Cromoblastomicosis: primer caso alóctono tratado en Chile / Chromoblastomycosis: first allochthonous case treated in Chile

Resumen La cromoblastomicosis es una infección fúngica de la piel y del tejido subcutáneo, de evolución crónica, causada por hongos dematiáceos que se caracterizan por presentar melanina en su pared celular. La enfermedad se presenta en todo el mundo, principalmente en regiones tropicales y subtropicales. En Chile, solo hay un reporte de caso humano hace más de 30 años. Se presenta el caso de un varón de 46 años, haitiano, residente en Chile, con placas verrucosas en la zona tibial anterior de un año de evolución. El diagnóstico de cromoblastomicosis se confirmó al observar células muriformes en la histopatología y colonias dematiáceas en el cultivo micológico; además, en la miscroscopía directa se observaron conidias compatibles con Fonsecaea spp. Luego de seis meses de tratamiento con antimicóticos sistémicos y crioterapia, se logró la remisión completa de las lesiones.

Abstract Chromoblastomycosis is a fungal infection of the skin and subcutaneous tissue, of chronic evolution, caused by dematiaceous fungi. The disease occurs worldwide, mainly in tropical and subtropical regions, but in regions like Chile there is only one report of a human case more than 30 years ago. We present the case of a 46-year-old Haitian man, resident in Chile, with verrucous plaques in the right anterior tibial area of one year of evolution. The diagnosis of chromoblastomycosis was confirmed when muriform cells and dematiaceous colonies were observed in the histopathological analysis and the direct microscopy, respectively. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.

Esporotricosis cutánea: experiencia de un hospital de tercer nivel en Cali, Colombia / Cutaneous sporotrichosis: experience at a thirdlevel hospital in Cali, Colombia

Introducción: la esporotricosis es una micosis subcutánea causada por especies del complejo Sporothrix schenckii, que se adquiere por la inoculación traumática del hongo. Objetivo: describir los aspectos epidemiológicos y clínicos de un grupo de pacientes con esporotricosis. Metodología: se realizó un estudio retrospectivo, descriptivo en un hospital de referencia de la ciudad de Cali, entre enero de 2000 y junio de 2011; de los registros de laboratorio se seleccionaron los pacientes que presentaron cultivo positivo para S. sckenckii y/o tinción con ácido peryódico de Schiff (PAS)-diastasa positiva para blastoconidias compatibles con las de este complejo. Resultados: el grupo estuvo formado por 20 hombres y 3 mujeres; ocho (34,8%) de ellos se desempeñaban en la agricultura y cuatro (17,4%), en la construcción; seis (26,1%) fueron niños menores de 15 años. En 22 (95,7%) se aisló S. sckenckii y 15 de 21 (71,4%) mostraron blastoconidias en el examen directo. Hubo 14 casos (60,9%) de la forma linfangítica y nueve (39,1%) de la fija. La enfermedad se presentó en las extremidades superiores en 16 (69,6%) pacientes, en las inferiores en cuatro (17,4%) y en la cara en tres (13%). Se hizo tratamiento con yoduro de potasio en 22 pacientes (95,6%). Conclusiones: la esporotricosis linfangítica fue la forma clínica más común en este estudio. La coloración de PAS-diastasa mostró ser útil en el diagnóstico de la enfermedad.

Introduction: Sporotrichosis is a subcutaneous mycosis caused by the Sporothrix schenckii species complex; it is acquired by traumatic inoculation of the fungus. Objective: To describe the epidemiological and clinical features of a group of patients with sporotrichosis. Methodology: A retrospective and descriptive study was performed at a third-level hospital in Cali, Colombia, from January 2000 to June 2011. Records from patients having positive cultures for S. schenckii and/or periodic acid-Schiff (PAS)-diastase stain showing blastoconidia were included in the analysis. Results: The group was made up of 20 men and three women. Eight patients (34.8%) were farmers and four (17.4%) worked in construction activities. Six (26.1%) were children aged under 15 years. Sporothrix sckenckii was isolated from cultures in 22 patients (95%) and in 15 out of 21 (71.4%) blastoconidia were observed by direct examination. Fourteen patients (60.9%) had the lymphangitic form of the disease. Upper limbs were most frequently affected (16 cases; 69.6%). Twenty two patients were treated with potassium iodine. Conclusions: Lymphangitic sporotrichosis was the most common clinical form of the disease in this study. PAS-diastase stain seems to be a useful diagnostic tool for sporotrichosis.

Treatment of severe chromoblastomycosis with itraconazole and 5-flucytosine association / Tratamento de cromoblastomicose severa com a associação itraconazole e 5-flucitosina

Chromoblastomycosis is a chronic human melanized fungi infection of the subcutaneous tissue caused by traumatic inoculation of a specific group of dematiaceous fungi through the skin, often found in barefooted agricultural workers, in tropical and subtropical climate countries. We report the case of a male patient presenting a slow-growing pruriginous lesion on the limbs for 20 years, mistreated over that time, which was diagnosed and successfully treated as chromoblastomycosis. Besides the prevalence of this disease, treatment is still a clinical challenge.

Cromoblastomicose é uma infecção fúngica crônica do tecido subcutâneo causada pela inoculação traumática de um grupo específico de fungos através da pele, encontrados eventualmente em trabalhadores do campo descalços em países de clima tropical e subtropical. Relatamos aqui o caso de um paciente do sexo masculino com uma lesão dermatológica de crescimento lento e pruriginosa nos membros inferiores por 20 anos, diagnosticada e tratada com sucesso para cromoblastomicose. Apesar da prevalência desta doença em nossa região, o tratamento ainda é um desafio.

Cladophialophora carrionii: a rare agent of chromoblastomycosis in Rio de Janeiro State, Brazil / Cladophialophora carrionii: agente raro de cromoblastomicose no estado do Rio de Janeiro, Brasil

A 73 year-old male farm laborer from a rural area presented a 15 year history of extensive tumoral lesions over his left leg. Histological studies of skin biopsy showed pseudoepitheliomatous hyperplasia and granulomatous chronic inflammatory process with muriform cells, confirming chromoblastomycosis (CBM). Cladophialophora carrionii was isolated in culture. Treatment with itraconazole 400 mg/day for 12 months resulted in complete remission of lesions. As far we aware, this is the first case report of CBM caused by Cladophialophora carrionii in Rio de Janeiro State, Brazil.

Lavrador, com 73 anos, residente em área rural apresentava há 15 anos lesões tumorais disseminadas na perna esquerda. Exame histopatológico de biópsia de pele mostrou hiperplasia pseudo-epiteliomatosa e processo inflamatório crônico granulomatoso com células muriformes, confirmando o diagnóstico de cromoblastomicose (CBM). Cladophialophora carrionii foi isolado na cultura. Tratamento com itraconazol 400 mg/dia durante 12 meses resultou na completa remissão das lesões. Este é o primeiro relato de CBM causado por C. carrionii no estado do Rio de Janeiro, Brasil.

Subcutaneous Mycoses in Korea / 한양의대학술지

The subcutaneous mycoses are infections caused by fungi that have been introduced directly into the dermis or subcutaneous tissue from puncture wounds, abrasions, or other trauma. The skin lesion of subcutaneous mycosis is a verrucous plaque or abscess that forms at the site of probable trauma in an exposed area of the body. The most commom subcutaneous mycosis in Korea is sporotrichosis. In recent years the dematiaceous fungi, characterized by having melanin in their cell walls, have become significant due to increasing cause of subcutaneous mycoses in Korea. The subcutaneous mycoses caused by demataceous fungi contain chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma.