Chromoblastomycosis: an overview of clinical manifestations, diagnosis and treatment

Abstract

Chromoblastomycosis is one of the most frequent infections caused by melanized fungi. It is a subcutaneous fungal infection, usually an occupational related disease, mainly affecting individuals in tropical and temperate regions. Although several species are etiologic agents, Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in the endemic areas. Chromoblastomycosis lesions are polymorphic and must be differentiated from those associated with many clinical conditions. Diagnosis is confirmed by the observation of muriform cells in tissue and the isolation and the identification of the causal agent in culture. Chromoblastomycosis still is a therapeutic challenge for clinicians due to the recalcitrant nature of the disease, especially in the severe clinical forms. There are three treatment modalities, i.e., physical treatment, chemotherapy and combination therapy but their success is related to the causative agent, the clinical form and severity of the chromoblastomycosis lesions. There is no treatment of choice for this neglected mycosis, but rather several treatment options. Most of the patients can be treated with itraconazole, terbinafine or a combination of both. It is also important to evaluate the patient's individual tolerance of the drugs and whether the antifungal will be provided for free or purchased, since antifungal therapy must be maintained in long-term regimens. In general, treatment should be guided according to clinical, mycological and histopathological criteria.

Case Study: Chromoblastomycosis

“…Secondary infection can cause ulceration and purulent discharge. Lymphadenopathy and elephantiasis can occur in severe cases [3]. The diagnosis is confirmed by skin biopsy and fungal culture to isolate the causative organism.…”

Linfangioma microcístico acral: diagnóstico diferencial em lesões verrucosas de extremidades

“…Vulvar lesions following surgery and/or radiotherapy for pelvic malignancies have also been described. 10,11 At histopathology, hyperkeratosis and acanthosis may be present in variable degrees. In the dermis, lymph vessels with thin walls containing no blood may be surrounded by lymphocytes or not.…”

Chromoblastomycosis of the leg

“…Chromoblastomycosis is a chronic cutaneous and subcutaneous fungal infection caused by dematiaceous fungus of order Chaetothyriales [3]. The char-…”

“…Consequently, the extremity is the most common site to be affected. CBM presents clinically in one of five forms: nodular, tumoural, verrucous, plaque and cicatricial [3]. Furthermore, these lesions can be classified according to the severity [8].…”

“…CheCk your diagnosis acteristic histopathological hallmark for diagnosing chromoblastomycosis is the presence of pigmented, muriform, thick-walled cells called sclerotic cells/ medlar bodies or copper pennies [3,4].…”