This document discusses various mycoses (fungal infections) that affect humans. It describes 10 specific mycoses - mycetoma, chromomycosis, sporotrichosis, rhinosporidiosis, subcutaneous phycomycosis, cryptococcosis, blastomycosis, paracoccidioidomycosis, coccidioidomycosis, and histoplasmosis. For each, it provides details on the causative agents, clinical manifestations, pathogenesis, diagnosis, and laboratory identification. Key diagnostic methods mentioned include microscopy, histopathology, culture, and serology. The document is intended as an educational reference for medical professionals regarding these important fungal diseases.

1. By – Dr.D.W.Deshkar
Assistant Professor, Deptt of Microbiology
D.Y.Patil Medical College ,Kolhapur.

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3. 
1. Mycetoma (Eumycotic)
2. Chromomycosis
3. Sporotrichosis
4. Rhinosporidiosis
5. Subcut. Phycomycosis
1. Cryptococcosis
2. Blastomycosis
3. Paracoccidioidomycosis
4. Coccidioidomycosis
5. Histoplasmosis

4.  1.Mycetoma – Is a slowly progressive, chronic granulomatous
infection of skin & subcutaneous tissues with involvement of
underlying fasciae & bones usually affecting extremities.
 This disease is defined by triad of tumefaction (swelling) of
affected tissue, formation of multiple draining sinuses &
presence of oozing granules.
Gill (1842) – Madurai, South India – also known as
Maduramycosis or Madura foot.
 Nocardia sps, Actinomadura sps,
Streptomyces sps, Allescheria sps,Madurella sps, Phialophora
sps, etc.

6.  TYPES OF MYCETOMA & CAUSATIVE AGENTS-
 Mycetoma – Two types – Can be caused by either fungal agents
(eumycetoma) or bacterial agents ( actinomycetoma). They differ
from each other by various properties like color of granules /
grains & clinical manifestation.
 A third category c/a botryomycosis – refers to mycetoma like
condition caused by some bacteria such as Staphylococcus aureus.

8. EUMYCETOMA ACTINOMYCETOMA
BLACK GRANULES WHITE TO YELLOW GRANULES
Madurella mycetomatis Nocardia species
Madurella grisea Streptomyces somalensis
Exophiala jeanselmi Actinomadura madurae
Curvularia species
WHITE GRANULES PINK TO RED GRANULES
Pseudallescheria boydii Actinomadura pelletieri
Aspergillus nidulans
Acremonium species
Fusarium species

9.  PATHOGENESIS –
 The causative agents enter the skin or
subcutaneous tissue from the
contaminated soil, usually by the
accidental trauma such as thorn prick or
splinter injury. Then the disease evolves
slowly; initially micro abscesses are
formed. The organism is in the centre of
microabscess formed by
polymorphonuclear leukocytes. The main
characteristic is the presence of
aggregates of filaments of causative
organisms in the centre of the chronic
inflammatory activity.

10.  CLINICAL MANIFESTATION -
CLINICAL
MANIFESTATION
EUMYCETOMA ACTINOMYCETOMA
Tumor Single, well defined margin Multiple tumor masses with ill defined margins
Sinuses Appear late, few in number Appear early, numerous with raised inflamed
opening.
Discharge Serous Purulent
Grains Black/white White/red
Bone Osteosclerotic lesions Osteolytic lesions
Grains contain Fungal hyphae (> 2 m) Filamentous bacteria (> 2 m)

11.  LABORATORY DIAGNOSIS -
 Specimen collection – Lesions cleaned with antiseptics & the grains are
collected on sterile gauze by pressing the sinuses from periphery or by using a
loop.

12.  LABORATORY DIAGNOSIS -
 Direct Examination – Granules washed in sterile saline, crushed between the slides &
examined
1. Macroscopic appearance of granules – color, size, shape, texture – provide imp clue to
identify etiological agent.
2. If eumycetoma is suspected – Grains are subjected to KOH mount, which reveals
hyphae of 2 – 6 m width along with chlamydospores at margins.
3. If actinomycetoma is suspected – Grains are subjected to Gram staining, which reveals
filamentous gram positive bacilli( 0.5 – 1 m width) Modified acid fast stain is
performed if Nocardia is suspected as it is partially acid fast.
4.Histopathological staining of the granules – Eumycetoma : Reveals granulomatous
reaction with palisade arrangement of hyphae in the cement substance.
Actinomycetoma : Shows granulomatous reaction with filamentous bacteria at the
margin.

