Deep fungal and higher bacterial skin infections in Thailand: clinical manifestations and treatment regimens

Background Deep fungal and higher bacterial skin infections occur fairly fr equently in Thailand. Methods Cases with a provisional diagnosis of deep fungal and higher bacter ial infections were prospectively collected from 1994 to 1997 in the Granul oma Clinic, Department of Dermatology, Faculty of Medicine, Siriraj Hospita l, Mahidol University Bangkok, Thailand. Demographic data, clinical manifes tations, causative organisms, histologic features, treatment, and outcome w ere investigated. Results The total cases in a 4-year period numbered 27. The male to female ratio was approximately 1 : 1, Mycetoma was most common, followed by chromo blastomycosis, Actinomycetoma was similar in incidence to eumycetoma, The o nly causative organism that could be identified among the mycetoma cases wa s Cladosporium carrionii, which caused mycetoma of the buttock of an aplast ic anemia patient at the site of bone marrow aspiration. Surgical treatment was recommended for eumycetoma. Chromoblastomycosis was caused by C. carri onii and F:compactum and responded well with itraconazole orally. Mycotic a bscesses were found in four cases, basidiobolomycosis in two cases, and cut aneous nocardiosis in one case, Cotrimoxazole was recommended in the treatm ent of actinomycetoma, cutaneous nocardiosis, and basidiobolomycosis. Conclusions Localized, chronic, stow, progressive, and usually asymptomatic were the main cutaneous manifestations of deep fungal and higher bacterial skin infections, A skin biopsy for histologic study and culture identifica tion should be performed in every suspected case. The causative organisms w ere found in the histologic sections of every case, but only about one-thir d were found by culture.