Neutrophil-suppressive activity over T-cell proliferation and fungal clearance in a murine model of Fonsecaea pedrosoi infection.

Neutrophils are essential to control several fungal infections. These cells are commonly known for their pro-inflammatory activities. However, some studies have demonstrated the anti-inflammatory properties of neutrophils during certain infectious diseases, culminating in the inhibition of T cell proliferation. Chromoblastomycosis (CBM) is a deep and progressive mycosis that affects thousands of people worldwide. Although neutrophil infiltrates are observed in the lesion histopathology, the fungus can overtake the immune system response and destroy the host-infected tissue. The present study demonstrated that neutropenic animals had an increase in the IL-6 production in the spleen and liver, followed by a lower fungal burden in these organs up to 14 days of infection. Neutropenic animals also showed a lower F. pedrosoi-specific antibody production 14-days post infection and higher T-cell proliferation in the in vitro experiments after stimulation with F. pedrosoi-purified proteins. Taken together, our results suggest that the presence of regulatory neutrophils in the mouse model of F. pedrosoi infection could act favoring the spread of the fungus and the chronicity of the infection. These findings shed light on the CBM treatment, which might target neutrophil polarization as a new therapy approach to treat CBM lesions.

Chromomycosis, an unusual cause of cicatricial ectropion: a case report.

Chromomycosis is a fungal infection that affects the epidermis, dermis, and subcutaneous tissue and is caused by dematiaceous fungal species that turn black on staining. We report the case of a 50-year-old male patient who was a rural worker and had been treated without success for three decades. Facial lesions progressed and caused severe cicatricial retraction. As the infection evolved, the left upper eyelid developed cicatricial ectropion. The surgical treatment was performed using skin obtained from the patient's own abdomen. Patient has developed a good postoperative appearance.

Chromomycosis, an unusual cause of cicatricial ectropion: a case report / Cromomicose como causa rara de ectrópio cicatricial: relato do caso

ABSTRACT Chromomycosis is a fungal infection that affects the epidermis, dermis, and subcutaneous tissue and is caused by dematiaceous fungal species that turn black on staining. We report the case of a 50-year-old male patient who was a rural worker and had been treated without success for three decades. Facial lesions progressed and caused severe cicatricial retraction. As the infection evolved, the left upper eyelid developed cicatricial ectropion. The surgical treatment was performed using skin obtained from the patient's own abdomen. Patient has developed a good postoperative appearance

RESUMO A cromomicose é uma infecção fúngica que afeta a epiderme, derme e tecido subcutâneo. A infecção é causada por espécies de fungo dematiáceos que se coram em preto. Nós relatamos o caso de um homen de 50 anos de idade, trabalhador da zona rural, que tinha sido tratado por três décadas sem êxito conclusivo. As lesões faciais progrediram causando retração cicatricial severa. Com a evolução do quadro, houve também retração também da pálpebra superior do olho esquerdo. O tratamento cirúrgico foi realizado utilizando pele abdominal do próprio paciente. O paciente apresentou uma boa aparência pós-operatória.

Squamous cell carcinoma derived from chronic chromoblastomycosis in Brazil.

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.

Subcutaneous dematiaceous fungal infection.

Subcutaneous dematiaceous fungal infections, which include chromoblastomycosis and phaeohyphomycosis, are a heterogeneous group of clinical entities that are caused by dematiaceous or pigmented fungi found in soil. These infections have a wide spectrum of clinical presentations that depend largely on the specific causative organism and on the integrity of the host's immune response. Treatment is challenging and involves a highly individualized plan that often combines both surgical and long-term medical treatment.

Chromoblastomycosis associated with a lethal squamous cell carcinoma.

Chromoblastomycosis is a subcutaneous mycosis caused by the dermatophytic fungi Fonsecaea, Phialophora and Cladophialophora. Usual complications include secondary infection, lymphedema and elephantiasis. Associated malignancies have been found in chronic cases. This case report describes a 72 year-old male with a 30 year history of chromoblastomycosis in the gluteal region, who went on to develop a squamous cell carcinoma.

Carcinoma epidermoide como complicação letal de lesões crônicas de cromoblastomicose / Chromoblastomycosis associated with a lethal squamous cell carcinoma

A cromoblastomicose é uma micose subcutânea, ocasionada por fungos dermatófitos, dos gêneros: Fonsecaea, Phialophora e Cladophialophora. As complicações habituais são: infecções secundárias, linfedema e elefantíase. Em lesões crônicas, tem-se documentado malignização. Relatamos um caso de um homem de 72 anos de idade, com cromoblastomicose de 30 anos de evolução, em região glútea, com desenvolvimento de carcinoma epidermoide.

Chromoblastomycosis is a subcutaneous mycosis caused by the dermatophytic fungi Fonsecaea, Phialophora and Cladophialophora. Usual complications include secondary infection, lymphedema and elephantiasis. Associated malignancies have been found in chronic cases. This case report describes a 72 year-old male with a 30 year history of chromoblastomycosis in the gluteal region, who went on to develop a squamous cell carcinoma.

