#IDBoardPearls #IDtwitter #IDPhotoQuiz
📟 A farmer from the Dominican Republic is here in the US visiting family & presents with a swollen foot that has been progressing over the past 8 years
📸 of his R foot along with biopsy of lesion
❓What is the mostly likely organism?
Answer: Madurella mycetomatis
🎙Cutaneous Fungal/Mold Infections:
🚨Madurella mycetomatis: Eumycetoma or “Madura foot”
🔎- traumatic inoculation ➡️ chronic nodular lesions w/ sinus tracts w/ macroscopic grains ➡️ 🦴 Evolve over yrs
🔬- grain w/ numerous hyphae
👇🏼
This is fungal
infection vs Acintomadura (which can also cause Madura foot but is bacterial)
⚡️ 🤔 👨🏻🌾or 🪵 cutting/carrying
💊- itraconazole 6-24 mo
🚨Fusarium solani:
🔎 -
Localized cutaneous disease - neutropenic patient, toe cellulitis in the setting of onychomycosis
Disseminated disease - refractory 🤒 with metastatic skin lesions. + Blood cultures
👇🏼
Similar to ecthyma gangrenosum
🚨Scedosporium:
🔎- papular skin lesions ➡️ necrosis OR mycetoma
⚡️Just know it can affect immunocompetent pts & is resistant to ampho B. Tx w/ voriconazole
⚡️🤔 neurological symptoms after a bear drowning experience. Sinuses/lungs ➡️🧠
🚨Mucormycosis:
⚡️🤔healthcare outbreaks
w/ adhesive bandages & construction.
🔎- necrotic lesions
👇🏼
Similar to ecthyma gangrenosum
🚨Chromoblastomycosis: commonly caused by Fonsecaea pedrosoi
- traumatic inoculation (🪵splinters or soil) ➡️ chronic wart like lesions that progress over years
🔬- sclerotic bodies or
“copper pennies” on KOH prep/skin biopsy
💊- itraconazole 6-24 mo
🚨Histoplasmosis:
🔎 - disseminated histo can cause papillae/nodular lesions
👇🏼
Similar to crytococcus neoformans BUT crypto is more molluscum like
🚨Blastomycosis:
🔎- skin is the most common site for disseminated blasto. Chronic lesions can be large, verrucous or ulcerative
👇🏼
Similar to basal cell carcinoma
Affinity for face
🚨Coccidioidomycosis:
🔎- disseminated cocci is common with the first few weeks of primary infection in immunosuppressed pts. Occurs anywhere with a variety of lesions
🚨Paracoccidioidomycosis:
🔎- mucocutaneous sites. Ulcerated lesions of lips, gum, tongue, & palate
Lastly, remember M ulcerans causes a Buruli ulcer.
⚡️ 🤔West Africa, Latin America, Australia, & Asian Pacific
⚡️AFB staining of skin scrapping can aid in dx
See review below for more info on a Buruli ulcer & M ulcerans thanks to @JClinMicro
👇🏼
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