13.  LABORATORY DIAGNOSIS -
 Culture – Granules from deep biopsies – Best specimen for culture as they contain
live organisms. Both fungal (e.g. SDA) & bacteriological media ( L.J. medium) should
be included.
 Identification of the eumycetoma – carried out by observation of the growth rate,
colony morphology, production of conidia, & their sugar assimilation tests.
 Actinomycetoma – identified by their growth rate, colony morphology, urease test,
acid fastness, & decomposition of media containing casein, tyrosine, xanthine.
 TREATMENT –
 Surgical removal followed by use of
1. Antifungal agents for eumycetoma ( itraconazole or amphoteracin B for 8 – 24
months).
2. Antibiotics for actinomycetoma such as amikacin + cotrimoxazole).

14.  2. CHROMOMYCOSIS -
 Clinical manifestations caused by various dematiaceous (pigmented) fungi.
a. CHROMOBLASTOMYCOSIS - Refers to a slow growing chronic subcutaneous
lesions caused by group of dematiaceous or phaeoid fungi ( i.e. darkly pigmented
fungi) that produce a characteristic morphology called sclerotic body.
Causative Agents -
1. Fonsecaea species ( F.pedrosoi, F. compacta)
2. Phialophora verrucosa
3. Cladosporium carrionii
4. Rhinocladiella aquaspersa

15.  2. CHROMOMYCOSIS -
 Clinical manifestations caused by various dematiaceous (pigmented) fungi.
a. CHROMOBLASTOMYCOSIS -
 Lesions - Lesions consists of warty nodules resembling florets of cauliflower –
confined to subcutaneous tissue of the feet & lower legs.
 Rarely, dorsum of the hands, elbow, wrist, buttocks, shoulder, neck & face.
 Most commonly seen in Tropical & Subtropical climates, often in rural areas.

16.  2. CHROMOMYCOSIS –
a. CHROMOBLASTOMYCOSIS -

17.  2. CHROMOMYCOSIS –
a. CHROMOBLASTOMYCOSIS -
a) Chromoblastomycosis :
 Entry – traumatic implantation – lesion
develops slowly.
 Histologically in the lesion – fungus seen as
round or irregular, dark brown, yeast-like
bodies with septae, called ‘Sclerotic bodies

18.  2. CHROMOMYCOSIS –
a. CHROMOBLASTOMYCOSIS -
 Diagnosis – demo. Of these Sclerotic cells in KOH mount or in
section & by culture on Sabouraud Agar.

19.  2. CHROMOMYCOSIS –
b) Phaeohypomycosis : -
 Refers to chronic subcutaneous lesions caused by dematiaceous or phaeoid
fungi other than that are described in chromoblastomycosis ( i.e. they do not
produce sclerotic bodies), They exist in mycelial form. Agents include :
 Alternaria species
 Bipolaris species
 Curvularia species
 Exophiala species
 Cladophialophora bantiana
 Phialospora

20.  3. SPOROTRICHOSIS –
 Sporotrichosis or Rose Gardener’s disease is presented as subcutaneous nodulo
– ulcerative lesions; caused by a thermally dimorphic fungus
 Pathogenesis: Spores of S.schenckii are introduced into skin following minor
trauma caused by thorn prick or splinter injury. Enzymes secreted by the fungus,
such as serine proteinase & aspartic proteinase help in local invasion. S.schenckii
has a typical tendency to spread along the lymphatics.

21.  3. SPOROTRICHOSIS –
 Clinical Manifestations : Sporotrichosis is a
chronic subcutaneous pyrogranulomatous
disease.
 I.P. : 3 weeks.
 Clinical types –
1. Lympho – cutaneous type - Most common
type (80%) – characterized by-
Nodulo – ulcerative lesions (painless)
occurring along the lymphatics.
Lymph nodes enlarged, suppurative,
indurated & have cord like feeling on
palpation.

22.  3. SPOROTRICHOSIS –
 Clinical types –
2. Other clinical types –
Osteoarticular – in alcoholics.
Pulmonary type – Occurs following spore inhalation,
in patients with COPD
Disseminated sporotrichosis – in
Immunocompromised patients (AIDS).
Fixed cutaneous type – Single nodule, less
progressive & does not spread by lymphatics.
Endemic in Mexico.

23.  3. SPOROTRICHOSIS –
 Laboratory Diagnosis –
 Direct microscopy – Specimens such as pus, aspirate from nodules, curettage or
swabbing from ulcers – subjected to KOH mount or calcofluor staining - reveals
elongated yeast cells of 3 – 5 m in diameter.
 Histopathological staining – ( e.g. H & E) of tissue sections – shows cigar shaped
asteroid bodies ( central basophilic yeast cells surrounded by radiating
extensions of eosinophilic mass composed of Ag – Ab complexes – c/a Splendor
– Hoeppli phenomenon.
 Culture – Specimens – inoculated on SDA & Blood agar in duplicate & incubated
at 250C & 370C simultaneously – as it is a dimorphic fungus.

