Response of chromoblastomycosis to voriconazole

Lima, Alexandre Moretti de; Sacht, Gabriely Lessa; Paula, Lauren Zogbi Pereira de; Aseka, Gabriela Kimie; Goetz, Hermann; Gheller, Maicon Felippe; Torraca, Pedro de Freitas Silva

doi:10.1590/abd1806-4841.20165142

Cited by 12 publications

(13 citation statements)

References 5 publications

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“…Terbinafine is the second most frequently used antifungal drug, specially in some countries as Madagascar and China, based on open and non-comparative clinical trials [ 163 , 240 ]. Voriconazole, posaconazole, and isavuconazole are used only in refractory disease [ 1 , 247 , 248 ]. Interestingly, some therapies have been abandoned, such as cholecalciferol, thiabendazole, intravenous amphotericin, ketoconazole, and topical 5-fluorouracil.…”

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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“…Oral voriconazole was tested in some cases of treatment in resistant forms of CBM. 106 , 120 , 121 Good clinical results were achieved with this drug, but adverse effects like visual disturbances and photosensitive skin reactions were observed. 121 …”

Section: Treatmentmentioning

confidence: 98%

Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update

Brito

Bittencourt

2018

An. Bras. Dermatol.

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Chromoblastomycosis is a chronic, granulomatous, suppurative mycosis of the skin and subcutaneous tissue caused by traumatic inoculation of dematiaceous fungi of the family Herpotrichiellaceae. The species Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in regions where the disease is endemic. Chromoblastomycosis lesions are polymorphous: verrucous, nodular, tumoral, plaque-like, and atrophic. It is an occupational disease that predominates in tropical and subtropical regions, but there have been several reports of cases in temperate regions. The disease mainly affects current or former farm workers, mostly males, and often leaving disabling sequelae. This mycosis is still a therapeutic challenge due to frequent recurrence of lesions. Patients with extensive lesions require a combination of pharmacological and physical therapies. The article provides an update of epidemiological, clinical, diagnostic, and therapeutic features.

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“…Itraconazole (ITC) and terbinafine (TRB) are the most used drugs in the treatment of CBM [ 10 , 13 – 15 ]. Other drugs used include posaconazole (POS), voriconazole (VRC), amphotericin B (AMB) and flucytosine (5FC) [ 10 , 16 , 17 ]. In addition, combined therapies of ITC with TRB [ 10 , 18 ], 5FC with AMB [ 17 ], or ITC with 5FC have been used [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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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Response of chromoblastomycosis to voriconazole

Cited by 12 publications

References 5 publications

The global burden of chromoblastomycosis

The global burden of chromoblastomycosis

Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update

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

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