Presentación de un paciente con cromomicosis / Presentation of a Patient with Chromomycosis

La cromomicosis es una micosis subcutánea o profunda, de curso crónico, causada por un grupo de hongos, se caracteriza por la formación de nódulos cutáneos verrucosos, localizados comúnmente en miembros inferiores, de evolución crónica y difícil curación total. Se presentó un paciente de 34 años de edad, que hace cinco años le salieron placas (de tres a cuatro) dispuestas de forma lineal, aspecto papuloverrucoso en dorso del brazo izquierdo. Se indicó examen micológico, donde se informó la presencia Fonsecaea pedrosoi, para lo cual recibió tratamiento con fluconazol; por elevación de las transaminasas se interrumpió el tratamiento, luego se aplicó crioterapia y por último recibió tratamiento quirúrgico.

Chromomycosis is a subcutaneous or deep mycosis of chronic course, caused by a group of fungi; it is characterized by the formation of coetaneous verrucous nodules, commonly located in lower limbs, of chronic evolution and total difficult cure. A 34- year-old patient that 5 years ago presented plaques (three-four) of lineal form, papulo verrucous in dorsum of the left arm, mycosis exam was indicated, and the diagnosis of Fonsecaea pedrosoiwas confirmed, treatment with fluconazol was given that was interrupted due to transaminase increase, thus cryotherapy was given and later surgical treatment.

Casuística de cromomicosis en el estado Bolívar (1987-2010) y evaluación de la sensibilidad in vitro de dos aislados de Fonsecaea pedrosoi / Chromomycosis cases in Bolivar State (1987-2010) and evaluation of the in vitro sensitivity of two Fonseca pedrosoi isolates

El objetivo de este estudio fue determinar la prevalencia de cromomicosis en un período de 23 años en dos hospitales de referencia del estado Bolívar. Se realizó un estudio retrospectivo, mediante la revisión de historias clínicas de pacientes con diagnóstico de cromomicosis, registrándose catorce casos de la enfermedad. El 78,6% correspondieron al sexo masculino, en su mayoría agricultores provenientes de zonas rurales; el 28,6% presentaron lesiones verrugosas. El tiempo de evolución de las lesiones osciló entre 5 meses y 35 años. Fonsecaea pedrosoi fue el agente etiológico aislado en tres (21,4%) de los cuatro pacientes en que las muestras fueron cultivadas. Sólo a dos aislados conservados de F. pedrosoi se les evaluó la sensibilidad in vitro mediante E-test®, demostrándose resistencia a los antifúngicos sistémicos: anfotericina B, 5-fluorocitosina, ketoconazol, fluconazol e itraconazol. Dos pacientes fueron tratados con itraconazol: uno de ellos mejoró; el otro presentó comorbilidad con micetoma eumicótico y falleció. La prevalencia de cromomicosis durante el período estudiado fue baja (0,6 casos/año), sin embargo esta infección representa un problema de salud en el personal de riesgo, principalmente agricultores y mineros del estado Bolívar, que presentan lesiones verrugosas de evolución crónica.

The purpose of this study was to determine chromomycosis prevalence during a 23-year period at two reference hospitals of Bolivar State. A retrospective study was carried out through the revision of clinical case histories of patients with a chromomycosis diagnosis, registering fourteen cases of this disease. Of these cases, 78.6% corresponded to males, most of them agricultural workers from rural areas; 28.6% presented verrucous lesions. The period of evaluation of the lesions varied between 5 months and 35 years. Fonsecae pedrosoi was the etiologic agent isolated in three (21.4%) of the four patients whose samples were cultured. Sensitivity was evaluated in vitro in only two cases through E-test®, showing resistance to systemic antifungals agents: amphotericine-B, 5-fluorocytosine, ketoconazole, fluconazole and itraconazole. Two patients were treated with itraconazol, one of them improved and the other presented co-morbility with eumycotic mycetoma and died. Chromomycosis prevalence during the period studied was low (0.6 cases/year); nevertheless, this infection constitutes a health problem for risk populations, mainly agricultural and mining workers at Bolivar State who present verrucous lesions with a chronic evolution.