Melanoma in a long-standing lesion of chromoblastomycosis.

BACKGROUND: Chromoblastomycosis is a chronic cutaneous fungal infection where the presence of fibrous scars and continuous inflammation might be the propitious condition for the development of malignant neoplasms. METHODS: We report a case of cutaneous melanoma arising on a leg of a man that had been affected by extensive chromoblastomycosis for more than 30 years. RESULTS: A 70-year-old white man presented with an irregularly pigmented lesion over an area of fibrosis and verrucous lesions, previously diagnosed as chromoblastomycosis, on his left ankle. Histological examination showed an acral lentiginous melanoma, Clark level IV, thickness of 2.3 mm. Follow-up for 7 years showed no signs of recurrence or metastasis. CONCLUSIONS: The association between malignancy and chromoblastomycosis is very uncommon, but medical staff who deal with this disease should be attentive to this possibility, as early detection of these neoplasms will provide an adequate treatment, improving survival and quality of life for those patients.

Clinical treatment of corneal infection due to Fonsecaea pedrosoi--case report.

UNLABELLED: To report an unusual case of fungus keratitis due to Fonsecaea pedrosoi that developed after corneal trauma. CASE REPORT: A 18-year-old male presented with a corneal ulcer in the right eye, 28 days after a trauma with glass fragments. Corneal scrapings were collected for smears and culture. Dematiaceous hyphae were seen on wet mounts of the scrapings and dark pigmented colonies grew repetitively on the culture media; all colonies were identical, and were subsequently identified as Fonsecaea pedrosoi. Treatment was initiated with topical natamycin at one hour intervals, 200 mg oral ketoconazole per day and later changed to a combination of 200 mg ketoconazole and amphotericin B. In humid tropical regions Fonsecaea pedrosoi is one of the primary causes of human chronic cutaneous mycosis, chromoblastomycosis. Combination of systemic and topical antifungal medications may provide the best option for cure in corneal chromoblastomycosis.

Clinical treatment of corneal infection due to Fonsecaea pedrosoi: case report

Relato de um caso atípico de infecção fúngica da córnea causada pelo microrganismo Fonsecaea pedrosoi após trauma ocular. Paciente, masculino, estudante de 18 anos, apresentou-se ao Setor de Doenças Externas Oculares do Departamento de Oftalmologia da UNIFESP com úlcera de córnea paracentral de 3,5 x 3,5 mm e aspecto branco-acinzentado com bordas infiltradas, 28 dias após trauma em ocular por vidro. Foi realizado raspado da córnea e o material enviado para análise microbiológica. Foi observado crescimento de colônias em meio de cultura e posteriormente colocadas em solução de lactofenol-azul de algodão. Verificou-se a presença de hifas dermáceas de pigmento escuro, identificado como Fonsecaea pedrosoi. Tratamento foi iniciado com natamicina 5% tópica a cada hora e cetoconazol 200 mg por dia. Subseqüentemente foi substituído pela combinação cetoconazol e anfotericina B. Fonsecaea pedrosoi é uma das principais causas em humanos de micose crônica cutânea, cromoblastomicose, em regiões úmidas tropicais. A combinação de antimicóticos sistêmicos e tópicos pode ser a melhor opção para pacientes no tratamento de cromoblastomicose da córnea.

Lymphoscintigraphic analysis in chromoblastomycosis.

BACKGROUND: One of the main complications of chromoblastomycosis is lymphedema. The purpose of this study was to evaluate the lymphatic system of the limbs of patients with chromoblastomycosis using lymphoscintigraphy. It is a reliable, objective and noninvasive means of supporting the diagnosis of lymphedema. METHODS: Lymphoscintigraphy was performed in seven patients with chromoblastomycosis, six with lesions in the lower limb and one in the upper limb. Tc-99 m dextran was injected into the interdigital spaces of the upper or lower extremities. The qualitative parameters analyzed were the visibilization of the lymph vessels and the lymph nodes, dermal backflow, and existence of collateral vessels. All patients were treated with the association of itraconazole and cryotherapy with liquid nitrogen. RESULTS: Three out of the 14 extremities examined had lymphedema clinically, and the lymphoscintigraphy showed abnormalities in the qualitative parameters; whereas these parameters were normal in the extremities without lymphedema. During the treatment of chromoblastomycosis, a second lymphoscintigraphy exam was performed on 10 limbs and did not show any improvement of the previous lymphoscintigraphic alterations. CONCLUSIONS: The qualitative lymphoscintigraphy was a reliable method to show the morphology of the lymph vessels and confirm objectively the diagnosis of lymphedema secondary to chromoblastomycosis. The association of oral itraconazole and cryotherapy did not modify the lymphatic alterations in chromoblastomycosis.

Concurrent chromoblastomycosis caused by Fonsecaea pedrosoi and actinomycetoma caused by Nocardia brasiliensis.

