DEEP FUNGAL INFECTIONS Flashcards
1
Q
Fungi are prokaryotic organisms (T/F)?
A
False
Eukaryotic
2
Q
Deep fungal diseases affects the subcutaneous tissues only (T/F)?
A
False
Subcutaneous tissue and dermis
3
Q
What are the routes of deep fungal infections?
A
direct inoculation of the fungi into the skin
Inhalation of their spores leading to a primary lung disease and then dissemination through the blood causing the skin involvement.
4
Q
What are the two distinct groups of conditions caused by deep fungal infections?
A
Subcutaneous mycosis
Systemic mycosis
5
Q
Subcutaneous Mycoses are very common (T/F)?
A
False
Subcutaneous Mycoses and systemic Mycoses are not common
6
Q
What group of patients are systemic Mycoses commonly found in?
A
immuno-compromised
7
Q
Patients with systemic fungal infections often presents to the physician with signs of skin involvements (T/F)?
A
False
It’s subcutaneous! Systemic only occasionally
8
Q
What is the infectious agent in HISTOPLASMOSIS?
A
Histoplasma capsulatum
9
Q
Outline the natural reservoir for organism causing HISTOPLASMOSIS?
A
Soil
Bat
Avian habitat
10
Q
Microscopic examination of tissue from patient with HISTOPLASMOSIS will reveal what?
A
Yeast cell in tissue (37°C)
Hyphae, microconidia and macroconidia (tuberculate chlamydospore) at 25 °C
11
Q
How does one get HISTOPLASMOSIS?
A
Inhalation of microconidia / primary cutaneous inoculation
12
Q
Outline 5 risk factors of getting HISTOPLASMOSIS?
A
Living in endemic areas AIDS Primary immuno-deficiencies Drug induced immunosuppressive states Extremes of age
13
Q
Mention 5 skin manifestations of HISTOPLASMOSIS?
A
Erythema nodosum Erythema multiforme Papules pustles noodles.
14
Q
a target or bulls eye type of skin reaction seen in patients with HISTOPLASMOSIS is known as?
A
Erythema multiforme
15
Q
Mention 10 clinical findings in HISTOPLASMOSIS?
A
Fever, Cough, Fatigue, Headache
Malaise, Myalgia
Abdominal pain
Joint pains and skin lesions(5-6%) of patients mostly females
Enlarged hilar and mediastinal lymph nodes(5-10%)
Haemoptysis
Chestpain
dysphagia
Chills
Individuals exposed to a large innoculum may develop severe dyspnea resulting from diffuse pulmonary involvement.
Broncholithiasis
16
Q
patients with HISTOPLASMOSIS rarely get better on their own without medication (T/F)?
A
False
many patients get better on their own without medication
17
Q
Sub-acute pulmonary histoplasmosis occurs mostly in older patients with underlying pulmonary disease, apical segment, pleural thickening.
A
False
It’s chronic pulmonary histoplasmosis
18
Q
Sub-acute pulmonary histoplasmosis is associated with cough, weight loss, fevers, and malaise < 3 months duration (T/F)?
A
False
It’s often asymptomatic!
However chronic pulmonary histoplasmosis presents with these symptoms Buh for > 3 months
19
Q
Cavitations,haemoptysis, sputum production and increasing dyspnea are common symptoms in acute pulmonary histoplasmosis (T/F)?
A
False
It’s chronic pulmonary histoplasmosis
20
Q
On imaging upper lobe infiltrates and thick walled cavities are usually seen in sub-acute pulmonary histoplasmosis (T /F)?
A
False
It’s chronic pulmonary histoplasmosis
21
Q
Fibrosis and scarring may be seen in chronic pulmonary histoplasmosis (T/F)?
A
True!
22
Q
Onset of symptoms occur 3-14 days after exposure In sub-acute histoplasmosis (T/F)?
A
True!
And acute too
23
Q
What’s the difference between acute and sub-acute histoplasmosis?
