Chromoblastomycosis and sporotrichosis, two endemic but neglected fungal infections in Madagascar

Rasamoelina, Tahinamandranto; Raharolahy, Onivola; Rakotozandrindrainy, Njary; Ranaivo, Irina Mamisoa; Andrianarison, Malalaniaina; Rakotonirina, Benja; Maubon, Danièle; Rakotomalala, Fetra Angelot; Andrianarivelo, Mala Rakoto; Andriantsimahavandy, A.; Rabenja, F. Rapelanoro; Ramarozatovo, Lala Soavina; Cornet, Muriel

doi:10.1016/j.mycmed.2017.08.003

Cited by 14 publications

(22 citation statements)

References 77 publications

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“…This is first study that evaluate in vitro antifungal susceptibility of CBM isolates in Rio de Janeiro. We found high MIC values for AMB corroborating other authors [ 35 , 36 ]. Treatment with AMB alone or combined with 5FC has not been used since the introduction of ITC during the 1980s.…”

Section: Discussionsupporting

confidence: 92%

Molecular identification and antifungal susceptibility profiles of clinical strains of Fonsecaea spp. isolated from patients with chromoblastomycosis in Rio de Janeiro, Brazil

et al. 2018

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BackgroundChromoblastomycosis (CBM) is a difficult-to-treat chronic subcutaneous mycosis. In Brazil, the main agent of this disease is Fonsecaea pedrosoi, which is phenotypically very similar to other Fonsecaea species, differing only genetically. The correct species identification is relevant since different species may differ in their epidemiologic aspects, clinical presentation, and treatment response.Methodology/Principal findingsPartial sequencing of the internal transcribed spacer (ITS) was used to identify twenty clinical isolates of Fonsecaea spp. Their in vitro antifungal susceptibility was determined using the broth microdilution method, according to the M38-A2 protocol. Amphotericin B (AMB), flucytosine (5FC), terbinafine (TRB), fluconazole (FLC), itraconazole (ITC), ketoconazole (KTC), posaconazole (POS), voriconazole (VRC), ravuconazole (RVC), caspofungin (CAS), and micafungin (MFG) were tested. The association between ITC/TRB, AMB/5FC, and ITC/CAS was studied by the checkerboard method to check synergism. The available patients’ data were correlated with the obtained laboratory results. Fonsecaea monophora (n = 10), F. pedrosoi (n = 5), and F. nubica (n = 5) were identified as CBM’ agents in the study. TRB and VRC were the drugs with the best in vitro activity with minimal inhibitory concentrations (MIC) lower than 0.25 mg/L. On the other hand, FLC, 5FC, AMB, and MFG showed high MICs. The AMB/5FC combination was synergistic for three F. monophora strains while the others were indifferent. Patients had moderate or severe CBM, and ITC therapy was not sufficient for complete cure in most of the cases, requiring adjuvant surgical approaches.Conclusions/SignificanceF. monophora, the second most frequent Fonsecaea species in South America, predominated in patients raised and born in Rio de Janeiro, Brazil, without cerebral involvement in these cases. TRB, VRC, and the AMB/5FC combination should be further investigated as a treatment option for CBM.

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Section: Discussionsupporting

confidence: 92%

Molecular identification and antifungal susceptibility profiles of clinical strains of Fonsecaea spp. isolated from patients with chromoblastomycosis in Rio de Janeiro, Brazil

et al. 2018

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“…We directly examined the clinical specimens under a microscope ( 5 , 11 ). The samples were used to inoculate Sabouraud medium supplemented with chloramphenicol and incubated at 30°C for 2–3 weeks.…”

Section: Methodsmentioning

confidence: 99%

“…Sporotrichosis is widespread throughout the world; several areas of known hyperendemicity are Brazil, Mexico, Peru, and China. Outbreaks from various environmental sources, involving thousands of persons, have been reported ( 1 – 3 , 11 , 12 ). In Brazil, a large zoonotic outbreak associated with cats is ongoing; it has been suggested that a strain of S .…”

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confidence: 99%

Sporotrichosis in the Highlands of Madagascar, 2013–20171

Rasamoelina¹,

Maubon²,

Raharolahy³

et al. 2019

Emerg. Infect. Dis.