Chromoblastomycosis and mycetoma are chronic infections caused by the repeated traumatic inoculation of organisms into the skin and subcutaneous tissue. Chromoblastomycosis is caused by several dematiaceous (pigmented) fungi, occurs in tropical regions, and usually affects the lower extremities. The lesions may be nodules, plaques, or tumorous masses. Mycetomas are caused by either true fungi (eumycetes) or filamentous bacteria (actinomycetes); they also occur predominantly in tropical areas and most frequently affect the foot or leg. Typically there is a firm swelling with multiple sinus tracts that drain small granules. The treatment of these infections is difficult. Surgery, cryotherapy, heat therapy, and antimicrobial agents are used to treat chromoblastomycosis. Surgery and antimicrobial agents are used for treatment of mycetomas. This is the first report of concurrent infections caused by these agents.

Associaçäo de cromoblastomicose e hanseníase: relato de dois casos / Chromoblastomycosis associated with leprosy: report of 2 cases

Ao estudar 30 casos de cromoblastomicose diagnosticados no Hospital dos Servidores do Estado do Maranhao, no período de novembro de 1988 a março de 1993, os autores observaram 2 (6,6 por cento) casos, que apresentaram associaçao desta doença com hanseníase. O primeiro paciente desenvolveu as duas doenças concomitantemente, apresentando espessamento no nervo cubital bilateral, mal perfurante plantar em pé direito e lesoes em placas verrucóides na perna esquerda, com biópsia de nervo cubital direito positiva para hanseníase dimorfa T e biópsia da lesao em placa, positiva para Fonsecaea pedrosoi. O segundo caso, paciente com história de hanseníase virchowiana há 30 anos, em pausa terapêutica por "cura", com lesoes verrugo-confluentes em cotovelo direito há 12 meses, histopatológico e cultura positiva, para cromoblastomicose. Os possíveis fatores para o desenvolvimento da cromoblastomicose nestes pacientes sao discutidos.

[Chromoblastomycosis associated with leprosy: report of 2 cases]. / Associação de cromoblastomicose e hanseníase: relato de dois casos.

Thirty cases of chromoblastomycosis were diagnosed at Hospital dos Servidores do Estado do Maranhão, from November, 1988 to March, 1993. The authors report 2 (6.6%) cases, that presented an association with leprosy. The first patient developed both diseases together, showing palpable bilateral cubital nerves, perforanting ulcer of the right foot, infiltration and lesions in verrucoid plaques in left leg, with positive biopsy for dimorphic leprosy. The second case, a patient with history of lepromatous leprosy for 30 years without treatment, with vegetant lesions with a warty aspect in right elbow for 12 months, histopathologic and positive culture for chromoblastomycosis. The possible factors for development of this disease in these patients are discussed.

Cromoblastomicose auricular: relato de um caso / Auricular chromoblastomycosis : case report

E apresentado um caso de cromoblastomicose auricular apresentado sob forma de lesao eritemato-escamosa, tendo tido o diagnostico de eczema. Os AA discutem sobre a raridade desta localizacao e aspecto clinico. Embora os poucos casos relatados de cromoblastomicose auricular tenham sido causados pela Fonsecaea pedrosoi, neste o agente etiologico foi a Phialophora verrucosa.

Treatment of chronic murine chromoblastomycosis with the triazole SCH39304

Congenitally athymic (nu/.nu) mice were inoculated sc with 105 conidia of Fonsecae pedrosoi and treated orally from the ls to the 16th week of infection with either a new triazole, SCH39304, or itraconazole at doses of 20 or 60 mg/kg/day. The volumes of the lesions were measured with calipers at 4 week intervals and compared statistically by the Wilcoxon test. At the end of the experiment, mice were killed and samples of thelesions were examinated histopathologically and by electron microscopy. Treatment with itraconazole or SCH39304 significantly reduced lesion sizes as compared with controls. There were no differences between the 2 drugs at the dosages used. Histopathologically, lesions of mice treated with either drug had less inflammation with fewer fungi and more diffuse fibrosis than controls. Electron microscopy showed damage to the fungal cell walls in mice treated with itraconazole or SCH39304, characterized by gaps, fragmentation, and delamination. These studies confirm clinical observations that itraconazole is effective in chromoblatomycosis and suggest that SCH39304 should be considered for clinical evaluation

Experimental murine chromomycosis mimicking chronic progressive human disease

Congenitally athymic (nu/nu) mice, mice defective in NK cell and macrophage function (bg/bg) and normal BALB/c mice were inoculated sc with 10 5-6 conidia of Fonsecae pedrosoi (FP). In immunologically intact and immunodeficient mice, a local infection developed approximately 2 weeks post-inoculation and enlarged over 1-2 weeks. In bg/bg and normal nu/+ mice, lesions resolved within 5-6 weeks. However, nu/nu mice continued to have enlarging cs lesions during >4-6 months od observation. These eventually metastasized. Lesions contained, few hyphal elements and massive numbers of sclerotic bodies. Five weeks after inoculation. 10 4-6 conidia froming units/gm of tissue were recovered from lesions. Delayed type hypersensitivity and serum antibody to FP antigens were demonstrated. Adoptive transfer of lymphocytes from nu/+ mice was followed in months bu the resolution of the lesions