A
Acute (<1month of symptoms)
Subacute(duration<3months)
24
Q
Approx 30% of patients with sub-acute pulmonary histoplasmosis are asymptomatic (T/F)?
A
False
It’s 90%
25
What category of patients are mostly affected by progressively disseminated histoplasmosis?
immuno-compromised
26
What are the risk factors for progressive pulmonary histoplasmosis?
```
Exposure to the fungus as an infant
AIDS with CD4count(<150cells/μL)
use of corticosteroids
haematologic malignancy
solid organ transplantation
patients requiring TNF antagonists(e.g etanercepts, infliximab)
```
27
What are the forms of progressively disseminated histoplasmosis?
Acute form
Sub-acute form
Chronic form
28
What are the symptoms of the acute form of progressively disseminated histoplasmosis?
```
fever
worsening cough
weight loss
malaise
dyspnea
cns involvement(5-20%)
```
29
What are the symptoms of Sub-acute form of progressively disseminated histoplasmosis?
wide variety of symptoms as a result of dissemination and sub acute expression in the affected organs!
GIT involvement
diarrhea, abdominal pain, abdominal mass, intestinal ulcers
CARDIAC involvement
valvular disease, cardiac insufficiency or vegetations may produce dyspnea, peri-edema, angina and fever, pulmonary rales or wheezes, petechiae or skin lesions
CNS involvement
headache,visual and gait disturbances, confusion, seizures,altered consciousness,and neck stiffness or pain
30
What are the symptoms of chronic form of progressively disseminated histoplasmosis?
constitutional symptoms
| mucous membrane lesions
31
Presumed ocular histoplasmosis syndrome occurs in 50% of individuals living in endemic areas have ocular involvement (T/F)?
False
| 1-10%
32
Presumed ocular histoplasmosis syndrome is Usually associated with eye pain, itchiness and discahrge and Macula involvement may result in blindness (T/F)?
False
| Although Macula involvement may result in blindness it's usually asymptomatic!
33
What are histo spots?
Atrophic scars containing foci of lymphocytic cell infiltration seen in presumed ocular histoplasmosis syndrome!
34
Histo spots are constant findings in presumed ocular histoplasmosis syndrome and are usually located posterior to the equator of the eye (T/F)?
False
| They are not constant findings!
35
What % of patients with acute pulmonary histoplasmosis develop rheumatologic manifestations of erythema multiforme, arthritis and erythema nodosum ?
5-6%
36
Under what situation would acute pulmonary histoplasmosis be associated with rales that mimic ARDS?
in cases with high innoculum, individuals may develop severe hypoxemia associated with tales that mimic ARDS
37
Hepatosplenomegaly may sometimes be associated with acute pulmonary histoplasmosis (T/F)?
True!
38
What cardiac complications may be seen in acute pulmonary histoplasmosis and in what % of patients?
Asymptomatic pleural effusion (10%)
| Pericarditis with rubs (5%)
39
non-specific rales and wheeze is a common feature of acute pulmonary histoplasmosis T/F)?
False
| Seen in chronic pulmonary histoplasmosis
40
oropharyngeal ulcers involving the buccal mucosa,tongue,gingiva, and larynx suggestive of dissemination is seen in chronic progressive disseminated histoplasmosis (T/F)?
False
Lesions are not suggestive of dissemination
Dissemination is seen in sub-acute form
41
Mention 4 differential diagnosis of Sub-acute progressive disseminated histoplasmosis?
Meningitis
Space occupying lesions
Endocarditis
Typhoid
42
Surgical abdomen is a serious complication of chronic progressive disseminated histoplasmosis (T/F)?
False
| It's sub-acute form
43
CNS and Endocarditis manifestations may be seen in both acute and sub-acute forms of progressive disseminated histoplasmosis (T/F)?
True!
44
Oropharyngeal lesions may be seen in acute and chronic forms of progressive disseminated histoplasmosis (T/F)?
True!
