Majocchi’s granuloma (MG) is a rare, atypical yet well recognized deep infection of dermal and subcutaneous tissue caused by dermatophytes such as anthropophilic Trichophyton rubrum; however, other dermatophytes including T. mentagrophytes T. epilans, T. violaceum, M. audouinii, M. gypseum, M. ferrugineum, and M. canis may be the causative agent usually limited to the superficial epidermis. In both healthy individuals and immunocompromised hosts MG is characterized clinically by papular, pustular or nodular inflammatory lesions occurring typically on the limbs or face, immunocompromised patients are at increased risk for infection. A favorable factor for the infection is an injury caused by epilation, which together with an existing fungal infection. The aim of this article is to provide a detailed review on clinical manifestations, diagnosis, risk factors, pathophysiology and pharmacological treatment options.
Clinicomycological profile of Dermatophytosis in a teaching hospitalinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Syed Hussain Shah's presentation topic is on mycosis, or fungal infections. Mycosis is caused by fungi like Aspergillus, Histoplasma, and other pathogenic fungi. Those at risk include people with weakened immune systems from HIV/AIDS, steroid use, chemotherapy, or diabetes. Mycoses are classified by the tissue initially infected, such as superficial infections of the outer skin/hair, cutaneous infections deeper in the skin/nails, subcutaneous infections of the dermis and muscles, and systemic infections originating in the lungs or from opportunistic pathogens in immunocompromised individuals. Prevention methods include keeping skin clean and dry, maintaining good hygiene, and washing clothes after contact
Myiasis is the infestation by larvae of flies. Myiasis may involve the skin, eyes, nasal passages, gastrointestinal and genitourinary tracts. Cases of urinary myiasis are very rare mostly occurs in immunocompromised hosts, those with previous urologic instrumentation or those with poor socioeconomic status. We present a case of successful outpatient treatment of urinary myiasis in two immunocompetent females without prior urological history.
Mycetoma is a chronic subcutaneous infection caused by certain fungi or bacteria that enters through the skin via minor trauma. It results in a painless swelling, draining sinuses, and discharge containing grains. The infection commonly affects the feet, legs, and other extremities in agricultural workers and those walking barefoot in endemic areas like parts of Africa and Asia. Diagnosis involves examining biopsy samples for characteristic grains and cultures to identify the causative organism. Treatment depends on whether it is caused by bacteria (actinomycetoma), requiring prolonged antibiotics, or fungi (eumycetoma), which may require surgery and antifungal therapy. Prevention involves wearing shoes in endemic areas.
This document provides information on antifungal agents, including their targets, mechanisms of action, and clinical uses. It discusses that fungi have cell walls made of chitin and cell membranes containing ergosterol. Major classes of antifungals are described such as azoles which inhibit ergosterol biosynthesis, and polyenes like amphotericin B which bind to ergosterol in the membrane. The development of antifungals over time is summarized, from amphotericin B to newer azoles and echinocandins. Common adverse effects of amphotericin B include fever, renal impairment, and hypotension.
1. Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by certain dematiaceous fungi, most commonly Fonsecaea pedrosoi. It is characterized by warty nodules or plaques that develop at the site of inoculation.
2. Diagnosis involves microscopic examination of skin scrapings or biopsies to identify the characteristic sclerotic bodies. Culture can aid in identification of the causal fungus.
3. Treatment is difficult as responses to drugs are often limited. For small, early lesions, local destruction methods may be used, while longer-standing or larger lesions typically require prolonged antifungal therapy.
This document discusses Penicillium marneffei, a dimorphic fungus that can cause opportunistic infections. P. marneffei primarily affects immunocompromised individuals, such as those with HIV. It can cause disseminated infections involving the skin, lungs, and intestines. The document describes the typical morphology, culture characteristics, and microscopy of P. marneffei. It also covers the epidemiology, pathogenesis, laboratory diagnosis, and immunity aspects of P. marneffei infections.
Dermatophytes are fungi that infect keratinized tissues like skin, hair, and nails. There are three genera of dermatophytes: Microsporum, Trichophyton, and Epidermophyton. They produce enzymes that allow them to invade keratinized tissues. Dermatophyte infections can occur on the scalp (tinea capitis), beard (tinea barbae), body (tinea corporis), groin (tinea cruris), hands (tinea manum), and feet/nails (tinea pedis/unguium). Diagnosis involves microscopic examination of skin or nail samples in potassium hydroxide (KOH), culture, and sometimes PCR.
Clinicomycological profile of Dermatophytosis in a teaching hospitalinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Syed Hussain Shah's presentation topic is on mycosis, or fungal infections. Mycosis is caused by fungi like Aspergillus, Histoplasma, and other pathogenic fungi. Those at risk include people with weakened immune systems from HIV/AIDS, steroid use, chemotherapy, or diabetes. Mycoses are classified by the tissue initially infected, such as superficial infections of the outer skin/hair, cutaneous infections deeper in the skin/nails, subcutaneous infections of the dermis and muscles, and systemic infections originating in the lungs or from opportunistic pathogens in immunocompromised individuals. Prevention methods include keeping skin clean and dry, maintaining good hygiene, and washing clothes after contact
Myiasis is the infestation by larvae of flies. Myiasis may involve the skin, eyes, nasal passages, gastrointestinal and genitourinary tracts. Cases of urinary myiasis are very rare mostly occurs in immunocompromised hosts, those with previous urologic instrumentation or those with poor socioeconomic status. We present a case of successful outpatient treatment of urinary myiasis in two immunocompetent females without prior urological history.
Mycetoma is a chronic subcutaneous infection caused by certain fungi or bacteria that enters through the skin via minor trauma. It results in a painless swelling, draining sinuses, and discharge containing grains. The infection commonly affects the feet, legs, and other extremities in agricultural workers and those walking barefoot in endemic areas like parts of Africa and Asia. Diagnosis involves examining biopsy samples for characteristic grains and cultures to identify the causative organism. Treatment depends on whether it is caused by bacteria (actinomycetoma), requiring prolonged antibiotics, or fungi (eumycetoma), which may require surgery and antifungal therapy. Prevention involves wearing shoes in endemic areas.
This document provides information on antifungal agents, including their targets, mechanisms of action, and clinical uses. It discusses that fungi have cell walls made of chitin and cell membranes containing ergosterol. Major classes of antifungals are described such as azoles which inhibit ergosterol biosynthesis, and polyenes like amphotericin B which bind to ergosterol in the membrane. The development of antifungals over time is summarized, from amphotericin B to newer azoles and echinocandins. Common adverse effects of amphotericin B include fever, renal impairment, and hypotension.
1. Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by certain dematiaceous fungi, most commonly Fonsecaea pedrosoi. It is characterized by warty nodules or plaques that develop at the site of inoculation.
2. Diagnosis involves microscopic examination of skin scrapings or biopsies to identify the characteristic sclerotic bodies. Culture can aid in identification of the causal fungus.
3. Treatment is difficult as responses to drugs are often limited. For small, early lesions, local destruction methods may be used, while longer-standing or larger lesions typically require prolonged antifungal therapy.
This document discusses Penicillium marneffei, a dimorphic fungus that can cause opportunistic infections. P. marneffei primarily affects immunocompromised individuals, such as those with HIV. It can cause disseminated infections involving the skin, lungs, and intestines. The document describes the typical morphology, culture characteristics, and microscopy of P. marneffei. It also covers the epidemiology, pathogenesis, laboratory diagnosis, and immunity aspects of P. marneffei infections.
Dermatophytes are fungi that infect keratinized tissues like skin, hair, and nails. There are three genera of dermatophytes: Microsporum, Trichophyton, and Epidermophyton. They produce enzymes that allow them to invade keratinized tissues. Dermatophyte infections can occur on the scalp (tinea capitis), beard (tinea barbae), body (tinea corporis), groin (tinea cruris), hands (tinea manum), and feet/nails (tinea pedis/unguium). Diagnosis involves microscopic examination of skin or nail samples in potassium hydroxide (KOH), culture, and sometimes PCR.
