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Chromoblastomycosis is one of the most frequent deep mycoses found in rural populations. This cross-sectional, retrospective and descriptive study was conducted with cases of chromoblastomycosis diagnosed throughout 20 years. A higher prevalence was observed among White male rural workers, with an average age of 59.69 years. Median time between onset of symptoms and diagnosis was 156 months. Lesions were predominantly located on the lower limbs; 34% of cases reported previous trauma. The most common associated symptoms were itching, pain and burning sensation. Mycological examination was positive in 91% of cases and Fonsecaea pedrosoi was the most prevalent etiologic agent.

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Subcutaneous mycoses include diverse clinical syndromes, characterized by invasion of the skin and subcutaneous tissue by saprobic fungi. Individuals living in rural areas constantly suffer lesions or trauma; however, only a few of them develop disease. In this contribution, we describe recent advances in the understanding of the virulence of these organisms, focusing on the most prevalent infections, sporotrichosis, chromoblastomycosis, and mycetoma. Although these infectious diseases are considered neglected tropical diseases, modern molecular techniques have been able to identify the etiologic agents and observe variations in the former monolithic concept of the species, which was based mostly on morphologic characteristics. The complete genetic characterization of the causative agents, along with that of their host, will help in the understanding of the factors on which the development of these infections depends.

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PURPOSE OF REVIEW: Eumycetoma, phaeohyphomycosis and chromoblastomycosis are subcutaneous mycoses having in common the fact that they are acquired as a result of penetrating trauma to the skin and may be caused by a large variety of fungi. This article will review recent data regarding the epidemiology and treatment of these infections. RECENT FINDINGS: Recent epidemiologic observations in these mycoses include an increased incidence of phaeohyphomycosis in immunosuppressed patients, the association of polymorphisms in genes involved in innate immunity, the occurrence of eumycetoma caused by Madurella mycetomatis and the nosocomial acquisition of phaeohyphomycosis. The management of these infections continues to be challenging. An approach that involves early diagnosis, the use of systemic antifungal agents and local therapies, including surgical removal of lesions, is the basis of the treatment of these diseases. SUMMARY: It is crucial that the epidemiology and clinical presentation of these infections are understood if we are to improve their outcomes.

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Se presentan dos casos de cromomicosis, de diferente sexo, ambos oriundos de Paraguay, con lesiones de distinta localización, cuyo agente etiológico fue Fonsecae Pedrosoi. Ambos respondieron al tratamiento con itraconazol 400 mg/día, sin que se presenten efectos indeseables. El tiempo de tratamiento promedio fue de 6 meses para ambos con muy buena evolución. La cromomicosis es una enfermedad producida por hongos dematiáceos de distribución universal, de climas tropicales y subtropicales. La lesión consiste en un nódulo rojo-violáceo que se ulcera volviéndose vegetante para luego formar placas infiltradas y costrosas, que muchas veces evolucionan a la fibrosis cicatrizal. Se han ensayado múltiples tratamientos todos con resultados variables, siendo el itraconazol con el que mejor respuesta se logró en la mayoría de las series publicadas (AU)

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Chromoblastomycosis is a subcutaneous mycosis for which there is no treatment of choice but rather, several treatment options, with low cure rates and many relapses. The choice of treatment should consider several conditions, such as the causal agent (the most common one being Fonsecaea pedrosoi ), extension of the lesions, clinical topography and health status of the patient. Most oral and systemic antifungals have been used; the best results have been obtained with itraconazole and terbinafine at high doses, for a mean of 6 - 12 months. In extensive and refractory cases, chemotherapy with oral antifungals may be associated with thermotherapy (local heat and/or cryosurgery). Limited or early cases may be managed with surgical methods, always associated with oral antifungal agents. It is important to determine the in vitro sensitivity of the major causal agents to the various drugs, by estimating the minimum inhibitory concentration, as well as drug tolerability and drug interactions.

