Chromoblastomycosis: Difference between revisions

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Chronic cutaneous fungal implantation infection

Background

Microbiology

Mostly members of the family Herpotrichiellaceae within the order Chaetothyriales
Fonsecaea species
- Fonsecaea pedrosoi (most common), which is present in Brazil, Mexico, Sri Lanka, Japan, and Madagascar
- F. monophora and F. pugnacius, which both have neurotropism
- F. nubica
Cladophialophora species
- Cladophialophora carrionii
- Cladophialophora samoensis
Cladosporium carrionii
Phialophora verrucosa
Rhinocladiella aquaspersa
Exophiala species, which is a black yeast-like mold
- Exophiala dermatitidis

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

More common in tropics and subtropics worldwide
In the US, Fonsecaea pedrosoi, Fonsecaea monphora, and Phialophora verrucosa
Higher rates in Mexico, Brazil, other parts of northern South America, Madagascar, and China
Relatively high rate in Japan, as well

Clinical Presentation

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

Fungi
- Other implantation mycoses: sporotrichosis, eumycetoma, and lacaziosis
- Dimorphic fungi
Bacteria
- Cutaneous non-tuberculous mycobacteria
- Leprosy
- Nocardiosis
- Actinomycosis
- Yaws
- Tertiary syphilis
Parasites
- Leishmaniasis
- Rhinosporidioisis
Viruses: Human papilloma virus
Non-infectious causes
- Squamous cell carcinoma
- Mycosis fungoides (cutaneous T-cell lymphoma)
- Sarcoidosis
- Systemic lupus serythematosus

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

Surgical excision is the main therapy
Can also treat with cryotherapy, laster therapy, or heat therapy
Antifungals include itraconazole, posaconazole, isavuconazole, and terbinafine
- Fonsecaea species are relatively difficult to treat

@@ Line 1: / Line 1: @@
+* Chronic cutaneous fungal implantation infection
 == Background ==
+=== Microbiology ===
-* Causative fungi
+* Mostly members of the family ''Herpotrichiellaceae'' within the order ''Chaetothyriales''
-** ''[[Fonsecaea pedrosoi]]'' (most common): present in Brazil, Mexico, Sri Lanka, Japan, and Madagascar
+* [[Is caused by::Fonsecaea species]]
-** ''[[Cladosporium carrionii]]''
+** ''[[Is caused by::Fonsecaea pedrosoi]]'' (most common), which is present in Brazil, Mexico, Sri Lanka, Japan, and Madagascar
-** ''[[Phialophora verrucosa]]''
+** [[Is caused by::Fonsecaea monophora|''F. monophora'']] and [[Is caused by::Fonsecaea pugnacius|''F. pugnacius'']], which both have neurotropism
-** ''[[Rhinocladiella aquaspersa]]''
+** [[Is caused by::Fonsecaea nubica|''F. nubica'']]
+* [[Is caused by::Cladophialophora species]]
+** ''[[Is caused by::Cladophialophora carrionii]]''
+** ''[[Is caused by::Cladophialophora samoensis]]''
+* ''[[Is caused by::Cladosporium carrionii]]''
+* ''[[Is caused by::Phialophora verrucosa]]''
+* ''[[Is caused by::Rhinocladiella aquaspersa]]''
+* [[Is caused by::Exophiala species]], which is a black yeast-like mold
+** [[Is caused by::Exophiala dermatitidis]]
+=== 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 ===
+* More common in tropics and subtropics worldwide
+* In the US, [[Is caused by::Fonsecaea pedrosoi]], [[Is caused by::Fonsecaea monphora]], and [[Is caused by::Phialophora verrucosa]]
+* Higher rates in Mexico, Brazil, other parts of northern South America, Madagascar, and China
+* Relatively high rate in Japan, as well
 == Clinical Presentation ==
 * 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, pathognomonic '''muriform cells''' (copper penny) found on histology
+** 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 ==
+* Fungi
+** Other implantation mycoses: [[sporotrichosis]], [[eumycetoma]], and [[lacaziosis]]
+** [[Dimorphic fungi]]
+* Bacteria
+** Cutaneous [[non-tuberculous mycobacteria]]
+** [[Leprosy]]
+** [[Nocardiosis]]
+** [[Actinomycosis]]
+** [[Yaws]]
+** Tertiary [[syphilis]]
+* Parasites
+** [[Leishmaniasis]]
+** [[Rhinosporidioisis]]
+* Viruses: [[Human papilloma virus]]
+* Non-infectious causes
+** Squamous cell carcinoma
+** Mycosis fungoides (cutaneous T-cell lymphoma)
+** Sarcoidosis
+** Systemic lupus serythematosus
+== 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 ==
+* Surgical excision is the main therapy
+* Can also treat with cryotherapy, laster therapy, or heat therapy
+* Antifungals include [[Is treated by::itraconazole]], [[Is treated by::posaconazole]], [[Is treated by::isavuconazole]], and [[Is treated by::terbinafine]]
+** [[Fonsecaea species]] are relatively difficult to treat
+== Further Reading ==
+* Chromoblastomycosis. ''Clin Microbiol Rev''. 2017;30(1):233–276. doi: [https://dx.doi.org/10.1128/CMR.00032-16 10.1128/CMR.00032-16]
 [[Category:Fungal infections]]