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Dermatology OAU > DEEP FUNGAL INFECTIONS > Flashcards

DEEP FUNGAL INFECTIONS Flashcards

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1
Q

Fungi are prokaryotic organisms (T/F)?

A

False

Eukaryotic

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2
Q

Deep fungal diseases affects the subcutaneous tissues only (T/F)?

A

False

Subcutaneous tissue and dermis

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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.

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4
Q

What are the two distinct groups of conditions caused by deep fungal infections?

A

Subcutaneous mycosis

Systemic mycosis

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5
Q

Subcutaneous Mycoses are very common (T/F)?

A

False

Subcutaneous Mycoses and systemic Mycoses are not common

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6
Q

What group of patients are systemic Mycoses commonly found in?

A

immuno-compromised

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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

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8
Q

What is the infectious agent in HISTOPLASMOSIS?

A

Histoplasma capsulatum

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9
Q

Outline the natural reservoir for organism causing HISTOPLASMOSIS?

A

Soil
Bat
Avian habitat

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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

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11
Q

How does one get HISTOPLASMOSIS?

A

Inhalation of microconidia / primary cutaneous inoculation

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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
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13
Q

Mention 5 skin manifestations of HISTOPLASMOSIS?

A 
Erythema nodosum
Erythema multiforme
Papules
pustles
noodles.
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14
Q

a target or bulls eye type of skin reaction seen in patients with HISTOPLASMOSIS is known as?

A

Erythema multiforme

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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

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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

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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

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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

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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

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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

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21
Q

Fibrosis and scarring may be seen in chronic pulmonary histoplasmosis (T/F)?

A

True!

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22
Q

Onset of symptoms occur 3-14 days after exposure In sub-acute histoplasmosis (T/F)?

A

True!

And acute too

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23
Q

What’s the difference between acute and sub-acute histoplasmosis?

A

Acute (<1month of symptoms)

Subacute(duration<3months)

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24
Q

Approx 30% of patients with sub-acute pulmonary histoplasmosis are asymptomatic (T/F)?

A

False

It’s 90%

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25
Q

What category of patients are mostly affected by progressively disseminated histoplasmosis?

A

immuno-compromised

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26
Q

What are the risk factors for progressive pulmonary histoplasmosis?

A 
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)
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27
Q

What are the forms of progressively disseminated histoplasmosis?

A

Acute form
Sub-acute form
Chronic form

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28
Q

What are the symptoms of the acute form of progressively disseminated histoplasmosis?

A 
fever
worsening cough
weight loss
malaise
dyspnea
cns involvement(5-20%)
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29
Q

What are the symptoms of Sub-acute form of progressively disseminated histoplasmosis?

A

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

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30
Q

What are the symptoms of chronic form of progressively disseminated histoplasmosis?

A

constitutional symptoms

mucous membrane lesions

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31
Q

Presumed ocular histoplasmosis syndrome occurs in 50% of individuals living in endemic areas have ocular involvement (T/F)?

A

False

1-10%

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32
Q

Presumed ocular histoplasmosis syndrome is Usually associated with eye pain, itchiness and discahrge and Macula involvement may result in blindness (T/F)?

A

False

Although Macula involvement may result in blindness it’s usually asymptomatic!

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33
Q

What are histo spots?

A

Atrophic scars containing foci of lymphocytic cell infiltration seen in presumed ocular histoplasmosis syndrome!

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34
Q

Histo spots are constant findings in presumed ocular histoplasmosis syndrome and are usually located posterior to the equator of the eye (T/F)?

A

False

They are not constant findings!

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35
Q

What % of patients with acute pulmonary histoplasmosis develop rheumatologic manifestations of erythema multiforme, arthritis and erythema nodosum ?

A

5-6%

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36
Q

Under what situation would acute pulmonary histoplasmosis be associated with rales that mimic ARDS?

A

in cases with high innoculum, individuals may develop severe hypoxemia associated with tales that mimic ARDS

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37
Q

Hepatosplenomegaly may sometimes be associated with acute pulmonary histoplasmosis (T/F)?

A

True!

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38
Q

What cardiac complications may be seen in acute pulmonary histoplasmosis and in what % of patients?

A

Asymptomatic pleural effusion (10%)

Pericarditis with rubs (5%)

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39
Q

non-specific rales and wheeze is a common feature of acute pulmonary histoplasmosis T/F)?

