Plasmacytoid dendritic cells in cutaneous lesions of patients with chromoblastomycosis, lacaziosis, and paracoccidioidomycosis: a comparative analysis.

Plasmacytoid dendritic cells (pDCs) are characterized by expression of CD123 and BDCA-2 (Blood Dendritic Cell Antigen 2) (CD303) molecules, which are important in innate and adaptive immunity. Chromoblastomycosis (CBM), lacaziosis or Jorge Lobo's disease (JLD), and paracoccidioidomycosis (PCM), are noteworthy in Latin America due to the large number of reported cases. The severity of lesions is mainly determined by the host's immune status and in situ responses. The dendritic cells studied in these fungal diseases are of myeloid origin, such as Langerhans cells and dermal dendrocytes; to our knowledge, there are no data for pDCs. Forty-three biopsies from patients with CBM, 42 from those with JLD and 46 diagnosed with PCM, were evaluated by immunohistochemistry. Plasmacytoid cells immunostained with anti-CD123 and anti-CD303 were detected in 16 cases of CBM; in those stained with anti-CD123, 24 specimens were obtained from PCM. We did not detect the presence of pDCs in any specimen using either antibody in JLD. We believe that, albeit a secondary immune response in PCM and CBM, pDCs could act as a secondary source of important cytokines. The BDCA-2 (CD303) is a c-type lectin receptor involved in cell adhesion, capture, and processing of antigens. Through the expression of the c-lectin receptor, there could be an interaction with fungi, similar to other receptors of this type, namely, CD207 in PCM and CD205 and CD209 in other fungal infections. In JLD, the absence of expression of CD123 and CD303 seems to indicate that pDCs are not involved in the immune response.

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.

Mucormycosis and chromoblastomycosis occurring in a patient with leprosy type 2 reaction under prolonged corticosteroid and thalidomide therapy.

Mucormycosis is an uncommon fungal infection caused by Mucorales. It frequently occurs in patients with neutropenia, diabetes, malignancy and on corticoid therapy. However, it is rare in patients with AIDS. Clinical disease can be manifested in several forms. The case reported illustrates the rare occurrence of chromoblastomycosis and mucormycosis in an immunosuppressed patient with multibacillary leprosy, under prolonged corticosteroid and thalidomide therapy to control leprosy type 2 reaction. Neutrophil dysfunction, thalidomide therapy and work activities are some of the risk factors in this case. Chromoblastomycosis was treated by surgical excision and mucormycosis with amphotericin B. Although the prognosis of mucormycosis is generally poor, in the reported case the patient recovered successfully. This case should alert dermatologists to possible opportunistic infections in immunosuppressed patients.

Mucormycosis and chromoblastomycosis occurring in a patient with leprosy type 2 reaction under prolonged corticosteroid and thalidomide therapy / Mucormicose e cromoblastomicose em um paciente com reação hansênica tipo II sob terapia prolongada com corticosteróide e talidomida

Mucormycosis is an uncommon fungal infection caused by Mucorales. It frequently occurs in patients with neutropenia, diabetes, malignancy and on corticoid therapy. However, it is rare in patients with AIDS. Clinical disease can be manifested in several forms. The case reported illustrates the rare occurrence of chromoblastomycosis and mucormycosis in an immunosuppressed patient with multibacillary leprosy, under prolonged corticosteroid and thalidomide therapy to control leprosy type 2 reaction. Neutrophil dysfunction, thalidomide therapy and work activities are some of the risk factors in this case. Chromoblastomycosis was treated by surgical excision and mucormycosis with amphotericin B. Although the prognosis of mucormycosis is generally poor, in the reported case the patient recovered successfully. This case should alert dermatologists to possible opportunistic infections in immunosuppressed patients.

Mucormicose é uma infecção fúngica incomum causada por Mucorales. Ocorre frequentemente em pacientes com neutropenia, diabetes, corticoterapia e condições malignas. Porém, é rara em pacientes com AIDS. A doença pode apresentar-se em diferentes formas. Este caso ilustra a rara ocorrência de mucormicose e cromoblastomicose em um paciente com hanseníase multibacilar, que estava sendo tratado com prednisona e talidomida devido a eritema nodoso (reação hansênica tipo II). Disfunção de neutrófilos, uso de talidomida e atividades profissionais são alguns fatores de risco neste caso. A cromoblastomicose foi tratada por excisão cirúrgica e a mucormicose com anfotericina B. Embora o prognóstico da mucormicose seja ruim, neste caso o tratamento foi bem sucedido. Este caso alerta dermatologistas para a possibilidade de infecções oportunistas em pacientes imunossuprimidos.

Chromoblastomycosis in Nepal: a study of 13 cases.

BACKGROUND: Chromoblastomycosis is a chronic fungal infection caused by several pigmented fungi commonly seen in tropical and subtropical climates. AIM: To evaluate the epidemiologic, clinical and pathological characteristics of chromoblastomycosis in our patients. METHODS: This retrospective and prospective study was conducted at the Manipal Teaching Hospital, Pokhara, Nepal. Clinical features and histopathology of all the cases diagnosed as chromoblastomycosis during the last eight years were studied. RESULTS: A total of 13 cases of chromoblastomycosis were diagnosed during the period of 1999-2006. The disease was seen predominantly in middle-aged male farmers and those from rural areas. The lesions commonly involved the lower extremity and were single or multiple in number. They clinically presented as verrucous or nodular growths. Out of these 13 cases, three were diagnosed clinically as squamous cell carcinoma and one as psoriasis. The histopathological features included sclerotic bodies in 12 cases (92%), microabscess formation in 10 cases (76.9%), pseudoepitheliomatous hyperplasia in nine cases (69.2%) and granuloma in eight cases (61.5%). CONCLUSION: Farming is the commonest occupation in patients with chromoblastomycosis. Early histological diagnosis helps in effective management of the condition.

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.

Dermatoses do pavilhäo auricular / External ear dermatosis

Apresentamos uma atualizaçäo sobre as dermatoses que ocorrem no pavilhäo auricular. Propomos uma classificaçäo em sete grupos e realizamos uma sucinta descriçäo clínica de cada uma das 84 entidades catalogadas, de forma didática, com a finalidade de auxiliar o médico, sobretudo o clínico geral, o dermatologista e o otorrinolaringologista, no diagnóstico de tais patologias.

[Squamous cell carcinoma arising from chromomycosis. Report of two cases]. / Carcinome épidermoïde développé sur des lésions de chromomycose. A propos de deux observations.

Madagascar is the principal area of endemic chromomycosis in the world with 1 400 cases registered from 1955 to 1996. Malignant transformation is rare and only 12 cases have been reported. We describe herein two new cases of squamous carcinoma arising from chronic lesions of chromomycosis. These carcinomas which develop slowly and are non invasive, are similar to those arising from burns, tropical phagedenic ulcers and chronic leprosy ulcers. Epidemiological aspects, histopathology and treatment are described.

Infections and infestations of the central nervous system in India. A review.

Based on extensive personal experiences during the past three decades, a review is given on infections and infestations of the central nervous system, which are found in India and in other tropical and subtropical areas. Besides the main disease such as tuberculosis, pyogenic infections and parasitic infestations, rare lesions are also discussed. The literature has been cited in extenso and more especially the contributions by Indian neurosurgeons and neurologists.