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Frioui R, Jaber K, Mtibaa L, Jemli B, Gargouri F, Rabhi F, Dhaoui R. An unusual case of nasal chromoblastomycosis progressing to squamous cell carcinoma in a non-endemic region. Indian J Dermatol Venereol Leprol 2023; 89:102-105. [PMID: 36331850 DOI: 10.25259/ijdvl_348_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Refka Frioui
- Department of Dermatology, Military Hospital of Instruction of Tunis, Tunisia
| | - Kahena Jaber
- Department of Dermatology, Military Hospital of Instruction of Tunis, Tunisia
| | - Latifa Mtibaa
- Department of Mycology, Military Hospital of Instruction of Tunis, Tunisia
| | - Boutheina Jemli
- Department of Mycology, Military Hospital of Instruction of Tunis, Tunisia
| | - Faten Gargouri
- Department of Pathology, Military Hospital of Instruction of Tunis, Tunisia
| | - Faten Rabhi
- Department of Dermatology, Military Hospital of Instruction of Tunis, Tunisia
| | - Raouf Dhaoui
- Department of Dermatology, Military Hospital of Instruction of Tunis, Tunisia
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Reviewing the Etiologic Agents, Microbe-Host Relationship, Immune Response, Diagnosis, and Treatment in Chromoblastomycosis. J Immunol Res 2021; 2021:9742832. [PMID: 34761009 PMCID: PMC8575639 DOI: 10.1155/2021/9742832] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause subcutaneous infections. This disease has been considered an occupational disease, occurring among people working in the field of agriculture, particularly in low-income countries. In 1914, the first case of CBM was described in Brazil, and although efforts have been made, few scientific and technological advances have been made in this area. In the field of fungi and host cell relationship, a very reduced number of antigens were characterized, but available data suggest that ectoantigens bind to the cell membrane of host cells and modulate the phagocytic, immunological, and microbicidal responses of immune cells. Furthermore, antigens cleave extracellular proteins in tissues, allowing fungi to spread. On the contrary, if phagocytic cells are able to present antigens in MHC molecules to T lymphocytes in the presence of costimulation and IL-12, a Th1 immune response will develop and a relative control of the disease will be observed. Despite knowledge of the resistance and susceptibility in CBM, up to now, no effective vaccines have been developed. In the field of chemotherapy, most patients are treated with conventional antifungal drugs, such as itraconazole and terbinafine, but these drugs exhibit limitations, considering that not all patients heal cutaneous lesions. Few advances in treatment have been made so far, but one of the most promising ones is based on the use of immunomodulators, such as imiquimod. Data about a standard treatment are missing in the medical literature; part of it is caused by the existence of a diversity of etiologic agents and clinical forms. The present review summarizes the advances made in the field of CBM related to the diversity of pathogenic species, fungi and host cell relationship, antigens, innate and acquired immunity, clinical forms of CBM, chemotherapy, and diagnosis.
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Guevara A, Siqueira NP, Nery AF, Cavalcante LRDS, Hagen F, Hahn RC. Chromoblastomycosis in Latin America and the Caribbean: epidemiology over the past 50 years. Med Mycol 2021; 60:6391503. [PMID: 34637525 DOI: 10.1093/mmy/myab062] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis is a chronic disease caused by melanized fungi that mainly affect individuals performing soil-related labour. The objective of this study was to analyse the epidemiological and clinical characteristics of chromoblastomycosis in Latin America and the Caribbean by an extensive literature review. An integrative review was performed of English, French, Portuguese, and Spanish publications in LILACS, SciELO, PubMed, SCOPUS and Web of Science databases covering the period 1969-2019. A total of 1,211 articles were identified, of which 132 were included in the review, covering 2,081 patients, 80.3% were male, the mean age was 56.1 years. The mean duration of the disease was 10.8 years. The lesions were mainly described in the lower limbs (60%). The most frequent clinical forms were verrucous (46.4%) and tumorous (21.7%). Major disease symptoms and signs consisted of itching and pain. Bacterial infection and functional limitation were important complications. Immunosuppression post-kidney transplantation was the most frequent comorbidity while leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi and Cladophialophora carrionii were the predominant etiological agents. Majority of the cured cases were treated with itraconazole as monotherapy or in combination with other antifungals, surgery or cryosurgery. Chromoblastomycosis affects hundreds of rural workers in Latin America and the Caribbean, causing disability and personal, family and economic losses. It is important to prioritize epidemiological surveillance and early diagnosis of this disease in order to reveal its real prevalence and direct resources to preventive actions, diagnosis and early treatment. LAY SUMMARY Chromoblastomycosis is a slowly progressing chronic disease caused by melanized fungi. We collected data from South America and the Caribbean covering 1969-2019, the 132 articles included 2 081 patients, mean disease duration was 10.8 years. Fonsecaea pedrosoi and Cladophialophora carrionii predominated.
