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GORGAS > Mycetoma And Subcutaneous Infections > Flashcards

Mycetoma And Subcutaneous Infections Flashcards

1
Q

What is myetoma?

A

Chronic subcutaneous infection, usually localised but may have deeper extension to bone and joints

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2
Q

How is mycetoma spread?

A

Soil transmitted: no human to human transmission

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3
Q

Where is the global burden of mycetoma?

A

Sudan, Mexico and India

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4
Q

What can mycetoma be split down into?

A

Actinomycetomas- nocardia and strep
Eumycetomas (fungal mycteomas)

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5
Q

Where is it dristibuted?

A

Mainly lower extremeties
Foot, but also shoulder

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6
Q

What is eumycetoma?

A

Fungal infection
Frows slowls, less aggressive with fewer Fistula compared to actinomycetoma
Predominantly in tropical countries and in males
Superinfections very common

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7
Q

What is the main fungal mycetoma? What is the main clinical sign?

A

Madurella mycetomatis
Black grains are the key sign

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8
Q

How do you diagnose eumycetoma?

A

Need to do fine needle aspiration
If not, biopsy
Wash drain, use KOH preparation

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9
Q

Tx of Eumycetoma?

A

Less responsive to medical treatment
Need itraconazole or voriconazole
Surgery only has a role in early disease

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10
Q

What is actinomycetoma?

A

This is a bacterial mycetoma
Aerobic pathogens
Typically caused by nocardia, streptomyces (white/yellow grains) and actinomadura (red or orange grain)
Nocardia Braziliensis predominates in America
Streptomyces Somaliensis

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11
Q

How do you diagnose actinomycetoma?

A

Culture using blood agar medium
DST is highly recommended

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12
Q

Tx of Actinomycetoma?

A

Combine antimicrobials: Trimethoprim + aminoglycoside or rifampicin or dapsone
Continue for 6 -24 months
Surgery does not have a role

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13
Q

Eumycetoma vs Actinomycetoma?

A

Eumycetoma:
typical from Africa and India
Typically feet, few Fistulas
Bigger grains
Needs medical and surgical tx

Actinomycetoma:
Typically Latin america
40-50 yrs
Limbs and chest
Grains white/yellowish and smaller
Much more aggressive with multiple fistulas
Medical tx only

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14
Q

What is botryomycosis?

A

Chronic, bacterial infection
Sinus tracts with grain discharge that is white or yellow
Male predominance
Cutaneous and visceral presentations
Staphylococcus Aureus most common

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15
Q

What is clinical presentation of botryomycosis?

A

Follows traumatic inoculation
Feet, hands and neck affected
Yellow/white grain discharge
Extends to subcutaneous structures

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16
Q

What is visceral botryomycosis?

A

Endogenous spread to organs
Need to do FNA to isolate bacteria

17
Q

What are the different grains under microscope?

A

Hyphae structure - eumycetoma
Filamentous bacteria -actinomycetoma
Bacteria cocci and rods- botryomycosis

18
Q

What is chromoblastomycosis?

A

STD
Usually involves trauma with wood or vegetation
80% agricultural workers
Male predominance

19
Q

What agents are most commonly involved?

A

Fonsecaea Pedrosi

20
Q

What is the clinical presentation of botryomycosis?

A

Chronic, slow growing
nodular, verrucous (cauliflower like)
Tumoral
Plaque and mixd form
Always has black dots on the surface which will show fungi

21
Q

Pathological finding of chromoblastomycosis?

A

See sclerotic or fumagoid bodies
Double walled brown structures

22
Q

How do you treat chromoblasto?

A

Need cryotherapy or thermotherapy

23
Q

Where do you find lobomycosis? What is the agent?

A

Amazon basin and Central America
Agent is Lacazia Loboi

24
Q

How does lobo present?

A

Often history of trauma with snake or insect
Usually a painless, localised nodular lesion
Outer legs and ears are typical places

25
Q

How do you Dx lobo? Tx?

A

Need KOH stain, round structures in a chain
Posaconazole

26
Q

What is Phaeohyphomycosis?

A

caused by dark cell moulds
Usually in immunocompromised hosts

27
Q

What is entomophthoramycosis?

A

Basidobolus spp and conidiobolus spp, normal soil inhabitants

28
Q

What is conidiobolus?

A

Nasal nodule which leads to obstruction, thickening of the skin and extension to face
Non seated hyphae
Need itraconazole

29
Q

What is basidiobolus?

A

Basidiobolus ranarum
Nodular Lesions on chest, trunk, arms and buttocks

GORGAS (33 decks)

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