45
A patient diagnosed with HISTOPLASMOSIS presents with dilatation of collaterals in the neck&thorax,edema of the face,neck , upper torso and conjunctiva. What form of histoplasmosis does this ptx have? What has caused this presentation?
Acute progressive disseminated histoplasmosis
| This is due to SVC syndrome+ lymphadenopathy severe enough to cause obstruction and increased venous pressure
46
What are the indications for medical treatment in histoplasmosis?
In cases of prolonged infection
cases of systemic infection
Those involving individuals who are immunocompromised
Otherwise, Most infections in individuals who are immunocompetent are self limiting and do not require therapy
47
No treatment is usually required in acute pulmonary histoplasmosis (T/F)?
True!
| It's asymptomatic
48
How would you treat a patient with acute pulmonary histoplasmosis with prolonged symp(>4wks) or those with overwhelming pulmonary involvement?
initiate therapy with itraconazole(6-12wks) response to therapy should be monitored using chest imaging
ptx should be monitored for several years after tx for possible relapse.
49
How would you manage a patient diagnosed of acute pulmonary histoplasmosis with severe infection?
tx with amphotericin B for 1-2 weeks
| once stable it should be changed to itraconazole and should be continued for 1yr
50
How would you manage a patient diagnosed of acute pulmonary histoplasmosis with ARDS symptoms?
Ptx may require methylprednisolone for 1-2 weeks.
51
Chronic pulmonary histoplasmosis may resolve without treatment (T/F)?
False
| Often fatal if not treated
52
What is the mortality rate of chronic pulmonary histoplasmosis without treatment and with treatment?
50% without treatment
| 28% with treatment
53
How are HISTOPLASMOSIS patients with cavitary lesions treated?
Itraconazole given for 1 year
| Follow up ptx due to risk of relapse (15%)
54
What is the definitive management of histoplasmosis patients with Persistent cavitations despite multiple courses of med tx?
Surgery
55
What are the principles of management of ptx with progressive disseminated histoplasmosis?
Initiate tx for all pt
Haemodynamic and respiratory compromise from pericardial and pleural involvement warrants immediate procedural intervention.
Perform thoracentesis or pericardiocentesis in pt with severe pleural effusions and pericardial tamponade, respectively.
56
Cutaneous and rheumatologic histoplasmosis are usually self limiting (T/F)?
True
57
When do we treat patients with cutaneous and rheumatological manifestations of histoplasmosis?
prolonged episodes
| those who are immuno-supressed
58
Anti fungal agents will effectively treat the broncholithiasis seen in histoplasmosis (T/F)?
False
| Antigungal TX does not play a role!
59
What is the definitive management of the broncholithiasis of histoplasmosis?
Bronchoscopic or surgical removal
60
Outline 6 complications of histoplasmosis?
```
Mediastinal and hilar lymphadenopathies
Lymph node enlargement/compression of surrounding structures
Post obstructive pneumonia
Bronchoectasis
Persistent cough
Haemoptysis
Dysphagia
Histoplasma induced mediastinal fibrosis
Adrenal insufficiency
Overwhelming sepsis with DIC and GI bleeding
Pleural effusions
```
61
Dysphagia and pleural effusion are common complications of histoplasmosis (T/F)?
False
| They are rare!
62
Mediastinal and hilar lymphadenopathies seen in histoplasmosis usually resolve (T/F)?
True
63
What is the most benign non malignant cause of SVC syndrome?
Histoplasma induced mediastinal fibrosis!
64
Adrenal insufficiency is seen in what form of histoplasmosis?
subacute pulmonary disseminated histoplasmosis regardless of tx
65
Overwhelming sepsis with DIC and GI bleeding is a common complication of what form of histoplasmosis?
acute proggressive disseminated histoplasmosis
66
What cells are predominantly found in histoplasmosis associated pleural effusion?
Lymphocyte predominant exudate
67
Pleuaral biopsy in patients with histoplasmosis will reveal what?
Non-caseating granulomas
68
Pleural effusion in histoplasmosis resolves spontaneously over several weeks (T/F)?
