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Subcutaneous mycosis at the Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital, Jakarta, 1989-2013

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Subcutaneous mycosis at the Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital, Jakarta, 1989-2013

Sammy Yahya, Sandra Widaty, Eliza Miranda, Kusmarinah Bramono, Artini Wijayanti Islami

Abstract


Introduction: Subcutaneous mycosis (SM) is a fungal infection involving dermis and subcutaneous tissue, which can disseminate slowly through systemic blood or lymphatic circulation. The subacute or chronic infection usually found in workers of rural tropical and subtropical area. SM occurs due to trauma along with other predisposing factors such as sex, genetic and occupation. 

Aim:  To identify the types of SM, its clinical findings, laboratory work-up and the treatment at the  Dermatomycology Division, Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital between the year 1989 and 2013.

Method: This retrospective study collected data from medical records and case reports of patients with SM who came at Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital (1989-2013).

Results: We found 16 cases of SM, i.e. subcutaneous mucormycosis (5 cases), eumycetoma  (4 cases), actinomycetoma (4 cases) and chromoblastomycosis (3 cases). There was a greater number of male than female patients ratio (3:1) and mostly were in the age group of 25-44 years. The direct microscopic examination did not reveal any fungal element, except for black spora in chromoblastomycosis (1 case). The culture revealed Basidiobolus ranarum in subcutaneous mucormycosis (5 cases), Nocardia transvalensis in actinomycetoma (1 case) and Phialophora sp. in 1 case of chromoblastomycosis. On histopathological examination, we found fine granules of actinomycetoma, sulphuric granules of actinomycetoma, coenocytic hyphae of subcutaneous mucormycosis, eosinophilic granule in 1 case of mycetoma and hyphae with black spore in chromoblastomycosis.

Conclusion: SM is still a rare disease, comprehensive management of SM needs supporting laboratory work-up, particularly the histopathological examination.

 

Keywords: mycosis, subcutaneous, culture, histological


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References


1. Hay RJ. Deep fungal infections. in: Wolf K. Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, editor. Fitzpatrick's dermatology in general medicine. 8th ed. New York: McGraw-Hill; 2012: p.2289-90

2. La Hoz RM, Baddley JW. Subcutaneous fungal infections. Curr Infect Dis Rep. 2012;14(5):530-9.

3. ArenasR, Moreno-CoutiñoG, WelshO. Classification of subcutaneous and systemic mycoses. Clin Dermatol .2012;30(4):369-71.

4. Pang KR, WuJJ, Huang DB, Tyring SK. Subcutaneous fungal infections. Dermatol Ther. 2004;17(6):523-531.

5. Bramono K. Cutaneous mycosis in Indonesia. Procedding of the 17th Congress of Internal Society of Human and Animal Mycology (ISHAM); 2009 May 25-29; Tokyo

6. Marpaung IM, Dewi SPAA, Swastika AM. Subcutaneous mycosis profunda profile in Sanglah Hospital Denpasar. Procedding of the 11th Annual Scientific Meeting Indonesia Scociety of Dermatology and Venereology, 2010 June 22-23; Bali.

7. Rippon JW. Mycetoma. In: Rippon JW, editor. Medical mycology. 3rd ed. Philadelphia: WB. Saunders Company; 1988:80-103.

8. Rippon JW. Zygomycosis. In: Rippon JW, editor. Medical mycology. 3rd ed. Philadelphia: WB. Saunders Company; 1988:681-713.

9. Joe LK, Eng NT. Subcutaneous phycomycosis: A new disease found in Indonesia. Ann. NY Acad Sci. 1960; 89;4-16.

10. AguaniI, Soeparlan AG, Kasan segari US. Subcutaneous phycomycosis in east jawa. Proceeding of the 8th Regional Conference of Dermatology Asian - Australian, 1988 June 16-20; Bali.

11. Rippon JW. Chromoblastomycosis and related dermal infections caused by dematiaceous fungi. In: Rippon JW, editor. Medical mycology. 3rd ed. Philadelphia: WB. Saunders Company; 1988:249-68.

12. Statistic Reports. Mycology Division. Department of Dermatovenereology (Unpublished Data). Jakarta: Dr. Cipto Mangunkusumo National Hospital; 2014.

13. Widaty S. Mycosis profunda in Indonesia. Procedding of the Scientific Meeting and National Congress Indonesia Society for Medical Mycology, 2013 June 29-30; Bandung

14. Chairunnisa S. Multiple and extensive subcutaneous zigomycosis treated with potassium iodide and itraconazole as combination therapy. Procedding of the 12th Annual Scientific Meeting Indonesia Society of Dermatology and Venereology, 2012 June 21-23; Solo

15. Olivia T. Chromoblastomycosis with multiple lesions. Procedding of the 12th Annual Scientific Meeting Indonesia Society of Dermatology and Venereology, 2012 June 21-23; Solo

16. Ramesh V, Ramam M, Capoor MR, Sugandhan S, Dhawan J, Khanna G. Subcutaneous zygomycosis: Report of 10 cases from two institutions in North India. Jeur Acad Dermatol Venereol. 2010;24(10):1220-5.

17. Queiroz-Telles F, McGinnis MR, SalkinI, Graybill JR. Subcutaneous mycoses. Infect Dis Clin North Am. 2003;17(1):59-85.

18. Maiti PK , Ray A, Bandyopadhyay S. Maiti PK, Ray A, Bandyopadhyay. Epidemiological aspects of mycetoma from a retrospective study of 264 cases in West Bengal. Trop Med Int Health. 2002;7(9):788-92.

19. Londero AT, Ramos CD. Chromoblastomycosis in Rio Grande do Sul state. Ann Brasderm.1989;64;55-8.