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Zheng J, Liu S, Xie Z, Chen Y, Xi L, Liu H, Liu Y. Successful management of chromoblastomycosis utilizing conventional antifungal agents and imiquimod therapy. Ann Clin Microbiol Antimicrob 2024; 23:57. [PMID: 38902740 PMCID: PMC11191280 DOI: 10.1186/s12941-024-00718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
Chromoblastomycosis (CBM), a chronic fungal infection affecting the skin and subcutaneous tissues, is predominantly caused by dematiaceous fungi in tropical and subtropical areas. Characteristically, CBM presents as plaques and nodules, often leading to scarring post-healing. Besides traditional diagnostic methods such as fungal microscopy, culture, and histopathology, dermatoscopy and reflectance confocal microscopy can aid in diagnosis. The treatment of CBM is an extended and protracted process. Imiquimod, acting as an immune response modifier, boosts the host's immune response against CBM, and controls scar hyperplasia, thereby reducing the treatment duration. We present a case of CBM in Guangdong with characteristic reflectance confocal microscopy manifestations, effectively managed through a combination of itraconazole, terbinafine, and imiquimod, shedding light on novel strategies for managing this challenging condition.
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Affiliation(s)
- Jinjin Zheng
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Shougang Liu
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Zhenmou Xie
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Yangxia Chen
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Liyan Xi
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
- Department of Dermatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongfang Liu
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.
| | - Yinghui Liu
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.
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Belda W, Passero LFD, de Carvalho CHC, Mojica PCR, Vale PA. Chromoblastomycosis: New Perspective on Adjuvant Treatment with Acitretin. Diseases 2023; 11:162. [PMID: 37987273 PMCID: PMC10660773 DOI: 10.3390/diseases11040162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause granulomatous and suppurative dermatosis. This infection is difficult to treat and there are limited therapeutic options, including terbinafine, itraconazole, and tioconazole. Classic treatment is administered for a long period of time, but some patients do not respond properly, and therefore, such therapeutic approaches possess low cure rates. Therefore, it is vital to develop new strategies for the treatment of CBM. In this regard, it has been observed that the association of immunomodulatory molecules such as glucan with therapy carried out with antifungal drugs improves cutaneous lesions in comparison to treatment with antifungal drugs alone, suggesting that drug association may be an interesting and significant approach to incorporate into CBM therapy. Thus, the aim of this work was to associate classical antifungal therapy with the adjuvants imiquimod and acitretin. In the present case, we reported a patient with extensive CBM caused by Fonsaecae pedrosoi, that affected an extensive area of the right leg, that was left without treatment for 11 years. He was treated with a classical combination of itraconazole and terbinafine via the oral route plus topical imiquimod and oral acitretin, as an adjuvant therapy. After five months of treatment, a significant regression of verrucous plaques was observed, suggesting that the use of these adjuvants combined with the classical antifungal drugs, intraconazole plus terbinafine, can reduce treatment time and rapidly improve the patient's quality of life. This result confirms that the use of coadjuvant drugs may be effective in the treatment of this infectious disease.
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Affiliation(s)
- Walter Belda
- Dermatology Department, Medical School, University of São Paulo, Sao Paulo 05403-000, Brazil; (C.H.C.d.C.); (P.C.R.M.); (P.A.V.)
- Laboratory of Pathology of Infectious Diseases, Medical School, University of São Paulo, Sao Paulo 01246-000, Brazil
| | - Luiz Felipe Domingues Passero
- Institute of Biosciences, São Paulo State University (UNESP), Sao Vicente 11330-900, Brazil;
- Institute for Advanced Studies of Ocean, São Paulo State University (UNESP), Sao Vicente 11350-011, Brazil
| | | | - Paula Celeste Rubiano Mojica
- Dermatology Department, Medical School, University of São Paulo, Sao Paulo 05403-000, Brazil; (C.H.C.d.C.); (P.C.R.M.); (P.A.V.)
| | - Pablo Andrade Vale
- Dermatology Department, Medical School, University of São Paulo, Sao Paulo 05403-000, Brazil; (C.H.C.d.C.); (P.C.R.M.); (P.A.V.)
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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: 8] [Impact Index Per Article: 2.7] [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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Belda W, Casolato ATS, Luppi JB, Passero LFD. Managing chromoblastomycosis with acitretin plus imiquimod: A case report on the improvement of cutaneous lesions and reduction of the treatment time. J Dermatol 2021; 48:1612-1615. [PMID: 34405444 DOI: 10.1111/1346-8138.16101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/23/2021] [Accepted: 07/21/2021] [Indexed: 11/27/2022]
Abstract
Chromoblastomycosis (CBM) is an infectious disease caused by fungi that is prevalent in tropical and subtropical countries. Besides few therapeutic options, the classical treatment of CBM needs to be administrated for a long period of time, and unfortunately some patients do not show improvement of the lesions. Thus, it becomes urgent to develop new strategies for the treatment of CBM. This work reports a successful treatment, performed with the combination of oral acitretin (50 mg/kg, once a day) plus topical imiquimod (50 mg/g, five times per week) for 5 months in a patient with CBM. A significant improvement of the lesions was observed in the 1st month, and in the 5th a complete regression of lesions was recorded. Changes in the biochemical parameters were not observed. These data suggest that the combination of acitretin and imiquimod may be effective at treating CBM.
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Affiliation(s)
- Walter Belda
- Dermatology Department, Medical School, Clinics Hospital, University of São Paulo, São Paulo, Brazil
- Laboratory of Pathology of Infectious Diseases, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Juliana Bronzato Luppi
- Dermatology Division, Medical School, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Luiz Felipe Domingues Passero
- São Paulo State University (UNESP), Institute of Biosciences, São Vicente, Brazil
- São Paulo State University (UNESP), Institute for Advanced Studies of Ocean, São Vicente, Brazil
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Cosio T, Gaziano R, Zuccari G, Costanza G, Grelli S, Di Francesco P, Bianchi L, Campione E. Retinoids in Fungal Infections: From Bench to Bedside. Pharmaceuticals (Basel) 2021; 14:ph14100962. [PMID: 34681186 PMCID: PMC8539705 DOI: 10.3390/ph14100962] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022] Open
Abstract
Retinoids-a class of chemical compounds derived from vitamin A or chemically related to it-are used especially in dermatology, oncohematology and infectious diseases. It has been shown that retinoids-from their first generation-exert a potent antimicrobial activity against a wide range of pathogens, including bacteria, fungi and viruses. In this review, we summarize current evidence on retinoids' efficacy as antifungal agents. Studies were identified by searching electronic databases (MEDLINE, EMBASE, PubMed, Cochrane, Trials.gov) and reference lists of respective articles from 1946 to today. Only articles published in the English language were included. A total of thirty-nine articles were found according to the criteria. In this regard, to date, In vitro and In vivo studies have demonstrated the efficacy of retinoids against a broad-spectrum of human opportunistic fungal pathogens, including yeast fungi that normally colonize the skin and mucosal surfaces of humans such as Candida spp., Rhodotorula mucilaginosa and Malassezia furfur, as well as environmental moulds such as Aspergillus spp., Fonsecae monofora and many species of dermatophytes associated with fungal infections both in humans and animals. Notwithstanding a lack of double-blind clinical trials, the efficacy, tolerability and safety profile of retinoids have been demonstrated against localized and systemic fungal infections.
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Affiliation(s)
- Terenzio Cosio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (L.B.)
| | - Roberta Gaziano
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.G.); (P.D.F.)
| | - Guendalina Zuccari
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy;
| | - Gaetana Costanza
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.C.); (S.G.)
| | - Sandro Grelli
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.C.); (S.G.)
| | - Paolo Di Francesco
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.G.); (P.D.F.)
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (L.B.)
| | - Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (L.B.)
- Correspondence:
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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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Wedy GF, Passero LFD, Criado PR, Belda W. A case of tuberculosis verrucosa cutis in Brazil undiagnosed for 15 years. Braz J Infect Dis 2021; 25:101593. [PMID: 34242596 PMCID: PMC9392159 DOI: 10.1016/j.bjid.2021.101593] [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: 03/12/2021] [Revised: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis verrucosa cutis is a rare medical condition that is caused by the inoculation of Mycobacterium tuberculosis into the skin of a previously sensitized individual. This clinical form of tuberculosis corresponds to 1-2% of all cases of tuberculosis and due to the paucibacillary characteristic of the lesions, patients can be misdiagnosed, accounting for the chronification of the skin infection. Herein, we report the case of a 26-year-old male farmer, presenting plaques with verrucosa and hyperkeratosis features in the left thigh and buttocks during 15 years. M. tuberculosis was identified by PCR and the patient was treated with standard anti-tuberculosis drugs, with subsequent improvement of the skin lesions.
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Affiliation(s)
| | - Luiz Felipe Domingues Passero
- São Paulo State University (UNESP), Institute of Biosciences, São Vicente, SP, Brazil; São Paulo State University (UNESP), Institute for Advanced Studies of Ocean, São Vicente, SP, Brazil
| | - Paulo Ricardo Criado
- Fundação Universitária do ABC (FUABC), ABC School of Medicine, Santo André, SP, Brazil
| | - Walter Belda
- University of São Paulo, Medical School, Clinics Hospital, São Paulo, SP, Brazil; University of São Paulo, Medical School, Laboratory of Pathology of Infectious Diseases, São Paulo, SP, Brazil.
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