True
69
When should Pleural effusion in histoplasmosis be treated?
persists for>3-4 weeks
| it occurs in an immuno-compromised pt
70
Outline 7 differentials of histoplasmosis?
```
Sarcoidosis
Tuberculosis
Aspergillosis
Aspiration pneumonitis and pneumonia
Bacterial pneumonia
Viral pneumonia
Fungal pneumonia
Chlamydial pneumonias
Pneumocystis jiroveci pneumonia
Pneumococcal infections(pneumonia)
Mycoplasma infections(mycoplasma pneumonia)
Blastomycosis
Coccidiodomycosis and valley fever
Carcinoid lung tumour
Small cell lung cancer
Mediastinal lymphoma
Pan coast syndrome
```
71
What is the causative organism of coccidioidomycosis
Coccidioides immitis, A dimorphic soil fungus found in the soil in arid areas
72
What geographical areas are commonly affected by coccidioidomycosis?
Arid areas in the USA(san juan valley califonia, southern Arizona)
nothern Mexico
central and south America
73
How does one get coccidioidomycosis?
Inhalation of the spores!
74
In most patients coccidioidomycosis infection becomes disseminated, with ulcers or deep abscesses in the skin (T/F)?
False!
| Occurs in a few patients.
75
What are the risk factors for coccidioidomycosis?
```
Direct exposure to soil harbouring Coccidiodes
Climatic factors
Heredity
Race
Sex (M>F)
Age
Compromised cell mediated immunity
```
76
Coccidioidomycosis is more commonly found in males than females (T/F)?
True
77
Outline the triad of coccidioidomycosis?
Fever
Erythema nodosum
Erythema multiforme
78
Skin manifestations of coccidioidomycosis are more common in males than females (T/F)?
False
Commoner in females!
i.e Erythema nodosum and Erythema multiforme
79
Erythema multiforme may be the first sign of systemic disease in coccidioidomycosis (T/F)?
False
| It's Erythema nodosum
80
Erythema nodosum are painless nodules commonly found on lower extremities in superficial fungal infections (T/F)?
False!
| They are painful and seen in deep fungal infections.
81
Migrating arthralgias are common findings in coccidioidomycosis (T/F)?
True
82
What is the triad of desert rheumatism?
erythema nodosum
erythema multiforme
Migrating arthralgias
83
Nodular lesions in lungs is a feature of disseminated coccidioidomycosis infection (T/F)?
False
| It's a feature of primary infection
84
What percentage of patients with coccidioidomycosis are asymptomatic?
60%
85
Outline the common clinical symptoms of coccidioidomycosis infection?
Fever
Cough
Weight loss
Chest pain
These symptoms are seen in 40% of ptx
86
What is the most common site of disseminated coccidioidomycosis infection?
The skin
87
Outline the common sites of secondary coccidioidomycosis infection?
Skin
Lungs
Bones
Meninges
88
What percentage of ptx with coccidioidomycosis have disseminated/secondary infection
1%
89
What are the reactive cutaneous lesions seen in coccidioidomycosis?
```
Maculopapular rash
Keratotic noodles
Cold subcutaneous abscesses
Urticaria
Sweet’s syndrome
Reactive interstitial granulomatous dermatitis
```
90
What are the organism specific cutaneous lesions seen in coccidioidomycosis?
Non healing ulcers
Verrucous ulcers due to subcutaneous fluctuant abscesses
Papules
Sinus tract abscesses
91
Organism specific cutaneous lesions have a pridilection for the nasolabial folds (T/F)?
False
| It's reactive cutaneous lesions
92
Non healing ulcers may be the 1st or only sign of disseminated infection (T/F)?
False
| It's Cold subcutaneous abscesses
93
What samples are required in the diagnosis of coccidioidomycosis?
Sputum
| Tissue biopsy
94
How is diagnosis of coccidioidomycosis made?
