Subcutaneous mycoses in coastal Karnataka in south India.
BACKGROUND
Subcutaneous mycoses are chronic, localized infections of the skin and subcutaneous tissue which occur following traumatic implantation of the etiological agent. The causative organisms are soil saprophytes of regional epidemiology with varying ability to adapt to the tissue environment and elicit disease.


OBJECTIVE
This study was conducted to evaluate the various types of subcutaneous mycoses, including actinomycotic mycetomas, in south coastal Karnataka, India.


METHODS
Between January 2005 and January 2013, a total of 25 patients were diagnosed with subcutaneous mycoses based on a detailed clinical history and presentation, histopathology, and culture of organisms.


RESULTS
Chromoblastomycosis was the infection most commonly seen (n = 16 patients, 64%), followed by mycetoma (n = 4, 16%), sporotrichosis (n = 4, 16%), and rhinoentomophthoromycosis (n = 1, 4%). The extremities were the most common site of involvement, with the lower limb being most affected (64%). Males were more commonly afflicted (64%) than females (36%). Most patients were agricultural workers, although preceding trauma was noted in only three patients. The majority of patients responded well to therapy and were disease-free on follow-up.


CONCLUSIONS
Subcutaneous mycoses are a rare group of disorders. Chromoblastomycosis is the most frequent subcutaneous fungal infection in south India. Morphologically, chromomoblastomycoses present as verrucous, ulcerative, nodular, or eczematous lesions. Clinical diagnosis is important as culture is often negative. The incidence of infection is higher among rubber tappers. It is important to clinically differentiate chromoblastomycosis from tuberculosis verrucosa cutis. Most of the subcutaneous mycoses respond well to treatment, with the exception of rhinoentomophthoromycosis, which is a rare form of deep mycosis with associated mutilation. Eumycetomas are not observed in this part of India.
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India.
Ramesh M
RM
Bhat
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India.
Rochelle C
RC
Monteiro
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India.
Nandakishore
N
Bala
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India.
Sukumar
S
Dandakeri
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India.
Jacintha
J
Martis
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India.
Ganesh H
GH
Kamath
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India.
Srinath M
SM
Kambil
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India.
Ramay
R
Asha Vadakayil
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002862:Chromoblastomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015331:Cohort Studies; D003881:Dermatomycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013174:Sporotrichosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D040521:Subcutaneous Tissue / Q000187:drug effects / Q000382:microbiology*; D016896:Treatment Outcome; D014329:Tropical Climate
D000935:Antifungal Agents