Chromoblastomycosis: Difference between revisions
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=== Microbiology === |
=== Microbiology === |
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* Mostly members of the family ''Herpotrichiellaceae'' within the order ''Chaetothyriales'' |
* Mostly members of the family ''Herpotrichiellaceae'' within the order ''Chaetothyriales'' |
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* [[Is caused by::Fonsecaea |
* [[Is caused by::Fonsecaea]] |
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** ''[[Is caused by::Fonsecaea pedrosoi]]'' (most common), which is present in Brazil, Mexico, Sri Lanka, Japan, and Madagascar |
** ''[[Is caused by::Fonsecaea pedrosoi]]'' (most common), which is present in Brazil, Mexico, Sri Lanka, Japan, and Madagascar |
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** [[Is caused by::Fonsecaea monophora|''F. monophora'']] and [[Is caused by::Fonsecaea pugnacius|''F. pugnacius'']], which both have neurotropism |
** [[Is caused by::Fonsecaea monophora|''F. monophora'']] and [[Is caused by::Fonsecaea pugnacius|''F. pugnacius'']], which both have neurotropism |
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** [[Is caused by::Fonsecaea nubica|''F. nubica'']] |
** [[Is caused by::Fonsecaea nubica|''F. nubica'']] |
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* [[Is caused by::Cladophialophora |
* [[Is caused by::Cladophialophora]] |
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** ''[[Is caused by::Cladophialophora carrionii]]'' |
** ''[[Is caused by::Cladophialophora carrionii]]'' |
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** ''[[Is caused by::Cladophialophora samoensis]]'' |
** ''[[Is caused by::Cladophialophora samoensis]]'' |
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* ''[[Is caused by::Phialophora verrucosa]]'' |
* ''[[Is caused by::Phialophora verrucosa]]'' |
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* ''[[Is caused by::Rhinocladiella aquaspersa]]'' |
* ''[[Is caused by::Rhinocladiella aquaspersa]]'' |
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* [[Is caused by::Exophiala |
* [[Is caused by::Exophiala]], which is a black yeast-like mold |
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** [[Is caused by::Exophiala dermatitidis]] |
** ''[[Is caused by::Exophiala dermatitidis]]'' |
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=== History === |
=== History === |
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* Relatively high rate in Japan, as well |
* Relatively high rate in Japan, as well |
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== Clinical |
== Clinical Manifestations == |
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* Chronic localized fungal infection of the skin and subcutaneous tissue that produces raised, scaly lesions, usually in the lower extremities |
* Chronic localized fungal infection of the skin and subcutaneous tissue that produces raised, scaly lesions, usually in the lower extremities |
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** Lesions are warty, cauliflower-like |
** Lesions are warty, cauliflower-like |
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* Can also treat with cryotherapy, laster therapy, or heat therapy |
* Can also treat with cryotherapy, laster therapy, or heat therapy |
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* Antifungals include [[Is treated by::itraconazole]], [[Is treated by::posaconazole]], [[Is treated by::isavuconazole]], and [[Is treated by::terbinafine]] |
* Antifungals include [[Is treated by::itraconazole]], [[Is treated by::posaconazole]], [[Is treated by::isavuconazole]], and [[Is treated by::terbinafine]] |
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** [[Fonsecaea |
** [[Fonsecaea]] are relatively difficult to treat |
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== Further Reading == |
== Further Reading == |
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Latest revision as of 20:40, 28 January 2022
- Chronic cutaneous fungal implantation infection
Background
Microbiology
- Mostly members of the family Herpotrichiellaceae within the order Chaetothyriales
- Fonsecaea
- 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
- Cladosporium carrionii
- Phialophora verrucosa
- Rhinocladiella aquaspersa
- Exophiala, which is a black yeast-like mold
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 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
- Fungi
- Other implantation mycoses: sporotrichosis, eumycetoma, and lacaziosis
- Dimorphic fungi
- Bacteria
- Cutaneous non-tuberculous mycobacteria
- Leprosy
- Nocardiosis
- Actinomycosis
- Yaws
- Tertiary syphilis
- Parasites
- 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 are relatively difficult to treat
Further Reading
- Chromoblastomycosis. Clin Microbiol Rev. 2017;30(1):233–276. doi: 10.1128/CMR.00032-16