Dermatophytoses and dermatomycoses are fungal infections of the skin. Dermatophytoses are caused by keratinophilic fungi that invade the keratinized tissues of skin, hair, and nails. Common causes are dermatophyte fungi of the genera Trichophyton, Microsporum, and Epidermophyton. Dermatomycoses include infections caused by Malassezia pachydermatis, an opportunistic lipophilic yeast commonly found on canine skin that can cause otitis externa and seborrheic dermatitis in dogs. Diagnosis involves microscopic examination of skin scrapings or hair samples to identify fungal elements,
This document discusses adjuvant medications in the treatment of pemphigus vulgaris. It begins with definitions and epidemiology of pemphigus vulgaris. It then discusses diagnostic features such as clinical manifestations involving mucous membranes and skin. Management is focused on using corticosteroids as the primary treatment along with immunosuppressive drugs as adjuvants to reduce steroid dosage and side effects. Newer treatments discussed include rituximab and mycophenolate mofetil. Prognosis is generally good with treatment but mucosal lesions can be recalcitrant.
Mycetoma is a chronic bacterial or fungal infection that affects the skin and subcutaneous tissues, usually in the foot. It is characterized by the formation of a painless swelling or mass beneath the skin that develops cavities and discharges fluid and grains. Over time, it can spread and cause deformity or disability by affecting muscles, bones, and surrounding tissue. Mycetoma is diagnosed based on symptoms, microscopy of discharge grains, biopsy, and culture. Treatment involves surgery to remove the infected tissue along with long-term antifungal or antibiotic drugs depending on the causative agent.
Mycetoma is a chronic, granulomatous skin disease characterized by swelling, abscess formation, and involvement of subcutaneous tissue, muscles and bones. It is caused by fungi (eumycetoma) or bacteria (actinomycetoma) that enter through skin trauma. Symptoms include subcutaneous nodules, papules and fibrosis. Diagnosis involves biopsy, microscopy, culture and serology. Treatment for eumycetoma involves antifungals like ketoconazole or itraconazole, while actinomycetoma uses antibiotics like TMP-SMX or dapsone, often for many months or years.
Chromoblastomycosis is a chronic fungal infection caused by several soil fungi that are acquired through traumatic skin inoculation. It is characterized by the development of warty or tumor-like skin lesions, usually on the legs or feet, that resemble cauliflower. Diagnosis involves microscopic identification of sclerotic bodies in skin scrapings or biopsy specimens. Treatment can include antifungal drugs like itraconazole or terbinafine for 6-18 months, sometimes combined with surgery, cryotherapy or heat therapy. The infection is difficult to treat and cure rates are variable.
Definition:
Madura foot or mycetoma (tumour-like)
Chronic granulomatous disease characterised by localised infection of subcutaneous tissues and sometimes bone characterised by discharging sinuses filled with organisms like actinomycetes or fungi.
History:
Gill first described the disease in the Madura district of India in 1842.
Hence the term Madura foot.
Pathophysiology:Typically present in agricultural workers(hands shoulders and back – from carrying contaminated vegetation and other burdens).
Causes:Due to fungi – eumycetoma (40%) or
Actinomycetes – (actinomycetoma) 60%
Actinomycetoma may be due to Actinomadura madurae Actinomadura pelletieri Streptomyces somaliensis Nocardia species
Clinical Features:Slow spreading skin infection
Local swelling
Small hard painless nodules
Ulceration
Pus discharge
Scarred skin & discoloration
Itching
Pain and burning sensation
Lab studies:Direct microscopy
Blood – leukocytosis & neutrophilia
Culture of exudates
Skin biopsy
Serology
DNA sequencing has been used for identification in difficult cases.
Microscopy:Serosanguinous fluid containing the granules examined using – 10% KOH and Parker ink or calcofluor white mounts
Tissue sections stained using H&E(Hematoxylin and Eosin stain) , PAS(Periodic Acid Shiffs Stain) and Grocott’s methenamine silver(GMS).
Actinomycotic grains contains very fine filaments.
Fungal grains contain short hyphae (branched filaments) that are often swollen
Culture:Sabouraud’s dextrose agar or mycobiotic agar to isolate fungi
Blood agar to isolate bacteria
Agar plates are cultured at 25-30 degree celcius and 37 degree celcius for up to six weeks . Fungi grow more quickly than actinomycetes.
Treatment;Due to the slow ,relatively pain –free progression of the disease, mycetoma is often at an advanced stage when diagnosed.
Antifungals
Antibiotics
Treatment of any secondary infections
Amputation-in severe cases
1. The document discusses various systemic and opportunistic mycoses.
2. Systemic mycoses are caused by dimorphic fungi that can exist as molds in the environment and yeasts in the body. The main systemic mycoses described are blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis.
3. Opportunistic mycoses are caused by fungi ubiquitous in the environment that can cause infection in immunocompromised individuals. Candidiasis and aspergillosis are two common opportunistic mycoses discussed in the document.
This document provides an overview of superficial and cutaneous mycoses. It begins with an introduction to these types of fungal infections, which typically cause chronic infections in the outermost layer of skin. The document then reviews the anatomy and histology of skin before distinguishing between superficial and cutaneous mycoses. Several specific fungal infections are described in detail, including Pityriasis versicolor, Tinea nigra, Piedra, and various forms of Tinea. The causative fungi, clinical features, diagnosis and treatment are discussed for each infection. The document also provides information on dermatophyte fungi, their classification, morphology and geographic distribution.
Laboratory diagnosis of the causative dermatophytes of tinea capitismaak16
Most laboratories do not perform mycologic examinations for
diagnosis of tinea capitis because laboratory practitioners still believe that mycological procedures are too difficult to do and that the fungi are too infectious to handle require specialized mycologist. This discussion presents conventional and modern methods suitable for use in laboratories of all sizes especially laboratories with limited resources. It is hoped that laboratories will take the initiative in offering diagnostic mycology services for Tinea capitis routinely to be both a rewarding experience to those who choose to become involved and provides an accurate diagnostic services for patients care and professional support and response to the requested tests by clinicians.
Microsporum spp infections, particularly M. canis, have significantly changed in recent decades. While historically more common in boys and involving the scalp, infections now affect all ages and genders. Deep kerion lesions of the scalp, once typically caused by T. mentagrophytes, are now often due to M. canis. Onychomycosis and disseminated infections associated with immunosuppression are also increasingly linked to M. canis. The pathogen has taken on varied clinical presentations, sometimes mimicking other skin conditions. These shifts reflect changes in epidemiology and highlight the need for accurate diagnosis and treatment of Microsporum spp infections.
Fungal diseases, also known as mycoses, are infections caused by fungi. There are several types of mycoses including superficial, cutaneous, subcutaneous, and systemic mycoses. Superficial mycoses are limited to the outer layers of skin while cutaneous mycoses penetrate deeper into the epidermis. Subcutaneous mycoses commonly affect the dermis, subcutaneous tissue, muscle and fascia. Systemic mycoses can involve multiple body systems and are caused by either primary or opportunistic pathogenic fungi. Common systemic fungal diseases include candidiasis, cryptococcosis, aspergillosis and mucromycosis. Diagnosis and treatment depends on the specific fungal
Clinical Management of Cutaneous Myiasis Wound Due To Post Traumatic Horn Inj...iosrjce
IOSR Journal of Agriculture and Veterinary Science (IOSR-JAVS) is a double blind peer reviewed International Journal edited by the International Organization of Scientific Research (IOSR). The journal provides a common forum where all aspects of Agricultural and Veterinary Sciences are presented. The journal invites original papers, review articles, technical reports and short communications containing new insight into any aspect Agricultural and Veterinary Sciences that are not published or not being considered for publication elsewhere.
This document discusses transdermal delivery of vaccines through the skin. It defines vaccines and describes different types of vaccines including live attenuated, inactivated, recombinant, toxoid, and conjugate polysaccharide protein vaccines. It then discusses the skin as a site for vaccine delivery and various approaches for transdermal vaccine delivery, including liquid jet injection, epidermal powder immunization, topical applications using adjuvants or colloidal carriers, and energy-based approaches like electroporation, ultrasound, thermal ablation, and microneedles.
Dermatophytoses, commonly known as ringworm, are fungal infections caused by dermatophytes which invade keratinized tissues like skin, hair, and nails. There are three main genera of dermatophytes - Trichophyton, Microsporum, and Epidermophyton. They are classified based on their morphology and site of infection. Dermatophytes are contracted through direct contact with infected skin, animals, or soil. Common clinical manifestations include tinea capitis, tinea corporis, tinea pedis, and tinea cruris. Laboratory diagnosis involves microscopic examination of skin or nail samples in KOH and fungal culture. Oral antifungals like terbinaf
1) Dermatomycosis is a fungal infection of the skin, hair, and nails caused by dermatophytes such as Microsporum, Epidermophyton, and Trichophyton. Common symptoms include a skin rash and nail discoloration.