A

False

Seen in chronic pulmonary histoplasmosis

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40
Q

oropharyngeal ulcers involving the buccal mucosa,tongue,gingiva, and larynx suggestive of dissemination is seen in chronic progressive disseminated histoplasmosis (T/F)?

A

False
Lesions are not suggestive of dissemination
Dissemination is seen in sub-acute form

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41
Q

Mention 4 differential diagnosis of Sub-acute progressive disseminated histoplasmosis?

A

Meningitis
Space occupying lesions
Endocarditis
Typhoid

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42
Q

Surgical abdomen is a serious complication of chronic progressive disseminated histoplasmosis (T/F)?

A

False

It’s sub-acute form

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43
Q

CNS and Endocarditis manifestations may be seen in both acute and sub-acute forms of progressive disseminated histoplasmosis (T/F)?

A

True!

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44
Q

Oropharyngeal lesions may be seen in acute and chronic forms of progressive disseminated histoplasmosis (T/F)?

A

True!

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45
Q

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?

A

Acute progressive disseminated histoplasmosis

This is due to SVC syndrome+ lymphadenopathy severe enough to cause obstruction and increased venous pressure

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46
Q

What are the indications for medical treatment in histoplasmosis?

A

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

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47
Q

No treatment is usually required in acute pulmonary histoplasmosis (T/F)?

A

True!

It’s asymptomatic

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48
Q

How would you treat a patient with acute pulmonary histoplasmosis with prolonged symp(>4wks) or those with overwhelming pulmonary involvement?

A

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.

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49
Q

How would you manage a patient diagnosed of acute pulmonary histoplasmosis with severe infection?

A

tx with amphotericin B for 1-2 weeks

once stable it should be changed to itraconazole and should be continued for 1yr

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50
Q

How would you manage a patient diagnosed of acute pulmonary histoplasmosis with ARDS symptoms?

A

Ptx may require methylprednisolone for 1-2 weeks.

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51
Q

Chronic pulmonary histoplasmosis may resolve without treatment (T/F)?

A

False

Often fatal if not treated

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52
Q

What is the mortality rate of chronic pulmonary histoplasmosis without treatment and with treatment?

A

50% without treatment

28% with treatment

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53
Q

How are HISTOPLASMOSIS patients with cavitary lesions treated?

A

Itraconazole given for 1 year

Follow up ptx due to risk of relapse (15%)

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54
Q

What is the definitive management of histoplasmosis patients with Persistent cavitations despite multiple courses of med tx?

A

Surgery

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55
Q

What are the principles of management of ptx with progressive disseminated histoplasmosis?

A

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.

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56
Q

Cutaneous and rheumatologic histoplasmosis are usually self limiting (T/F)?

A

True

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57
Q

When do we treat patients with cutaneous and rheumatological manifestations of histoplasmosis?

A

prolonged episodes

those who are immuno-supressed

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58
Q

Anti fungal agents will effectively treat the broncholithiasis seen in histoplasmosis (T/F)?

A

False

Antigungal TX does not play a role!

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59
Q

What is the definitive management of the broncholithiasis of histoplasmosis?

A

Bronchoscopic or surgical removal

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60
Q

Outline 6 complications of histoplasmosis?

A 
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
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61
Q

Dysphagia and pleural effusion are common complications of histoplasmosis (T/F)?

A

False

They are rare!

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62
Q

Mediastinal and hilar lymphadenopathies seen in histoplasmosis usually resolve (T/F)?

A

True

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63
Q

What is the most benign non malignant cause of SVC syndrome?

A

Histoplasma induced mediastinal fibrosis!

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64
Q

Adrenal insufficiency is seen in what form of histoplasmosis?

A

subacute pulmonary disseminated histoplasmosis regardless of tx

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65
Q

Overwhelming sepsis with DIC and GI bleeding is a common complication of what form of histoplasmosis?

A

acute proggressive disseminated histoplasmosis

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66
Q

What cells are predominantly found in histoplasmosis associated pleural effusion?

A

Lymphocyte predominant exudate

67
Q

Pleuaral biopsy in patients with histoplasmosis will reveal what?

A

Non-caseating granulomas

68
Q

Pleural effusion in histoplasmosis resolves spontaneously over several weeks (T/F)?

