chromoblastosis
Introduction
Introduction to colored buds Chromoblastomycosis, also known as staining fungal disease, is a chronic, localized skin and subcutaneous tissue infection characterized by the appearance of brown-separated thick-walled spores in tissues caused by a group of dark fungi, occasionally disseminated. basic knowledge The proportion of the disease: the incidence rate is about 0.003% - 0.007%, which is common to traditional agricultural workers. Susceptible people: no specific population Mode of infection: non-infectious Complications: brain abscess meningitis
Cause
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(1) Causes of the disease
A chronic, localized skin and subcutaneous tissue infection characterized by the appearance of brown-separated thick-walled spores in the tissue caused by a group of dark fungi. The pathogens are mainly the genus Mycelium, the sclerotium and the bacterium of the genus It is more common in China, and other pathogens include tightly colored mold, Cladosporium ssp., thorny outer mold, Acetin, Helminthosporium, Staphylococcus aureus, S. serrata Variants and Phytophthora variabilis, the fungi are mostly classified as Aspergillus spp., belonging to the ascomycetes, which are often found in moist and decaying trees, plants and soils, and are often caused by spores implanted into the skin after trauma.
(two) pathogenesis
The pathogens are mostly rotted in humid and decaying trees, plants and soils. Most of them are caused by spores implanted into the skin after trauma. The mucous membranes are not tired. The lesions are newly developed as papules. The development is slow, the surface is hyperkeratotic, and it forms a wart. The changes of suppurative granulomatous proliferative dermatitis are generally divided into nodular type, tumor type, sputum type, patch type, hypertrophic scar type 5.
Prevention
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Pay attention to skin hygiene, avoid trauma, and promptly diagnose and treat when there is suspicious infection.
Complication
Coloring blastomy complications Complications, brain abscess, meningitis
Occasionally reported cases of brain abscess or meningitis.
Symptom
Symptoms of colored radiculosis common symptoms contracture scar pruritus squamous meningitis nodules secondary infection
The patients are mainly agricultural workers, all ages can occur, often have a history of skin trauma, mainly invading the exposed parts, usually in the lower third of the lower limbs and the feet, followed by the hips, neck, forearms, etc., hands, Face, torso also appeared at the same time, the mucous membrane is not tired, the damage is initially pimples, the development is slow, the surface is hyperkeratotic, forming a wart, which is an early characteristic of the disease, generally divided into 5 types:
1. Nodular type is early damage, soft red nodules with dark red or light brown, smooth or scorpion-like surface, or scaly, and continue to develop into a tumor type.
2. The tumor type is papillary or lobular, and some or all of the surface is stained with gray scales, suede and horny granules, sometimes expanding into cauliflower.
3. The sacral lesion is mainly hyperkeratotic, and the surface resembles common sputum or verrucous skin tuberculosis (Fig. 1).
4. Patch type is more common in the limbs, the surface is dry, there is a central healing phenomenon or atrophic scar, as a ring, bow or snake shape.
5. Hypertrophic scar type extrusion damage can be discharged a light white, cheese-like or purulent secretions, with a special odor, easy to cause secondary infection, long-term illness, due to deep tissue fibrosis, the formation of hypertrophic scars, Can cause lymphatic obstruction, causing elephantiasis, after very slow, conscious pruritus or pain, long-term illness can invade a whole limb, but the nearby lymph nodes are not tired.
Mucosa and nails can be affected, generally do not invade the internal organs, and occasionally report cases of brain abscess or meningitis.
Examine
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Mycological examination:
1. Direct microscopic examination of the skin, pus and granulation tissue as a KOH smear, visible single or group of brown-yellow round thick-walled spores.
2. Fungal culture At room temperature, the growth on the sand castle agar is slower, the colonies are grayish green, grayish black or brownish black, flat, centrally piled up, the surface has short villi-like aerial hyphae, and the back of the colony is black.
Histopathology is a change of chronic pyogenic granulomatous proliferative dermatitis. In the abscess and multinucleated giant cells, characteristic brown-separated thick-walled spores (5-13 m in diameter) can be seen, called sclerotic cells or bricks. In the corpus, the epidermis is mostly pseudoepithelial-like hyperplasia. In the hyperplastic epidermis, small abscesses and focal necrosis can be seen in the funnel and dermis of the hair follicle. The dermis is dense and diffuse inflammatory cells infiltrate, including lymphocytes, plasma cells, and tissues. Cells, multinucleated giant cells and a few eosinophils.
Diagnosis
Diagnosis and identification of colored buds
diagnosis
According to clinical manifestations, brown-yellow thick-walled spores can be diagnosed in mycological examination and histopathology.
1. Direct microscopic examination of suede, pus and granulation tissue as KOH smear, visible single or group of brown-yellow round thick-walled spores, called muriform bodies, can be vertically and horizontally separated, diameter 10m Left and right, is the characteristic manifestation of the disease.
2. Fungal culture at room temperature, slow growth on sand castle agar, colony is grayish green, grayish black or brownish black, flat, central pile up, the surface has short villi-like aerial hyphae, the back of the colony is black, under the microscope See the mycelium is thick, brown, branch separated, the genus Mycelium has a spore-type, the genus Mycoplasma and the bottle stalk type three sporulation methods, the conidia are single cells, oval or cylindrical, Is a spore-forming spore, conidia semi-endogenous, single-cell, round or elliptical, deposited on the top of the collar opening, and the bacterium of the genus Coriolus sp. is a spore-forming spore, forming a multi-branched The conidia chain, the spores are elliptical, with dark umbilical structures at both ends.
Differential diagnosis
1. Although the lesion of tuberculous skin tuberculosis is scorpion-like, there is a miliary abscess, brown infiltration around it, reticular scars often remain in the center, and the fungal test is negative.
2. Sporotrichosis This disease is a sickle, more common in the hands and forearms, most of the nodules are often arranged in a line, mycological examination can be identified.
3. Nodular ulcerative syphilis damage color is copper red, hard nature, significant infiltration, no wart-like proliferation, previous sexual history, syphilis serum test is often positive, mycological examination is negative.
In addition, it should be differentiated from diseases such as viral infection, foreign body granuloma, lupus erythematosus, leprosy, leishmaniasis, keratoacanthoma, cutaneous sarcoma, vulgaris and malignant tumors.