2) Epidermophyton floccosum is an anthropophilic dermatophyte that causes infections like athlete's foot and ringworm. It produces smooth-walled macroconidia in clusters and grows in culture as greenish-brown colonies.
3) Infections are diagnosed microscopically by viewing macroconidia in skin scrapings or cultures. Topical and oral antifungals
This document discusses Coccidioidomycosis, an endemic mycosis caused by the dimorphic fungus Coccidioides immitis. It is found in arid regions of the Americas. In soil, it forms hyphae and arthrospores that can be inhaled and cause infection in the lungs, forming spherules filled with endospores. Most infections are asymptomatic or cause flu-like symptoms, but some can disseminate to bones, meninges or skin. Diagnosis involves identifying spherules microscopically or culturing the fungus from specimens. Serologic tests can also detect antibodies. There is no treatment for mild cases but disseminated disease requires antifungal therapy
This document provides information about antifungal agents. It begins with an introduction to fungi and fungal infections. It then discusses the classification, mechanisms of action, and clinical uses of various antifungal drug classes, including azoles, polyenes, allylamines, and echinocandins. Side effects and resistance mechanisms are also covered. The document aims to outline the potential targets and modes of action of different antifungal agents used in clinical practice.
1. Cutaneous mycoses are fungal infections of the skin, hair, and nails caused by dermatophytes like Trichophyton, Microsporum, and Epidermophyton. Laboratory diagnosis involves microscopic examination of skin scrapings or nail clippings in KOH to identify fungal elements, as well as fungal culture.
2. Subcutaneous mycoses involve fungal infection of the subcutaneous tissue and overlying skin, such as mycetoma, chromoblastomycosis, sporotrichosis, and rhinosporidiosis. They are caused by a heterogeneous group of fungi introduced through the skin via minor trauma.
This document discusses various pathogenic fungi and the diseases they cause. It describes different types of fungal infections including superficial mycoses affecting the skin surface, cutaneous mycoses like ringworm that infect the skin, and subcutaneous mycoses which occur beneath the skin. Specific fungi that cause diseases like athlete's foot, ringworm, and mycetoma are outlined. The modes of transmission between environments, people, and animals are also summarized. Treatment options and laboratory diagnosis methods for different fungal infections are mentioned.
This document discusses cutaneous mycoses, including the causative organisms, clinical manifestations, laboratory diagnosis, treatment, and prevention. It describes several common fungal infections of the skin caused by dermatophytes, including athlete's foot, ringworm, jock itch, and nail fungus. It provides details on the characteristic features of common dermatophyte genera (e.g. Trichophyton, Microsporum, Epidermophyton) and discusses methods for laboratory diagnosis through direct microscopy, culture, and identification of fungal structures. Treatment involves topical and oral antifungal drugs while prevention focuses on maintaining good hygiene and cleanliness to avoid spreading fungal spores.
Dermatophytoses and dermatomycoses are fungal infections of the skin. Dermatophytoses are caused by keratinophilic fungi that invade the keratinized tissues of skin, hair, and nails. Common causes are dermatophyte fungi of the genera Trichophyton, Microsporum, and Epidermophyton. Dermatomycoses include infections caused by Malassezia pachydermatis, an opportunistic lipophilic yeast commonly found on canine skin that can cause otitis externa and seborrheic dermatitis in dogs. Diagnosis involves microscopic examination of skin scrapings or hair samples to identify fungal elements,
This document discusses adjuvant medications in the treatment of pemphigus vulgaris. It begins with definitions and epidemiology of pemphigus vulgaris. It then discusses diagnostic features such as clinical manifestations involving mucous membranes and skin. Management is focused on using corticosteroids as the primary treatment along with immunosuppressive drugs as adjuvants to reduce steroid dosage and side effects. Newer treatments discussed include rituximab and mycophenolate mofetil. Prognosis is generally good with treatment but mucosal lesions can be recalcitrant.
Mycetoma is a chronic bacterial or fungal infection that affects the skin and subcutaneous tissues, usually in the foot. It is characterized by the formation of a painless swelling or mass beneath the skin that develops cavities and discharges fluid and grains. Over time, it can spread and cause deformity or disability by affecting muscles, bones, and surrounding tissue. Mycetoma is diagnosed based on symptoms, microscopy of discharge grains, biopsy, and culture. Treatment involves surgery to remove the infected tissue along with long-term antifungal or antibiotic drugs depending on the causative agent.
Mycetoma is a chronic, granulomatous skin disease characterized by swelling, abscess formation, and involvement of subcutaneous tissue, muscles and bones. It is caused by fungi (eumycetoma) or bacteria (actinomycetoma) that enter through skin trauma. Symptoms include subcutaneous nodules, papules and fibrosis. Diagnosis involves biopsy, microscopy, culture and serology. Treatment for eumycetoma involves antifungals like ketoconazole or itraconazole, while actinomycetoma uses antibiotics like TMP-SMX or dapsone, often for many months or years.
Chromoblastomycosis is a chronic fungal infection caused by several soil fungi that are acquired through traumatic skin inoculation. It is characterized by the development of warty or tumor-like skin lesions, usually on the legs or feet, that resemble cauliflower. Diagnosis involves microscopic identification of sclerotic bodies in skin scrapings or biopsy specimens. Treatment can include antifungal drugs like itraconazole or terbinafine for 6-18 months, sometimes combined with surgery, cryotherapy or heat therapy. The infection is difficult to treat and cure rates are variable.
Definition:
Madura foot or mycetoma (tumour-like)
Chronic granulomatous disease characterised by localised infection of subcutaneous tissues and sometimes bone characterised by discharging sinuses filled with organisms like actinomycetes or fungi.
History:
Gill first described the disease in the Madura district of India in 1842.
Hence the term Madura foot.
Pathophysiology:Typically present in agricultural workers(hands shoulders and back – from carrying contaminated vegetation and other burdens).
Causes:Due to fungi – eumycetoma (40%) or
Actinomycetes – (actinomycetoma) 60%
Actinomycetoma may be due to Actinomadura madurae Actinomadura pelletieri Streptomyces somaliensis Nocardia species
Clinical Features:Slow spreading skin infection
Local swelling
Small hard painless nodules
Ulceration
Pus discharge
Scarred skin & discoloration
Itching
Pain and burning sensation
Lab studies:Direct microscopy
Blood – leukocytosis & neutrophilia
Culture of exudates
Skin biopsy
Serology
DNA sequencing has been used for identification in difficult cases.
Microscopy:Serosanguinous fluid containing the granules examined using – 10% KOH and Parker ink or calcofluor white mounts
Tissue sections stained using H&E(Hematoxylin and Eosin stain) , PAS(Periodic Acid Shiffs Stain) and Grocott’s methenamine silver(GMS).
Actinomycotic grains contains very fine filaments.
Fungal grains contain short hyphae (branched filaments) that are often swollen
Culture:Sabouraud’s dextrose agar or mycobiotic agar to isolate fungi
Blood agar to isolate bacteria
Agar plates are cultured at 25-30 degree celcius and 37 degree celcius for up to six weeks . Fungi grow more quickly than actinomycetes.
Treatment;Due to the slow ,relatively pain –free progression of the disease, mycetoma is often at an advanced stage when diagnosed.
Antifungals
Antibiotics
Treatment of any secondary infections
Amputation-in severe cases
1. The document discusses various systemic and opportunistic mycoses.
2. Systemic mycoses are caused by dimorphic fungi that can exist as molds in the environment and yeasts in the body. The main systemic mycoses described are blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis.
3. Opportunistic mycoses are caused by fungi ubiquitous in the environment that can cause infection in immunocompromised individuals. Candidiasis and aspergillosis are two common opportunistic mycoses discussed in the document.
This document provides an overview of superficial and cutaneous mycoses. It begins with an introduction to these types of fungal infections, which typically cause chronic infections in the outermost layer of skin. The document then reviews the anatomy and histology of skin before distinguishing between superficial and cutaneous mycoses. Several specific fungal infections are described in detail, including Pityriasis versicolor, Tinea nigra, Piedra, and various forms of Tinea. The causative fungi, clinical features, diagnosis and treatment are discussed for each infection. The document also provides information on dermatophyte fungi, their classification, morphology and geographic distribution.
