Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update

Abstract

Chromoblastomycosis is a chronic, granulomatous, suppurative mycosis of the skin and subcutaneous tissue caused by traumatic inoculation of dematiaceous fungi of the family Herpotrichiellaceae. The species Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in regions where the disease is endemic. Chromoblastomycosis lesions are polymorphous: verrucous, nodular, tumoral, plaque-like, and atrophic. It is an occupational disease that predominates in tropical and subtropical regions, but there have been several reports of cases in temperate regions. The disease mainly affects current or former farm workers, mostly males, and often leaving disabling sequelae. This mycosis is still a therapeutic challenge due to frequent recurrence of lesions. Patients with extensive lesions require a combination of pharmacological and physical therapies. The article provides an update of epidemiological, clinical, diagnostic, and therapeutic features.

Fonsecaea pedrosoi conidia and hyphae activate neutrophils distinctly: Requirement of TLR-2 and TLR-4 in neutrophil effector functions

“…Currently, CBM treatment has low cure rates and is based on multidrug prescriptions and, in some cases, cryo/heat therapy with surgery (10)(11)(12)(13)(14). More effective treatment is needed, therefore, a better understanding of the host-pathogen interaction is crucial.…”

“…The treatment is difficult and involves the combination of antifungal prescriptions (10), cryo/heat-therapy (11) and, in some cases, surgery to remove all the infected tissue (12). CBM is one of the most difficult deep mycosis to treat and has low rates of cure (13,14). The treatment is long and expensive, and because the disease affects mainly low-income individuals, there is a high rate of treatment dropout, leading to a high rate of disease relapse (14).…”

“…CBM is one of the most difficult deep mycosis to treat and has low rates of cure (13,14). The treatment is long and expensive, and because the disease affects mainly low-income individuals, there is a high rate of treatment dropout, leading to a high rate of disease relapse (14). Therefore, a better understanding of the pathogen-host interaction is needed to improve the treatment of CBM, to increase the rate of successful treatment rate and decrease the time and cost of treatment.…”

A screening of the MMV Pathogen Box® reveals new potential antifungal drugs against the etiologic agents of chromoblastomycosis

“…CBM is difficult to treat because there is no standardized drug of choice. In addition, relapses are frequent for this mycosis [5]. The taxonomic diversity of the CBM agents adds another obstacle to the development of new drugs against this disease, because most patients are diagnosed exclusively on the basis of the presence of muriform cells in infected tissues [2].…”

“…In developing countries, including Brazil, treatment based on the use of these drugs is long and expensive, and some patients show recurrence and refractoriness [2,4]. These patients usually require more than one therapeutic method, often including physical methods, such as cryosurgery or laser therapy [5]. The in vitro response of the chromoblastomycosis agents to other antifungal drugs currently used to treat mycotic infections, such as amphotericin B, fluconazole, flucytosine, and micafungin is not satisfactory [6].…”