Clinical, epidemiological and mycological report on 65 patients from the Eastern Amazon region with chromoblastomycosis

Abstract

BACKGROUND: Chromoblastomycosis is a chronic fungal infection caused by fungi from the Dematiaceae family. According to several studies, Fonsecaea pedrosoi is the most common of these fungi. The infection is more common in tropical countries, with the Brazilian state of Pará having one of the largest infected populations worldwide. The disease is difficult to treat and recurrences are common. OBJECTIVES: To describe the epidemiological and mycological aspects of cases of chromoblastomycosis and its clinical forms in the state of Pará, Brazil. METHODS: Mycological exams (direct mycological examinations, culture and microculture) were performed and a clinical/epidemiological evaluation was made of 65 patients receiving care at the Dermatology Department of the Federal University of Pará between 2000 and 2007. The clinical classification proposed by Carrión in 1950 was used in this study. RESULTS: The majority of the patients were male (93.8%), agricultural workers (89.2%) of 45 to 55 years of age, and the majority of lesions (55.4%) were of the verrucous type, located principally on the lower limbs (81.5%). In the majority of the cases investigated (61.5%), the infection had been present for a long time, with a mean duration of 11 years. Direct mycological examination was performed in 86.2% of the patients (n=56). Of these, 96.4% (n=54) tested positive. Culture and microculture were performed in vitro in 47 cases of those that tested positive at direct microscopy, results showing Fonsecaea pedrosoi to be the only agent present in this sample. CONCLUSION: This study highlighted the extent to which chromoblastomycosis still affects the quality of life of the local population, principally individuals working in agriculture. This is a chronic disease for which there is no effective treatment. The importance of continuing to investigate this disease should be emphasized, as further studies may lead to new clinical or epidemiological findings.

Chromoblastomycosis

“…The sex distribution in a case series reported in the southern region of Brazil showed that disease was prevalent in males (4:1) (126). In two other studies involving 390 cases in the same region, the sex ratio distribution was much higher for males (17:1) (123,124). The difference related to sex distribution in patients with CBM may be related to hormonal protection, as observed for paracoccidioidomycosis patients (150).…”

“…After Brazil, Venezuela and Colombia account for most cases of CBM. Within Brazil, CBM is endemic in many geographical areas, especially in the northern regions, where 872 cases were retrospectively reported during the last decades (3,79,123,124). Although 332 cases were reported from other provinces, a significant decrease in the number of new CBM cases has been observed, especially in the southern regions of this country (125,126).…”

“…Although 332 cases were reported from other provinces, a significant decrease in the number of new CBM cases has been observed, especially in the southern regions of this country (125,126). The mean annual incidences of cases of CBM reported in Brazil were 6.4/year (71 cases/11 years) for the state of Paraná (southern region), 5.9/year (325 cases/55 years) for Pará 45 (northern region), 4.3/year (13 cases/3 years) for Maranhão (northeastern region), and 2.6/year (73 cases/28 years) for Rio Grande do Sul (southern region) (8,13,(123)(124)(125)(126). The principal etiological agent of CBM in Brazil is F. pedrosoi (which may include its molecular siblings), followed by sporadic reports of P. verrucosa and E. spinifera.…”

Cromoblastomicosis: características clínicas y microbiológicas de una enfermedad desatendida

“…Sin embargo, es en Brasil donde se ha comunicado el mayor número de casos (500 publicados) 9 , con una prevalencia estimada de uno de cada 196.000 habitantes 10 . La presentación clínica de ambos casos fue en las extremidades superiores, en contraste con un estudio realizado en Brasil, donde la presentación más frecuente fue en los miembros inferiores (81,5%) 7 .…”

“…Los macrófagos no son capaces de destruir las células fúngicas fagocitadas y éstas se desarrollan en su interior. Según la respuesta inmune dominante se pueden diferenciar cinco formas clínicas: nodulares, lesiones tumorales, verrugosa, placa y cicatriciales 4 ; pudiendo ser formas leves, como pequeños nódulos 5 , hasta enfermedades incapacitantes extensas 6,7 . Actualmente se busca un diagnóstico temprano y oportuno que logre diferenciar las micosis subcutáneas de otras enfermedades fúngicas, así como otras enfermedades dermatológicas (leishmaniasis, esporotricosis, psoriasis, lepra, tuberculosis cutánea) para un manejo oportuno 2 .…”