Laboratory diagnosis of the causative dermatophytes of tinea capitismaak16
Most laboratories do not perform mycologic examinations for
diagnosis of tinea capitis because laboratory practitioners still believe that mycological procedures are too difficult to do and that the fungi are too infectious to handle require specialized mycologist. This discussion presents conventional and modern methods suitable for use in laboratories of all sizes especially laboratories with limited resources. It is hoped that laboratories will take the initiative in offering diagnostic mycology services for Tinea capitis routinely to be both a rewarding experience to those who choose to become involved and provides an accurate diagnostic services for patients care and professional support and response to the requested tests by clinicians.
Microsporum spp infections, particularly M. canis, have significantly changed in recent decades. While historically more common in boys and involving the scalp, infections now affect all ages and genders. Deep kerion lesions of the scalp, once typically caused by T. mentagrophytes, are now often due to M. canis. Onychomycosis and disseminated infections associated with immunosuppression are also increasingly linked to M. canis. The pathogen has taken on varied clinical presentations, sometimes mimicking other skin conditions. These shifts reflect changes in epidemiology and highlight the need for accurate diagnosis and treatment of Microsporum spp infections.
Fungal diseases, also known as mycoses, are infections caused by fungi. There are several types of mycoses including superficial, cutaneous, subcutaneous, and systemic mycoses. Superficial mycoses are limited to the outer layers of skin while cutaneous mycoses penetrate deeper into the epidermis. Subcutaneous mycoses commonly affect the dermis, subcutaneous tissue, muscle and fascia. Systemic mycoses can involve multiple body systems and are caused by either primary or opportunistic pathogenic fungi. Common systemic fungal diseases include candidiasis, cryptococcosis, aspergillosis and mucromycosis. Diagnosis and treatment depends on the specific fungal
Clinical Management of Cutaneous Myiasis Wound Due To Post Traumatic Horn Inj...iosrjce
IOSR Journal of Agriculture and Veterinary Science (IOSR-JAVS) is a double blind peer reviewed International Journal edited by the International Organization of Scientific Research (IOSR). The journal provides a common forum where all aspects of Agricultural and Veterinary Sciences are presented. The journal invites original papers, review articles, technical reports and short communications containing new insight into any aspect Agricultural and Veterinary Sciences that are not published or not being considered for publication elsewhere.
This document discusses transdermal delivery of vaccines through the skin. It defines vaccines and describes different types of vaccines including live attenuated, inactivated, recombinant, toxoid, and conjugate polysaccharide protein vaccines. It then discusses the skin as a site for vaccine delivery and various approaches for transdermal vaccine delivery, including liquid jet injection, epidermal powder immunization, topical applications using adjuvants or colloidal carriers, and energy-based approaches like electroporation, ultrasound, thermal ablation, and microneedles.
Dermatophytoses, commonly known as ringworm, are fungal infections caused by dermatophytes which invade keratinized tissues like skin, hair, and nails. There are three main genera of dermatophytes - Trichophyton, Microsporum, and Epidermophyton. They are classified based on their morphology and site of infection. Dermatophytes are contracted through direct contact with infected skin, animals, or soil. Common clinical manifestations include tinea capitis, tinea corporis, tinea pedis, and tinea cruris. Laboratory diagnosis involves microscopic examination of skin or nail samples in KOH and fungal culture. Oral antifungals like terbinaf
1) Dermatomycosis is a fungal infection of the skin, hair, and nails caused by dermatophytes such as Microsporum, Epidermophyton, and Trichophyton. Common symptoms include a skin rash and nail discoloration.
2) Epidermophyton floccosum is an anthropophilic dermatophyte that causes infections like athlete's foot and ringworm. It produces smooth-walled macroconidia in clusters and grows in culture as greenish-brown colonies.
3) Infections are diagnosed microscopically by viewing macroconidia in skin scrapings or cultures. Topical and oral antifungals
This document discusses Coccidioidomycosis, an endemic mycosis caused by the dimorphic fungus Coccidioides immitis. It is found in arid regions of the Americas. In soil, it forms hyphae and arthrospores that can be inhaled and cause infection in the lungs, forming spherules filled with endospores. Most infections are asymptomatic or cause flu-like symptoms, but some can disseminate to bones, meninges or skin. Diagnosis involves identifying spherules microscopically or culturing the fungus from specimens. Serologic tests can also detect antibodies. There is no treatment for mild cases but disseminated disease requires antifungal therapy
This document provides information about antifungal agents. It begins with an introduction to fungi and fungal infections. It then discusses the classification, mechanisms of action, and clinical uses of various antifungal drug classes, including azoles, polyenes, allylamines, and echinocandins. Side effects and resistance mechanisms are also covered. The document aims to outline the potential targets and modes of action of different antifungal agents used in clinical practice.
1. Cutaneous mycoses are fungal infections of the skin, hair, and nails caused by dermatophytes like Trichophyton, Microsporum, and Epidermophyton. Laboratory diagnosis involves microscopic examination of skin scrapings or nail clippings in KOH to identify fungal elements, as well as fungal culture.
2. Subcutaneous mycoses involve fungal infection of the subcutaneous tissue and overlying skin, such as mycetoma, chromoblastomycosis, sporotrichosis, and rhinosporidiosis. They are caused by a heterogeneous group of fungi introduced through the skin via minor trauma.
This document discusses various pathogenic fungi and the diseases they cause. It describes different types of fungal infections including superficial mycoses affecting the skin surface, cutaneous mycoses like ringworm that infect the skin, and subcutaneous mycoses which occur beneath the skin. Specific fungi that cause diseases like athlete's foot, ringworm, and mycetoma are outlined. The modes of transmission between environments, people, and animals are also summarized. Treatment options and laboratory diagnosis methods for different fungal infections are mentioned.
This document discusses cutaneous mycoses, including the causative organisms, clinical manifestations, laboratory diagnosis, treatment, and prevention. It describes several common fungal infections of the skin caused by dermatophytes, including athlete's foot, ringworm, jock itch, and nail fungus. It provides details on the characteristic features of common dermatophyte genera (e.g. Trichophyton, Microsporum, Epidermophyton) and discusses methods for laboratory diagnosis through direct microscopy, culture, and identification of fungal structures. Treatment involves topical and oral antifungal drugs while prevention focuses on maintaining good hygiene and cleanliness to avoid spreading fungal spores.
NTM, also known as atypical mycobacteria, are environmental bacteria that can cause disease in humans under certain conditions. There are over 150 known NTM species, most of which rarely cause human illness. NTM diseases are associated with lung infections and skin lesions. Identification of the NTM species involves biopsy of infected tissue and culture analysis. Treatment depends on the species and severity of infection, typically involving antibiotics over an extended period.
Understanding Fungal Skin Infections and Ringworm: Causes, Symptoms, and Trea...NoorulainMehmood1
Fungal skin infections, including the common condition known as ringworm, represent a significant dermatological concern affecting millions worldwide. This review delves into the multifaceted nature of fungal skin infections, elucidating their etiology, clinical manifestations, and therapeutic approaches. Fungal skin infections are caused by various species of fungi, with dermatophytes being the primary culprits behind ringworm. The clinical presentation of fungal skin infections varies, encompassing symptoms such as itching, redness, scaling, and characteristic circular lesions. Diagnosis typically involves clinical examination, microscopy, and culture of skin scrapings. Treatment strategies range from topical antifungal agents for mild cases to systemic therapy for severe or recurrent infections. Additionally, preventive measures and lifestyle modifications play pivotal roles in managing and preventing fungal skin infections. A comprehensive understanding of fungal skin infections, including ringworm, is essential for healthcare practitioners to facilitate timely diagnosis and effective management, thereby improving patient outcomes.
