CHROMOBLASTOMYCOSIS: A NEGLECTED TROPICAL DISEASE

Abstract

Chromoblastomycosis (CMB) is a chronic fungal infection of the skin and the subcutaneous tissue caused by a transcutaneous traumatic inoculation of a specific group of dematiaceous fungi occurring mainly in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM require long term therapy with systemic antifungals, sometimes associated with physical methods. Unlike other neglected endemic mycoses, comparative clinical trials have not been performed for this disease. Nowadays, therapy is based on a few open trials and on expert opinion. Itraconazole either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been successfully employed in combination with antifungals in patients presenting with CBM. In the present revision the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient's outcome.

Fig. 1. - Severe and recalcitrant clinical form of chromoblastomycosis.

Fig. 2. - Clinical and microbiological aspects of chromoblastomycosis: The etiologic agent is easily found in the "black dot" lesion covered area (circled) A. Muriform cells are pathognomonic for this disease. They are observed either on wet mount (B) or in histologic sections. Fonsecaea pedrosoi is one of the prevalent agents in humid areas. Figures C and D depicts its macro and micromorphology aspects.

Fig. 3. - Geographic distribution of chromoblastomycosis according to reported cases. (Courtesy of Dr Daniel Wagner dos Santos, University of Sao Paulo, Brazil).

Fig. 4. Babassu (Orbignya phalerata) nutcracker woman in the State of Maranhao, Brazil. (Courtesy of Professor Conceição Pedroso, Federal University of Maranhao, Brazil).

Fig. 5. - Lesions of chromoblastomycosis may depict clinical polymorphism end elicit several differential diagnoses. The initial lesion of chromoblastomycosis (1A), may evolve to five main clinical types: nodular lesions on the lower leg (1B), verrucous lesion of the foot (1C), scar lesions on the knee and lower leg (1D), plaque lesion on the buttocks (1E), tumoral (cauliflower) lesions on the foot (1G) and mixed lesions composed by plaque, nodular and verrucous lesions involving the lower limb (1H).