Video:Chromoblastomycosis

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Description

Chromoblastomycosis is a long-term fungal infection of the skin, which following injury, a small bump appears before forming a purplish roundish patch.[1][2] It tends to occur on the legs.[3] Gradually the nodules get bigger and the leg can swell.[4] Chromoblastomycosis is difficult to cure. The primary treatments of choice are: itraconazole, an antifungal azole, is given orally, with or without flucytosine.[5][6]

Presentation

In terms of the presentation we find that a raised, erythematous, asymptomatic papule develops. This leads to either clinical variants- nodular or plaque.[7]

Complications

In terms of possible complications in an affected individual we find the following: atrophic scarring, joint immobility, ulceration, and secondary bacterial infection.[8]

Cause

Chromoblastomycosis is believed to originate from minor trauma to the skin, usually from vegetative material such as thorns or splinters; this trauma implants fungi in the subcutaneous tissue.[6][5]Among the fungi most commonly observed to cause chromoblastomycosis is: Fonsecaea pedrosoi.[9][10]

Mechanism

In terms of the mechanism we find that fungi is introduced via traumatic inoculation. Once inside the persons body, the fungi replicate and form muriform ( or sclerotic) cells, which are characteristic of this fungal infection.The immune response has a consequential role, as the infection triggers a nonprotective T helper type 2 immune response, which is not effective against the infection. Humoral immunity also has a role in the body's response.[11][12][13]

Diagnosis

Diagnosis of Chromoblastomycosis is done via obtaining a skin biopsy. Microscopically the confirmation of Chromoblastomycosis is then done per the characteristic presentation of the fungal cells in question.[14]

Differential diagnosis

Other conditions that may present similarly to Chromoblastomycosis are : Lobomycosis, Eumycetoma, Blastomycosis, Sporotrichosis, Botryomycosis, Verruca vulgaris, Leishmaniasis and Rhinosporidiosis.[8]

Treatment

Chromoblastomycosis is intractable , the primary treatments of choice are: itraconazole, an antifungal azole, is given orally, with or without flucytosine. Alternatively, cryosurgery with liquid nitrogen has also been shown to be effective.[8][5]

Epidemiology

Chromoblastomycosis occurs around the world, but is most common in rural areas . Madagascar and Japan have the highest rates.[15][16]

History

Chromoblastomycosis was first described by Max Rudolph, a German physician, in 1914. He observed the disease in rural workers in the State of Minas Gerais, Brazil.[17]

References

  1. ↑ Johnstone, Ronald B. (2017). "25. Mycoses and Algal infections". Weedon's Skin Pathology Essentials (2nd ed.). Elsevier. p. 453. ISBN 978-0-7020-6830-0. Archived from the original on 2023-06-30. Retrieved 2023-06-20.
  2. ↑ "ICD-11 - ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Archived from the original on 1 August 2018. Retrieved 1 June 2021.
  3. ↑ Morris-Jones, Rachael (2019). "18. Tropical dermatology". In Morris-Jones, Rachael (ed.). ABC of Dermatology (7th ed.). Hoboken: Wiley Blackwell. p. 152. ISBN 978-1-119-48899-6. Archived from the original on 2023-06-30. Retrieved 2023-06-20.
  4. ↑ James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2019). "13. Diseases resulting from fungi and yeasts". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. pp. 316–317. ISBN 978-0-323-54753-6. Archived from the original on 2023-01-12. Retrieved 2021-07-13.
  5. ↑ 5.0 5.1 5.2 "Chromoblastomycosis Basics". Chromoblastomycosis. 30 August 2024. Archived from the original on 2 September 2024. Retrieved 31 August 2024.
  6. ↑ 6.0 6.1 Kurien, George; Sugumar, Kavin; Sathe, Nishad C.; Chandran, Veena (2024). "Chromoblastomycosis". StatPearls. StatPearls Publishing.
  7. ↑ "Chromoblastomycosis Clinical Presentation: History, Physical Examination, Complications". emedicine.medscape.com. Retrieved 11 September 2024.
  8. ↑ 8.0 8.1 8.2 Kurien, George; Sugumar, Kavin; Sathe, Nishad C.; Chandran, Veena (2024). "Chromoblastomycosis". StatPearls. StatPearls Publishing. Archived from the original on 2023-11-16. Retrieved 2024-08-24.
  9. ↑ Bonifaz A, Carrasco-Gerard E, Saúl A (2001). "Chromoblastomycosis: clinical and mycologic experience of 51 cases". Mycoses. 44 (1–2): 1–7. doi:10.1046/j.1439-0507.2001.00613.x. PMID 11398635.
  10. ↑ de Andrade TS, Cury AE, de Castro LG, Hirata MH, Hirata RD (March 2007). "Rapid identification of Fonsecaea by duplex polymerase chain reaction in isolates from patients with chromoblastomycosis". Diagn. Microbiol. Infect. Dis. 57 (3): 267–72. doi:10.1016/j.diagmicrobio.2006.08.024. PMID 17338941.
  11. ↑ Alvarez, Diego C; García, Olga CR; Martinez, Joyce MG (August 2018). "Chromoblastomycosis. A forgotten mycosis". Cambridge Medicine Journal. doi:10.7244/cmj.2018.07.001. Archived from the original on 2024-09-08. Retrieved 2024-09-05.
  12. ↑ "Chromoblastomycosis". www.who.int. Archived from the original on 2 September 2024. Retrieved 5 September 2024.
  13. ↑ Queiroz-Telles, Flavio; de Hoog, Sybren; Santos, Daniel Wagner C. L.; Salgado, Claudio Guedes; Vicente, Vania Aparecida; Bonifaz, Alexandro; Roilides, Emmanuel; Xi, Liyan; Azevedo, Conceição de Maria Pedrozo e Silva; da Silva, Moises Batista; Pana, Zoe Dorothea; Colombo, Arnaldo Lopes; Walsh, Thomas J. (January 2017). "Chromoblastomycosis". Clinical Microbiology Reviews. 30 (1): 233–276. doi:10.1128/CMR.00032-16. ISSN 0893-8512.
  14. ↑ "Clinical Overview of Chromoblastomycosis". Chromoblastomycosis. 3 September 2024. Retrieved 16 September 2024.
  15. ↑ "Chromoblastomycosis: Background, Pathophysiology, Etiology". eMedicine. 13 May 2024. Archived from the original on 31 July 2019. Retrieved 28 August 2024.
  16. ↑ Santos, Daniel Wagner C. L.; Azevedo, Conceição de Maria Pedrozo e Silva de; Vicente, Vania Aparecida; Queiroz-Telles, Flávio; Rodrigues, Anderson Messias; Hoog, G. Sybren de; Denning, David W.; Colombo, Arnaldo Lopes (12 August 2021). "The global burden of chromoblastomycosis". PLOS Neglected Tropical Diseases. 15 (8): e0009611. doi:10.1371/journal.pntd.0009611. ISSN 1935-2735.
  17. ↑ Queiroz-Telles, Flavio; Esterre, Phillippe; Perez-Blanco, Maigualida; Vitale, Roxana G; Salgado, Claudio Guedes; Bonifaz, Alexandro (January 2009). "Chromoblastomycosis: an overview of clinical manifestations, diagnosis and treatment". Medical Mycology. 47 (1): 3–15. doi:10.1080/13693780802538001.
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