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Santos DWCL, de Azevedo CDMPES, Vicente VA, Queiroz-Telles F, Rodrigues AM, de Hoog GS, Denning DW, Colombo AL. The global burden of chromoblastomycosis. PLoS Negl Trop Dis 2021; 15:e0009611. [PMID: 34383752 PMCID: PMC8360387 DOI: 10.1371/journal.pntd.0009611] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected Tropical Disease (NTD) and mainly affects populations living in poverty with significant morbidity, including stigma and discrimination. METHODS AND FINDINGS In order to estimate the global burden of CBM, we retrospectively reviewed the published literature from 1914 to 2020. Over the 106-year period, a total of 7,740 patients with CBM were identified on all continents except Antarctica. Most of the cases were reported from South America (2,619 cases), followed by Africa (1,875 cases), Central America and Mexico (1,628 cases), Asia (1,390 cases), Oceania (168 cases), Europe (35 cases), and USA and Canada (25 cases). We described 4,022 (81.7%) male and 896 (18.3%) female patients, with the median age of 52.5 years. The average time between the onset of the first lesion and CBM diagnosis was 9.2 years (range between 1 month to 50 years). The main sites involved were the lower limbs (56.7%), followed by the upper limbs (19.9%), head and neck (2.9%), and trunk (2.4%). Itching and pain were reported by 21.5% and 11%, respectively. Malignant transformation was described in 22 cases. A total of 3,817 fungal isolates were cultured, being 3,089 (80.9%) Fonsecaea spp., 552 (14.5%) Cladophialophora spp., and 56 Phialophora spp. (1.5%). CONCLUSIONS AND SIGNIFICANCE This review represents our current knowledge on the burden of CBM world-wide. The global incidence remains unclear and local epidemiological studies are required to improve these data, especially in Africa, Asia, and Latin America. The recognition of CBM as NTD emphasizes the need for public health efforts to promote support for all local governments interested in developing specific policies and actions for preventing, diagnosing and assisting patients.
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Affiliation(s)
- Daniel Wagner C. L. Santos
- Special Mycology Laboratory—LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Vania Aparecida Vicente
- Microbiology, Parasitology, and Pathology Post Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Flávio Queiroz-Telles
- Department of Public Health, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - G. Sybren de Hoog
- Microbiology, Parasitology, and Pathology Post Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
- Center of Expertise in Mycology, Radboud University Medical Center/CWZ, Nijmegen, The Netherlands
| | - David W. Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester, United Kingdom
| | - Arnaldo Lopes Colombo
- Special Mycology Laboratory—LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, 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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Lan LJ, Lien YS, Wang SC, Ituaso-Conway N, Tsai MC, Tseng PY, Yeh YL, Chen CT, Lue KH, Chung JG, Hsiao YP. Dermatological disorders in Tuvalu between 2009 and 2012. Mol Med Rep 2015; 12:3629-3631. [PMID: 25998560 DOI: 10.3892/mmr.2015.3806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/18/2014] [Indexed: 11/06/2022] Open
Abstract
There is a distinct lack of knowledge on the prevalence of skin disorders in Tuvalu. The aim of the current study was to assess the prevalence of cutaneous diseases and to evaluate access dermatological care in Tuvalu. Cutaneous disorders in the people of Tuvalu between 2009 and 2012 were examined. The most common skin conditions were eczema/dermatitis, superficial fungal infections, impetigo, carbuncles, furuncles, folliculitis, acne, scabies, warts and keloids. Infrequent skin conditions included infectious granulomatous disease, albinism, actinic keratosis, skin cancer, cutaneous lupus erythematosus and mammary Paget's disease, which required medical attention. This is the first epidemiological report on skin disorders in the southwest Pacific Island, Tuvalu.
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Affiliation(s)
- Li-Jung Lan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan, R.O.C
| | - Ying-Shuang Lien
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan, R.O.C
| | - Shao-Chuan Wang
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan, R.O.C
| | - Nese Ituaso-Conway
- Public Health, Princess Margaret Hospital, Ministry of Health, Funafuti, Tuvalu
| | - Ming-Che Tsai
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan, R.O.C
| | - Pao-Ying Tseng
- International Medical Service Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan, R.O.C
| | - Yu-Lin Yeh
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan, R.O.C
| | - Chun-Tzu Chen
- Department of Chief Secretary Group, Chung Shan Medical University Hospital, Taichung 40201, Taiwan, R.O.C
| | - Ko-Huang Lue
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan, R.O.C
| | - Jing-Gung Chung
- Department of Biological Science and Technology, China Medical University, Taichung 40201, Taiwan, R.O.C
| | - Yu-Ping Hsiao
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan, R.O.C
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Monchy D, Huerre MR, de Bièvre C. Deep-seated fungal diseases in the South Pacific, especially in New Caledonia. Mycoses 1998; 41:31-4. [PMID: 9610130 DOI: 10.1111/j.1439-0507.1998.tb00372.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The main deep-seated fungal diseases and their encountered pathology in New Caledonia and other islands of the South Pacific are reviewed (1970-96). Cryptococcosis is encountered in all islands of the South Pacific, Australia and Papua New Guinea, with a predominance of variety gattii, which is associated with some species of Eucalyptus. Histoplasmosis is not uncommon, and there was an epidemic in New Caledonia in 1994 among people who had visited a bat-inhabited cave. Mycetomas, in particular presenting as pale granules in tissues, are encountered in New Caledonia, Vanuatu, Papua New Guinea, Fiji and French Polynesia. Other fungal infections, such as zygomycosis, sporotrichosis (three cases) and chromomycosis (six cases) are rarely observed in New Caledonia.
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Affiliation(s)
- D Monchy
- Institut Pasteur de Nouvelle Calédonie, Nouméa, New Caledonia, Paris, France
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Santos LD, Arianayagam S, Dwyer B, Lee KC, O'Kane G, Withnall K, Currie B. Chromoblastomycosis: a retrospective study of six cases at the Royal Darwin Hospital from 1989 to 1994. Pathology 1996; 28:182-7. [PMID: 8743828 DOI: 10.1080/00313029600169843] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Chromoblastomycosis, a localized chronic cutaneous and subcutaneous infection of the skin caused by pigmented fungi, is most common in the world's tropical and subtropical zones. The condition rarely occurs in Australia. We present 6 cases of chromoblastomycosis seen at the Royal Darwin Hospital, Northern Territory, from 1989 to 1994 and affecting predominantly male Caucasians ranging from 38 to 71 yrs of age. Clinically the lesions were verrucous or nodular. They mimicked basal or squamous cell carcinoma, nevi or solar keratoses. Histopathologic findings were nonspecific. The only pathognomonic finding was the presence of brown spores or sclerotic bodies within granulomata or within microabscesses in the skin.
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Affiliation(s)
- L D Santos
- Department of Pathology, Royal Darwin Hospital, NT
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