Key Words: Fungal skin infections, ringworm, dermatophytes, antifungal therapy, diagnosis, prevention, dermatology
Clinico-mycological profile of isolates of superficial fungal infection: A st...Open Access Research Paper
The superficial (cutaneous) fungal infections involve skin and its appendages, hair and nails. The causative fungi colonize only cornified layer of epidermis or supra-follicular portion of hair and usually do not penetrate into deeper tissues. The distribution and frequency of these infections and their etiological agents vary according to the geographic region, the socioeconomic level of population, climatic variation, presence of domestic animals and age. These infections are usually presented as scaly patches with central clearing with sharply demarcated as annular, erythematous, sometimes with vesicles, blisters and pustules. These superficial fungal infections are also responsible for morbidity, affecting quality of life, have recurrent relapses and drug resistance. This study was carried to find out the prevalence of various fungi associated with superficial fungal infection. This is a retrospective observational study carried to see clinical and laboratory profile of clinically suspected cases of superficial (cutaneous) fungal infection cases attending Dermatology Out Patient Department (OPD) and Skin scrapings, hair and nail samples were collected and processed according to standard mycological protocol. A total of 120 specimens were collected from clinically diagnosed superficial fungal infection cases. Tinea corporis was the most common clinical type in our study followed by Pityriasis versicolor, Onycomycosis and Tinea pedis. Most common dermatophyte species isolated was Trichophyton mentegrophyte and Malassezia sp. followed by Trichophyton violaceum, Candida sp., Trichophyton rubrum, Microsporum audouinii and Fusarium sp. Along with dermatophytes, nondermatophytic fungal infections are emerging as important debilitating problems affecting quality of life. Due to different type of antifugal use in different superficial mycoses, laboratory confirmation is desired, to decrease inappropriate use of drugs and drug resistance.
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2) Epidermophyton floccosum is an anthropophilic dermatophyte that causes infections like athlete's foot and ringworm. It produces smooth-walled macroconidia in clusters on hyphal threads.
3) Diagnosis involves microscopic examination of skin or nail samples in KOH to observe fungal elements, as well as culturing samples on agar to observe characteristic mold growth. Molecular identification methods
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Fungi are eukaryotic organisms that can be single-celled or multicellular. Their cell walls contain chitin and glucans. Fungi can cause superficial infections of the skin and nails, subcutaneous infections beneath the skin, and systemic infections of internal organs. Common fungal diseases include ringworm, athlete's foot, histoplasmosis, and coccidiomycosis. Fungi are classified based on their modes of reproduction and microscopic structures. Identification and diagnosis involves microscopic examination, culturing, and serological tests.
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Medical mycology is the study of fungi that impact human health. It has increased in importance with more immunosuppressed individuals. New diagnostic techniques allow for earlier detection of invasive fungal infections compared to traditional culture methods. Emerging fungal pathogens include non-albicans Candida species, Zygomycetes, and other molds in immunocompromised patients. Antifungal drug resistance is a growing problem, particularly in Candida species.
Superficial fungal skin infections can be caused by dermatophytes, Pityrosporum, or Candida. Dermatophyte infections (tinea) present in various forms depending on the infected area, such as tinea capitis affecting the scalp. Pityrosporum infection causes pityriasis versicolor, presenting as macules on the trunk that fluoresce under wood's light. Candidiasis can infect skin, nails, and mucous membranes. Diagnosis involves clinical examination, microscopy, culture, and wood's light testing. Topical and oral antifungals are used for treatment.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
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8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Majocchi Granuloma, Masquerading As Psoriasis: A Review
1. International Journal of Science and Healthcare Research
Vol.5; Issue: 3; July-Sept. 2020
Website: ijshr.com
Review Article ISSN: 2455-7587
International Journal of Science and Healthcare Research (www.ijshr.com) 541
Vol.5; Issue: 3; July-September 2020
Majocchi Granuloma, Masquerading As Psoriasis:
A Review
Harsha A.M1
, Nandini H.B2
, Chaithanya K.J3
1
Dept. of Pharmacy Practice, Mallige College of Pharmacy, Bangalore, Karnataka, India.
2
Dept. of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, B.G Nagar,
Bangalore, Karnataka, India.
3
Dept. of Pharmacy Practice, Mallige College of Pharmacy, Bangalore, Karnataka, India.
Corresponding Author: Harsha A.M
ABSTRACT
Majocchi’s granuloma (MG) is a rare, atypical
yet well recognized deep infection of dermal
and subcutaneous tissue caused by
dermatophytes such as anthropophilic
Trichophyton rubrum; however, other
dermatophytes including T. mentagrophytes T.
epilans, T. violaceum, M. audouinii, M.
gypseum, M. ferrugineum, and M. canis may be
the causative agent usually limited to the
superficial epidermis. In both healthy
individuals and immunocompromised hosts MG
is characterized clinically by papular, pustular or
nodular inflammatory lesions occurring
typically on the limbs or face,
immunocompromised patients are at increased
risk for infection. A favorable factor for the
infection is an injury caused by epilation, which
together with an existing fungal infection. The
aim of this article is to provide a detailed review
on clinical manifestations, diagnosis, risk
factors, pathophysiology and pharmacological
treatment options.
Keywords: Dermatophyte, fungal infection,
immunocompromised, inflammation,
Majocchi’s granuloma, histopathology.
1) INTRODUCTION
Majocchi’s granuloma (MG) is a
folliculitic and perifolliculitic dermatophyte
infection of the dermis. [1]
It is characterized
by inflammatory papules, pustules, or
nodules, which usually occur on the limbs.
[2]
There are four well described forms of
invasive dermatophytic infections: (i)
Majocchi’s granuloma (MG), which is also
known as nodular granulomatous
perifolliculitis; (ii) deeper dermatophytosis;
(iii) disseminated dermatophytosis; and (iv)
mycetoma and pseudomycetoma caused by
dermatophytes. [1]
Majocchi's granuloma
occurs as a localized dermal infection,
usually in individuals who have chronic
dermatophytosis but are otherwise healthy.
[2]
It usually appears on the scalp, face or on
the forearms, hands or legs and as nodules
that are often grouped, but may appear
solitary. Dermatophytes usually do not
invade beyond the epidermis. However,
mechanical breakage of the skin resulted
from scratching or trauma and
immunocompromised state may allow
penetration of the fungi into the reticular
dermis. [3]
MG is a rare infection that is
mostly seen in immunocompromised
patients or those treated with topical
glucocorticoids. [4]
Dermatophytes are
highly specialized filamentous fungi of the
genera Trichophyton, Microsporum, and
Epidermophyton with capability to degrade
keratins by keratolytic enzymes. [5]
Tinea
incognito is a dermatophytic infection in
which misapplication of topical
corticosteroids modifies the clinical
appearance of fungal infection. As a result,
it can lead to misdiagnosis of
dermatophytosis. Herein we report a case of
tinea incognito caused by Microsporum
canis presenting as a Majocchi’s granuloma.
[6]
A favourable factor for the infection is an
injury caused by epilation which together
2. Harsha A.M et. al. Majocchi granuloma, masquerading as psoriasis: a review
International Journal of Science and Healthcare Research (www.ijshr.com) 542
Vol.5; Issue: 3; July-September 2020
with an existing fungal infection can lead to
the spread of folliculitis to other parts of the
body. [7]
Deep penetration of the skin by
dermatophytic agents may provoke
granulomatous inflammatory skin reaction.
[8]
2) HISTORICAL BACKGROUND
MG was first described in 1883 by
Professor Domenico Majocchi (1849-1929)
as an intracutaneous or subcutaneous
granulomatous inflammation that arose as a
result of invasion by a dermatophytic fungus
(T. tonsurans); he termed the condition
‘Granuloma tricofitico’.[9]
Majocchiin1883
stands first fungal etiology of nodular
lesions of the scalp isolating a red-violet
dermatophyte and clinically differentiating
from kerion Celsi. Majocchi masterfully
described the clinical, morphological, and
histological characteristics of the disease.
Sabouraud in his work “Les teignes” draws
Majocchi as the discoverer of the disease
where Trichophyton penetrates into the
dermis of the scalp and then provokes the
skin disease which he called Tricoficia
ciscunscripta neoplastiforme. Few studies
after Majocchi’s descriptions reflect the lack
of knowledge about disease pathogenesis,
especially on immune aspects. One of the
few reports, done by Tchernogouffand
Pelvine in 1927 in Moscow, describes
extensive cases of MG due to Trichophyton
violaceum affecting hairless skin, mucous
membranes and lymph and provoking
osteolysis; this report is apparently the first
of dermatophytic invasion away from
keratinized structures and concluded that the
fungus can survive in unkeratinized
environments. Wilson and Cremer in 1954
speculate the possibility of dermal invasion
described as nodular granulomatous
perifolliculitis caused by T.rubrum. They
described a variety of granuloma of the
hairless skin in women who shaved their
legs and had primary tinea of the feet; a new
variety of trichophytic granuloma, now
called Wilson’s granuloma, which is
currently the most commonly observed in
clinical practice. Hadida in 1957 described
the dermatophyte diseaseas a granulomatous
infection that spreads and generalizes to all
organs and usually affects
immunosuppressed patients, and usually
leads to a poor prognosis; however, Smith
and Blanck in 1960 successfully tested
griseofulvin in 10 patients with this disease.
