RESUMEN
BACKGROUND: Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected Tropical Disease (NTD) and mainly affects populations living in poverty with significant morbidity, including stigma and discrimination. METHODS AND FINDINGS: In order to estimate the global burden of CBM, we retrospectively reviewed the published literature from 1914 to 2020. Over the 106-year period, a total of 7,740 patients with CBM were identified on all continents except Antarctica. Most of the cases were reported from South America (2,619 cases), followed by Africa (1,875 cases), Central America and Mexico (1,628 cases), Asia (1,390 cases), Oceania (168 cases), Europe (35 cases), and USA and Canada (25 cases). We described 4,022 (81.7%) male and 896 (18.3%) female patients, with the median age of 52.5 years. The average time between the onset of the first lesion and CBM diagnosis was 9.2 years (range between 1 month to 50 years). The main sites involved were the lower limbs (56.7%), followed by the upper limbs (19.9%), head and neck (2.9%), and trunk (2.4%). Itching and pain were reported by 21.5% and 11%, respectively. Malignant transformation was described in 22 cases. A total of 3,817 fungal isolates were cultured, being 3,089 (80.9%) Fonsecaea spp., 552 (14.5%) Cladophialophora spp., and 56 Phialophora spp. (1.5%). CONCLUSIONS AND SIGNIFICANCE: This review represents our current knowledge on the burden of CBM world-wide. The global incidence remains unclear and local epidemiological studies are required to improve these data, especially in Africa, Asia, and Latin America. The recognition of CBM as NTD emphasizes the need for public health efforts to promote support for all local governments interested in developing specific policies and actions for preventing, diagnosing and assisting patients.
Asunto(s)
Cromoblastomicosis/epidemiología , Carga Global de Enfermedades , Ascomicetos/aislamiento & purificación , Fonsecaea/aislamiento & purificación , Humanos , Phialophora/aislamiento & purificaciónRESUMEN
Chromoblastomycosis (CBM) is a chronic cutaneous and subcutaneous infection caused by melanized fungal species. We quantified the extractable melanin of 77 strains of CBM agents distributed within five genera. Moreover, resistance to oxidative stress was evaluated in strains exposed or not to the melanin inhibitor tricyclazole. The median percentage of melanin mass extracted from dry fungal mass varied from 0.69 (Rhinocladiella similis) to 3.81 (Phialophora americana). Inhibition of melanin synthesis decreased survival rates to hydrogen peroxide. Together, these data highlight the importance of melanin in CBM agents.
Asunto(s)
Ascomicetos/química , Ascomicetos/fisiología , Cromoblastomicosis/microbiología , Melaninas/análisis , Estrés Oxidativo , Antifúngicos/farmacología , Ascomicetos/efectos de los fármacos , Ascomicetos/aislamiento & purificación , Humanos , Peróxido de Hidrógeno/farmacología , Melaninas/biosíntesis , Viabilidad Microbiana/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Phialophora/química , Phialophora/efectos de los fármacos , Phialophora/aislamiento & purificación , Phialophora/fisiología , Especificidad de la Especie , Esporas Fúngicas/fisiología , Tiazoles/farmacologíaRESUMEN
Chromoblastomycosis is characterized by the slow development of polymorphic skin lesions (nodules, verrucas, tumores, plaques and scar tissue). Inside the host, infectious propagules adhere to epithelial cells and differentiate into sclerotic forms, which effectively resist destruction by host effector cells and allow onset of chronic disease. A cellular immune response against fungi is essential to control infection. Amongst the cells of the immune system, macrophages play the most important role in controlling fungal growth. In this study, we show that the fungicidal characteristic of macrophages is dependent on the fungal species that causes chromoblastomycosis. We began by observing that the phagocytic index was higher for Fonsecaea pedrosoi and Rhinocladiella aquaspersa compared with that of other fungi. Complement-mediated phagocytosis was more important for Phialophora verrucosa and R. aquaspersa and was inhibited by mannan when F. pedrosoi and R. aquaspersa conidia were phagocytosed by macrophages. We showed that macrophages killed significantly only R. aquaspersa. We also found that the phagocytosis of fungi has functional consequences for macrophages as phagocytosis resulted in down-modulation of MHC-II and CD80 expression as well as in the inhibition of the basal liberation of NO. However, the inhibition of the basal liberation of NO nor the down-modulation of MHC and co-stimulatory molecules were observed in the presence of R. aquaspersa.
Asunto(s)
Ascomicetos/inmunología , Cromoblastomicosis/inmunología , Cromoblastomicosis/microbiología , Citocinas/biosíntesis , Mediadores de Inflamación/metabolismo , Macrófagos Peritoneales/microbiología , Óxido Nítrico/biosíntesis , Fagocitosis/inmunología , Animales , Ascomicetos/crecimiento & desarrollo , Ascomicetos/aislamiento & purificación , Células Cultivadas , Cromoblastomicosis/metabolismo , Citocinas/fisiología , Exophiala/crecimiento & desarrollo , Exophiala/inmunología , Exophiala/aislamiento & purificación , Femenino , Mediadores de Inflamación/fisiología , Macrófagos Peritoneales/inmunología , Macrófagos Peritoneales/metabolismo , Ratones , Ratones Endogámicos BALB C , Phialophora/crecimiento & desarrollo , Phialophora/inmunología , Phialophora/aislamiento & purificación , Especificidad de la Especie , VirulenciaRESUMEN
BACKGROUND: Chromoblastomycosis is a chronic subcutaneous mycosis that occurs more frequently in tropical and subtropical areas and is caused by a group of dematiaceous fungi. It is a difficult-to-treat mycosis with low cure rates and a high rate of relapses. OBJECTIVE: The objective of this trial is to prove the efficacy and tolerance of oral terbinafine in four cases of chromoblastomycosis. METHODS AND RESULTS: We included four cases of chromoblastomycosis, proved clinically and mycologically, that are presented herein; three of them caused by Fonsecaea pedrosoi and one by Phialophora verrucosa. Two had a small extension and the other two were of medium and large extension. Oral terbinafine was administered at a dose of 500 mg/day, which was reduced to half in two of the cases once an 80% improvement had been reached; in the third case the initial dose was maintained, and in the fourth case the dose was increased to 750 mg/day. Three cases reached clinical and mycological cure in a mean treatment period of 7 months, the fourth case reached a significant improvement only after 1.2 years of treatment. The medication was well tolerated; no liver alterations occurred; only one patient suffered mild dyspepsia. CONCLUSION: Terbinafine at 500 mg/day doses represents one of the best treatments for chromoblastomycosis due to its efficacy and excellent tolerability.