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Affiliation(s)
- Armando Guevara
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Nathan Pereira Siqueira
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Andreia Ferreira Nery
- Department of Internal Medicine, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | | | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Utrecht The Netherlands
| | - Rosane Christine Hahn
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
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Belda Junior W, Criado PR, Casteleti P, Domingues Passero LF. Chromoblastomycosis evolving to sarcomatoid squamous cell carcinoma: A case report. Dermatol Reports 2021; 13:9009. [PMID: 34497696 PMCID: PMC8404429 DOI: 10.4081/dr.2021.9009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
Chromoblastomycosis (CMB) is a cutaneous fungal infection caused by dematiaceous fungi. According to the World Health Organization CMB has been elected as a tropical disease, and it is prevalent in tropical and subtropical regions. The lower extremities are the most affected areas, and the lesions progress with erythema, papules, nodules, verrucose plates and/or ulcerations. So far, few works have demonstrated neoplastic transformation in chronic CMB lesions, and it may be a consequence of prolonged inflammatory response. In the present case report, we described a neoplastic transformation from CMB lesion of a 55- year-old man, presenting lesions only in the left leg for 35 years. After treatment, a verrucous white plate with thick and irregular borders emerged in the ankle, which was identified as a sarcomatoid squamous cell carcinoma. The present case report highlights the importance of an early diagnosis and treatment.
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Affiliation(s)
- Walter Belda Junior
- Dermatology Department, University of São Paulo, Medical School, Clinics Hospital, São Paulo.,Laboratory of Pathology of Infectious Diseases, Medical School, University of São Paulo, São Paulo
| | | | - Paula Casteleti
- Dermatology Department, University of São Paulo, Medical School, Clinics Hospital, São Paulo
| | - Luiz Felipe Domingues Passero
- Institute of Biosciences, São Paulo State University (UNESP), São Vicente.,Institute for Advanced Studies of Ocean, São Paulo State University (UNESP), São Vicente, Brazil
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Wang J, Zhu M, Wang P. Chromoblastomycosis by Exophiala jeanselmei associated with squamous cell carcinoma. J Mycol Med 2021; 31:101105. [PMID: 33422739 DOI: 10.1016/j.mycmed.2020.101105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Chromoblastomycosis is a subcutaneous, chronic, granulomatous mycosis that occurs more frequently in tropical and subtropical countries. Herein, we describe a case of a 90-year-old female patient with diagnosis of chromoblastomycosis by Exophiala jeanselmei with a 22-year evolution who developed a squamous cell carcinoma. In the meantime, She underwent two misdiagnoses and an unnecessary operation. This case is also the fifth case of E. jeanselmei caused CBM in history.
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Affiliation(s)
- Jiaqi Wang
- Fourth Clinical College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China.
| | - Mengyan Zhu
- Fourth Clinical College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China.
| | - Ping Wang
- Department of Dermatology, the Affiliated 3rd Hospital of Hangzhou, Anhui Medical University, Hangzhou, 310009, China.
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Abstract
The paper describes a case of chromoblastomycosis, a rare implantation mycosis in the Russian Federation. It gives data on the prevalence, etiology, and clinical presentations of the disease, and the diagnostic possibilities. Emphasis is laid on the leading role of a pathomorphological study in the diagnosis of chromoblastomycosis in non-endemic countries, including Russia. The clinical and pathomorphological presentations are described in detail. Histological examination detected 5-12-µm spherical or polygonal pigmented cells that are fungal elements, which allows chromoblastomycosis to be diagnosed in the cytoplasm of macrophages and extracellularly. A refusal to conduct a pathomorphological study leads to diagnostic errors and an irrational treatment policy.
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Affiliation(s)
- V A Molochkov
- M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - A N Khlebnikova
- M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - M S Petrova
- M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - M A Bobrov
- M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
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A comparative study of extracellular enzymes from chromoblastomycosis agents reveals the potential association of phospholipase with the severity of the lesions. Microb Pathog 2020; 147:104367. [PMID: 32649963 DOI: 10.1016/j.micpath.2020.104367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022]
Abstract
Chromoblastomycosis is a chronic, progressive subcutaneous mycosis that is endemic in tropical and subtropical countries. Cladophialophora carrionii and Fonsecaea pedrosoi are prevalent etiological agents. The potential role of the proteolytic activity of extracellular enzymes in these fungi and its relationship with the pathogenesis of the disease has not been proven. Some phenotypic traits have been associated with the virulence of other fungi; i.e., their different rate of protease, phospholipase, and esterase excretion, melanin, and thermotolerance. The aim of this study was the identification of extracellular enzymes that could be considered virulence markers of chromoblastomycosis agents. Therefore, we tested 29 C. carrionii and 11 F. pedrosoi clinical isolates to determine their hydrolytic and physiologic characteristics. All the tested isolates grew at a range of 30°-37 °C; except 2 strains of F. pedrosoi that grew slowly at 40 °C. We noticed that the hydrolytic capabilities of the tested isolates were positive for urea hydrolysis in almost all, while both strains were negative for DNase, hemolysin, and gelatin. C. carrionii and F. pedrosoi had phospholipase and esterase activity. These findings were similar for most isolates. All strains showed an association between phospholipase activity and moderate to severe lesions. However, only in F. pedrosoi isolates, the association remains significant. We conclude that the different enzymatic production reported here may be linked to the clinical manifestations of these pathologies. Notwithstanding, the influence of other virulence factors is not excluded.
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Lima BJFDS, Voidaleski MF, Gomes RR, Fornari G, Soares JMB, Bombassaro A, Schneider GX, Soley BDS, de Azevedo CDMPES, Menezes C, Moreno LF, Attili-Angelis D, Klisiowicz DDR, de Hoog S, Vicente VA. Selective isolation of agents of chromoblastomycosis from insect-associated environmental sources. Fungal Biol 2020; 124:194-204. [PMID: 32220380 DOI: 10.1016/j.funbio.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/13/2020] [Accepted: 02/05/2020] [Indexed: 01/17/2023]
Abstract
Chromoblastomycosis is a neglected disease characterized by cutaneous, subcutaneous or disseminated lesions. It is considered an occupational infectious disease that affects mostly rural workers exposed to contaminated soil and vegetal matter. Lesions mostly arise after a traumatic inoculation of herpotrichiellaceous fungi from the Chaetothyriales order. However, the environmental niche of the agents of the disease remains obscure. Its association with insects has been predicted in a few studies. Therefore, the present work aimed to analyze if social insects, specifically ants, bees, and termites, provide a suitable habitat for the fungi concerned. The mineral oil flotation method was used to isolate the microorganisms. Nine isolates were recovered and phylogenetic analysis identified two strains as potential agents of chromoblastomycosis, i.e., Fonsecaea pedrosoi CMRP 3076, obtained from a termite nest (n = 1) and Rhinocladiella similis CMRP 3079 from an ant exoskeleton (n = 1). In addition, we also identified Fonsecaea brasiliensis CMRP 3445 from termites (n = 1), Exophiala xenobiotica CMRP 3077 from ant exoskeleton (n = 1), Cyphellophoraceae CMRP 3103 from bees (n = 1), Cladosporium sp. CMRP 3119 from bees (n = 1), Hawksworthiomyces sp. CMRP 3102 from termites (n = 1), and Cryptendoxyla sp. from termites (n = 2). The environmental isolate of F. pedrosoi CMRP 3076 was tested in two animal models, Tenebrio molitor and Wistar rat, for its pathogenic potential with fungal retention in T. molitor tissue. In the Wistar rat, the cells resembling muriform cells were observed 30 d after inoculation.