Beiranaand Novales in 1959 described the
first case of MG in Mexico; since then,
several cases have been described by
different authors. [5,8,10]
3) EPIDEMIOLOGY
MG is a global disease because the
causative agents are omnipresent fungus in
humans and are easily adapted to the
environment that surrounds them. [5]
Trichophyton mentagrophytes is considered
to be a zoophilic fungus with a worldwide
distribution and a wide variety of animal
hosts including mice, horses, sheeps and
rabbits. [11]
It is estimated that prevalence is
63.5% (33) and 36.5% (19) among men and
women respectively in 52 enrolled patients.
Estimates from Department of
Dermatology, Seoul National University
Hospital (SNUH), Seoul, Korea, from
January 2001 to December 2016.[12]
Recent
studies suggest that it prevails on women in
ratio 3:1; this can be explained on the basis
of women because they are more susceptible
to develop tinea captitis after puberty. In
cases of hairless skin, it can also be
explained because they often shave their
legs. When MG is present in men, it is
familiar to associate with
immunosuppression.[5]
The prevalence of
dermatophytosis among transplant
recipients has been reported between 10%
and 25%.[13]
MG can be frequently seen
between 3rd
and 4th
decade of life. General
cases usually occur in children between 3
and 5 years. [5,12]
T.rubrum is the most
common cause for dermatophytic infection
in men, whereas M.canis is more frequently
found in women. [12]
A recent case studies
reported severe infection with Trichophyton
interdigitale occurring in a number of
immunocompetent adults in Germany, after
travelling to South East Asia.[4]
A more
3. Harsha A.M et. al. Majocchi granuloma, masquerading as psoriasis: a review
International Journal of Science and Healthcare Research (www.ijshr.com) 543
Vol.5; Issue: 3; July-September 2020
recent study in US indicated that 60% of
college wrestlers and 75% of high school
wrestlers had tinea corporis
gladiatorum.[14,15]
Although lower
extremities (48%) were reported to be the
most common site of infection in
immunosuppressed patients and from past
5years facial involvement (34.5%) has been
predominant in immunocompetent
patients.[12,16]
4) CLASSIFICATION
There are two forms of Majocchi’s
granuloma;
a) Small perifollicular papular form: The
superficial perifollicular form, which is
caused by Trichophyton rubrum, occurs
mainly on the legs of otherwise healthy
individuals, especially on women who
shave their legs.[1,6,10]
A rare case of
superficial perifollicular form of
Majocchi’s granuloma caused by T.
rubrum that was found on the scrotum of
a healthy man.[3]
The follicular type
usually develops after trauma which is
mostly observed in the lower
extremities, repeated shaving of hair-
bearing legs, or topical corticosteroid
treatment and in cases of long-standing
immunosuppression.[7,8,16]
b) Deep subcutaneous nodular form: The
deeper form is usually seen in
immunosuppressed individuals and is
characterized by firm or fluctuant
nodules which usually appear on the
upper extremities like scalp, face or
hands and forearms. [1,3,7,8,10,16]
In the
deeper and severe form, Majocchi’s
granuloma may simulate various skin
diseases such as bacterial cellulitis, non-
tuberculous mycobacterial infections,
and other non-infectious skin diseases
making diagnosis delayed.[1]
5) ETIOLOGY
MG is a rare dermal and
subcutaneous granulomatous inflammation
caused by dermatophytes.[8,12,13,16,17]
Concurrent superficial dermatophyte
infection presented with MG include Tinea
corporis, T. pedis, T. unguium, T. cruris, T.
manus, T. capitis, T. barbae, T. incognito
and T. faciale.[6,11,12,14,15,18]
Dermatophytic
fungi are highly specialised keratinophilic
and keratinolytic fungi that consist of eight
genera : Epidermophyton, Trichophyton,
Trichosporon, Microsporum and recently
introduced Arthroderma, Paraphyton,
Nannizzia and Lophophyton.[5,9,13,16,17]
Dermatophyte infections can occur through
many modes including:
Contact with an infected animal
(zoophilic dermatophytes - direct
infection)
Contact with a sick person or a person
carrying dermatophytes (anthropophilic
dermatophytes - direct infection)
Contact with exfoliated skin or hair that
contain dermatophytes (indirect
infection). [7]
Although MG is primarily caused by
keratinophilic dermatophytes such as
anthropophilic Trichophyton rubrum.[12-23]
Also, species from Aspergillus and
Phomagenera have been occasionally
detected as etiologic agents of MG.[5,8,9,13,16]
Other dermatophytes causing MG include;
T.mentagrophytes[12,13,16,17,19,22,24]
M.canis[15,22]
T.violaceum[8,17,22]
T.epilans[2,3]
T.verrucosum[15]
T.tonsurans[13-15,20]
M.ferrugineum[22]
M.audouinii[5,22]
M.gypseum[22]
Aspergillus fumigatus[5,9]
Epidermophyton floccosum[7,16]
T.interdigitale[16]
Trichosporoncutaneum[5]
T.schoenleinii[5]
M.gallinae[7]
M.nanum[7]
T.equinum[7,15]
N.gypsea[16]
6) RISK FACTORS
Sex
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Women: It is more likely to affect legs
of women who is often associated with
frequent shaving of legs. [1,4-7,16,22]
Men: It is less likely to cause men.
When MG is present in men, it is
familiar to associate with
immunosuppression, razor trauma and
implanting of organisms beneath the
skin.[5,9,22]
Superficial fungal infection:
ex: dermatophytosis of the buttock, foot
or toenail progressively disseminates
into the subcutaneous tissues.[1,9,12, 21]
Systemic or Local immunosuppression:
Systemic immunocompromised status
was reported in patients with diabetes
mellitus, organ transplantation,
Cushing’s disease, acquired immune
deficiency syndrome (AIDS), acute
lymphocytic leukaemia, breast cancer on
chemotherapy, liver cirrhosis, psoriasis
treated with methotrexate, persons with
primary T cell deficiency syndromes
[1,2,4,5,9,12,16,20]
and also in cases in cases
of idiopathic interstitial lung disease,
Bechet’s syndrome, CREST syndrome,
Raynaud’s phenomenon, rheumatoid
arthritis, systemic lupus erythematosus,
bullous pemphigoid.[5,9]
Both cellular
immunity and the inflammatory
response, including defects in neutrophil
production and function, and/or
chemotaxis are crippled in these persons
due to use of immunosuppressive
drugs.[2,5,9,13]
Immunosuppressive drugs
include systemic corticosteroids,
tacrolimus, azathioprine, mycophenolate
mofetil, cyclosporine, systemic
chemotherapy, methotrexate,
adalimumab, abatacept and anti-
thymocyte globulin.[9,16,19,24]
Chronic dermatophytosis: T. rubrum
triggers a low-titer humoral response
through specific IgE antibodies, which
may interfere or block cellular
immunity. Especially in patients with
chronic dermatophytosis, such
antibodies are ineffective to control
and/or eliminate the infection.[5]
Hair follicle injury: this allows
dermatophyte passive income to the
dermis. Within the dermis, the alkaline
medium and the keratin present in the
injured follicle provide a suitable
substrate for fungus growth.[5,16]
Animal exposure: It is noted that
domestic and wild animals may be
carriers of pathogenic fungi. The most
common disease transmitting carriers
are cats, guinea pigs, mice, rats and
hamsters.[1,6,11,16]
Solid organ transplant (SOT) recipients:
MG was reported in SOT recipients who
underwent renal, cardiac, liver
transplants and facial tissue
allotransplantation.[5,7,9,13,16,17,21]
Long term use of potent topical steroid:
long term use of potent topical steroid is
more likely to cause MG.[17,18,22]
Sexual activity: Sexual activity appears
to be a major risk factor for acquisition
and transmission of such infections.[4,16]
Infected individuals: Exposure to factors
such as epidermal scales, microscopic
fragments of the nails and hair of
infected individuals.[7]
Wrestlers: Cutaneous infections are
relatively common among athletes,
especially wrestlers due to close contact
between opponents and the large
percentage of abrasions involved in the
sport.[14,15]
Trauma: Physical trauma from
scratching because of tinea cruris
formed follicular disruption of the
scrotal skin, which leads to the
migration of T. rubrum into the dermis,
in turn leads to Majocchi’s
granuloma.[2,3,6,7,12,16,22]
7) CLINICAL MANIFESTATION
The clinical presentation of infections
caused by dermatophytes depends on many
factors: host’s defences against fungi,
virulence of the infecting microorganism,
anatomical site of infection and
environmental characteristics. It is possible
that association of alcoholism/
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immunosuppression resulted in the severity
of the clinical manifestations. [20]
General features: multiple types of
lesions appeared both in
immunocompetent and
immunosuppressed groups. The most
predominant forms were nodules and
plaques. [16]
Lesions are more common
in extremities, rarely shows cephalic
involvement. [20]
plaques: first phase is characterized by
erythematous plaques with short hair
pustules and crusts are observed on the
erythematous plaques. Dark erythematous
plaques with painless nodules appear and
disappear over months with or without
exudates that can go yellowish pink to frank
purulent. Deep plaque lesions are seen in
immunocompromised patients. [8,22,24]
nodules: Second phase is nodular phase that
is characterized by true nodules of
approximately 2cm, which acquire a red-
violet coloration, and are painful to
palpation and usually tend to be outward
forming ulcers, which are the main
constituent of the third phase. Firm or
fluctuant nodules are seen on scalp, face or
hands and forearms. Nodular lesions were
detected in 53.3% and 65.3% of cases in
immunosuppressed hosts and healthy
individuals respectively. [13,14,17]
pruritus: pruritic border, usually progressing
to the second nodular phase characterized
by large nodules (upto 3cm) and tend to
cluster as a “nodosum cord” that eventually
evolves into the final phase. [13,14]
Inflammatory papules: numerous skin-
coloured hard papules like red-purple or
occasionally brown papular lesions are seen
and may resolve without cutaneous scarring.
