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.

Diagnóstico microbiológico en un paciente con cromomicosis / Microbiological diagnosis in a patient with chromomycosis

RESUMEN La cromomicosis es una micosis subcutánea; uno de los pilares para su diagnóstico certero son los resultados de los estudios microbiológicos. Se presenta el caso de un hombre campesino, que tenía, desde hacía ocho años, lesiones papulares que evolucionaron a placas verrugosas y escamosas en el antebrazo izquierdo. El examen directo micológico de las escamas, así como su cultivo, apoyaron el diagnóstico de una cromomicosis. En la microscopía de su forma de esporulación se identificó al agente etiológico: fonsecaea pedrosoi. Este hallazgo resultó novedoso pues hacía más de una década que no se diagnosticaba ni se informaba un caso de cromomicosis en el laboratorio. La promoción y prevención de salud es un pilar fundamental en el sistema de salud, ya que mediante la educación del campesinado cubano se puede prevenir esta enfermedad, disminuir los costos médicos, curar oportunamente, y mejorar la calidad de vida de los campesinos.

ABSTRACT Chromomycosis is a subcutaneous mycosis; the results of microbiological studies are one of the pillars for its accurate diagnosis. A male farmer who had, for eight years, papular lesions that evolved to warty and scaly plaques on the left forearm is presented. The direct mycological examination of the scales, as well as their culture, supported the diagnosis of a chromomycosis. The etiological agent Fonsecaea pedrosoi was identified in the microscopy of its sporulation form. This finding was novel since a case of chromomycosis had not been diagnosed or reported in the laboratory for more than a decade. Health prevention and promotion is a fundamental pillar in the health system, since through the education of the Cuban farmers this disease can be prevented, medical costs can be reduced, timely cures and the quality of life of the farmers can be improved.

Chromoblastomycosis caused by Rhinocladiella aquaspersa: first case report in Guatemala

Abstract The authors report a case of 40-year-old male patient with a five-year history of chromoblastomycosis on his right leg. Diagnosis was performed by direct 40% KOH exam of skin scales, culture with micro- and macromorphologic analysis, and genotypic characterization (sequencing of a fragment of the ITS region and phylogenetic analysis) of the isolated fungus. Rhinocladiella aquaspersa was identified as the etiological agent. Initially, the treatment was with oral itraconazole 200 mg/day for one year. However, the presence of "sclerotic cells" with filaments ("Borelli spiders") resulted in a change of medical treatment: a higher dose of itraconazole (400 mg/day) and surgery, achieving clinical and mycological cure in one year. This is the first report of chromoblastomycosis caused by R. aquaspersa in Guatemala.

Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update

Abstract: Chromoblastomycosis is a chronic, granulomatous, suppurative mycosis of the skin and subcutaneous tissue caused by traumatic inoculation of dematiaceous fungi of the family Herpotrichiellaceae. The species Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in regions where the disease is endemic. Chromoblastomycosis lesions are polymorphous: verrucous, nodular, tumoral, plaque-like, and atrophic. It is an occupational disease that predominates in tropical and subtropical regions, but there have been several reports of cases in temperate regions. The disease mainly affects current or former farm workers, mostly males, and often leaving disabling sequelae. This mycosis is still a therapeutic challenge due to frequent recurrence of lesions. Patients with extensive lesions require a combination of pharmacological and physical therapies. The article provides an update of epidemiological, clinical, diagnostic, and therapeutic features.

Chromoblastomycosis: tissue modifications during itraconazole treatment

Abstract: Background: Histological and mycological changes during itraconazole use have not been totally established in chromoblastomycosis. Objectives: To evaluate tissue modifications in chromoblastomycosis carriers under itraconazole treatment. Methods: A histological retrospective study of 20 cases of chromoblastomycosis seen at the university hospital at the south of Brazil, during itraconazole 400 mg daily treatment. Patients were classified into two groups: plaque or tumor lesions, and underwent periodic evaluations every four months during three years. Hematoxylin-eosin stain was used to analyze epidermal modifications, inflammatory infiltrate and fibrosis, and Fontana-Masson stain for parasite evaluation. Results: Fontana-Masson stain was superior to hematoxylin-eosin stain in fungal count in the epidermis (mean difference=0.14; p<0.05). The most distinct mycosis tissue responses were registered in the dermis. Epidermal thinning, granulomatous infiltrate decrease or disappearance, fibrosis increase and quantitative/morphological changes occurred during treatment. Study limitations: Patients could not be located to have their current skin condition examined. Conclusion: Parasitic and tissue changes verified in this study can reflect the parasite-host dynamics under itraconazole action.

Cromoblastomicosis: características clínicas y microbiológicas de una enfermedad desatendida / Chromoblastomycosis: clinical and microbiological characteristics of a neglected disease

Resumen La cromoblastomicosis es una enfermedad fúngica desatendida de curso crónico, que infecta por inoculación al tejido subcutáneo de personas con riesgo ocupacional. Comunicamos dos casos de adultos procedentes de regiones tropicales del norte del Perú, afectados con lesiones crónicas eritemato-escamosas y puntos negros múltiples, con dolor, prurito y cicatrización en áreas más antiguas de la lesión. El diagnóstico se realizó con el examen directo de escamas dérmicas con presencias de células fumagoides típicas y el aislamiento de hongos dematiáceos Fonsecaea pedrosoi y Fonsecaea sp., en el primer y segundo caso; respectivamente. Los pacientes recibieron tratamiento antifúngico con itraconazol, sin poder observar el resultado final debido al abandono del tratamiento y control médico.

Chromoblastomycosis is a neglected and chronic fungal disease, mainly affects the subcutaneous tissue in limbs of people with occupational risk. Here, we report two cases of adult patients from tropical regions of northern Peru, affected with chronic erythematous scaly lesions and multiple blackheads, pain, itching and scarring in older areas of injury. Direct examination of the dermal scales showed typical of this disease fumagoides cells; Fonsecaea pedrosoi and Fonsecaea sp. were isolated for at first and second case respectively. Patients received antifungal treatment with itraconazole; however, in both cases the final outcome was not observed due to treatment abandonment and medical care.

Fonsecaea pedrosoi as a rare cause of acute conjunctival ulceration / Fonsecaea pedrosoi como agente raramente associado à úlcera conjuntival aguda

ABSTRACT Conjunctival ulceration accompanied with secretion and pain was observed in a 30-year-old male, 3 days after a perforating corneal trauma. Cultures of conjunctival ulcer samples grew Fonsecaea pedrosoi, a major causative agent of chromoblastomycosis that is typically transmitted during trauma. The conjunctival ulcer was successfully treated with amphotericin B, itraconazole, and fluconazole. This case report summarizes the diagnosis and treatment of a conjunctival ulcer due to F. pedrosoi, which is a rare complication of contaminated ocular trauma. To the best of our knowledge, this is the first reported case of F. pedrosoi causing acute conjunctival ulceration in the literature.

RESUMO O quadro clínico de uma úlcera conjuntival acompanhada de secreção e dor foi observado em homem de 30 anos de idade, 3 dias após um trauma perfurante da córnea. As culturas de uma amostra retirada da úlcera conjuntival foi positiva para Fonsecaea pedrosoi, uma cromoblastomicose, geralmente transmitido após traumatismos. O caso foi tratado com sucesso com a anfotericina B, itraconazol e fluconazol. Este relato de caso reporta o diagnóstico e tratamento de uma úlcera conjuntival causada por F. pedrosoi, que raramente é visto nos olhos expostos a traumatismos contaminados. Até onde sabemos, este é o primeiro caso relatado na literatura de F. pedrosoi causando úlcera conjuntival aguda.

