Chromoblastomycosis in Latin America and the Caribbean: Epidemiology over the past 50 years

Abstract

Chromoblastomycosis is a chronic disease caused by melanized fungi that mainly affect individuals performing soil-related labour. The objective of this study was to analyse the epidemiological and clinical characteristics of chromoblastomycosis in Latin America and the Caribbean by an extensive literature review. An integrative review was performed of English, French, Portuguese, and Spanish publications in LILACS, SciELO, PubMed, SCOPUS and Web of Science databases covering the period 1969–2019. A total of 1,211 articles were identified, of which 132 were included in the review, covering 2,081 patients, 80.3% were male, the mean age was 56.1 years. The mean duration of the disease was 10.8 years. The lesions were mainly described in the lower limbs (60%). The most frequent clinical forms were verrucous (46.4%) and tumorous (21.7%). Major disease symptoms and signs consisted of itching and pain. Bacterial infection and functional limitation were important complications. Immunosuppression post-kidney transplantation was the most frequent comorbidity while leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi and Cladophialophora carrionii were the predominant etiological agents. Majority of the cured cases were treated with itraconazole as monotherapy or in combination with other antifungals, surgery or cryosurgery. Chromoblastomycosis affects hundreds of rural workers in Latin America and the Caribbean, causing disability and personal, family and economic losses. It is important to prioritize epidemiological surveillance and early diagnosis of this disease in order to reveal its real prevalence and direct resources to preventive actions, diagnosis and early treatment. Lay Summary Chromoblastomycosis is a slowly progressing chronic disease caused by melanized fungi. We collected data from South America and the Caribbean covering 1969-2019, the 132 articles included 2 081 patients, mean disease duration was 10.8 years. Fonsecaea pedrosoi and Cladophialophora carrionii predominated.

Chromoblastomycosis-Leprosy Co-Infection in Central West Brazil. Presentation of Three Cases and Literature Review

“…When observing the epidemiological characteristics of patients with chromoblastomycosis- leprosy co-infection, we can find common aspects present in both co-infection and in the two diseases separately: male predominance, all age groups are affected, occupation and origin mainly related to the rural area, poverty, living conditions, inequity, difficulty in accessing public health services. Factors that are present in different countries in tropical and subtropical regions where these diseases are endemic [1,4,5,13,[17][18][19][20][21][22][23]. There is no predisposing relationship from one disease to another, except for prolonged treatment with corticosteroids in leprosy reactions or other complications of this disease, which can cause immunosuppression and predispose patients to other infectious diseases such as chromoblastomycosis, as described in the various cases published.…”

“…When observing the epidemiological characteristics of patients with chromoblastomycosis-leprosy co-infection, we can find common aspects present in both co-infection and in the two diseases separately: male predominance, all age groups are affected, occupation and origin mainly related to the rural area, poverty, living conditions, inequity, difficulty in accessing public health services. Factors that are present in different countries in tropical and subtropical regions where these diseases are endemic [ 1 , 4 , 5 , 13 , 17 – 23 ].…”

“…The explanation of co-infection could be attributed to the epidemiology of both diseases. Brazil is one of the countries with the highest incidence and prevalence of chromoblastomycosis and leprosy, thus co-infection can be expected in some patients [ 1 – 3 , 12 , 13 ]. Co-infection should be especially considered if a patient: (i) resides or works in a rural area; (ii) is exposed to the habitats of the etiological agents of chromoblastomycosis; (iii) is within the habitat of armadillos ( Dasypus species) that are known to be zoonotic reservoirs of leprosy [ 1 , 2 , 9 , 24 , 25 ].…”

“…Both chromoblastomycosis and leprosy, separately, can affect the elderly. Recent studies about the epidemiology of chromoblastomycosis have reported that the average age is above 52 years [ 5 , 13 ]. While studies on the epidemiology of leprosy found an increase in the detection of this disease in the elderly when compared to other age groups [ 20 , 29 , 30 ].…”

“…Patients have often occupations related to plant-and-soil activitie, such as farmers, gardeners, lumberjacks, and sellers of agricultural products. Hence, chromoblastomycosis is considered an occupational and implantation disease [ 1 , 8 , 12 , 13 ].…”