Asunto(s)
Enfermedades de los Trabajadores Agrícolas/tratamiento farmacológico , Antifúngicos/uso terapéutico , Cromoblastomicosis/tratamiento farmacológico , Naftalenos/uso terapéutico , Administración Oral , Adulto , Anciano , Antifúngicos/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Naftalenos/administración & dosificación , Phialophora/aislamiento & purificación , Terbinafina , Resultado del TratamientoRESUMEN
This is a study of 51 cases of chromoblastomycosis detected in a 17-year period, all of which were clinically and mycologically proven by direct examinations, cultures and biopsies. The therapeutic results of the various treatments used are reported. Most cases were males (36 of 51; 70%), the mean age was 35 years and farmers predominated (74%); the most frequent lesions were in the lower limbs (54%). Major clinical presentations were nodular (41%) and verrucous (26%). The principal aetiologic agent isolated was Fonsecaea pedrosoi (90%). Overall results of the various treatments were as follows: 31% were cured, 57% improved and 12% failed. The best results were obtained with cryosurgery for small lesions, with itraconazole for large ones, and in some cases the combination of both treatments.
Asunto(s)
Antifúngicos , Cromoblastomicosis , Dermatomicosis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Niño , Cromoblastomicosis/tratamiento farmacológico , Cromoblastomicosis/epidemiología , Cromoblastomicosis/microbiología , Cromoblastomicosis/patología , Criocirugía , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/epidemiología , Dermatomicosis/microbiología , Dermatomicosis/patología , Femenino , Hongos/aislamiento & purificación , Humanos , Masculino , Phialophora/aislamiento & purificación , Estudios RetrospectivosRESUMEN
A retrospective study of 325 cases of chromoblastomycosis diagnosed in the last 55 years in the Amazon region was carried out by the main Mycology services of the state of Pará, Brazil (Department of Tropical Pathology--UFPA and Mycology Department of the Evandro Chagas Institute/FNS). The data obtained showed that: (a) the main age group affected by the diseases range from 41 to 70 years-old, (b) 86.1% of the patients were agricultural-workers, (c) 93.2% of them were males and (d) 80.7% showed lesions on the lower limbs (feet and legs). The diagnosis of 62% of the cases was confirmed by laboratory studies considering the tissue form in histopathological analysis. In 24% of patients (78 cases), the etiological agent was isolated and identified through culture. Fonsecaea pedrosoi was present in 77 cases and Phialophora verucosa in only one case.
Asunto(s)
Cromoblastomicosis/epidemiología , Cromoblastomicosis/microbiología , Hongos Mitospóricos/aislamiento & purificación , Phialophora/aislamiento & purificación , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Cromoblastomicosis/patología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Ocupaciones , Estudios Retrospectivos , Distribución por SexoRESUMEN
Foram revistos os protocolos clínico-micológicos de 73 pacientes com cromoblastomicose vistos no interior do Estado do Rio Grande do Sul. A relaçäo entre pacientes homens e mulheres foi de 7:1. Lesöes precoces foram observadas em 8,2% dos pacientes. As lesöes localizavam-se nos membros superiores e face em 8,2 e 4,1% dos doentes, respectivamente. F. pedrosi foi o único agente da infecçäo isolada. Foi discutida a distribuiçäo geográfica peculiar que a micose apresente no Estado
Asunto(s)
Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Cromoblastomicosis/epidemiología , Brasil , Cromoblastomicosis/diagnóstico , Cladosporium/aislamiento & purificación , Phialophora/aislamiento & purificaciónRESUMEN
Una muestra de Fonsecaea pedrosoi (Brumpt) Negroni 1936, fue aislada de un caso de cromomicosis forma plana y presentó tres fases de esporulación: Cladosporium, Rhinocladiella y Phialophora
Asunto(s)
Anciano , Humanos , Masculino , Cromoblastomicosis/microbiología , Hongos Mitospóricos/aislamiento & purificación , Phialophora/aislamiento & purificación , Chile , Dermatomicosis/etiologíaRESUMEN
Os autores registram caso de feo-hifomicose subcutânea, do couro cabeludo em paciente adulta, do sexo feminino, provocado pela Phialophora parasitica, fungo demácio identificado por AJELLO e cols. Säo descritas as principais características deste hifomiceto. A histopatologia foi conclusiva para o diagnóstico de feo-hifomicose, cujas lesöes simulavam favo do couro cabeludo. Näo havia, no presente caso, manifestaçöes clínicas de uma imunodeficiência