Chromoblastomycosis in Mainland China: A Systematic Review on Clinical Characteristics

Abstract

Chromoblastomycosis is one of the most frequent chronic infections caused by melanized fungi. In order to evaluate the clinical characteristics of chromoblastomycosis in Mainland China, we performed an evidence-based review of published literature. PubMed and Chinese-language database of CNKI, VIP and Wanfang data during January 1990-August 2011 were searched. Epidemiology, clinical features, laboratory findings, therapy and prognosis were analyzed. Cladophialophora carrionii was the most common causative agent in the north of the Mainland China, and Fonsecaea monophora and F. pedrosoi were the most common agents in the southern part of the Mainland China. Infection commonly initiated after the etiologic agents gain entrance through puncture wounds and more common involved extremities of the males. Skin lesions were found in different sites, like the extremities, buttocks, trunk and face, and presented diversity morphology. There were about seven different clinical types found in Mainland China: plaque type, tumoral type, cicatricial type, verrucous type, pseudo-vacuole type, eczymatous type and mixed type of lesions. The success of treatment for chromoblastomycosis was related to the causative agent, the clinical form and severity of the lesions. Most of the patients could be treated successfully with the physical treatment, chemotherapy and/or combination therapy. The itraconazole, terbinafine or a combination of both were commonly medication for these mycosis patients. Physical methods were usually indicated to support chemotherapy with some severe forms and long-lasting cases. Photodynamic therapy has been extended from the oncological field to that of antimicrobial chemotherapy in these years. We applied it on some recalcitrant cases of chromoblastomycosis and found its good clinical response, and hopeful it could be a promising therapy in near future.

Chromoblastomycosis

“…During labor activities, individuals living in areas of endemicity are probably infected through diverse traumas related to environmental materials (80,(84)(85)(86)(87)(88) (Table 2). Remarkably, however, etiological agents of CBM are difficult to recover from their environment due to their saprobiotic lifestyle: direct isolation by the use of selective methods usually yields saprobic counterparts of the pathogens, while the pathogens are almost exclusively restricted to warm-blooded hosts.…”

“…Over time, this classification has been used by several authors for different types of lesions: nodular, tumoral (cauliflower-like), verrucous, scarring, and plaque (3,239,249) (Table 5). Recently, Lu et al (87) referred to pseudovacuolar and eczematous types in patients with a short time of evolution and showing mild to moderate severities of disease and a favorable response to therapy. In more severe and advanced cases, patients may present a combination of lesion types, one of which may predominate (Table 5 and Fig.…”

Chromoblastomycosis: A Neglected Tropical Disease

“…Madagascar, Brazil, Mexico, Dominican Republic, Venezuela, India and Southern China contribute with the majority of cases ( Fig. 3 ) 3 , 11 , 16 , 17 , 23 , 25 , 29 , 34 , 38 .…”

Hidden under a Cauliflower-Like Skin Tumor: Chromoblastomycosis

“…Chromoblastomycosis is an endemic fungal infection in tropical and subtropical regions where most published cases come from [1, 7, 8]. Cases from Europe are rare and often related to a tropical travel history or to work with tropical woods [2–6].…”