Cromomicosis: reporte de un caso incapacitante / Chromomycosis: report of a disabling case

La cromomicosis es una micosis profunda subcutánea producida por hongos dimórficos que de forma habitual habitan en restos vegetales. Se presenta el caso de un paciente de 51 años que seis años antes del ingreso se dedicaba a la fabricación de tejas en Madre de Dios, Perú; donde sufrió una lesión inicial papular en una pierna la cual se extendió hasta comprometer los cuatro miembros, con lesiones verrucosas que lo llevaron a la discapacidad. Se observaron cuerpos fumagoides en la biopsia de piel. El paciente fue hospitalizado y recibió curaciones tópicas, antibioticoterapia y terbinafina. Fue dado de alta al cabo de dos meses con mejoría clínica.

Chromomycosis is a deep subcutaneous mycosis caused by different dymorphic fungi species that normally live in vegetal debris. We report the case of a 51 year-old patient that six years previous to the evaluation worked making roof tiles in Madre de Dios, Peru; where he presented an initial papular lesion in a leg, which continued expanding until the 4 limbs were affected with disabling verrucous lesions. Fumagoid cells were found in the skin biopsy. The patient was hospitalized and received topical cleaning, antibiotics and terbinafine. He was discharged two months later with clinical improvement.

Cromomicosis: una endemia rural en la región noroccidental en Venezuela / Chromomycosis: rural endemic in the north-western region of Venezuela

INTRODUCCIÓN: la cromomicosis, descrita por Max Rudolph en 1914, es una micosis subcutánea de desarrollo crónico, que se adquiere generalmente a partir de un traumatismo cutáneo y es causada por hongos dematíaceos. En Venezuela se ha reportado en todo el país aunque hay franco predominio en los estados de Lara, Zulia y Falcón. OBJETIVO: establecer algunos factores que pudieran explicar la endemia en la zona rural del estado de Falcón, Venezuela. MÉTODOS: se procedió a la detección in vitro de Cladophialophora carrionii a partir de la vegetación típica de esta región, semiárida, descrita como "bosque xerófilo de espinar". Se realizó además, búsqueda activa de casos clínicos entre los habitantes de la zona, mediante examen directo y cultivo de las escamas obtenidas a partir de lesiones y se trató de establecer, la existencia un factor de susceptibilidad hereditario mediante el cálculo del factor de heredabilidad de Falconer y la metodología de problemas genéticos heredables de Arias. RESULTADOS: se pudo aislar C. carrionii a partir de especies xerófilas abundantes en la zona: Prosopis juliflora; y varias cactáceas. La casuística acumulada, en nuestro estado representa 54,4 % (490/900) de todos los casos reportados en Venezuela, desde 1983 hasta 2005. La mayoría de los pacientes fueron infectados por C. carrionii y refirieron traumas frecuentes con espinas de cactáceas. Mediante estudios genealógicos se demostró la concentración de los casos en grupos familiares (hasta 11 % superior a la comunidad) así como un factor de heredabilidad de 65 % y alta frecuencia de matrimonios consanguíneos (25 %) asociados con 7 % de personas con cromomicosis. CONCLUSIONES: se consideró que se trata de una endemia rural, laboral y familiar, posiblemente relacionada con un factor de susceptibilidad heredable.

INTRODUCTION: chromomycosis, described by Max Rudolph in 1914, is a chronic subcutaneous mycosis that are generally caught from a cutaneous trauma and caused by dematiaceous fungi. This disease has been reported throughout Venezuela, but it is predominant in the states of Lara, Zulia and Falcón. OBJECTIVE: to ascertain some factors that might explain the endemic at Falcon State rural zone. METHODS: in vitro detection of Cladophialophora carrionii from the typical vegetation of this semiarid area known as "xerophilous woods of prickles" and also, active search of clinical cases among inhabitants of this area through direct testing and culture of flakes from skin lesions. It was intended to determine a hereditary susceptibility factor through the estimation of Falconer´s heritability factor and Arias´ methodology of heritable genetic disorders. RESULTS: it was possible to isolate C. carrionii from abundant xerophilous species in the area such as Prosopis juliflora and several Cactaceae. The accumulated casuistry in our state accounts for 54,4% (490/900) of all cases reported in Venezuela from 1983 to 2995. Most of the patients were infected by C. carrionii and they mentioned frequent injures by cactaceae prickles. On the basis of genealogical studies, it was proved that cases were concentrated in family groups (up to 11% higher than in the community) as well as 65% heritability factor and high frequency of blood-related marriages (25%) associated with 7% of people affected by chromomycosis. CONCLUSIONS: it was concluded that this is a rural, work and family endemic that is likely associated with a hereditary susceptibility factor.

