Chromoblastomycosis in Brazil: A review of 450 published cases

Abstract

Chromoblastomycosis is a skin infection caused by melanized fungi that primarily affects rural workers. This study aimed to analyze the clinical and epidemiological manifestations of chromoblastomycosis in Brazil through an extensive literature review. A review of case reports or series of cases in English and Portuguese was conducted using the SciELO, LILACS, SCOPUS, PubMed, and Web of Science databases from 1963 to 2022. A total of 46 articles involving 450 patients were identified, among which, 83.1% were male rural workers with a mean age of 52.2 years. The clinical manifestations were most commonly observed in the lower extremities (78.7%). The most frequent clinical presentations of the disease were verrucous lesions and plaques. Fonsecaea and Rhinocladiella spp. were the most common agents responsible for chromoblastomycosis. Most cured cases were treated with itraconazole, either as monotherapy or in combination with other antifungals, surgery, or cryosurgery. Chromoblastomycosis affects hundreds of rural workers in Brazil, leading to financial disabilities as well as personal and family losses. It is essential to prioritize epidemiological surveillance and ensure the early diagnosis of this disease to reveal its true prevalence, guide resource allocation, improve diagnosis, ensure early treatment, and implement preventive measures.

FIGURE 1:. Flowchart depicting the methodology utilized for literature review.

FIGURE 2:. Number of cases of chromoblastomycosis by Brazilian states. The map was drawn based on the case reports available in the literature. The states in red represent the North-east region; those in blue, the South region; those in pink, the South-east region; those in green, the North region; and those in yellow, the Central-west region of Brazil. States of Brazil: Acre: AC; Alagoas: AL; Amapá: AP; Amazonas: AM; Bahia: BA; Ceará: CE; Espírito Santo: ES; Goiás: GO; Maranhão: MA; Mato Grosso: MT; Mato Grosso do Sul: MS; Minas Gerais: MG; Pará: PA; Paraíba: PB; Paraná: PR; Pernambuco: PE; Piauí: PI; Rio de Janeiro: RJ; Rio Grande do Norte: RN; Rio Grande do Sul: RS; Rondônia: RO; Roraima: RR; Santa Catarina: SC; São Paulo: SP; Sergipe: SE; Tocantins: TO. The graph represents the percentage of cases for the respective regions described on the map.

FIGURE 3:. Clinical presentation of Chromoblastomycosis. a) Scarring, b) Nodular lesion, c) Coalescing warty nodules forming plaque, d) Verrucous, e) Verrucous plaque.