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La cromomicosis es una micosis subcutánea y cutánea crónica que predomina en las áreas tropicales y subtropicales. Determinar las características epidemiológicas, clínicas e histopatológicas de los pacientes diagnosticados como cromomicosis; con énfasis en los datos histopatológicos y terapéuticos. Se informan cinco pacientes estudiados entre 1987 y 1997; 3 hombres y dos mujeres con una evolución promedio de 15,8 años. La topografía fue extremidades inferiores y superiores, y un caso diseminada a cara, tronco y extremidades superiores, manifestándose en todos los casos como placas verrucosas. En todos los casos se aisló Fonsecaea pedrosoi. En cuanto a distribución geográfica, 2 pacientes eran de Oaxaca y el resto de Puebla, Tamaulipas y Chiapas respectivamente. En el estudio histopatológico se demostraron cambios proliferativos en la epidermis, constituidos por acantosis e hiperplasia pseudoepiteliomatosa aguda y crónica; así como proliferación vascular y fibrosis: Se pudieron observar células fumagoides tanto dentro de células gigantes multinucleadas, en forma libre, como en los microabscesos de neutrófilos. Las modalidades terapéuticas se basaron en su mayoría en la combinación de procedimientos médicos y quirúrgicos. Debido al número de pacientes incluidos en este estudio, solo podemos describir las características clínicas, histopatológicas y etiología de la cromomicosis. Así mismo podemos concluir que no existe un tratamiento de elección, y que la combinación de procedimientos quirúrgicos y médicos siguen siendo la mejor opción en la cromomicosis

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This is the report of a case of acute chromoblastomycosis observed in a 59-year-old immunosuppressed patient in Barinas, Barinas State, Venezuela, provoked by an insect bite in the right upper arm, apparently cured by extirpation. Because the final diagnosis was made only by histological examination of the surgical specimen, no culture was performed.

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Após estudo de 3O pacientes portadores de cromoblastomicose, acompanhados no hospital dos servidores do Estado do Maranhao, verificou-se em 2 (6,6 por cento) lesoes na regiao glútea, diferindo do que geralmente se observa, pois na cromoblastomicose existe sempre história de microtraumatismo sofridos durante o trabalho na lavoura, propiciando o desenvolvimento mais freqüente das lesoes nas extremidades, principalmente dos membros inferiores. Ambos pacientes, doentes há 10 anos, apresentavam lesoes modulares e verrugo-confluentes em placas coalescentes na regiao glútea direita. O diagnóstico etiológico foi firmado através de exame histopatológico e cultura, com isolamento de Fonsecaea pedrosoi. Na investigaçao epidemiológica do tipo de exposiçao verificou-se que os mesmos desempenhavam a profissao de quebradores de coco-babaçú, atividade relativamente comum no Estado. Parece evidente a relaçao entre o tipo de atividade profissional e o desenvolvimento da infecçao.

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During a survey of 30 patients with chromoblastomycosis followed at the Hospital dos Servidores do Estado do Maranhão, the authors observed in 2 (6.6%) patients with lesions on the buttock. This is an uncommon site for the initial lesions of chromoblastomycosis. There is often a history of microtraumatism during the farming job hence the more frequent development of lesions in the lower limbs. Both patients had 10 years disease, with the presence of nodules and vegetant warty lesions in coalescent plaques on the right buttock. Etiologic diagnosis made through histopatologic and culture exams, with Fonsecaea pedrosoi isolated. The epidemiological exposure of the patients, was suggested by the fact that both worked as babaçu coconut cutters a common activity in Maranhão State. The relation between this kind of professional activity and the development of infection merits for the investigation.

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O presente trabalho visa uma revisäo das diferentes opiniöes de diversos autores em relaçäo à etiopatogenia, diagnóstico, associaçäo com doenças sistêmicas, potencial de malignizaçäo e tratamento da Poroceratose de Mibelli. A sua incidência e distribuiçäo na populaçäo mundial por sexo e idade säo mencionadas. As manifestaçöes clínicas da doença säo variadas, havendo diferentes formas clínicas. Apresentamos um caos típico de Poroceratose de Mibelli na sua forma clássica e concomitantemente com aspectos verrucosos raros

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Una cepa de Fonsecaea pedrosoi mantenida durante 7 años bajo vaselina e inoculada en la almohadilla plantar de ratones, produjo en períodos cortos de tiempo, lesiones agudas con transformación morfogenética y la formación de células esclerotiales a los 15 día de la inoculación

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Four more cases of chromomycosis in Jamaica are described. One case exhibited the classical picture of verrucous nodules, plaques and cauliflower growths. Two other cases showed a pseudo-epitheliomatous picture. The fourth case showed the not uncommon 'mossy foot' appearance. The pleomorphism of the clinical picture is emphasized and treatment by surgery with skin grafting is recommended. The opinion is expressed that the disease is not as uncommon in Jamaica as was once thought (AU)

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