Tumoral chromoblastomycosis: a rare manifestation with typical complementary exams

Abstract: Chromoblastomycosis is a chronic subcutaneous fungal infection caused by traumatic implantation of dematiaceous fungi in the skin. The clinical presentation is usually a verrucous plaque lesion and the diagnosis is confirmed by the visualization of muriform bodies at direct examination or at the histologic study. This report describes a rare case of tumoral chromoblastomycosis confirmed by histologic study and whose agent was identified by culture and micromorphology.

Clinical, epidemiological and mycological report on 65 patients from the Eastern Amazon region with chromoblastomycosis / Relato clínico, epidemiológico e micológico de 65 pacientes com cromoblastomicose procedentes da Amazônia oriental

BACKGROUND: Chromoblastomycosis is a chronic fungal infection caused by fungi from the Dematiaceae family. According to several studies, Fonsecaea pedrosoi is the most common of these fungi. The infection is more common in tropical countries, with the Brazilian state of Pará having one of the largest infected populations worldwide. The disease is difficult to treat and recurrences are common. OBJECTIVES: To describe the epidemiological and mycological aspects of cases of chromoblastomycosis and its clinical forms in the state of Pará, Brazil. METHODS: Mycological exams (direct mycological examinations, culture and microculture) were performed and a clinical/epidemiological evaluation was made of 65 patients receiving care at the Dermatology Department of the Federal University of Pará between 2000 and 2007. The clinical classification proposed by Carrión in 1950 was used in this study. RESULTS: The majority of the patients were male (93.8%), agricultural workers (89.2%) of 45 to 55 years of age, and the majority of lesions (55.4%) were of the verrucous type, located principally on the lower limbs (81.5%). In the majority of the cases investigated (61.5%), the infection had been present for a long time, with a mean duration of 11 years. Direct mycological examination was performed in 86.2% of the patients (n=56). Of these, 96.4% (n=54) tested positive. Culture and microculture were performed in vitro in 47 cases of those that tested positive at direct microscopy, results showing Fonsecaea pedrosoi to be the only agent present in this sample. CONCLUSION: This study highlighted the extent to which chromoblastomycosis still affects the quality of life of the local population, principally individuals working in agriculture. This is a chronic disease for which there is no effective treatment. The importance of continuing to investigate this disease should be emphasized, as further studies may lead to new clinical or epidemiological findings.

FUNDAMENTOS: A cromoblastomicose é uma infecção fúngica crônica, causada por fungos da família Dematiaceae, sendo Fonsecaea pedrosoi a mais comum, segundo vários estudos. É mais frequente em países tropicais e o estado do Pará possui grande casuística mundial. A doença é de difícil tratamento e apresenta recorrência frequente. OBJETIVOS: Descrever os aspectos epidemiológicos, micológicos e formas clínicas dos casos de cromoblastomicose procedentes do estado do Pará - Brasil. MÉTODOS: Foram realizados exames micológicos (direto, cultura e microcultivo) e observação clinicoepidemiológica em 65 pacientes do Serviço de Dermatologia da Universidade Federal do Pará, atendidos no período de 2000 a 2007. Empregou-se a classificação clínica proposta por Carrión em 1950. RESULTADOS: Os pacientes eram, em sua maioria, homens (93,8%), lavradores (89,2%), faixa etária entre 45-55 anos, com predominância de lesões verruciformes (55,4%), localizadas principalmente nos membros inferiores (81,5%). A maioria dos casos pesquisados (61,5%) apresentou um longo tempo de doença, com uma média de 11 anos. O exame micológico direto foi realizado em 86,2% (n=56) dos pacientes; destes, 96,4% (n=54) apresentaram resultado positivo. Foram realizados cultura e microcultivo in vitro de 47 pacientes com exame micológico positivo e os resultados mostraram o Fonsecaea pedrosoi como único agente etiológico identificado nesta amostra. CONCLUSÃO: Este estudo mostrou o quanto a cromoblastomicose ainda compromete a qualidade de vida da população local, principalmente a de indivíduos que trabalham em lavouras, cursando com evolução crônica e sem tratamento eficaz. Observa-se a importância de dar continuidade a este estudo, o que poderá proporcionar novas contribuições clínicas ou epidemiológicas.

