The global burden of chromoblastomycosis

Abstract

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.

First report of phaeohyphomycosis caused by Phialophora americana in a domestic cat from Argentina

“… 24 , 25 Strategies with other azoles, other than itraconazole or posaconazole, have also been used. 26 The use of voriconazole in cats has been proposed as a first-line treatment. 2 However, the clinical recurrence when stopping treatment, as well as the cost of the medication, does not favor its use as the drug of choice.…”

In vivo reflectance confocal microscopy, dermoscopy, high-frequency ultrasonography, and histopathology features in a case of chromoblastomycosis

“…Chromoblastomycosis is a neglected and chronic infectious disease that has a peculiar characteristic, the transepidermal elimination of fungal structures in its early stages. Considered one of the implantation mycoses, the disease is present in several countries especially in developing countries; chromoblastomycosis is relatively common in Brazil [ 2 ]. The etiological agents are geophilic melanized fungi present in nature, particularly in rural areas.…”

Evolutionary Relationships, Phylogeographic Patterns, and a Hypothesis for Air- and Sea-driven Global Spread of Chromoblastomycosis by Etiological Fonsecaea Agents

“…The tropical oceans produce about 80 tropical storms per year, of which about two-thirds are severe (classi ed on a Sa r-Simpson intensity scale of 1 or higher). Almost 90% of storms form within 20° north or south of the equator (Britannica, 2022;National Hurricane Center and Central Paci c Hurricane Center National Oceanic and Atmospheric Administration, 2022), and CBM is also endemic in this region (Queiroz-Telles et al, 2017;Santos et al, 2021). Notably, the ndings of DeLeon-Rodriguez et al, (2013) (DeLeon-Rodriguez et al, 2013 suggested that fogging of large fungal spore communities occurs during tropical hurricanes, and airborne fungi may remain viable after being carried aloft (Alsante et al, 2021;Mayer et al, 2020), where long-distance, transcontinental and even oceanic transport occurs.…”

“…An increasing number of endemic tropical diseases caused by prevalent fungi (Boekhout et al, 2021), bacteria, viruses, and parasites are expanding their geographical distribution (Tedersoo et al, 2021), while a large number of natural products of tropical biomes have excellent therapeutic e cacy and show promise for treating these diseases (Adegboye et al, 2021). This provides new possible treatment options for the large number of patients with severe illnesses (Khan et al, 2019) or very poor treatment results (Schwalb & Seas, 2020) who are currently widespread, because the complete cure of severe cases of Fonsecaea spp.-caused infections is a great challenge for clinicians and researchers (Santos et al, 2021). At present, the exact cost of CBM driven by etiological Fonsecaea agents is unknown, as there is no national surveillance mechanism in China to examine CBM in sentinel centers.…”

“…Fonsecaea spp. is the most common pathogen underlying CBM (Queiroz-Telles et al, 2017;Santos et al, 2021). At present, the Fonsecaea clade contains the clinically relevant species F. pedrosoi (Belda et al, 2020;de Andrade et al, 2020;Santos et al, 2007;Singh et al, 2006;Vicente et al, 2008), F. monophora (Campos-Macias et al, 2021), F. nubica (You et al, 2019) and F. pugnacius (Bombassaro et al, 2020).…”