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Sporotrichosis is a saprozoonotic fungal infection found mostly in tropical and subtropical areas. Few case reports in Madagascar have been published. To document sporotrichosis epidemiology in Madagascar, we conducted a cross-sectional study. During March 2013–June 2017, we recruited from select hospitals in Madagascar patients with chronic cutaneous lesions suggestive of dermatomycosis. Sporotrichosis was diagnosed for 63 (42.5%) of 148 patients. All but 1 patient came from the central highlands, where the prevalence was 0.21 cases/100,000 inhabitants. Frequency was high (64.7%) among patients <18 years of age. Sporotrichosis was diagnosed for 73.8% of patients with arm lesions, 32.3% with leg lesions, and 15.4% with lesions at other sites. Molecular identification identified 53 Sporothrix schenckii isolates. Among the 32 patients who were followed up, response to itraconazole was complete or major for 15 and minor for 17. Overall, endemicity of sporotrichosis in Madagascar was high, concentrated in the highlands.

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“…CBM is defined as a chronic cutaneous and subcutaneous fungal infection caused by traumatic implantation of the skin in endemic tropical and subtropical regions. It is associated with low cure and high relapse rates and may affect individuals around the world, with higher prevalence in Southern Africa, 6 Latin America, 7 East Asia 8,9 and Australia. 10 CBM presents clinically in one of five types of lesions, including nodular, tumoural, verrucous, cicatricial and plague.…”

Section: Re Vie W and Discussionmentioning

confidence: 99%

Retinoid combined with photodynamic therapy against hyperkeratotic chromoblastomycosis: A case report and literature review

Lan

Zhang

2020

Mycoses

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is a chronic cutaneous and subcutaneous disease caused by melanised fungi. It is usually associated with traumatic inoculation and occurs in the lower extremities. The treatment of this infectious disease remains challenging because of the diversity of clinical manifestations and aetiological agents. Without proper treatment, the disease can lead to incapacity in the work due to fibrotic sequelae or other complications. In worst cases, it can lead to skin cancer. 1 The aetiological agents of CBM are Fonsecaea, Phialophora, Cladophialophora, Rhinocladiella and Exophiala, among them the genus Fonsecaea is the most common. The species of the genus Fonsecaea comprises four species: F pedrosoi, F monophora, F nubica and F pugnacius. 2 F monophora and F pugnacious show significant neurotropism, which eventually leads to transmission to the brain and other organs. 3,4 In southern China, chromoblastomycosis is mainly caused by Fonsecaea pedrosoi and Fonsecaea monophora. Here, we presented a case of chromoblastomycosis with 20-year duration caused by F monophora. Clinical manifestations were not only included typical plaques and scales, but also appeared recurrent keratinised protrusions, and the infection lasted for a long time and involved an entire forearm. We observed a positive clinical effect of oral antifungal drugs, retinoid combined with carbon dioxide laser and ALA-PDT.

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Chromoblastomycosis and sporotrichosis, two endemic but neglected fungal infections in Madagascar

Cited by 14 publications

References 77 publications

Molecular identification and antifungal susceptibility profiles of clinical strains of Fonsecaea spp. isolated from patients with chromoblastomycosis in Rio de Janeiro, Brazil

Molecular identification and antifungal susceptibility profiles of clinical strains of Fonsecaea spp. isolated from patients with chromoblastomycosis in Rio de Janeiro, Brazil

Sporotrichosis in the Highlands of Madagascar, 2013–20171

Retinoid combined with photodynamic therapy against hyperkeratotic chromoblastomycosis: A case report and literature review

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