[1,3,9,12,19,24]
patches: painful brownish patchy rash can
be seen. M.canis usually develop multiple
annular patches. [3,4,12]
erythema: coin-sized, ring-shaped erythema
can be seen.[11]
pustules [12,19]
slight tenderness [9]
swelling [9,13]
crusts: crust can also be seen on
lesions.[6,9,13]
itching [11]
scaling [11,14,18]
rash [11]
pus [13]
easy bleeding [13]
Table 1: Majocchi’s Granuloma in Immunocompetent and Immunocompromised patients [25]
CHARACTERISTICS IMMUNOCOMPETENT PATIENTS IMMUNOCOMPROMISED PATIENTS
Locations Follicular type Follicular or subcutaneous nodular type
Mechanism Trauma or local immunosuppression Trauma or systemic immunosuppression
Clinical presentation Clustered erythematous, perifollicular
papules or small nodules or pustules
Clustered erythematous, perifollicular papules or small
nodules or subcutaneous nodules with abscesses. Rare
systemic dissemination.
Associated conditions Atopic dermatitis, topical steroid use,
occlusion, leg shaving, scratching.
Leukemia or lymphoma, autoimmune diseases, high dose
chemotherapy, post-organ transplantation, inherited
CARD9 deficiency, biologics
8) PATHOPHYSIOLOGY
The pathogenesis of MG is not
entirely known; however, some mechanisms
have been proposed. It is believed that the
initiating factor is the physical trauma that
leads directly or indirectly to changes in the
follicle and consequently to the passive
introduction of the fungus, keratin, and
necrotic material in the injured hair
follicle.[5,16]
The first and most important
host factor is a physical skin barrier that
prevents fungal skin infections.[16]
MG
described a phenomenon in dermatophytes,
usually limited to stratum corneum become
more aggressive and invade the superficial
dermis.[22]
This invasion occurs because of
damage to the epidermal barrier’s integrity
and follicular disruption; thus,
microorganisms, along with keratin and
necrotic materials, can enter the dermis.[5,16]
One of the most important factors related to
fungal progression is the secretion of several
enzymes as proteases, lipases, elastases,
collagenases, phosphatases and esterases.
These proteins degrade the keratin which
acts as media for continuing growth in non-
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living keratinized tissues to survive and
therefore facilitate the dermatophytic
adherence and penetration to the stratum
corneum. [5,16, 22]
Fungi must hide from the
host’s immune system, and they cause an
inflammatory response during infection.
Fungal LysM domain-associated proteins
mask chitin on the fungal cell wall and
regulate fungal growth and development. [16]
The microorganisms express several genes
that encode the key components of the
glyoxylate pathway (i.e. isocitrate lyase and
malate synthase) and excrete a large amount
of sulfite to degrade the components of the
skin. [16]
Protective Factors
In immunocompetent patients, there
are several factors that protect against deep
invasion by dermatophytes, e.g., the non-
specific serum factor inhibitor (NSFI) and
the physical environment in the dermis
(PED). The NSFI plays an important role by
suppressing the growth of dermatophytes
and limiting their penetration into the
dermis. This factor is also associated with
the unsaturated transferrin, related to
inhibition of dermatophytes by binding to
iron, which is required for fungus growth.
Moreover, in regard to the PED, its function
is to block the invasion of dermatophytes to
the dermis; the major components of PED
are the production of keratin, epidermal
turnover rate, and the degree of hydration of
the skin, the lipid composition of the
stratum corneum, the CO2 tension, and the
presence or absence of hair. [5]
(Figure 1) Pathogenesis of invasive dermatophytosis
NOTES: physical trauma impairs the epidermal barrier. Penetration of the dermatophytes into the skin causes a granulomatous,
inflammatory response, including neutrophils (N), eosinophils (E), lymphocytes (T), macrophages (M) and multinuclear giant cells
(MGC). Majocchi’s granuloma (A), mycetoma (B), deeper dermatophytosis (C) and disseminated dermatophytosis (D) [16]
9) DIAGNOSIS
The presence of non-tender, usually
unilateral, erythematous or purplenodules,
papules, and plaques that are refractory to
the initial treatment should elicit a high
degree of suspicion. [9]
Diagnosis is based
on clinical, mycological, cytologic and
histological characteristics. Clinical,
cytologic and/or mycological diagnoses
should be confirmed by demonstration of
perifollicular granulomatous inflammation
by histopathological examination. [5,9]
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a) Histopathological analysis: Histological
examination is considered the gold
standard; key findings include
granulomas in the middle and deep
dermis; they are usually well
constituted, and either foreign body type
and/or Langhans type granuloma;
dermatophyte structures are identified in
the form of hyphae and/or
conidia.[5,12,16,20]
The cases were
confirmed by histopathological analysis,
with evidence of dermatophytes using
hematoxylin and eosin (H&E) staining
and Grocott methenamine silver (GMS),
or Periodic acid–Schiff (PAS)
staining.[12]
Histopathologic sectioning
reveals perifollicular granulomatous
inflammation with dermal abscesses.
[3,9,19]
Biopsy: Biopsy sections from all
patients were examined under polarized
light. Acanthosis was present to varying
degrees in most biopsies. Capillary
proliferation, vascular ectasia, and
extravasated red blood cells were also
present in all lesions. Fibrinoid changes
within vessels were occasionally seen.
[1,2]
A punch biopsy of the papule
showed numerous spores within and
around the hair follicles and a dense
perifollicular suppurative inflammation.
[14,18]
A scalp biopsy revealed follicular
fungal invasion.[20]
Periodic acid Schiff (PAS) and Grocott
methenamine silver (GMS) staining:
These are confirmatory stains. PAS and
GMS stains demonstrated hyphae and
arthrospores in the keratin layer and
fungal elements were found in the
dermis.[2,9,13]
PAS positive matrix
material represents antigen-antibody
complexes.[2]
GMS staining can be more
helpful because it is distinct from PAS
staining. Although GMS staining has
advantage over PAS because it has
better ability to detect on low- and
intermediate-power microscopy.[16]
Figure 2: Closer view of perifollicular abscess, showing
numerous fungal hyphae, with unusual bulbous dilatation of
hyphal segments (periodic acid-schiff stain). [17]
Hematoxylin and eosin (H&E) staining:
when histopathologic examination is
performed with the hematoxylin-eosin
stain; a mixed cell, granulomatous
inflammatory reaction in the dermis is
revealed.[6,9,12]
Mucicarmine stain and colloidal iron
(AMP): The mucicarmine stain and
colloidal iron (AMP), with and without
hyaluronidase digestion, were performed
in the cases in which blocks were
available.[2]
b) Direct examination
Fungal cultures: KOH examination of
the scraped materials and
histopathologic examination of the skin
biopsy are often difficult to identify
fungus; clinical suspicion with fungus
culture is needed. Preferred cultures
include standard media such as
Sabouraud dextrose agar, and Sabouraud
dextrose agar+antibiotics; it is advisable
to select thick exudates draining ulcers
or get the material to an open nodule
with a scalpel.[8,17,23]
c) Cytologic examination: Cytologic
examination can also be performed.