Detection of Infectious Fungal Diseases of Frogs Inhabiting in Korea

In recent years, there has been a rapid decrease in amphibian populations worldwide, and infectious diseases have been associated with this decline. Diseased frogs inhabiting Korea were collected from fields, and the diseases were identified by morphological and molecular analyses. Two fungal diseases-saprolegniasis and chromomycosis-were detected in the frogs. Saprolegniasis caused by Saprolegnia spp. was found in Rana plancyi chosenica from Gangwon-do and Rana huanrenensis from Chungbuk. Chromomycosis, which is caused by infection with Cladosporium cladosporioides, was detected in Rana catesbeiana from Busan.

Respuestas inflamatorias y de anticuerpos contra Cladophialophora carrionii en caprinos / Inflamatory and Antibody Responses against Cladophialophora carrionii in Goats

Cladophialophora carrionii es un hongo dimórfico con melanina que causa en humanos una micosis profunda, localizada y crónica llamada cromomicosis, y se adquiere a través de la inoculación con espinas de cactáceas infectadas. El estado Falcón es una zona endémica para esta enfermedad, donde las poblaciones están integradas principalmente por campesinos criadores de caprinos. El objetivo de este trabajo fue evaluar la respuesta inmunitaria humoral e inflamatoria contra C. carrionii en caprinos con el fin de conocer la interacción hospedador-parásito en un animal usualmente considerado como resistente a la infección, a pesar de su exposición permanente a las espinas infectadas. Se inocularon seis cabritos con 1×10(6) células de C. carrionii, vía subcutánea, en la tabla del cuello. Se midió la temperatura corporal de cada animal y se tomaron muestras de sangre completa y suero para análisis hematológicos y ensayos inmunoenzimáticos (ELISA) dos veces a la semana. Se midió el diámetro de la piel 24 y 48 horas después de la inoculación. La respuesta inflamatoria en el sitio de inoculación fue notoria a las 48 horas. No hubo respuesta significativa de anticuerpos en los animales inoculados a partir de los 50 días post-inoculación. Se confirma que la respuesta celular es importante en la resistencia contra C. carrionii, pero la respuesta de anticuerpos parece no ser relevante en esta especie animal.

Cladophialophora carrionii is a dimorphic fungus with melanin which causes a deep, localized and chronic mycosis in humans, named chromomycosis, acquired through inoculation with cactuses infected-spines. Falcon state is an endemic zone to this disease, where human populations make use of goat breeding as their main way of living. The objective of this work was to evaluate both humoral immune and inflammatory responses against C. carrionii in goats to improve knowledge about host-parasite interactions in a species usually considered as infection-resistant, in spite of permanent exposition to infected spines. Six kids were inoculated with 1 ×10(6) cells of C. carrionii, by subcutaneous route on the neck. Blood and sera samples for hematological and immunoenzimatic tests were taken and body temperature was also measured. The diameter of the inoculated skin was also evaluated 24 and 48 hours post-inoculation. Inflammatory response was considerable at 48 hours. There was no valuable response of antibodies. It is established that inflammatory response is important in resistance against C. carrionii, but antibody response seems not to be relevant for this animal specie.

Fungal Keratitis Caused by Chromomycetes

PURPOSE: Chromomycetes is a plant parasite and one of the pigmented filamentous fungi, which rarely causes human infection. The authors report the first case of fungal keratitis caused by chromomycetes in korea. METHODS: A 65-year-old woman developed pain, redness, and an yellowish-brown infiltrate in her right eye. She had a history of corneal scratch by a pumpkin stalk and transferred by a local clinic after management for about 1 months. The clinical features suggested fungal keratitis, and the patient was undertaken surgical debridement with amniotic membrane graft and treated with oral terbinafine with natamycin and amphotericin B eyedrops. Surgically taken biopsy specimen was cultured. Amniotic membrane was removed after 1 week. After slight improvement of symptom, necrotizing ulceration was enlarged in spite of continuous antifungal therapy. Lamellar keratoplasty with amniotic membrane graft was done with antifungal therapy. Systemic agent was changed to fluconazole. Clinical improvement was achieved after about 2 months. The fungus was identified as Fonsecaea pedrosoi. RESULTS: Fungal keratitis was successfully treated with antifungal medication combined with amniotic membrane graft. CONCLUSIONS: This is a rare case of infectious keratitis caused by chromomycetes. But its clinical course was severe, so exact culture and identification following aggressive surgical and medical treatment was needed.