Concurrent mycetoma and chromomycosis.

Chromoblastomycosis and Madura foot are chronic localised mycotic infection of the skin and subcutaneous tissue that follows the implantation of the fungi through minor trauma, mainly found in persons working outdoors on bare foot. In cases where both Madura and chromoblastomycosis are present, the treatment becomes difficult with low cure rates and frequent relapses. Here, we present such a very rare case of a 38-year-old cattle farmer who presented with verrucose nodules, tumefaction and multiple discharging nodules on the left lower 1/3 rd leg and foot since last 9 years. Direct KOH mount of the verrucose tissue showed Fonsecaea pedrosoi sclerotic muriform bodies and a biopsy of one granule discharging nodule demonstrated fungal mycetoma. He was put on tab. Itraconazole 200 mg o.d. and cotrimoxazole bid for 6 months with very little improvement. The rarity of this combination is most probably due to different geographical distribution.

Cromoblastomicose: relato de 27 casos e revisão da literatura / Chromoblastomycosis: study of 27 cases and review of medical literature

FUNDAMENTOS: A cromoblastomicose é uma micose subcutânea que acomete principalmente homens trabalhadores rurais, sendo cada vez mais observada em outras atividades profissionais. O fungo penetra na pele após inoculação, e o agente mais frequentemente isolado é a Fonsecaea pedrosoi. OBJETIVOS: Este estudo visa a avaliar os pacientes com cromoblastomicose admitidos no departamento de dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de 1997 a 2007. MÉTODOS: É um estudo retrospectivo, utilizando a revisão de prontuários, e inclui 27 pacientes. Analisaram-se os tratamentos prévios e os atuais instituídos, o tempo entre o aparecimento das lesões e o diagnóstico, a idade, o gênero, a profissão, a procedência, a localização das lesões e os agentes isolados em cultivo. RESULTADOS: Vinte e dois pacientes eram procedentes do estado de São Paulo. Os demais eram procedentes da Bahia e Rondônia. A maioria dos pacientes estudados eram trabalhadores rurais (37 por cento). Os homens foram os mais acometidos (85 por cento). A maior parte dos pacientes apresentava lesões nos membros inferiores (59,2 por cento). Em 52 por cento dos casos foi isolado o fungo F. pedrosoi. O exame anatomopatológico mostrou corpos escleróticos em 92,5 por cento dos casos. CONCLUSÃO: Os dados encontrados estão concordantes com os da literatura, sendo este o segundo estudo retrospectivo sobre as características dos doentes portadores de cromoblastomicose no âmbito do estado de São Paulo publicado na literatura indexada.

BACKGROUND: Chromoblastomycosis is a subcutaneous mycosis that occurs mainly in rural workers although is being more commonly found among people working in other sectors. The fungus penetrates the skin after its inoculation and the most frequently isolated agent is the Fonsecaea pedrosoi. OBJECTIVES: This study aims at evaluating patients suffering from chromoblastomycosis admitted into the Department of Dermatology of the University Hospital of the Faculty of Medicine of São Paulo State during the ten-year period from 1997 to 2007. METHODS: It is a retrospective study and the medical report cards of 27 Brazilian patients diagnosed as suffering from Chromoblastomycosis from 1997 to 2007 at the Dermatology Department of the Medical School, University of Sao Paulo were reviewed. The following items were analyzed: previous therapeutic approaches; treatment implemented by the group; length of time between the appearing of the lesion and diagnosis; age; gender; profession; origin; site of lesions; isolated agents found in culture and histopathology. RESULTS: Twenty two patients were from the state of Sao Paulo whereas the others came from the states of Bahia and Rondonia. 37 percent of them were rural workers. Men were more frequently infected (85 percent). Lesions were more commonly found on the lower limbs (59.2 percent). In 52 percent of the cases the isolated agent was the dematiaceous fungus Fonsecaea. pedrosoi. Biopsies showed sclerotic bodies in 92.5 percent of the cases. CONCLUSION: Data found are in accordance with medical literature on the subject. The disease had been previously studied in our institution in 1983 by Cucé et al. This present study is the second retrospective one about the characteristics of patients suffering from chromoblastmycosis which has been published in indexed medical literature in the state of Sao Paulo.

Secretion of five extracellular enzymes by strains of chromoblastomycosis agents / Secreção de cinco enzimas extracelulares por amostras de agentes da cromoblastomicose

The gelatinase, urease, lipase, phospholipase and DNase activities of 11 chromoblastomycosis agents constituted by strains of Fonsecaea pedrosoi, F. compacta, Phialophora verrucosa, Cladosporium carrionii, Cladophialophora bantiana and Exophiala jeanselmei were analyzed and compared. All strains presented urease, gelatinase and lipase activity. Phospholipase activity was detected only on five of six strains of F. pedrosoi. DNase activity was not detected on the strains studied. Our results indicate that only phospholipase production, induced by egg yolk substrate, was useful for the differentiation of the taxonomically related species studied, based on their enzymatic profile.

As atividades gelatinase, urease, lipase, fosfolipase e DNase de 11 agentes da cromoblastomicose constituídos por amostras de Fonsecaea pedrosoi, F. compacta, Phialophora verrucosa, Cladosporium carrionii, Cladophialophora bantiana e Exophiala jeanselmei foram analisadas e comparadas. Todas as amostras apresentaram atividade urease, gelatinase e lipase. A atividade fosfolipase foi detectada apenas em cinco das seis amostras de F. pedrosoi. A atividade DNase não foi detectada nas amostras estudadas. Os resultados indicam que para a diferenciação entre espécies taxonomicamente relacionadas estudadas, baseado no seu perfil enzimático, apenas a produção de fosfolipase, induzida pelo substrato com gema de ovo, foi útil.

Posaconazole treatment of refractory eumycetoma and chromoblastomycosis

Eumicetoma e cromoblastomicose são infecções fúngicas crônicas do tecido subcutâneo que evoluem com aspecto desfigurado, raramente involuindo espontaneamente. A maioria dos pacientes não apresenta melhora sustentada por longo tempo com os tratamentos disponíveis, sendo de grande importância as novas opções terapêuticas. A eficácia do posaconazol, um novo agente antifúngico de amplo espectro do grupo dos triazóis, foi estudada em 12 pacientes com eumicetoma ou cromoblastomicose refratária às terapêuticas antifúngicas disponíveis. Os pacientes receberam por no máximo 34 meses, doses divididas de 800 mg/dia de posaconazol. Resposta clínica parcial ou completa foi considerada como sucesso; doença estável ou falha terapêutica foi considerada como insucesso. Todos os 12 pacientes tinham infecções comprovadas ou prováveis, refratárias à terapêutica padrão preconizada. Sucesso clínico foi registrado em cinco de seis pacientes com eumicetoma e cinco de seis pacientes com cromoblastomicose. Em dois pacientes observou-se doença estável. Como parte do protocolo de extensão do tratamento, dois pacientes com eumicetoma que inicialmente tinham tido sucesso terapêutico e que após um intervalo maior de 10 meses apresentaram recidiva da micose, foram retratados com sucesso com posaconazol. Posaconazol foi bem tolerado durante o longo período de administração (até 1015 dias). A terapêutica com posaconazol foi seguida de sucesso na maioria dos pacientes com eumicetoma ou cromoblastomicose refratária à terapêutica padrão, sugerindo que tal droga possa ser uma importante opção no tratamento de tais doenças.

