Chromoblastomycosis

From IDWiki
  • Chronic cutaneous fungal implantation infection

Background

Microbiology

History

  • Known by many names worldwide, including chapa (Cuba), figueira or formigueiro (Brazil), sundo or sustra (South America), foratra, gajo-miala, or didra (Madagascar)
  • Other medical names include black or yellow blastomycosis

Pathophysiology

  • Characterized by a non-protective TH2 cell response

Risk Factors

  • Agriculture work
  • Adult males (thought to be a protective effect of progesterone)

Epidemiology

Clinical Manifestations

  • Chronic localized fungal infection of the skin and subcutaneous tissue that produces raised, scaly lesions, usually in the lower extremities
    • Lesions are warty, cauliflower-like
    • Does not usually involve deeper structures like muscle or bone
  • Typically an implantation infection secondary to traumatic inoculation
    • Plants: wood, straw, grass, thorns, palm trees, bamboo, coconut shells, cacti
    • Animals: insect stings, cow stomp, buck rear, cock spine, caterpillars, leeches
    • Farming tools: hoes, axes, knives, and mills
    • May be associated with natural disasters (hurricanes and flooding), motor vehicle collisions, bricks, and shoes
  • Severity based on

Differential Diagnosis

Diagnosis

  • Skin scrapings or skin biopsy followed by histology and culture
    • Try to get areas where there are black specks ("cayenne pepper")
  • Histology
    • Pathognomonic muriform cells (copper penny cells)
  • Culture
    • Resistant to cycloheximide
    • May take up to 6 weeks to grow

Management

Further Reading