Chromoblastomycosis: tissue modifications during itraconazole treatment

Abstract

BackgroundHistological and mycological changes during itraconazole use have not been totally established in chromoblastomycosis.ObjectivesTo evaluate tissue modifications in chromoblastomycosis carriers under itraconazole treatment.MethodsA 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.ResultsFontana-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 limitationsPatients could not be located to have their current skin condition examined.ConclusionParasitic and tissue changes verified in this study can reflect the parasite-host dynamics under itraconazole action.

In vivo reflectance confocal microscopy, dermoscopy, high-frequency ultrasonography, and histopathology features in a case of chromoblastomycosis

“…In the near future, this technique will provide a fast, practical, and precise evaluation of many dermatological diseases, while studies are still necessary to create adequate guidelines and protocols for further implementation of in vivo reflectance confocal microscopy in clinical practice [ 16 ]. We propose that the 2 hyperreflective spots found in this case, measuring approximately 20 to 40 μm, indicate the high reflective power of chitin and melanin present in the fungal wall corresponding to the muriform bodies, as also seen on histopathology [ 17 ].…”

Successful treatment of chromoblastomycosis using cryosurgery in association with low-dose itraconazole

“…6 Durante o tratamento com itraconazol, as respostas teciduais mais importantes foram registradas na derme, observando-se redução da espessura da epiderme, diminuição parcial ou total do infiltrado granulomatoso, aumento da fibrose e alterações quantitativas/ morfológicas. 7 A criocirurgia com nitrogênio líquido tem sido descrita como método eficaz no tratamento da cromoblastomicose há várias décadas. [8][9][10] Embora seja aceita como modalidade eficaz de tratamento, ainda não se sabe ao certo qual o mecanismo que leva à cura da doença.…”

Diagnosis of Cutaneous Chromoblastomycosis and Its Response to Amphotericin B Therapy: A Case Report

“…CBM is a slowly progressing indolent subcutaneous fungal infection that is often neglected, underdiagnosed, and untreated at an early stage because of its slowly evolving lesions which can be confused with similar infectious (lupus vulgaris, tertiary syphilis, leprosy, sporotrichosis, coccidioidomycosis, leishmaniasis, filariasis) and non-infectious (mycosis fungoides, psoriasis, sarcoidosis, squamous cell carcinoma) disease processes [8]. Patients usually live in tropical/subtropical areas where the environment is humid and favors the growth of the causative fungal organisms in soil [9]. Patients might provide a history of physical trauma to their exposed extremities and face likely leading to the inoculation of fungi into their wound.…”