A

True

69
Q

When should Pleural effusion in histoplasmosis be treated?

A

persists for>3-4 weeks

it occurs in an immuno-compromised pt

70
Q

Outline 7 differentials of histoplasmosis?

A 
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
Q

What is the causative organism of coccidioidomycosis

A

Coccidioides immitis, A dimorphic soil fungus found in the soil in arid areas

72
Q

What geographical areas are commonly affected by coccidioidomycosis?

A

Arid areas in the USA(san juan valley califonia, southern Arizona)
nothern Mexico
central and south America

73
Q

How does one get coccidioidomycosis?

A

Inhalation of the spores!

74
Q

In most patients coccidioidomycosis infection becomes disseminated, with ulcers or deep abscesses in the skin (T/F)?

A

False!

Occurs in a few patients.

75
Q

What are the risk factors for coccidioidomycosis?

A 
Direct exposure to soil harbouring Coccidiodes
Climatic factors
Heredity
Race
Sex (M>F)
Age 
Compromised cell mediated immunity
76
Q

Coccidioidomycosis is more commonly found in males than females (T/F)?

A

True

77
Q

Outline the triad of coccidioidomycosis?

A

Fever
Erythema nodosum
Erythema multiforme

78
Q

Skin manifestations of coccidioidomycosis are more common in males than females (T/F)?

A

False
Commoner in females!
i.e Erythema nodosum and Erythema multiforme

79
Q

Erythema multiforme may be the first sign of systemic disease in coccidioidomycosis (T/F)?

A

False

It’s Erythema nodosum

80
Q

Erythema nodosum are painless nodules commonly found on lower extremities in superficial fungal infections (T/F)?

A

False!

They are painful and seen in deep fungal infections.

81
Q

Migrating arthralgias are common findings in coccidioidomycosis (T/F)?

A

True

82
Q

What is the triad of desert rheumatism?

A

erythema nodosum
erythema multiforme
Migrating arthralgias

83
Q

Nodular lesions in lungs is a feature of disseminated coccidioidomycosis infection (T/F)?

A

False

It’s a feature of primary infection

84
Q

What percentage of patients with coccidioidomycosis are asymptomatic?

A

60%

85
Q

Outline the common clinical symptoms of coccidioidomycosis infection?

A

Fever
Cough
Weight loss
Chest pain

These symptoms are seen in 40% of ptx

86
Q

What is the most common site of disseminated coccidioidomycosis infection?

A

The skin

87
Q

Outline the common sites of secondary coccidioidomycosis infection?

A

Skin
Lungs
Bones
Meninges

88
Q

What percentage of ptx with coccidioidomycosis have disseminated/secondary infection

A

1%

89
Q

What are the reactive cutaneous lesions seen in coccidioidomycosis?

A 
Maculopapular rash
Keratotic noodles
Cold subcutaneous abscesses
Urticaria
Sweet’s syndrome
Reactive interstitial granulomatous dermatitis
90
Q

What are the organism specific cutaneous lesions seen in coccidioidomycosis?

A

Non healing ulcers
Verrucous ulcers due to subcutaneous fluctuant abscesses
Papules
Sinus tract abscesses

91
Q

Organism specific cutaneous lesions have a pridilection for the nasolabial folds (T/F)?

A

False

It’s reactive cutaneous lesions

92
Q

Non healing ulcers may be the 1st or only sign of disseminated infection (T/F)?

A

False

It’s Cold subcutaneous abscesses

93
Q

What samples are required in the diagnosis of coccidioidomycosis?

A

Sputum

Tissue biopsy

94
Q

How is diagnosis of coccidioidomycosis made?

A 
1. DIRECT EXAMINATION (KOH; H&amp;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
Q

What are the differential diagnosis of coccidioidomycosis?

A

INFLAMATORY
Sarcoidosis
Pars planitis
SLE

INFECTIOUS
Syphilis
TB
Toxoplasmosis
Lyme disease

NEOPLASTIC
Primary CNS lymphoma
Systemic lymphoma
leukemia

96
Q

What are the treatment options for coccidioidomycosis?

A

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
Q

What is the causative agent in blastomycosis?

A

Blastomyces dermatitidis

98
Q

Blastomycosis is less frequently disseminated (T/F)?

A

False

It’s Frequently disseminated!

