Treatment Of Department Disease

MUSHROOM DISEASE
Sporotrichosis (Gardener Disease)
1. Epidemiology and etiology
Sporotrichosis is a chronic disease caused by Sporothrix schenckii that causes damage to the skin or internal organs (also known as gardener disease - gardener's disease).
This is a dimorphic mushroom. In nature, mushrooms often live in soil and trees.
The disease was first described by Schencki in the United States (1898), and later by Beumann (1903) and Ramond in Europe

. In 1912 Beurmann and Gougerot described in detail the shape of mushrooms. The disease occurs throughout the world, mainly in the United States, Mexico, and is also found in France, the former Soviet Union, and South Africa. Vietnam also appears this disease, often found in the North
The disease is most common in men, healthy, 20-30 years old, rarely seen in children, or common in gardeners, farmers, masons, florists or florists, people who are in contact with the soil, have many schools infection in the laboratory
2. Clinical symptoms.



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2.1. Functional symptoms: pain at first, then pain; No fever.
2.2 Physical symptoms: there are many clinical forms
- Skin and lymphatic form: this form is most common.
When the skin and mucosa are built close, it is easy for the fungus to penetrate into the skin to spread through blood or lymph roads. Injury usually begins in the extremities, especially in the fingers of the hand through the site of injury and abrasions.
The disease is found at any age, usually at working age.



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Incubation period is usually 20-90 days.
Skin lesions appear as erasions, papules on the surface of the skin in different places, but most of the skin on the lower legs, arms. In particular eraser eruption grows on the lymphatic route. Erasers, papules develop fast, at first, hard to move without pain Then it becomes soft, often painful and not moving. Latex eruption starts from the surface and the middle of the gum leads to a soft eraser in the middle and the surrounding rim is a bit hard. When injecting playdough, there is a little bit of pus, yellowish color, no cocoon like pyoderma, this is also a typical image of the disease. The lesions may develop into small abscesses or large abscesses that are deep under the skin, have a pinkish color, difficult to break the pus on their own. When squeezing and squeezing it, it is often thick like oil with a lemon yellow color.
- Skin type alone: skin lesions in the form of warts, such as rice seeds, or warts, can become enlarged but not spread along the lymphatic vessels.



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- Mucous form: lesions are usually papular warts with pus, ulcers often appear in the mucous membranes of nose, throat, mouth, then easily confused with bacterial dermatitis.
- Osteoarthritis: patients with upper limb pain, inflammation, stiffness, mainly large joints such as knees, elbows, ankles, wrists, hip joints and shoulder joints are less likely
- Primary pulmonary form: Very rarely, due to inhalation of spore fungi into the lungs, the swelling of the umbilical lymph nodes, pulmonary infiltrates.
- Fixed form: This most common lesion is a slow-progressing ulcer covered by a scab and secretions that can form a wart. Another form of this form of acne-like characteristic is the final papules. and covered with secretions. This body has no satellite damage and does not move along the vein.
- Can be disseminated: Very rare, primary lesions are often not recognized or primary lesions in the lungs or other organs. Many subcutaneous lumps appear simultaneously and scattered over the body at the same time, these lumps have the same properties and progression as lumps in the skin and lymph, and eventually the crusted crusted ulcers. Fungi move to the surface of bone, bone marrow, central nervous system, kidney, genitals, fluid, and breast.




3. Testing
- Fresh examination: take samples from pus, fluid from ulcers. Very long yeast cells can be found and have typical cigar or shuttle image, size 6-10 * 2-3micromet. difficult to find..
- Staining gram: to eliminate other bacterial or foreign objects.
- Acid resistant staining: staining tissue and pus to assess for Mycobacterial infection.
- Fungal culture: isolated S schenckii. This is a dimorphic mushroom in the sabouraud dextrose medium at 25 o¬c colony having characteristic of brown black filamentous fungus, at 37oC for yeast to sprout.



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- Mycobacterial culture: to eliminate Mycobacterial infection.
- Chest x-ray if symptoms are present.
- Sporotrichin test: skin test uses sporotrichin antigen to diagnose sprotrichosis but does not use the rules because of the high rate of positive and false negative.
- Cultivation of cerebrospinal fluid, semen, urine by needle aspiration or biopsy tissue indicated in the diffuse form.
- Histopathology: The granulomatous reaction has no signal with the image of over-prognosed metastatic tumor. PAS staining with round, oval or cigar spores in granulomas, starfish-like appearance outside the cells in the center of this body with yeast cells is a special sign of sprotrichosis but is very rare
4. Differential diagnosis.
Differential diagnosis with: Leishmaniasis; Infection with the skin mycobacterium Marium; Nocardiosis; Primary syphilis; Warts in the skin; Tularemia; Cat scratch disease; Purulent granuloma; Relics granuloma; Dermatophytoses; Blastomycosis; Chromomycosis; Mycetoma; Papules caused by insects; Phong.
5.



. Treatment:
5.1. Amphotericin B: designated sprotrichosis of bones, lungs, meninges, dissemination.
- Adults: Amphotericin B lipit: 3-5m

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