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D'Ávila, Solange Corrêa Garcia Pires; Pagliari, Carla; Duarte, Maria Irma Seixas

doi:10.1023/a:1022948329193

Cited by 51 publications

(12 citation statements)

References 27 publications

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“…More than 1 type of lesion can develop in advanced, severe cases. Morphologically nodular is the most frequent variety followed by verrucous and plaquelike lesions [ 25 , 28 ]. In contrast to this, plaque was the most common in our study, followed by verrucous, with 4.7% of cases showing mixed types of lesions.…”

Section: Discussionmentioning

confidence: 99%

Chromoblastomycosis in India: Review of 169 cases

et al. 2017

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Chromoblastomycosis (CBM) is a chronic, progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi. The disease has worldwide prevalence with predominant cases reported from humid tropical and subtropical regions of America, Asia, and Africa. Diagnosis is often delayed or misdirected either due to poor degree of clinical suspicions or clinical simulation of dermatological conditions. The infection is not uncommon in India and several case reports from the sub-Himalayan belt and western and eastern coasts of India have been published; however, very few have reviewed the cases. We reviewed 169 cases published in English literature from India during 1957 through May 2016, including 2 recent cases from our institute. A tremendous increase in the number of reported cases was noticed since 2012, since which, more than 50% of the cases had been published. A majority of the patients (74.1%) were involved in various agricultural activities directly or indirectly. The mean age at presentation was 43.3 years ± 16.0, with male to female ratio of 4.2:1. The duration of disease at the time of presentation varied from 20 days to 35 years. Any history of trauma was recalled only in 33.8% of the studied cases. The lower extremity was the most common site afflicted, followed by the upper extremity. The culture was positive in 80.3% of the cases with Fonsecaea pedrosoi, isolated as the most common fungal pathogen, followed by Cladophialophora carrionii. Although all the commercially available antifungals were prescribed in these cases, itraconazole and terbinafine were the most commonly used, either alone or in combination with other drugs/physical methods, with variable degrees of outcome. Combinations of different treatment modalities (chemotherapy and physical methods) yielded a cure rate of 86.3%. CBM is refractory to treatment and no single antifungal agent or regimen has demonstrated satisfactory results. Increased awareness with early clinical suspicion of the disease and adequate therapy are necessary to improve the outcome. However, depending upon the causative agent, disease severity, and the choice of antifungals, variable outcomes can be observed.

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Section: Discussionmentioning

confidence: 99%

Chromoblastomycosis in India: Review of 169 cases

et al. 2017

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“…In CBM the immune response is mediated mainly by Th2 cytokines [11]. Previously we demonstrated that in CBM lesions a predominance of Th17 cells over Treg cells occurs [8].…”

Section: Discussionmentioning

confidence: 99%

Langerhans Cells Express IL-17A in the Epidermis of Chromoblastomycosis Lesions

et al. 2017

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Chromoblastomycosis (CBM) is a chronic fungal infection that affects skin and subcutaneous tissue, and little is known about the immunological aspects of such lesions. We have previously described the high expression of IL-17 in this group. Understanding the innate immune response of patients with CBM would improve the knowledge of its immunopathogenesis and contribute to the most appropriate therapies. Nineteen biopsies of verrucous form were obtained from patients with clinical and histopathological diagnosis of CBM, without treatment. This was done with a double immunostaining with conventional immunohistochemistry and immunofluorescence technique as well as confocal microscopy to detect Langerin and IL-17 expression. All of the specimens that were analyzed showed expression of Langerin in the epidermis - the same as the control group. However, only the CBM group presented cells expressing CD207 in the dermis. Interestingly, the coexpression of IL-17 and Langerin was visualized along the epidermis and dermis in 100% of the lesion group. We demonstrated for the first time in situ coexpression of IL-17 and Langerin (CD207) in epidermal cells of patients with CBM and speculated on their role as IL-17-producing cells or whether they could be a new subpopulation of dendritic cells distinct from Langerhans cells.

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“…On the contrary, lesions of plaque type are characterized by a Th1 pattern of cytokines and therefore a better immune response, according to Minotto (unpublished data) and D'ávila [17]. However, there are no reports studying the immune dynamics of the lesions or inferences about what it takes to develop such responses.…”

Section: Discussionmentioning

confidence: 99%

“…The average form is related to the Th1 profile, with high production of IFN-γ, low levels of IL-10, scarce number of fungi and relates to the better granulomatous immune response, resulting in less severe injuries (plaque type lesion) [17], [18].…”

Section: Introductionmentioning

confidence: 99%

In Situ Immune Response in Human Chromoblastomycosis – A Possible Role for Regulatory and Th17 T Cells

et al. 2014

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BackgroundChromoblastomycosis is a chronic fungal infection that affects skin and subcutaneous tissue. Lesions can be classified in tumorous, verrucous, cicatricial and plaque type. The cellular immune response in the severe form of the disease seems to correlate with a Th2 pattern of cytokines. The humoral immune response also seems to play a role. We intended to explore the populations of regulatory T cells and the Th17 pattern.MethodologyTwenty-three biopsies of verrucous form were obtained from patients with clinical, culture and histopathological diagnostic of chromoblastomycosis, without treatment. It was performed an immunohistochemistry method to detect Foxp3, CD25, TGF-β, IL-6, IL-17 and IL-23.Principal findingsIL-17 was the only cytokine with high expression in CBM when compared to normal skin. The expression of Treg cells, TGF- β, IL-6 and IL-23 were similar to normal skin.Conclusions/SignificanceThe constitution of a local immune response with high expression of IL-17 and low expression of other cytokines could be at least in part, an attempt to help the immune system against fungal infection. On the other hand, high levels of local immune response mediated by Th17 profile could overcome the role of Treg cells. The inefficient immunomodulation as a consequence of the unbalance by Treg/Th17 cells seems to corroborate with the less effective immune response against fungi.

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Cited by 51 publications

References 27 publications

Chromoblastomycosis in India: Review of 169 cases

Chromoblastomycosis in India: Review of 169 cases

Langerhans Cells Express IL-17A in the Epidermis of Chromoblastomycosis Lesions

In Situ Immune Response in Human Chromoblastomycosis – A Possible Role for Regulatory and Th17 T Cells

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