Subcutaneous Mycoses

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Subcutaneous Mycoses

• Sporothrichosis
• Eumycotic Mycetoma
• Chromoblastomycosis

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Subcutaneous Mycoses

• These are chronic, localized infections of the
  epidermis and adjacent connective tissue and
  lymphatics following the traumatic implantation
  of the organism.  The causative fungi are all
  soil saprophytes whose ability to adapt to the
  tissue environment and elicit disease is
  extremely variable.
• Subcutaneous sporotrichosis, mycetoma, and
  chromoblastomycosis are well characterized
  subcutaneous mycoses
• As you will see, these are clearly more
  significant than the superficial and
  dermatophycoses

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Sporotrichosis

• Common name Rose Gardeners Disease
• Etiology Sporothrix schenckii
• Sporothrix schenckii is the only dimorphic fungus
  to cause subcutaneous mycosis
• Epidemiology
• Occurs world wide and in all age groups, although
  it is more common in tropical and subtropical
  areas
• More infections occur in men due to occupational
  exposure (foresters, gardeners, horticulturists)

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Sporotrichosis

• Epidemiology
• Sporothrix schenckii grows frequently as an
  environmental saprobe on woody plants and rich
  organic soil
• They are well known to grow on roses
• Most cases are traced to rose thorns, splinters
  or other plant materials penetrating the skin
• Many recent cases have been traced to sphagnum
  moss purchased from commercial suppliers

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Sporotrichosis

• Clinical manifestations
• Most cases are cutaneous (relatively
  local/shallow mild) or lymphocutaneous
• Primary fixed cutaneous lesions at site of
  injury are small papules (colored raised area)
  most often occurring on an extremity
• Lymphocutaneous lymph nodes become sequentially
  infected as organisms are swept along the lymph
  channels

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Sporotrichosis

• Clinical manifestations
• Lymph nodes become enlarged, firm, and discolored
  (buboes)
• Draining sinuses may develop from a lymph node
  and terminate in the adjacent skin
• One rare occasions disease occurs following when
  conidia from environment are inhaled (in
  particular the recent cases related to sphagnum
  moss exposure)

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Primary fixed lessions of cutaneous
sporotrichosis
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Lymphocutaneous sporotrichosis
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Sequential infection of lymph nodes
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Sporotrichosis

• Clinical manifestations
• The rare pulmonary cases cause symptoms that
  range from bronchitis to tuberculosis-like
  infections
• The most common extracutaneous dissorder is
  osteoarticular in nature confined to long bones
  near joints
• Dissemination is rare and limited to
  immunocompcomised patients many organs involved