A Case of Chromomycosis Showing Ulcerative Lesions on Dorsa of Hands / 대한피부과학회지

Chromomycosis is a chronic mycosis of the skin and subcutaneous tissue characterized by a brown, thick-walled, round, nonbudding form of causative fungi in the tissue. We report a case of chromomycosis caused by Fonsecaea pedrosoi in a 56-year-old Korean woman who showed 3 x 4cm sized deep ulcerations on the dorsa of both hands. Histopathologically, chronic granulomatous inflammation and sclerotic cells were observed. Fonsecaea pedrosoi was grown into typical black colonies in fungus culture. She was treated with pedicle flap graft followed by oral itraconazole, and showed clinical improvement.

Chromomycosis of the Nasolacrimal Duct: Report of a case

Chromomycosis is a chronic cutaneous fungal infection characterized by the presence of dark brown parasitic forms of fungi in biopsied tissues. It is usually resulted from the entry of the causative organism through a minor trauma, and therefore, most lesions are found on the exposed part of the body, such as limbs or face, and occurrence on the nasolacrimal duct is extremely rare. We report a case of chromomycosis of the right nasolacrimal duct, which was presented with clinical symptoms of nasolacrimal duct obstruction. The patient was a 40 year-old male who had had minor injuries on his left eye twice by paper and branches of the tree two months prior to epiphora in right eye. On dacryocystorhinostomy, right nasolacrimal duct was obstructed by pinkish brown mucoid ball. Microscopically, the mucoid ball revealed eosinophilic, amorphous, necrotic materials admixed with brown pigmented fungi. The organism showed characteristic dark brown, round, thick-walled, often septated, sclerotic bodies and brown pigmented long bead-like hyphae. The adjacent mucosa shows marked chronic nonspecific inflammation with fibrosis.

Laboratory Observation and Analysis of 287 Strains of Fungi in Patients with Chromoblastomycosis / 中华皮肤科杂志

Objective Two hundred and eighty seven strains of fungi isolated from the cutaneous lesions in patients with chromoblastomycosis from Zhang Qiu county and its surrounding region were observed and analysed. Methods The fungi were cultured and the morphologic characters of colonies were observed under scanning electron microscope. Results There were 283 strains of C.carrionii, 2 strains of F.pedrosoi, 1 strain of P.verrucosa and 1 strain of undeterminate phialophora sp.were identificated. Conclusion The predominant pathogenic fungi isolated from patients with chromoblastomycosis in Zhang Qiu county and its surrounding region were C.carrionii which confirms that the pathogenic fungi in nothern China is C.carrionii.

Chromomycosis of the Skin: A case report

Cutaneous chromomycosis is a slow growing verrucous skin infection caused by five species, identified as Philadophara verruscosa, Fonsecaea dermatitidis, Fonsecaea pedrosoi, Fonsecaea compactum, Cladosporium, carionii. We report a case of chromomycosis of the skin causing by Cladosporium genus, in view of its rarity and unique light microscopic and ultrastructural features. This 65-year-old female had suffered from eczematous and lichenified skin lesion for the last two years since she burned her dorsum of the left hand by boiling oil. The lesion was slowly progressed, and ended up to the brownish hardening of the skin covered with crusts. Skin punch biopsy was done. Histologically, the sections revealed typical features of chronic granulomatous inflammation along with the heavy infiltration of the lymphocytes, plasma cells and histiocytes. Pseudocarcinomatous downgrowth of the epidermis and microabscesses in the upper dermis were also found. Numerous thick walled fungal organisms were noted within the giant cells and freely in the dermis, which were positive ant PAS stain, and diastase resistant. Thick mucous capsule is not observed. The organisms showed very faint yellowish walls with a few buddings and a few short elongated hyphae were also noted. Ultrastructurally, the fungus wall was multilayered and inner organelles were sparse. There is no evidence of systemic involvement, especially brain.

A Case of Chromonycosis / 대한피부과학회지

We report a 55-year-old male, who has had erythematous, scaly, verrucous plaque on the left lower leg. About 1 year ago, rice sized erythematous papule on the left lower leg was developed. The lesion had been aggravated abruptly and rapidly in size since about one month ago. Histopathologic finding showed clusters of fungal spores in the upper dermis and intraepidermal microabscesses. The patient had been treated with wide excision and intravenous injection of amphotericin B. We observed a good response without evidence of recurrence.