99
Q

Blastomycosis has a fairly good prognosis (T/F)?

A

False!

All patients have done very poorly

100
Q

What %of patients with blastomycosis usually have cns involvement?

A

3-10%

101
Q

How do patients get blastomycosis?

A

Inhalation of infectious particles

Primary cutaneous inoculation

102
Q

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)?

A

False!

Seen in primary cutaneous blastomycosis infection

103
Q

Subcutaneous nodules and ulcerations are clinical findings seen in primary cutaneous blastomycosis infection (T/F)?

A

False

Seen in chronic cutaneous blastomycosis infection

104
Q

What are the common sites of disseminated blastomycosis infection?

A 
Skin
bone
GUT
CNS
spleen
105
Q

Itemize 5 various clinical findings seen in blastomycosis?

A 
Asymptomatic 
Pulmonary infection 
Disseminated infection 
Chronic cutaneous infection 
Primary cutaneous infection
106
Q

Sporotrichosis is otherwise known as?

A

Rose Gardener’s disease

107
Q

What is the causative organism of Sporotrichosis?

A

Sporothrix schenckii

108
Q

Itemize 3 unique properties of Sporotrix shenckii?

A

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
Q

What form of Sporotrix shenckii is found in the environment on plants and decaying matter?

A

The hyphal form (25c)

110
Q

What form of Sporotrix shenckii predominates in the host?

A

The yeast form (37c)

111
Q

What group of people are commonly affected by Sporotrichosis?

A 
gardeners
forest workers
manual labourers
landscapers
Immunocompromised (often exhibit a severe form of the dx)
112
Q

How do patients get Sporotrichosis?

A

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
Q

Sporotrichosis affects mainly the skin and bones (T/F)?

A

False
Affects mainly the skin
other rare forms can affect the lungs, joints, bones, and even the brain.

114
Q

Sporotrichosis is an acute fungal infection producing nodules and ulcers in the lymph nodes and skin. (T/F)?

A

False

It’s a chronic infection!

115
Q

Although S. schenckii has a worldwide distribution but certain areas of the world including africa, have a higher incidence of disease (T/F)?

A

False

Areas like Peru

116
Q

What is the most common manifestation of Sporotrichosis?

A

lymphagitic sporotrichosis

117
Q

Lymphagitic Sporotrichosis is characterized by a painful red nodule which forms at the site of innoculation (T/F)?

A

False

The nodule is nearly painless!

118
Q

Lymphagitic Sporotrichosis is xterised by formation of similar nodules along distal lymphatic channels with intermittent discharge of small amount of pus. (T/F)

A

False

The similar nodules are formed in proximal lymphatic channels

119
Q

Itemize 4 other organisms that mimic the proximal extension of lesions often with skip areas seen in Sporotrichosis?

A

Nocardia brasiliensis
leishmania brasiliensis
mycobacteriun marinum
Mycobacterium kansasii

120
Q

Ulcerations is a constant feature seen in Sporotrichosis (T/F)?

A

False

Ulcerations may occur

121
Q

What specimen are used in the diagnosis of Sporotrichosis?

A 
aspiration fluid
pus
biopsy material
skin scrapings
swabs
122
Q

How is Sporotrichosis diagnosed in the laboratory?

A

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
Q

What laboratory investigation is especially helpful in the diagnosis of extracutaneous or systemic infection?

A

Serology!

124
Q

Itemize the treatment options for Sporotrichosis?

A

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
Q

Mention 2 differential diagnosis of Sporotrichosis

A

Fish tank granuloma

Cutaneous leishmaniasis

126
Q

What is the causative agent in actinomycosis?

A

Actinomyces israeli

127
Q

Actinomyces Israeli is a normal flora of the mouth and bowel. (T/F)

A

True

128
Q

Actinomycosis is a rare fungal disease (T/F)?

A

False

It’s a rare bacteria dx

129
Q

Actinomycosis is a fairly common bacteria disease (T/F)?

A

False

It’s rare

130
Q

Actinomycosis is a polymicrobial anaerobic infection (T/F)?

A

False

polymicrobial aerobic anaerobic infection

131
Q

Itemize 2 other organisms implicated in actinomycosis?

A

A. gerencseriae

Propionibacterium propionicus

132
Q

Actinomycosis is more commonly seen in males than females (T/F)?