24.  3. SPOROTRICHOSIS –
 Laboratory Diagnosis –


25.  3. SPOROTRICHOSIS –
 Laboratory Diagnosis –
 Culture – Specimens – inoculated on SDA & Blood agar in
duplicate & incubated at 250C & 370C simultaneously – as it is
a dimorphic fungus.
 At 250C – produce mycelial form, consisting of slender delicate
hyphae with conidia arranged in flower like pattern.
 At 370C – produces yeast form, characterized by moist creamy
white colonies becoming brown black in 10 – 14 days.
 Serology - Latex agglutination test detects serum antibodies.
 Skin test – Demonstrate delayed type of hypersensitivity
reaction against sporotrichin Ag.

26.  3. SPOROTRICHOSIS –
 Laboratory Diagnosis –

27.  4. RHINOSPORIDIOSIS–
 Rhinosporidiosis is a chronic granulomatous
disease, characterized by large friable polyps
(soft red to purple) in the nose ( most common),
conjunctiva & occasionally in ears, larynx,
bronchus & genitalia.
 Causative agent –
Rhinosporidium seeberi
Not cultivable in media.

28.  4. RHINOSPORIDIOSIS–
 Lesion composed of large no. of fungal
spherules embedded in a stroma of connective
tissue & capillaries.
 Spherules are 10-200 µ in diameter, contains
thousands of endospores.
 Mode of infection – unknown – may be due to
stagnant water or aquatic life.

29.  5. SUBCUTANEOUS PHYCOMYCOSIS :
Causative agent –
Basidiobolus hepatosporus
 Infection acquired by bites of insect.
 A painless subcut. nodule which enlarges to
involve a whole limb or large area of the body.

30. 1. Cryptococcosis : “European Blastomycosis”
 Causative agent –
Cryptococcus neoformans
 A yeast with budding cells, 4-20 µ in diameter,
capsulated.
 Present in faeces of pigeons & other birds,

31. 1. Cryptococcosis : “European Blastomycosis”
 Pulmonary Cryptococcosis may lead to
pneumonitis – disseminated thro’ blood – lead
to visceral, cutaneous & meningial disease.
 Visceral form – stimulates TB & cancer clinically,
 Involve bones & joints;

32. 1. Cryptococcosis : “European Blastomycosis”
 Causative agent –
Cryptococcus neoformans
Diagnosis –
 Demo. of capsulated, budding yeast in lesions &
by culture.
 Demo. of capsule - Negative staining;

33. 2. Blastomycosis :
“North American Blastomycosis”
 Causative agent –
Blastomyces dermatitidis –
 Chronic infection characterised with the formation of suppurative &
granulomatous lesions in any part of the body especially lungs & skin.
 Cutaneous lesions – skin of the face & other exposed parts;
 Initial lesion – papule around which secondary nodules develop & coalesce
leading to large, elevated, ulcerative lesion.

34. 2. Blastomycosis :
“North American Blastomycosis”
 Diagnosis – Dimorphic;
 Budding Yeast phase – in tissue & culture at
37°C,
 – large (7-20µ), spherical with thick, double-
contoured walls;
 Mycelial phase – in soil & culture at room
temp.
 Septate hyphae & many round or oval conidia.
 In older cultures – Chlamydospores.

35. 3. Paracoccidioidomycosis :
“South American Blastomycosis”
 Causative agent – Paracoccidioides brasiliensis - dimorphic fungi;
 Chronic granulomatous disease of the skin, mucosa & LNs & internal organs.
 Ulcerative granulomas of the buccal & nasal mucosa are a prominent features of
the disease.

36. 3. Paracoccidioidomycosis :
“South American Blastomycosis”
 Causative agent – Paracoccidioides
brasiliensis - dimorphic fungi;
 Yeast phase in in tissue & culture at 37˚C,
consists of large, round or oval cells with
multiple budding,
 Mycelial phase at room temp.

37. 4. Coccidioidomycosis :
 Diagnosis –
 Yeast form – a spherule, 15-75 µ in diameter,
with a thick doubly refractile wall & filled with
endospores.
 Mycelial form – hyphae – fragment into
arthrospores – highly infectious.

38. . Histoplasmosis :
 Causative agent –
Histoplasma capsulatum
- a dimorphic fungi;
 Intracellular infection of the RE System,
acquired by inhalation;
 Initially asymptomatic – heals & calcifies;
 Rarely resembles pulmonary TB – may
disseminate;

39. . Histoplasmosis :
 Causative agent –
Histoplasma capsulatum
- a dimorphic fungi;
 Yeast phase – In tissue –
present inside the phagocytes;
 Oval, budding cells, 2-4 µ.
 Skin test – ‘Histoplasmin’ – analogous to
Tuberculin test

40. . Histoplasmosis :
 Causative agent –
Histoplasma capsulatum
- a dimorphic fungi;
 Mycelial phase -
 On Sabouraud’s Agar – white, cottony mycelial
growth with large, thick walled spherical spores
with tubercles or finger like projections –
‘Tuberculate Spores’ – Diagnostic.