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Fungal diseases can be grouped arbitrarily into three broad categories based on the predominant location of infection within the body: superficial, cutaneous and subcutaneous, and systemic. The superficial mycoses are those in which the fungus is usually confined to the keratinized layer of the skin and its appendages. Because fungal growth is superficial, there is little or no inflammatory response. These infections are the more common of the mycoses, cause minor discomfort, and are primarily of cosmetic importance.They are rarely encountered by the histopathologist. The cutaneous and subcutaneous mycoses are a polymorphic group of diseases caused by a wide variety of fungi. These fungi enter the skin and subcutaneous tissue as a result of traumatic implantation or contamination of open wounds. Although infections remain localized, they occasionally spread through the lymphatics to involve other sites. The systemic mycoses usually have a pulmonary inception, from where they may disseminate to other organs. The gastrointestinal tract is occasionally a primary focus of infection, and primary cutaneous forms of the systemic mycoses rarely occur as a result of direct inoculation of an agent after an injury. In some patients, systemic infections are asymptomatic. In other patients, they produce severe disease, which can be fatal if not promptly diagnosed and treated.
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June 2007
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