```
1. DIRECT EXAMINATION (KOH; H&E)
to visualize Spherule
2.CULTURE
SDA: Mould colonies at 25 °C
3. SEROLOGY
latex agglutination (IgM) test
Complement fixation (IgG)
Disseminated (> 1:32)
4. SKIN TEST (coccidioidin and spheruline antigens) Negative result may rule out the diagnosis!
```
95
What are the differential diagnosis of coccidioidomycosis?
INFLAMATORY
Sarcoidosis
Pars planitis
SLE
```
INFECTIOUS
Syphilis
TB
Toxoplasmosis
Lyme disease
```
NEOPLASTIC
Primary CNS lymphoma
Systemic lymphoma
leukemia
96
What are the treatment options for coccidioidomycosis?
Amphotericin B
(0.5-0.7mg/Kg/day); IV
Itraconazole
(200mg b.d); PO
Fluconazole(particularly for meningitis)
(400—800mg/day); PO or IV
Ketoconazole
(400mg/day) PO
97
What is the causative agent in blastomycosis?
Blastomyces dermatitidis
98
Blastomycosis is less frequently disseminated (T/F)?
False
| It's Frequently disseminated!
99
Blastomycosis has a fairly good prognosis (T/F)?
False!
| All patients have done very poorly
100
What %of patients with blastomycosis usually have cns involvement?
3-10%
101
How do patients get blastomycosis?
Inhalation of infectious particles
| Primary cutaneous inoculation
102
wart-like, hyperkeratotic nodules, which spread peripherally with a verrucose edge, while tending to clear and scar centrally are clinical findings in chronic cutaneous blastomycosis infection (T/F)?
False!
| Seen in primary cutaneous blastomycosis infection
103
Subcutaneous nodules and ulcerations are clinical findings seen in primary cutaneous blastomycosis infection (T/F)?
False
| Seen in chronic cutaneous blastomycosis infection
104
What are the common sites of disseminated blastomycosis infection?
```
Skin
bone
GUT
CNS
spleen
```
105
Itemize 5 various clinical findings seen in blastomycosis?
```
Asymptomatic
Pulmonary infection
Disseminated infection
Chronic cutaneous infection
Primary cutaneous infection
```
106
Sporotrichosis is otherwise known as?
Rose Gardener’s disease
107
What is the causative organism of Sporotrichosis?
Sporothrix schenckii
108
Itemize 3 unique properties of Sporotrix shenckii?
fungus that can be found world-wide in the environment.
The species is present in soil as well as in and on living and decomposing plant material such as peat moss.
can be found in one of two morphologies, hyphal or yeast.
109
What form of Sporotrix shenckii is found in the environment on plants and decaying matter?
The hyphal form (25c)
110
What form of Sporotrix shenckii predominates in the host?
The yeast form (37c)
111
What group of people are commonly affected by Sporotrichosis?
```
gardeners
forest workers
manual labourers
landscapers
Immunocompromised (often exhibit a severe form of the dx)
```
112
How do patients get Sporotrichosis?
It enters through small cuts and abrasions in the skin to cause the infection.
by cat bites or scratches
Inhalation of spores (a rare route of infection largely associated with immunocompromised hosts)
113
Sporotrichosis affects mainly the skin and bones (T/F)?
False
Affects mainly the skin
other rare forms can affect the lungs, joints, bones, and even the brain.
114
Sporotrichosis is an acute fungal infection producing nodules and ulcers in the lymph nodes and skin. (T/F)?
False
| It's a chronic infection!
115
Although S. schenckii has a worldwide distribution but certain areas of the world including africa, have a higher incidence of disease (T/F)?
False
| Areas like Peru
116
What is the most common manifestation of Sporotrichosis?
lymphagitic sporotrichosis
117
Lymphagitic Sporotrichosis is characterized by a painful red nodule which forms at the site of innoculation (T/F)?
False
| The nodule is nearly painless!
118
Lymphagitic Sporotrichosis is xterised by formation of similar nodules along distal lymphatic channels with intermittent discharge of small amount of pus. (T/F)
False
| The similar nodules are formed in proximal lymphatic channels
119
Itemize 4 other organisms that mimic the proximal extension of lesions often with skip areas seen in Sporotrichosis?
