Deep mycoses: causes, symptoms, diagnosis, treatment

The group of deep (systemic) mycoses of the skin include fungal diseases, in the clinical picture of which morphological elements such as tubercles, nodes prone to decay with the formation of ulcers and lesions of deep layers of skin, subcutaneous tissue, underlying muscles, bones, internal organs prevail. This course of the disease determines the variety of the clinical picture and sometimes severe general symptoms, not precluding death. A characteristic feature of deep mycoses is their weak contagiousness, the duration of the course, the torpidity of the therapy, the spread of the pathogens of these diseases in the soil, on plants like saprophytes, mainly in the tropical climate. Infection occurs when infection of skin injuries, scratches, cracks. The group of deep mycoses includes blastomycosis North American, blastomycosis haloid, sporotrichosis, chromomycosis and a number of other mycoses.

Chromomycosis is a chronic granulomatous fungal disease of the skin. Characterized by warty, sometimes ulcerative lesions of the skin and subcutaneous tissue, in some cases combined with the defeat of internal organs (liver, brain) and bones. It is more common in areas with a tropical and subtropical climate. The causative agent of the disease is Hormodendram pedrosoi, which is found in soil and on plants. Infection occurs when a skin injury.

Symptoms of Chromomycosis

The disease is characterized by a relatively benign course with a propensity to progress and the formation of granulomatous-verruzed rashes. For the disease, the predominantly lower limbs are affected. At the site of the pathogen in a few days, and sometimes months, a red bump appears. The element grows slowly, accompanied by the appearance of new similar elements (tubercle stage). As a result of the fusion of elements, a deep infiltrate is formed in the form of a conglomerate of tubercles that resembles warty tuberculosis. The bumps are large (up to the walnut and even the chicken egg), abruptly rise above the skin, have a scalloped outline. After their opening, an ulcer with a papillomatous bottom (papillomatous-ulcerative stage) is formed. When the nodes appear, a gummy form is formed. Sometimes several clinical varieties are combined. Possible formation of keloid scars. The pathological process can be located on the skin of the face, trunk or mucous membranes.

Histopathology

With all clinical varieties of chromomycosis, the histological pattern is the same and is characterized by chronic infected granuloma with subcorneal and intradermal microabscesses, characteristic spherical corpuscles of the causative agent, surrounded by leukocytes, epithelioid and giant cells.

Diagnosis and differential diagnosis

The diagnosis is confirmed by the mandatory detection of fungal elements and the isolation of the culture of the pathogen. Differentiate chromomycosis from skin tuberculosis, chronic pyoderma, other deep mycoses (sporotrichosis, blastomycosis).

Treatment of chromomycosis

Cryotherapy, surgical excision, electrocoagulation of elements are carried out. Recommended intravenous drip or intraocular injection of amphotericin B (in 2% solution of novocaine), ingestion of nizoral, itraconazole (tecnazol, orungal, etc.), iodine preparations inside the courses for 2 months with interruptions of 2-3 weeks; local - antiseptic solutions and antifungal ointments.

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