Mixed secondary bacterial infection is associated with severe lesions of chromoblastomycosis in a neglected population from Brazil

Marques, Sirlei Garcia; Bomfim, Maria Rosa Quaresma; Azevedo, Conceição de Maria Pedroso e Silva; Martins, Cleide Viviane Buzanello; Marques, Ana Claudia G.; Gonçalves, Aline Ferreira Lima; Vicente, Vânia A.; Santos, Alcione Miranda dos; Costa, Marliete Carvalho; Freitas, Gustavo José Cota de; Santos, Danielle Anjos dos; Stoianoff, Maria Aparecida de Resende

doi:10.1016/j.diagmicrobio.2019.05.018

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…Although the diagnosis of CBM does not rely on expensive and sophisticated laboratory tools, the disease remains neglected by all health systems, making the time of diagnosis too long (mean of 9 years). This aspect certainly impacts in morbidity, including disease progression, risk of superinfection and malignant transformation [ 8 , 56 , 68 , 99 , 167 , 175 , 240 , 241 , 242 ]. Considering the insidious progression of the fungal disease, patients continue their labor and social activities for many years before having the diagnosis made [ 1 , 3 , 5 , 48 , 176 ].…”

Section: Discussionmentioning

confidence: 99%

The global burden of chromoblastomycosis

et al. 2021

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Background Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected Tropical Disease (NTD) and mainly affects populations living in poverty with significant morbidity, including stigma and discrimination. Methods and findings In order to estimate the global burden of CBM, we retrospectively reviewed the published literature from 1914 to 2020. Over the 106-year period, a total of 7,740 patients with CBM were identified on all continents except Antarctica. Most of the cases were reported from South America (2,619 cases), followed by Africa (1,875 cases), Central America and Mexico (1,628 cases), Asia (1,390 cases), Oceania (168 cases), Europe (35 cases), and USA and Canada (25 cases). We described 4,022 (81.7%) male and 896 (18.3%) female patients, with the median age of 52.5 years. The average time between the onset of the first lesion and CBM diagnosis was 9.2 years (range between 1 month to 50 years). The main sites involved were the lower limbs (56.7%), followed by the upper limbs (19.9%), head and neck (2.9%), and trunk (2.4%). Itching and pain were reported by 21.5% and 11%, respectively. Malignant transformation was described in 22 cases. A total of 3,817 fungal isolates were cultured, being 3,089 (80.9%) Fonsecaea spp., 552 (14.5%) Cladophialophora spp., and 56 Phialophora spp. (1.5%). Conclusions and significance This review represents our current knowledge on the burden of CBM world-wide. The global incidence remains unclear and local epidemiological studies are required to improve these data, especially in Africa, Asia, and Latin America. The recognition of CBM as NTD emphasizes the need for public health efforts to promote support for all local governments interested in developing specific policies and actions for preventing, diagnosing and assisting patients.

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Section: Discussionmentioning

confidence: 99%

The global burden of chromoblastomycosis

et al. 2021

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“…Staphylococcus aureus is the commonly involved microorganism in secondary infections, and mixed infection with Streptococcus pyogenes is commonly associated with severe lesions. 76 Three patients had chromoblastomycosis-leprosy coinfection. There are few reports of this coinfection, most of them from Brazil.…”

Section: Discussionmentioning

confidence: 99%

“…7,11,15,46,52,59,60,62,72 The complications mainly described in chromoblastomycosis have been secondary bacterial infections and carcinomatous degeneration of the lesions. 7,11,15,17,45,50,52,57,62,71,75,76 The complication found in patients from Mato Grosso was a bacterial infection. This complication is mainly caused by Gram-positive cocci in the upper limbs and Gram-negative bacilli in the lower limbs.…”

Section: Discussionmentioning

confidence: 99%

“…The complications mainly described in chromoblastomycosis have been secondary bacterial infections and carcinomatous degeneration of the lesions 7,11,15,17,45,50,52,57,62,71,75,76 . The complication found in patients from Mato Grosso was a bacterial infection.…”

Section: Discussionmentioning

confidence: 99%

“…This complication is mainly caused by Gram‐positive cocci in the upper limbs and Gram‐negative bacilli in the lower limbs. Staphylococcus aureus is the commonly involved microorganism in secondary infections, and mixed infection with Streptococcus pyogenes is commonly associated with severe lesions 76 …”

Section: Discussionmentioning

confidence: 99%

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Molecular epidemiology and clinical‐laboratory aspects of chromoblastomycosis in Mato Grosso, Brazil

Guevara

Nery

Melhem

et al. 2022

Mycoses

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Introduction Chromoblastomycosis is a disease caused by melanized fungi, primarily belonging to the genera Fonsecaea and Cladophialophora, mainly affecting individuals who are occupationally exposed to soil and plant products. This research aimed to determine the clinical, epidemiological and laboratory characteristics of chromoblastomycosis in the state of Mato Grosso, Brazil. Materials and Methods Patients diagnosed with chromoblastomycosis treated at the Júlio Müller University Hospital, Cuiabá, Brazil, from January 2015 to December 2020, whose isolates were preserved in the Research Laboratory of the Faculty of Medicine of the Federal University of Mato Grosso. Isolates were identified by partly sequencing the Internal Transcribed Spacer (ITS) and β‐tubulin (BT2) loci. AFLP fingerprinting was used to explore the genetic diversity. Susceptibility to itraconazole, voriconazole, 5‐fluorocytosine, terbinafine and amphotericin B was determined by the broth microdilution technique. Results Ten patients were included, nine were male (mean age = 64.1 years). Mean disease duration was 8.6 years. Lesions were mainly observed in the lower limbs. Predominant clinical forms were verrucous and scarring. Systemic arterial hypertension and type II diabetes mellitus were the predominant comorbidities. Leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi was the unique aetiological agent identified with moderate genetic diversity (H = 0.3934–0.4527; PIC = 0.3160–0.3502). Antifungal agents with the highest activity were terbinafine, voriconazole and itraconazole. Conclusion Chromoblastomycosis is affecting the poor population in rural and urban areas, mainly related to agricultural activities, with F. pedrosoi being the dominant aetiologic agent. All isolates had low MICs for itraconazole, voriconazole and terbinafine, confirming their importance as therapeutic alternatives for chromoblastomycosis.

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

et al. 2021

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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.

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Mixed secondary bacterial infection is associated with severe lesions of chromoblastomycosis in a neglected population from Brazil

Cited by 4 publications

References 24 publications

The global burden of chromoblastomycosis

The global burden of chromoblastomycosis

Molecular epidemiology and clinical‐laboratory aspects of chromoblastomycosis in Mato Grosso, Brazil

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

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