Subcutaneous mycoses ➢1-Mycetoma ➢2-Sporotrichosis ➢3-Chromoblastomycosis ➢4-Rhinosporidiosis ➢5- Lobomycosis ➢6- Entomophthoramycosis Sporotrichosis Rose gardener’s disease Chronic desease Agent Sporothrix schenckii: ➢ Thermal dimorphic ➢ In soil ➢ On decaying vegetation,plants,plant products (hay, straw, sphagnum moss), and a variety of animals (cats) ➢ less than 37° C (hyphal) ➢ 37° C (yeast) ➢ Sporothrix brasiliensis ➢ Sporothrix globosa Epidemiology ➢Worldwide ➢Tropical regions ➢Mexico ➢Brazile ➢France ➢USA Occupational disease: ➢Farmers ➢ ➢Workers ➢Gardeners ➢Florists Predisposing factors: ➢Trauma ➢Inhalation (very rarely) ➢HIV Clinical Syndromes 1-lymphocutaneous 2-Fixed cutaneous 3- Osteoarticular involvement 4-Pulmonary 5-Systemic Primary infection 1-Lymphocutaneous sporotrichosis 2-Fixed cutaneous sporotrichosis: Fixed cutaneous sporotrichosis verrucous-type sporotrichosis localized cutaneous type Paronychia sporotrichosis Osteoarticular involvement Pulmonary sporotrichosis: ➢Alcoholic ➢Pulmonary tuberculosis, diabetes mellitus and steroid ➢A productive cough ➢Low-grade fever ➢Weight loss Systemic sporotrichosis Transmission: ➢Dog bite ➢parrot bite ➢Insects bite ➢Cases of animal-to-human transmission Laboratory Diagnosis: 1-Collection of samples: ➢Drainage from skin lesions ➢Exudates ➢Pus ➢Blood ➢Pulmonary secretions ➢Tissue biopsy specimens 2-Direct examination ➢Gram ➢PAS ➢GMS ➢H & E ❖Yeast Cells ❖Asteroid body: Elongated Buds (“Cigar Body”) Wet Mount BHI Blood 37˚C Yeast with Elongated Daughter Cell Biopsy of subcutaneous tissue H & E Stain Asteroid body Culture: Media: ➢SCC. S…22 ➢BHI.BA…37 Serology: ❖In extracutaneous and systemic forms: ✓LA ✓Enzyme immunoassay (EIA) Treatment: ❖lymphocutaneous: ❖Itraconazole; 100-200 mg/day, 3-6 months ❖Terbinafine ➢Saturated solution of potassium iodine (SSKI); 6-12 weeks Definition: Chronic granulomatous mucosal infection. polyps ➢Human ➢Animals ➢Nose ➢Eyes ➢Other (rare) Agent: ❖Rhinosporidium seeberi ➢Protozoan: (Seeberi G,1900) ➢Fungus: (Ashworth JH,1923) ➢Hydrophilic pathogen ➢Cosmopolitan organism ➢Endemic in all of the continents ➢Except Australia ➢Ground water in ponds and lakes ➢Soil Predisposing factors: ➢Trauma ➢Bath in pools of stagnant water ➢Labour in river ➢Dust storms 1-Rhinosporidiosis (nose): 72% 2-Oculosporidiosis (eyes): 15% 3-Others: 13% Nasal and oropharyngeal Rhinosporidiosis ➢Nasal obstruction Involvement of palpebral conjunctiva and nose Lesions developing far up in the turbinates Oculosporidiosis (eyes): ➢USA ➢Iran (22%) ➢India (15%) ➢South Africa Lesion on the hard palate Cutaneous: ➢Rare ➢Primary infection ➢Small papules ➢Verrucous ➢Painless Disseminated cutaneous rhinosporidiosis ➢Lesion on the tip of nose ➢Hyperpigmented verrucous on the back ➢Discoid verrucous plaque over the forearm Epidemiology: ➢Worldwide ➢Southern India ➢Sri Lanka ➢Brazil ➢Argentina ➢Tropical ➢Subtropical ➢Muslims • Male • 20-40 years old • Sporadic ➢Ardabil ➢Tabriz ➢Zanjan animal ➢Domestic bovines ➢Dog ➢Horse ➢Pink river dolphin Laboratory Diagnosis: ➢Nasal discharge ➢Nasal biopsy ➢KOH ➢Spherules = Sporangium ➢Geimsa ➢10 to 200-400 µm ➢H & E ➢PAS ➢Spore: 7-9 µm ➢GMS ➢Culture – ➢White dots ➢Serology - Nasal polyp Young sporangia. H & E Mature sporangium Coccidioidomycosis: ❖ Coccidioides immitis ➢Spherule: 80 µm ➢ (10 to 200-400 µm) ➢Spore: 2.5µm (in c. immitis) (Spore: 7-9 µm) Cocci…: Lung tissue. PAS Treatment: ➢Surgery ➢Cryosurgery ➢Wide excision ➢Cauterization ➢Amp.B in prokaen solution (local) Complications: ➢Excessive bleeding ➢Secondary bacterial infection ➢Fatal sepsis *** .