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C. bantiana, Rhinocladiella mackenziei, Verruconis gallopava Exophiala dermatitidis.

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are also commonly associated with phaeophyomycosis

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Alternaria, Exserohilum, Bipolaris, E. jeanselmei, Exophiala spinifera, and Curvularia spp.

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Laboratory Diagnosis Phaeohyphomycosis colonies are rapidly growing, fluffy, and gray to gray-brown or gray-green.

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Alternaria spp

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produce rapidly growing colonies that resemble those of Alternaria spp

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Curvularia spp

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produce colonies that are gray-green to dark brown and slightly powdery, as do Exserohilum spp.

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Bipolaris spp.

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grow slowly (7 to 21 days) and initially produce shiny, black, yeastlike colonies.

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E. jeanselmei and E. dermatitidis

Question 45

● Bacterial: Nocardia, Actinomadura, and Streptomyces spp. ● White grain mycetoma: S. apiospermum complex and Acremonium and Fusarium spp. ● Black grain mycetoma: Madurella spp., E. jeanselmei, and Curvularia spp.

Answer 45

Mycetoma

Question 46

Cladophialophora, Phialophora, and Fonsecaea spp.

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Chromoblastomycosis

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E. jeanselmei; E.dermatitidis; and Curvularia, Bipolaris, Alternaria, and Exserohilum sp

Answer 47

Phaeohyphomycosis

Question 48

is a subcutaneous infection, but lymph and pulmonary infections can occur

Answer 48

Sporotrichosis

Question 49

Also known as rose gardener’s disease, as infections can come from rose thorns and contact with sphagnum moss

Answer 49

Sporotrichosis

Question 50

have a worldwide distribution, and their natural habitat is living or dead vegetation.

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S. schenckii, Sporothrix brasiliensis, Sporothrix globosa, Sporothrix luriei

Question 51

-It is a dimorphic fungus - When grown on media with blood at 35°C, these fungi grow as small yeasts

Answer 51

Sporothrix schenckii

Question 52

When grown on SDA or PDA at room temperature, they are in the _____ phase characterized by delicate hyphae and microconidia

Answer 52

mold phase / Sporothrix schenckii