Subcutaneous mycoses

Three fungal infections - Madura feet (mycetoma), chromomycosis and sporotrichosis - fall into the category of subcutaneous mycoses, their distribution is mainly in tropical and subtropical areas. The ideal treatment for madura feet caused by fungi is not yet established the azoles are of some benefit, however, neither the optimal drug, dose, nor the treatment schedules are known. Chromomycosis responds well to ITRA monotherapy or the combination of 5FC plus ITRA. ITRA has been set up as standard therapy for cutaneous and lymphatic sporotrichosis. 

Superflcial mycoses are usually clinically evident (some will fluoresce when using a Wood s lamp) and can be confirmed by microscopy (using KOH solution) and culture of hairs, nails or scrapings from the edge of skin lesions. Species of Microsporum, Trichophyton, Epidermophyton (all moulds), and of Malassezia, Candida, Pityrospo-rum (all yeasts) cause most superflcial infections. Subcutaneous mycoses are caused by Sporothrix... 

It is indicated in dermatophytoses, tinea versicolor, onychomycoses, oropharyngeal candidiasis, cutaneous candidiasis, chronic mucocutaneous candidiasis, oculomycoses systemic mycoses like cryptococcosis, candidiasis and aspergillosis subcutaneous mycoses like sporotrichosis and chromomycosis. 

The drugs used in the treatment of subcutaneous and systemic mycoses are amphotericin B, flucytosine, and the new group of azoles, ketoconazole, fluconazole and itraconazole. 

Histopathology (hematoxylin-eosin stain, periodic acid-Schiff stain, Grocott s methenamine-silver stain) may be helpful in the diagnosis of dermato-phytosis and plays an important role in the diagnosis of subcutaneous mycoses. 

Many fungi are able to infect man, provoking common superficial mycoses or subcutaneous and systemic infections. Dermatophytoses, candidosis and pityriasis versicolor are the most common cutaneous mycoses systemic mycoses such as cryptococcosis are also of prime importance in some parts of the world. In the following sections, we refer only to mycotic infections that are provoked or significantly worsened by the work environment. 

Subcutaneous mycoses, or mycoses of implantation are sporadically occurring infections caused by fungi present in the natural environment, which are directly inoculated into the dermis or subcutaneous tissue through a penetrating injury. They are not common, even in endemic countries, and are mainly seen in the tropics (Hay and Moore 1998). We have summarised, in Table 1, some of the features of the most important subcutaneous mycoses, including occupational sources of infection. 

Table 1. Main subcutaneous mycoses implying occupational sources of infection...

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