Isolation of Fonsecaea pedrosoi from thorns of Mimosa pudica, a probable natural source of chromoblastomycosis

Este trabalho demonstra o isolamento de Fonsecaea pedrosoi de espinhos da planta Mimosa pudica L., a partir do local de suposta infecção identificado pela paciente infectada. O diagnóstico clínico de cromoblastomicose foi estabelecido pelo achado de corpos fumagóides no exame microscópico direto e pelas culturas de F. pedrosoi do material obtido da lesão da paciente. A mesma espécie foi isolada da paciente e da planta. A microscopia eletrônica de transmissão da superfície dos espinhos evidenciou a disposição conidial característica de F. pedrosoi. Estes dados indicam que a planta M. pudica deve ser uma fonte natural de infecção do fungo F. pedrosoi.

Cerebral chromoblastomicosis--a rare case report of cerebral abscess and brief review of literature--a case report.

A rare case of Cerebral Chromomycosis caused by chromogenic fungus Cladosporium trichoides in a 35 year old male with classical presentation of cerebral abscess is being presented. The case report lays emphasis on the histological diagnosis of chromogenic fungus in the wall of the abscess cavity, surgically removed from a well delineated circumscribed lesion in the frontal lobe of the cerebrum. The causative fungus could be detected even in unstained paraffin sections. The diagnosis could be made only after surgical removal and histopathological examination. The mycological culture could not be made as the material was received in formaldehyde fixative. The unique features of the case is its recurrence free uneventful survival five years after surgical excision. This is probably the fifth reported case of cerebral chromomycosis from India and first of its type from arid zone of Rajasthan.

Cromoblastomicose no Rio Grande do Sul: relato de 12 casos / Chromoblastomycosis in Rio Grande do Sul: a report of 12 cases

São relatados 12 casos de cromoblastomicose diagnosticados no interior do Rio Grande do Sul, no período 1988-1995. Os aspectos clínicos e evolutivos são analisados e comparados com a literatura. O único agente isolado foi Fonsecaea pedrosoi.

Twelve cases of chromoblastomycosis diagnosed in Rio Grande do sul during 1988-1995 are reported. The clinical aspects are analyzed and compared with the literature. Fonsecaea pedrosoi was the only microorganism isolated.

Case reports of chromomycosis.

Two cases of chromomycosis were diagnosed in B.Y.L. Nair Charitable Hospital during the years 1980-1989. Isolates were identified as Fonsecea compactum.

Cromoblastomicose produzida por Fonsecaea pedrosoi no estado do Maranhäo: I - aspectos clínicos, epidemiológicos e evolutivos / Fonsecaea pedrosoi caused chromoblastomycosis in state of Maranhäo: I - the clinical, epidemiological and evolutionary aspects

Com o objetivo de verificar o comportamento clínico-epidemiológico da cromoblastomicose no Estado do Maranhäo, foi feito um estudo retrospectivo de 13 casos, no serviço de Doenças Infecciosas e Parasitárias do Hospital dos Servidores do Estado do Maranhäo no período de nov/88 a julho/91. Para a investigaçäo, foi utilizada uma ficha protocolo com todos os dados necessários para uma análise posterior. Nos casos analisados observou-se maior prevalência na faixa etária entre 50 e 60 anos (46,1 por cento) e do sexo masculino (84,6 por cento). Doze pacientes eram procedentes do estado do Maranhäo, dentre os quais 10 da microrregiäo da baixada ocidental maranhense. Quanto à profissäo, 12 (92,3 por cento) eram lavradores. Na sua maioria apresentavam as lesöes nos membros inferiores de forma verrugo-confluentes, cor acastanhada, com prurido. O tempo de evoluçäao variou de 0 a 15 anos em 12 casos (92,3 por cento). Quanto aos aspectos laboratoriais, o exame histológico feito em 12 pacientes, diagnosticando cromoblastomicose em 100 por cento deles e a cultura isolou Fonsecaea pedrosoi em 9 casos (70 por cento). O tratamento realizado em todos os pacientes, com algumas variaçöes foi feito com 5 - fluorocitosina apresentado bons resultados evolutivamente. Constatou-se neste trabalho uma provável zona endêmica de cromoblastomicose na microrregiäo da baixada ocidental maranhense, até agora desconhecida