Molecular epidemiology and clinical-laboratory aspects of chromoblastomycosis in Mato Grosso, Brazil.

INTRODUCTION: Chromoblastomycosis is a disease caused by melanized fungi, primarily belonging to the genera Fonsecaea and Cladophialophora, mainly affecting individuals who are occupationally exposed to soil and plant products. This research aimed to determine the clinical, epidemiological and laboratory characteristics of chromoblastomycosis in the state of Mato Grosso, Brazil. MATERIALS AND METHODS: Patients diagnosed with chromoblastomycosis treated at the Júlio Müller University Hospital, Cuiabá, Brazil, from January 2015 to December 2020, whose isolates were preserved in the Research Laboratory of the Faculty of Medicine of the Federal University of Mato Grosso. Isolates were identified by partly sequencing the Internal Transcribed Spacer (ITS) and ß-tubulin (BT2) loci. AFLP fingerprinting was used to explore the genetic diversity. Susceptibility to itraconazole, voriconazole, 5-fluorocytosine, terbinafine and amphotericin B was determined by the broth microdilution technique. RESULTS: Ten patients were included, nine were male (mean age = 64.1 years). Mean disease duration was 8.6 years. Lesions were mainly observed in the lower limbs. Predominant clinical forms were verrucous and scarring. Systemic arterial hypertension and type II diabetes mellitus were the predominant comorbidities. Leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi was the unique aetiological agent identified with moderate genetic diversity (H = 0.3934-0.4527; PIC = 0.3160-0.3502). Antifungal agents with the highest activity were terbinafine, voriconazole and itraconazole. CONCLUSION: Chromoblastomycosis is affecting the poor population in rural and urban areas, mainly related to agricultural activities, with F. pedrosoi being the dominant aetiologic agent. All isolates had low MICs for itraconazole, voriconazole and terbinafine, confirming their importance as therapeutic alternatives for chromoblastomycosis.

Chromoblastomycosis-Leprosy Co-Infection in Central West Brazil. Presentation of Three Cases and Literature Review.

Chromoblastomycosis and leprosy are chronic diseases with high prevalence in tropical and subtropical regions. Brazil is one of the countries with the highest incidence and prevalence for both diseases, however, reports of co-infections are scarce. The aim of this study was to describe three cases of chromoblastomycosis-leprosy co-infection in patients from Mato Grosso state, Brazil. A review of chromoblastomycosis-leprosy co-infection was performed of English, Portuguese and Spanish publications in LILACS, SciELO, PubMed and Web of Science databases using the descriptors (chromoblastomycosis OR cromoblastomicose OR cromoblastomicosis) AND (leprosy OR hanseníase OR lepra), without time period delimitation. Nineteen cases were included, 16 cases were published in 11 articles, plus the three cases reported in the current study. Most reported coninfection cases came from Brazil. Majority of the patients were male with a mean age of 52.2 years. Farmer was the main occupational activity reported. In 12 patients, the clinical signs and symptoms of leprosy started first. No contacts with patients affected by leprosy, armadillos or history of injuries at the anatomical site of chromoblastomycosis lesions were reported. Five leprosy patients who received steroid treatment for leprosy reactions or neuropathies, were diagnosed with chromoblastomycosis during immunosuppressive therapy. Four cases (21.1%) were reported among the elderly patients. Co-infections in patients with chromoblastomycosis or leprosy are uncommon, but the possibility should always be considered, especially if the patient is undergoing immunosuppressive treatment or is elder.

Chromoblastomycosis in Latin America and the Caribbean: Epidemiology over the past 50 years.

Chromoblastomycosis is a chronic disease caused by melanized fungi that mainly affect individuals performing soil-related labor. The objective of this study was to analyze 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 1211 articles were identified, of which 132 were included in the review, covering 2081 patients, 80.3% were males, 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 2081 patients, mean disease duration was 10.8 years. Fonsecaea pedrosoi and Cladophialophora carrionii predominated.

Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 1: micosis subcutáneas / Cutaneous involvement in the deep mycoses: a literature review. Part I-subcutaneous mycoses

Las micosis profundas son infecciones poco frecuentes en nuestro medio. Se presentan principalmente en pacientes inmunodeprimidos o en regiones de climas tropicales, que abarcan las micosis subcutáneas y las micosis sistémicas. Las micosis subcutáneas o por implantación siempre producen signos de afectación cutánea. En la primera parte de esta revisión se realizará una revisión de las principales micosis subcutáneas: esporotricosis, cromoblastomicosis, micetomas, feohifomicosis, hialohifomicosis y lacaziosis. Reconocer y tratar estas micosis subcutáneas de forma precoz es importante, ya que a menudo están asociadas a una alta morbilidad

The deep mycoses are uncommon in our setting. These fungal infections occur mainly in immunosuppressed patients or in tropical climates, and include subcutaneous infections and systemic infections. The skin is always involved in the former. In the first part of this review, we describe the main subcutaneous mycoses: sporotrichosis, chromoblastomycosis, mycetoma, phaeohyphomycosis, hyalohyphomycosis, and lacaziosis. Early recognition and treatment is important, as these infections are frequently associated with high morbidity

Chromoblastomycosis in a resident of a leprosarium.

Chromoblastomycosis is caused by dematiaceous fungi. It develops after inoculation of the organism into the skin. The lesion begins as a pink, scaly papule or warty growth. We report a case of chromoblastomycosis occurring in a multibacillary leprosy patient, who had already been released from treatment (RFT). The diagnosis was confirmed by the presence of sclerotic bodies (Medlar bodies/copper penny bodies). Systemic antifungal treatment has been found effective. The case is being reported in view of the association of two diseases and the dramatic clinical response to systemic treatment with Itraconazole.

Chromoblastomycosis in Kerala, India.

BACKGROUND: We are reporting 35 new cases of Chromoblastomycosis from Central Kerala. A majority of the cases from India are reported from the Sub Himalayan belt and South India. The disease scenario in India and abroad is briefly reviewed. AIMS: To study chromoblastomycosis in Central Kerala including the demographic and clinico- investigative profile. METHODS: This report is a retrospective record analysis of 35 cases of chromoblastomycosis who presented to the Dermatology Outpatient department of our tertiary center from January 2003 to July 2010 after obtaining Institutional Review Board approval. RESULTS: The disease was found to be more common among male agriculturists. The majority of cases were from the central districts of Kerala in and around the Western Ghats. The lower extremity (60%) was more affected with 40% of the subjects remembering a prior history of trauma. Sclerotic bodies were demonstrable in scrapings from black dots in 42.8%. The characteristic mixed mycotic granuloma was demonstrable in 77.1% of cases. The most common species isolated was Fonsecaea pedrosoi. CONCLUSIONS: Chromoblastomycosis is very common in Central Kerala. The disease mainly affects male agriculturists especially those employed in rubber plantations. The most common organism is F. pedrosoi.

Lymphangitic chromoblastomycosis.

Chromoblastomycosis (CM), a chronic subcutaneous mycosis, is caused by several dematiaceous fungi, the most common being Fonsecaea pedrosoi. It usually occurs in the lower extremities following traumatic implantation of the organisms. We are reporting a case of chromoblastomycosis on the right lower limb in a sporotrichoid pattern caused by F. pedrosoi. The pattern was probably due to lymphatic spread that seems to be one of the rare presentations. The histopathology showed typical muriform or medlar bodies both intracellularly and extracellularly within the granuloma. Culture revealed sporulating organisms (Cladosporium and Rhinocladiella type) by a combination method, characteristic of F. pedrosoi. Our case responded well to itraconazole.

Cromomicose e lepra: apresentação de 2 casos

Os AA. apresentam 2 casos de cromomicose associada à lepra, num dos quais conseguiram isolar o fungo causador da moléstia que foi identificado como Phialophora pedrosoi. Comentando a literatura mundial sôbre o assunto e ausência de diagnósticos desta associação nos principais Institutos de Pesquisa sôbre Lepra, do pa¡s, salientam a necessidade de pesquisas mais sérias para apurar as causas da raridade desta associação.