Nocardia brasiliensis
leishmania brasiliensis
mycobacteriun marinum
Mycobacterium kansasii
120
Ulcerations is a constant feature seen in Sporotrichosis (T/F)?
False
| Ulcerations may occur
121
What specimen are used in the diagnosis of Sporotrichosis?
```
aspiration fluid
pus
biopsy material
skin scrapings
swabs
```
122
How is Sporotrichosis diagnosed in the laboratory?
MICROSCOPY
KOH MOUNT of specimen or histopathological examination of tissue sections stained by METHANAMINE SILVER STAIN
CULTURE
The fungus may not be demonstrable in pus or tissue.
Hence, culture is done on media incubated at 250C and 370C
SEROLOGY
A slide latex agglutination test, using PEPTIDO-L-RHAMNO-D-MANNAN as antigen is a reliable, sensitive and specific test
123
What laboratory investigation is especially helpful in the diagnosis of extracutaneous or systemic infection?
Serology!
124
Itemize the treatment options for Sporotrichosis?
CUTANEOUS INFECTION
POTASSIUM IODIDE given topically or orally. Therapy should be continued for one month after the resolution of all lesions.
For LYMPHOCUTANEOUS INFECTION ITRACONAZOLE(100-200mg) daily is effective
For DISSEMINATED INFECTION
AMPHOTERICIN B is the drug of choice
125
Mention 2 differential diagnosis of Sporotrichosis
Fish tank granuloma
| Cutaneous leishmaniasis
126
What is the causative agent in actinomycosis?
Actinomyces israeli
127
Actinomyces Israeli is a normal flora of the mouth and bowel. (T/F)
True
128
Actinomycosis is a rare fungal disease (T/F)?
False
| It's a rare bacteria dx
129
Actinomycosis is a fairly common bacteria disease (T/F)?
False
| It's rare
130
Actinomycosis is a polymicrobial anaerobic infection (T/F)?
False
| polymicrobial aerobic anaerobic infection
131
Itemize 2 other organisms implicated in actinomycosis?
A. gerencseriae
| Propionibacterium propionicus
132
Actinomycosis is more commonly seen in males than females (T/F)?
True
133
Which age group are commonly affected in actinomycosis?
20-60yrs
134
What is a known risk factor for genitourinary actinomycosis in females?
The use of intrauterine devices
135
The Incidence of oral actinomycosis which is easier to diagnose has increased (T/F)?
False
| It's harder to diagnose!
136
What condition is known as "the great masquerader"?
Actinomycosis!
137
What are the clinical features of actinomycosis?
Painful abscesses in the mouth, lungs,breast or GI which grow larger as the disease progresses.
lumpy induration and scarring coexisting with multiple sinuses discharging pus containing ‘sulphur granules’, made up of tangled filaments
138
What sites are favoured in actinomycosis?
Jaw
| Chest and abdominal wall
139
Diagnosis of actinomycosis is often a difficult one to make (T/F)?
True
140
What are the treatment options for actinomycosis?
PENICILLIN
In cases of allergy, use DOXYCYCLINE
Sulfonamides such as SULFAMETHOXAZOLE may be used as an alternative regimen. (2-4g/day)
Response to therapy is slow and may take months
HYPERBARIC OXYGEN THERAPY may also be used as an adjunct to conventional tx when the dx is refractory to antibiotics and surgical tx
141
Maduramycosis is an acute infection of the skin and/or subcutaneous tissue resulting in tumefaction(swelling) studded with sinuses discharging grains. (T/F)?
False
| It's a chronic infection
142
What body sites is typically affected in maduramycosis?
Feet, Lower extremities ,hands (but it can occur in almost any region of the body)
143
What group of individuals are at increased risk for mycetoma?
Farm workers!
144
Mycetoma due to true fungi infection is known as?
Eumycetoma
145
Mycetoma due to aerobic bacteria infection is known as?