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Affiliation(s)
| | - Morgana Ferreira Voidaleski
- Graduate Program in Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil.
| | - Renata Rodrigues Gomes
- Graduate Program in Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil.
| | | | | | - Amanda Bombassaro
- Graduate Program in Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil.
| | - Gabriela Xavier Schneider
- Graduate Program in Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil.
| | | | | | | | | | - Derlene Attili-Angelis
- Department of Biochemistry and Microbiology, Institute of Biological Sciences, UNESP-São Paulo State University, Rio Claro, Brazil; Division of Microbial Resources, CPQBA, University of Campinas, Paulínia, Brazil.
| | - Débora do Rocio Klisiowicz
- Graduate Program in Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil.
| | - Sybren de Hoog
- Graduate Program in Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil; Center of Expertise in Mycology of Radboud, University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
| | - Vânia Aparecida Vicente
- Graduate Program in Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil.
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de Brito AC, Bittencourt MDJS. Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update. An Bras Dermatol 2018; 93:495-506. [PMID: 30066754 PMCID: PMC6063100 DOI: 10.1590/abd1806-4841.20187321] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/24/2017] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis is a chronic, granulomatous, suppurative mycosis of the skin and subcutaneous tissue caused by traumatic inoculation of dematiaceous fungi of the family Herpotrichiellaceae. The species Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in regions where the disease is endemic. Chromoblastomycosis lesions are polymorphous: verrucous, nodular, tumoral, plaque-like, and atrophic. It is an occupational disease that predominates in tropical and subtropical regions, but there have been several reports of cases in temperate regions. The disease mainly affects current or former farm workers, mostly males, and often leaving disabling sequelae. This mycosis is still a therapeutic challenge due to frequent recurrence of lesions. Patients with extensive lesions require a combination of pharmacological and physical therapies. The article provides an update of epidemiological, clinical, diagnostic, and therapeutic features.
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Affiliation(s)
- Arival Cardoso de Brito
- Dermatology Course, Universidade Federal do Pará,
Belém (PA), Brazil
- Medical Residency in Dermatology, Universidade Federal do
Pará, Belém (PA), Brazil
- Dermatopathology Laboratory, Universidade Federal do Pará,
Belém (PA), Brazil
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Abstract
Chromoblastomycosis (CBM), also known as chromomycosis, is one of the most prevalent implantation fungal infections, being the most common of the gamut of mycoses caused by melanized or brown-pigmented fungi. CBM is mainly a tropical or subtropical disease that may affect individuals with certain risk factors around the world. The following characteristics are associated with this disease: (i) traumatic inoculation by implantation from an environmental source, leading to an initial cutaneous lesion at the inoculation site; (ii) chronic and progressive cutaneous and subcutaneous tissular involvement associated with fibrotic and granulomatous reactions associated with microabscesses and often with tissue proliferation; (iii) a nonprotective T helper type 2 (Th2) immune response with ineffective humoral involvement; and (iv) the presence of muriform (sclerotic) cells embedded in the affected tissue. CBM lesions are clinically polymorphic and are commonly misdiagnosed as various other infectious and noninfectious diseases. In its more severe clinical forms, CBM may cause an incapacity for labor due to fibrotic sequelae and also due to a series of clinical complications, and if not recognized at an early stage, this disease can be refractory to antifungal therapy.
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Minotto R, Albano Edelweiss MI, Scroferneker ML. Study on the organization of cellular elements in the granulomatous lesion caused by chromoblastomycosis. J Cutan Pathol 2017; 44:915-918. [PMID: 28753235 DOI: 10.1111/cup.13014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chromoblastomycosis is a deep fungal infection characterized by a complex cellular granuloma. The aim of this study was to analyze the arrangement of cells responsible for the granuloma configuration of this disease by semiquantification of the cellular components of chromoblastomycosis skin biopsies. METHODS The cells of cutaneous biopsies slides from 100 patients with untreated chromoblastomycosis were stained with hematoxylin-eosin and the granuloma cells were evaluated by microscopic examination of the elements of each granuloma and semiquantified the number of cells through its expressivity in crosses and the histopathological variables. Their presence were coded in degrees of intensity and classified in two categories: low expression and high expression. The cells that constituted the granulomas were separated into three groups: A, B and C. RESULTS The chromoblastomycotic granuloma analyzed by this semiquantification of its cellular components showed that there was high expression of the elements setting up a mixed organized mycotic granuloma. It was observed that mononuclear phagocytic system (A), polymorphonuclear phagocytic system (B) and lymphoplasmocytic infiltrate (C) were located around the fungus. CONCLUSION The results indicated that the granuloma present in the cutaneous lesion of chromoblastomycosis is a mixed organized mycotic granuloma with high expression of the cellular components.
