Deep mycoses: causes, symptoms, diagnosis, treatment

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

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

Symptoms of chromomycosis

The disease is characterized by a relatively benign course with a tendency to progress and the formation of granulomatous-verrucous rashes. The disease is characterized by lesions mainly of the lower extremities. At the site of the pathogen's introduction, a red tubercle appears after a few days, and sometimes months. The element grows slowly, accompanied by the appearance of new similar elements (tuberculous stage). As a result of the fusion of elements, a deep infiltrate is formed in the form of a conglomerate of tubercles, which resembles warty tuberculosis. The tubercles are large (up to a walnut and even a chicken egg), sharply rise above the skin, have scalloped outlines. After they open, an ulcer with a papillomatous bottom is formed (papillomatous-ulcerative stage). When nodes appear, a gummatous form is formed. Sometimes several clinical varieties are combined. The formation of keloid scars is possible. The pathological process can be located on the skin of the face, body or on the mucous membranes.

Histopathology

In all clinical varieties of chromomycosis, the histological picture is uniform and is characterized by a chronic infected granuloma with subcorneal and intradermal microabscesses, characteristic spherical bodies of the pathogen, surrounded by leukocytes, epithelioid and giant cells.

Diagnosis and differential diagnosis

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

Treatment of chromomycosis

Cryotherapy, surgical excision, and electrocoagulation of elements are performed. Intravenous drip or intralesional administration of amphotericin B (in a 2% solution of novocaine), oral administration of nizoral, itraconazole (teknazole, orungal, etc.), iodine preparations taken orally in courses over 2 months with breaks of 2-3 weeks are recommended; locally - antiseptic solutions and antifungal ointments.

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