Mochi, Majocchi, Gnocchi, Ossibuchi

 Martini, alveoli, abaci, smelly. I could go on. I have a minor talent of making jumbles of similar sounding words. I charge $50 an hour for anyone who needs someone with that particular skill. A bit of self aggrandizing, I got feedback on a paper that said “it was a pleasure and a privilege to read your insightful paper, and I thank you.”  Ego much? You got it buddy. Did you come here to listen to me brag? Probably not. Did you come her intentionally? Probably not. Majocchi. 

Great Segway, I know. What the hell kinda cuisine is Majocchi? Think truffles and porcini, or Dermatophytes. Yes fungi, probably don’t eat it thought, might make you sick and I guess cannibalism is frowned upon. Let’s get to brass tacks (tax, tacts, facts).

Majocchi’s granuloma is a deep, fungal folliculitis, that is an infected hair follicle. Maybe from an ingrown hair or a razor cut which allows the microbe to break into your skin. It is pretty uncommon and the risk factors are shared with many other skin infections, or infection in general. Incompetent immune system, malignancies (I suppose they do a lot of damage to the immune system), malnutrition, and Cushing’s disease. 

With that, in generally healthy individuals, a break in the skin is needed. When I think about your garden variety fungal skin infection, they are generally superficial and while they can be chronic, don’t usually cause invasive disease. Majocchi’s granuloma is the next step. Like Clayton Lonetree, it gets into a vulnerable place and begins its work causing damage. 

Cool fact, the fungi feeds off keratin (so generally stays in the epidermis) and the waste causes inflammation and a drop in pH to allow the wee beasts to dig in further. Often it stops there, deep enough to resist complete eradication by topical antifungals. Other times, it differs deeper and gets into the subcutaneous tissue and blood supply causing it invasive fungemia. Most fungemia is caused by Candida species so, it wouldn’t be normal to look for these Dermatophytes in the blood. 

I found case studies of both deep tissue abscesses and one of invasive Dermatophyte fungemia in a patient with HIV. It presents in three phases, plaques, nodules, and degenerative (killing the tissues, use your imagination). I’ll put a pic in here for you to see so that this doesn’t end up being a novel. What I could find is that it is confirmed by culture as the lesions can appears as a skin cancer or bacterial cellulitis.

For treatment, terbinafine is the first line drug, for 1-6 months in a patient who’s liver works well. Azoles can also be used, and for that I recommend you listen to the experts on the exquisite Febrile Podcast episode 57  I promise it is more informative and not as boring. Promise. 

Either way. That’s enough for today. I’ll probably talk more about this and other fungi later. They really are interesting organisms and challenging to treat (from what I have read and researched). So checkout the above mentioned podcast and let me know if you have cool stories or stuff to teach me. Also, share this, please. 


References

Changing Concepts and Current Definition of Majocchi's Granuloma by Durdu et al. in Mycopathologia 2020. 

Febrile Podcast episode 57. Here https://febrilepodcast.captivate.fm/episode/57- or here https://podcasts.apple.com/us/podcast/febrile/id1544626580?i=1000582113701

Image of three different presentations of Majocchi’s granuloma and information for this post from Majocchi’s granuloma on the forearm caused by Trichophyton tonsurans in an immunocompetent patient from the Annals of Clinical Microbiology and Antimicrobials by Zheng et al. 2020.

Majocchi's granuloma: current perspectives from Infection and Drug Resistance by Oral, Durdu, and Ilkit from 2018. 

Unusual Inflammatory Tinea Infections: Majocchi’s Granuloma and Deep/Systemic Dermatophytosis by Castellanos et al. from the Journal of Fungi 2021. 


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