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Affiliation(s)
- Renan Minotto
- Dermatology Service, Santa Casa de Misericórdia de Porto Alegre Complexo Hospitalar, Porto Alegre, Brazil.,Graduate Program in Medicine: Department of Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Isabel Albano Edelweiss
- Graduate Program in Medicine: Department of Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Pathology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Lúcia Scroferneker
- Graduate Program in Medicine: Department of Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
Chromoblastomycosis (CBM) is a chronic, progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi. The disease has worldwide prevalence with predominant cases reported from humid tropical and subtropical regions of America, Asia, and Africa. Diagnosis is often delayed or misdirected either due to poor degree of clinical suspicions or clinical simulation of dermatological conditions. The infection is not uncommon in India and several case reports from the sub-Himalayan belt and western and eastern coasts of India have been published; however, very few have reviewed the cases. We reviewed 169 cases published in English literature from India during 1957 through May 2016, including 2 recent cases from our institute. A tremendous increase in the number of reported cases was noticed since 2012, since which, more than 50% of the cases had been published. A majority of the patients (74.1%) were involved in various agricultural activities directly or indirectly. The mean age at presentation was 43.3 years ± 16.0, with male to female ratio of 4.2:1. The duration of disease at the time of presentation varied from 20 days to 35 years. Any history of trauma was recalled only in 33.8% of the studied cases. The lower extremity was the most common site afflicted, followed by the upper extremity. The culture was positive in 80.3% of the cases with Fonsecaea pedrosoi, isolated as the most common fungal pathogen, followed by Cladophialophora carrionii. Although all the commercially available antifungals were prescribed in these cases, itraconazole and terbinafine were the most commonly used, either alone or in combination with other drugs/physical methods, with variable degrees of outcome. Combinations of different treatment modalities (chemotherapy and physical methods) yielded a cure rate of 86.3%. CBM is refractory to treatment and no single antifungal agent or regimen has demonstrated satisfactory results. Increased awareness with early clinical suspicion of the disease and adequate therapy are necessary to improve the outcome. However, depending upon the causative agent, disease severity, and the choice of antifungals, variable outcomes can be observed.
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Cancer et mycoses et revue de la littérature. ACTA ACUST UNITED AC 2017; 110:80-84. [DOI: 10.1007/s13149-017-0543-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/25/2016] [Indexed: 12/20/2022]
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Azevedo CMPS, Marques SG, Santos DWCL, Silva RR, Silva NF, Santos DA, Resende-Stoianoff MA. Squamous cell carcinoma derived from chronic chromoblastomycosis in Brazil. Clin Infect Dis 2015; 60:1500-4. [PMID: 25681378 DOI: 10.1093/cid/civ104] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/04/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chromoblastomycosis (CBM) is a chronic fungal infection caused mainly by the melanized fungi Fonsecaea species. The chronic lesions may be predisposed to develop into cancer, the most serious complication of the disease. METHODS In this report, 7 cases of squamous cell carcinoma (SCC) resulting from chronic CBM in patients from Maranhão in the Brazilian Amazon are described. RESULTS The 7 patients presented with SCC that resulted from chronic CBM, caused by Fonsecaea species >10 years' duration. The malignant lesions occurred independent of the antifungal therapy and all patients underwent curative amputation, except for 1 patient who developed metastases in the inguinal and intra-abdominal lymph nodes and thigh muscles. A majority of previous reports have focused on the malignant transformation of CBM described in only 1 patient each. This is a first report describing a group of patients from a single Brazilian state. CONCLUSIONS Here, we provide new epidemiologic data on malignant CBM lesions, an endemic disease that is seemingly neglected worldwide. We reinforce the idea that typically chronic lesions may be predisposed to turn malignant.
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Affiliation(s)
| | - Sirlei G Marques
- Departamento de Patologia, Universidade Federal do Maranhão, São Luiz
| | | | - Raimunda R Silva
- Departamento de Patologia, Universidade Federal do Maranhão, São Luiz
| | - Nayara F Silva
- Departamento de Patologia, Universidade Federal do Maranhão, São Luiz
| | - Daniel Assis Santos
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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