Chromoblastomycosis: Difference between revisions
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+ | * Chronic cutaneous fungal implantation infection |
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+ | |||
== Background == |
== Background == |
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+ | === Microbiology === |
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− | * Causative fungi |
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+ | * Mostly members of the family ''Herpotrichiellaceae'' within the order ''Chaetothyriales'' |
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⚫ | |||
+ | * [[Is caused by::Fonsecaea species]] |
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⚫ | |||
⚫ | |||
⚫ | |||
+ | ** [[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'']] |
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+ | * [[Is caused by::Cladophialophora species]] |
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+ | ** ''[[Is caused by::Cladophialophora carrionii]]'' |
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+ | ** ''[[Is caused by::Cladophialophora samoensis]]'' |
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⚫ | |||
⚫ | |||
⚫ | |||
+ | * [[Is caused by::Exophiala species]], which is a black yeast-like mold |
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+ | ** [[Is caused by::Exophiala dermatitidis]] |
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+ | |||
+ | === History === |
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+ | * Known by many names worldwide, including chapa (Cuba), figueira or formigueiro (Brazil), sundo or sustra (South America), foratra, gajo-miala, or didra (Madagascar) |
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+ | * Other medical names include black or yellow blastomycosis |
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+ | |||
+ | === Pathophysiology === |
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+ | * Characterized by a non-protective TH2 cell response |
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+ | |||
+ | === Risk Factors === |
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+ | * Agriculture work |
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+ | * Adult males (thought to be a protective effect of progesterone) |
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+ | |||
+ | === Epidemiology === |
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+ | * More common in tropics and subtropics worldwide |
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+ | * In the US, [[Is caused by::Fonsecaea pedrosoi]], [[Is caused by::Fonsecaea monphora]], and [[Is caused by::Phialophora verrucosa]] |
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+ | * Higher rates in Mexico, Brazil, other parts of northern South America, Madagascar, and China |
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+ | * Relatively high rate in Japan, as well |
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== Clinical Presentation == |
== Clinical Presentation == |
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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 |
+ | ** Does not usually involve deeper structures like muscle or bone |
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+ | * Typically an implantation infection secondary to traumatic inoculation |
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+ | ** Plants: wood, straw, grass, thorns, palm trees, bamboo, coconut shells, cacti |
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+ | ** Animals: insect stings, cow stomp, buck rear, cock spine, caterpillars, leeches |
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+ | ** Farming tools: hoes, axes, knives, and mills |
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+ | ** May be associated with natural disasters (hurricanes and flooding), motor vehicle collisions, bricks, and shoes |
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+ | * '''Severity''' based on |
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+ | |||
+ | == Differential Diagnosis == |
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+ | * Fungi |
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+ | ** Other implantation mycoses: [[sporotrichosis]], [[eumycetoma]], and [[lacaziosis]] |
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+ | ** [[Dimorphic fungi]] |
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+ | * Bacteria |
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+ | ** Cutaneous [[non-tuberculous mycobacteria]] |
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+ | ** [[Leprosy]] |
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+ | ** [[Nocardiosis]] |
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+ | ** [[Actinomycosis]] |
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+ | ** [[Yaws]] |
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+ | ** Tertiary [[syphilis]] |
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+ | * Parasites |
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+ | ** [[Leishmaniasis]] |
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+ | ** [[Rhinosporidioisis]] |
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+ | * Viruses: [[Human papilloma virus]] |
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+ | * Non-infectious causes |
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+ | ** Squamous cell carcinoma |
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+ | ** Mycosis fungoides (cutaneous T-cell lymphoma) |
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+ | ** Sarcoidosis |
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+ | ** Systemic lupus serythematosus |
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+ | |||
+ | == Diagnosis == |
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+ | * Skin scrapings or skin biopsy followed by histology and culture |
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+ | ** Try to get areas where there are black specks ("cayenne pepper") |
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+ | * Histology |
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+ | ** Pathognomonic '''muriform cells''' (copper penny cells) |
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+ | * Culture |
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+ | ** Resistant to cycloheximide |
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+ | ** May take up to 6 weeks to grow |
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+ | |||
+ | == Management == |
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+ | * Surgical excision is the main therapy |
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+ | * 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]] |
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+ | ** [[Fonsecaea species]] are relatively difficult to treat |
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+ | |||
+ | == Further Reading == |
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+ | * Chromoblastomycosis. ''Clin Microbiol Rev''. 2017;30(1):233–276. doi: [https://dx.doi.org/10.1128/CMR.00032-16 10.1128/CMR.00032-16] |
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[[Category:Fungal infections]] |
[[Category:Fungal infections]] |
Revision as of 12:11, 3 November 2019
- 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
- Cladosporium carrionii
- Phialophora verrucosa
- Rhinocladiella aquaspersa
- Exophiala species, 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 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
- 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
Further Reading
- Chromoblastomycosis. Clin Microbiol Rev. 2017;30(1):233–276. doi: 10.1128/CMR.00032-16