A

True

133
Q

Which age group are commonly affected in actinomycosis?

A

20-60yrs

134
Q

What is a known risk factor for genitourinary actinomycosis in females?

A

The use of intrauterine devices

135
Q

The Incidence of oral actinomycosis which is easier to diagnose has increased (T/F)?

A

False

It’s harder to diagnose!

136
Q

What condition is known as “the great masquerader”?

A

Actinomycosis!

137
Q

What are the clinical features of actinomycosis?

A

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
Q

What sites are favoured in actinomycosis?

A

Jaw

Chest and abdominal wall

139
Q

Diagnosis of actinomycosis is often a difficult one to make (T/F)?

A

True

140
Q

What are the treatment options for actinomycosis?

A

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
Q

Maduramycosis is an acute infection of the skin and/or subcutaneous tissue resulting in tumefaction(swelling) studded with sinuses discharging grains. (T/F)?

A

False

It’s a chronic infection

142
Q

What body sites is typically affected in maduramycosis?

A

Feet, Lower extremities ,hands (but it can occur in almost any region of the body)

143
Q

What group of individuals are at increased risk for mycetoma?

A

Farm workers!

144
Q

Mycetoma due to true fungi infection is known as?

A

Eumycetoma

145
Q

Mycetoma due to aerobic bacteria infection is known as?

A

Actinomycetoma

146
Q

Eumycetoma and actinomycetoma have very different clinical findings (T/F)?

A

False

Both types have similar clinical findings.

147
Q

Itemize the fungal organisms causing maduramycosis?

A 
FUNGI
Madurella mycetomatis
Madurella grisea
Leptospaeria senegalensis
Neotestudina rosatii
Fusarium moniliforme
Fusarium soloni
148
Q

Itemize the bacteria(actinomycetes) organisms causing mycetoma foot

A 
ACTINOMYCETES
Actinomadura madurae
Actinomadura pelletieri
Nocardia brasiliensis
Nocadia asteroides
Streptomyces somaliensis
149
Q

What group of mycetoma causing organism causes RED discharge?

A

Actinomadura pelletieri

150
Q

What group of mycetoma causing organism causes WHITE or YELLOW discharge?

A 
Acremonium strictum
Actinomadura madurae
Aspergillus nidulans
Noetestudina rosatii
Phaeoacremonium krajdenii
Pseudallescheria boydii
151
Q

What group of mycetoma causing organism causes BLACK discharge?

A 
Aspergillus terreus
  Curvularia lunata
  Cladophialophora bantiana
   Exophiala jeanselmei
   Leptosphaeria senegalensis
   Leptosphaeria tompkinsii
   Madurella grisea
   Madurella mycetomatis
   Pyrenochaeta romeroi
152
Q

2 common causative organisms in maduramycosis are?

A

Actinomadura madurae

Streptomyces somaliensis

153
Q

What is the classic triad of mycetoma?

A

Tumefaction (tumor-like swelling)
Multiple draining sinuses
Sclerotia (granules/grains in sinuses)

154
Q

Mycetoma originates in the sub-cutaneous tissue (T/F)?

A

True

155
Q

Mention 3 characteristics of the infected site in mycetoma?

A

PAINLESS swelling
woody induration
sinus tracts that discharge pus intermittently

156
Q

Systemic symptoms commonly develops in maduramycosis (T/F)?

A

False

Systemic symptoms do not develop

157
Q

Mycetoma can sometimes spread to distant sites (T/F)?

A

False
Spread to distant sites does not occur
Affects surrounding muscle and bone

158
Q

What are the differential diagnoses of mycetoma foot?

A

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
Q

Mycetoma can be accurately diagnosed by what?

A

Fine Needle Aspiration (FNA) cytology.

160
Q

What is the distinct appearance of mycetoma lesion in a cytology smear?

A

presence of polymorphous inflammatory cells consisting of an admixture of neutrophils, lymphocytes, plasma cells

161
Q

How is mycetoma diagnosed in the laboratory?

A

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
Q

What are the treatment options for maduramycosis?

A

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
Q

Adequate vaccination may prevent against maduramycosis (T/F)?

A

False

No vaccine is available

164
Q

How may we prevent mycetoma foot?

A

Simple hygienic precautions

wearing shoes or sandals while working in fields washing hands and feet at regular intervals

Dermatology OAU (10 decks)

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