Actinomycetoma
146
Eumycetoma and actinomycetoma have very different clinical findings (T/F)?
False
| Both types have similar clinical findings.
147
Itemize the fungal organisms causing maduramycosis?
```
FUNGI
Madurella mycetomatis
Madurella grisea
Leptospaeria senegalensis
Neotestudina rosatii
Fusarium moniliforme
Fusarium soloni
```
148
Itemize the bacteria(actinomycetes) organisms causing mycetoma foot
```
ACTINOMYCETES
Actinomadura madurae
Actinomadura pelletieri
Nocardia brasiliensis
Nocadia asteroides
Streptomyces somaliensis
```
149
What group of mycetoma causing organism causes RED discharge?
Actinomadura pelletieri
150
What group of mycetoma causing organism causes WHITE or YELLOW discharge?
```
Acremonium strictum
Actinomadura madurae
Aspergillus nidulans
Noetestudina rosatii
Phaeoacremonium krajdenii
Pseudallescheria boydii
```
151
What group of mycetoma causing organism causes BLACK discharge?
```
Aspergillus terreus
Curvularia lunata
Cladophialophora bantiana
Exophiala jeanselmei
Leptosphaeria senegalensis
Leptosphaeria tompkinsii
Madurella grisea
Madurella mycetomatis
Pyrenochaeta romeroi
```
152
2 common causative organisms in maduramycosis are?
Actinomadura madurae
| Streptomyces somaliensis
153
What is the classic triad of mycetoma?
Tumefaction (tumor-like swelling)
Multiple draining sinuses
Sclerotia (granules/grains in sinuses)
154
Mycetoma originates in the sub-cutaneous tissue (T/F)?
True
155
Mention 3 characteristics of the infected site in mycetoma?
PAINLESS swelling
woody induration
sinus tracts that discharge pus intermittently
156
Systemic symptoms commonly develops in maduramycosis (T/F)?
False
| Systemic symptoms do not develop
157
Mycetoma can sometimes spread to distant sites (T/F)?
False
Spread to distant sites does not occur
Affects surrounding muscle and bone
158
What are the differential diagnoses of mycetoma foot?
Chronic osteomyelitis of bacterial or tuberculous origin(characteristics grain are not discharged)
Elephantiasis(no sinus tract)
Primary cutaneous actinomycosis(develops on the exposed site, very rare type of actinomycosis,a normal flora of the mouth)
159
Mycetoma can be accurately diagnosed by what?
Fine Needle Aspiration (FNA) cytology.
160
What is the distinct appearance of mycetoma lesion in a cytology smear?
presence of polymorphous inflammatory cells consisting of an admixture of neutrophils, lymphocytes, plasma cells
161
How is mycetoma diagnosed in the laboratory?
Granules differ in colour, shape, dimension and composition!
1)Transport in distilled water or sterile normal saline
Black granules usually fungal
Small red granules – Streptomyces
Whitish yellow granules either bacterial or fungal
KOH of granules- presence or absence of hyphae
Histological stains of biopsy from sinus tract
The causative organism is cultured in Sabouraud’s dextrose agar medium.
162
What are the treatment options for maduramycosis?
ACTINOMYCETOMA
may respond to prolonged combination chemotherapy!
STREPTOMYCIN(14mg/kg daily IM for 3 months) and either DAPSONE(1.5mg/kg 12 hourly orally) or TMP-SMX
EUMYCETOMA
rarely responds to chemotheraphy!
some cases caused by Madurella mycetomatis have appeared to respond to KETOCONAZOLE or ITRACONAZOLE.
SURGERY;(amputation) may be a valuable alternative to the often poor results of medical treatment, which is with systemic antibiotics or antifungal drugs, depending on the organism isolated.
163
Adequate vaccination may prevent against maduramycosis (T/F)?
False
| No vaccine is available
164
How may we prevent mycetoma foot?
Simple hygienic precautions
| wearing shoes or sandals while working in fields washing hands and feet at regular intervals