Samples may be taken by a slit-skin
smear or fi ne-needle aspiration and can
then be quickly stained using the May-
Grünwald-Giemsa method. Hyphae and
spores can be detected in foreign body-
type giant cells.[9]
d) Mycologic examination
KOH Test: Fungal hyphae can be
observed by the potassium hydroxide
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(KOH) test. Upon direct microscopic
examination of the extracted hairs, the
fungi were detected mostly as an
ectothrix mosaic mantle of rather large
spherical or oval spores. Direct
examination (KOH 10%) of scales and
hairs helps demonstrate endothrix,
which is usually associated to the genus
Trichophyton. [5,9,11,13,16,19]
10) DIFFERENTIAL DIAGNOSIS
Due to the presence of pain in these
lesions, they are usually recognised as
symptoms of bacterial infections, and this
confusion results in patients receiving
antibiotic treatment. Other chronic
infections may also be misleading. [16]
If the
confirmatory stains are also negative, the
histopathologic findings may be confused
with other granulomatous diseases. [9,16]
We
now consider MG as a localized
‘dermatophytic granuloma’. Therefore, the
correct diagnosis of MG relies upon a high
degree of clinical suspicion followed by
skin biopsy with pathologic correlation and
fungal cultures of biopsy materials. The
disease should be differentiated from
several diseases that present with papules,
nodules, or plaques. Additionally, when
Phoma sp. and A.fumigatus are included as
the etiologic fungi contributing to MG, a
differential diagnosis to distinguish it from
other diseases, such as hyphomycosis and
phaeohyphomycosis, is required.[9]
The
differential diagnosis is extremely wide due
to its location and clinical picture. It
includes many dermatologic diseases such
as acne vulgaris, lupus miliaris disseminates
faciei, insect bites, granulomatous rosacea,
sarcoidosis, cutaneous tuberculosis,
cutaneous leishmaniasis, bacterial or fungal
cellulitis, eosinophilic cellulitis,
eosinophilic or other panniculitis,
eczematization of psoriasis, inverse
psoriasis, kaposi’s sarcoma, nodular
erythematosus, gastritis, foreign body
granuloma and contact dermatitis.[1,7,9,16]
In
addition to histopathology, bacterial, fungal,
and parasitic examinations, as well as
polymerase chain reaction and other
molecular diagnostic tools, are crucial for
reliable organism detection.[16]
1. Tissue homogenate cultures: this may be
used to detect dermatophyticfungi.[8,9]
2. ELISA-PCR: molecular-based
techniques, such as PCR may be used to
detect dermatophytic fungi.[9,11]
3. Internal transcribed spacer (ITS)
sequencing: in immunocompromised
patients, it is important to use molecular
based techniques such as ITS
sequencing for identifying fungal
species.[16]
4. Light microscopy: Confirmatory test to
diagnose MG is light micropscopy.[5]
On
microscopy, numerous fusiform and
rough-walled macroconidias were
observed after lactophenol cotton blue
staining.[6-8,16]
11) TREATMENT
a) Pharmacological therapy
For the treatment of Majocchi’s
granuloma, topical antifungals are usually
ineffective due to their poor penetration into
the deeper layers of the skin. However, they
are often prescribed in combination to
systemic antifungal therapy in the treatment
of MG. [1,3,7,9]
In modern medicine, the GOLD
STANDARD of treatment for MG is
systemic antifungals such as griseofulvin;
itraconazole and terbinafine are the
mainstays of therapy as they are safe and
effective. [3,8,12]
Duration of therapy should be of at
least 4-8 weeks and treatment should be
continued until all lesions are cleared. In the
reports of literature, nearly all lesions
resolve without scarring within 6 weeks of
starting antifungal. [8,9,16]
Depending on the severity of disease, the
duration of MG treatment varies from 1 to 6
months. [16]
Terbinafine: It is the preferred oral
therapy for treating MG not only for its
superior efficacy in eliminating
dermatophytes, but also because of its
greater selectivity for the skin structures
involved in MG. [14,18]
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Dose: 250mg/day for 4-6 weeks. [7,9]
Advantages: fewer drug interactions
than azole antifungals, adequate
penetration into common sites of
dermatophyte infection, lower rates of
recurrence and its cost effectiveness
when long-term therapy is assured to
prevent relapse. [7,9]
Griseofulvin: It is undoubtedly the best
therapy for MG since Blanck and Smith
first used. [5,23]
Dose: 0.5-1g/day for 4-6weeks. [5,16,22]
Itraconazole:
Dose: oral itraconazole 100-200mg
twice daily for 20-30 days. [1,5,7]
Voriconazole:
Dose: 200mg twice daily for 4 months.
[5,16]
Fluconazole:
Dose: 200mg once weekly for total of 3
weeks. [13,15]
Ketoconazole:
Dose: 200mg/day for 30-90days. [5]
Econazole nitrate
Dose: topical cream 1% for 6 months.
[13]
Clotrimazole:
Dose: topical cream 1% w/w twice daily
for 3 weeks. [15]
Amphotericin B:
Dose: 1mg/kg daily for 9-10 days. [13]
It is important to avoid long-term refillable
prescriptions for antifungal and strong
topical steroid combinations. Patients
continue to use them in unusual situations
and suffer many side effects. [22]
Traditional therapy
This therapy included oral potassium
iodide, mildly filtered local X-radiation
and topical applications of 2-
dimethylamino-6-benzothiazole as a
fungicide in both tincture and ointment
forms. [9,16]
Nitrogen cryotherapy
Nitrogen cryotherapy can be used as an
additional modality in persistent skin
lesions after antifungal systemic
treatment. [5,12]
Surgical approach
Surgical approach includes incision and
drainage or surgical excision. [13]
Surgery was used as rescue therapy
along with itraconazole, after
nephrotoxicity developed while
receiving Amphotericin B. [13]
Surgical excision is recommended as a
treatment for deep fungal infections in
primary-origin immunosuppressed
patients, although it is often
recommended to combine surgical
therapy with systemic antifungals. [5]
Multi-therapy approaches
Multi-therapy approaches included the
combination of
Amphotericin B and Terbinafine,
Surgery and fluconazole,
Surgery and griseofulvin. [13]
12) COMPLICATIONS
Alopecia: Individuals can be
predisposed to MG by the long-standing
natural occlusion of the hair follicle.
[14,16]
Scarring. [4,16]
Post-inflammatory pigmentation. [16]
Fungalsepticaemia: It is a potential
complication in immunocompromised
patients.[1,10]
Bacterialcellulitis. [1,10]
Scaly erythematous plaque. [14]
Non-
tuberculousmycobacterialinfections. [1,10]
13) CONCLUSION
The diagnosis of MG should be
verified by histological examinations, and
PAS or GMS staining reveals evidence of
the infection. MG can mimic several other
infections; therefore, it is important to
differentiate MG and begin treatment as
soon as possible. [16]
MG can occur in both
immunocompetent (62%) and
immunosuppressed (38%) hosts. Patients
receiving immunosuppressive treatments
that lead to a reduction of cellular immunity
are at increased risk for MG.
Histopathologic examinations reveal a deep
suppurative and granulomatous folliculitis
in patients with MG. [9]
The diagnosis of
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MG is possible after conducting a thorough
dermatological examination, including a
detailed interview, physical and
mycological evaluation. Even though this
diagnosis is rare in daily clinical practice, it
is imperative to keep Majocchi’s granuloma
or other fungal infections as a potential
differential especially since more
immunosuppressed agents (e.g. steroids,
biologic agents) are being used as treatment
preferences in the general population. [7]
MG is one of the manifestations of the
indiscriminate use of steroids and other
causes of immunosuppression. [5]
Source of funding: None.
Conflict of interest: None.
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How to cite this article: Harsha AM, Nandini
HB, Chaithanya KJ. Majocchi granuloma,
masquerading as psoriasis: a review.
International Journal of Science & Healthcare
Research. 2020; 5(3): 541-551.
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