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PLoS Neglected Tropical Diseases Aug 2021Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected...
BACKGROUND
Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected Tropical Disease (NTD) and mainly affects populations living in poverty with significant morbidity, including stigma and discrimination.
METHODS AND FINDINGS
In order to estimate the global burden of CBM, we retrospectively reviewed the published literature from 1914 to 2020. Over the 106-year period, a total of 7,740 patients with CBM were identified on all continents except Antarctica. Most of the cases were reported from South America (2,619 cases), followed by Africa (1,875 cases), Central America and Mexico (1,628 cases), Asia (1,390 cases), Oceania (168 cases), Europe (35 cases), and USA and Canada (25 cases). We described 4,022 (81.7%) male and 896 (18.3%) female patients, with the median age of 52.5 years. The average time between the onset of the first lesion and CBM diagnosis was 9.2 years (range between 1 month to 50 years). The main sites involved were the lower limbs (56.7%), followed by the upper limbs (19.9%), head and neck (2.9%), and trunk (2.4%). Itching and pain were reported by 21.5% and 11%, respectively. Malignant transformation was described in 22 cases. A total of 3,817 fungal isolates were cultured, being 3,089 (80.9%) Fonsecaea spp., 552 (14.5%) Cladophialophora spp., and 56 Phialophora spp. (1.5%).
CONCLUSIONS AND SIGNIFICANCE
This review represents our current knowledge on the burden of CBM world-wide. The global incidence remains unclear and local epidemiological studies are required to improve these data, especially in Africa, Asia, and Latin America. The recognition of CBM as NTD emphasizes the need for public health efforts to promote support for all local governments interested in developing specific policies and actions for preventing, diagnosing and assisting patients.
Topics: Ascomycota; Chromoblastomycosis; Fonsecaea; Global Burden of Disease; Humans; Phialophora
PubMed: 34383752
DOI: 10.1371/journal.pntd.0009611 -
Mycoses Oct 2019Phaeohyphomycosis is a chronic cutaneous, subcutaneous or systemic mycotic infection caused by various dematiaceous fungi. The diverse clinical manifestations and poor...
BACKGROUND
Phaeohyphomycosis is a chronic cutaneous, subcutaneous or systemic mycotic infection caused by various dematiaceous fungi. The diverse clinical manifestations and poor prognosis of phaeohyphomycosis necessitate studies on it to better recognise the disease and improve its management.
OBJECTIVES
To investigate the epidemiology, aetiology, diagnosis, treatment and prognosis of phaeohyphomycosis in China over the past 20 years, and to study the first case of phaeohyphomycosis caused by Phialophora americana and the genetic and immunological mechanisms.
PATIENTS/METHODS
Clinical and laboratory findings of the case were studied, and the patient's DNA was sequenced for CARD9, followed by immunological studies using patient's PBMCs. Cases of phaeohyphomycosis in China from 1998 to 2018 in both the Chinese and English literature were collected and analysed, including 45 articles and 46 patients.
RESULTS
We confirmed the patient holding a homozygous frameshift mutation of CARD9, which led to impairment of pro-inflammatory cytokine production, and lower Th17- and Th22-associated responses upon fungus-specific stimulation. From the literature review, we revealed that the clinical presentations of phaeohyphomycosis were diverse. Diagnoses were established mainly on the basis of histopathology and fungal culture. Oral itraconazole, voriconazole, and posaconazole are the first choices for treatment, and a combination with surgical excision is also recommended.
CONCLUSIONS
Our study establishes that obtaining detailed histories is vital for understanding the immune state and that patients with recurrent or chronic phaeohyphomycosis in the absence of known immunodeficiencies should be tested for CARD9 mutations. We hope our findings will aid clinicians in the diagnoses and treatment of such infections.
Topics: Adolescent; Adult; Aged; Antifungal Agents; CARD Signaling Adaptor Proteins; Child; Child, Preschool; China; Cytokines; Female; Frameshift Mutation; Humans; Male; Middle Aged; Mutant Proteins; Phaeohyphomycosis; Phialophora; Sequence Analysis, DNA; T-Lymphocytes; Young Adult
PubMed: 31271673
DOI: 10.1111/myc.12962 -
Journal of Global Antimicrobial... Mar 2019Chromoblastomycosis (CBM) is a chronic granulomatous mycosis caused by dematiaceous fungi that affects cutaneous and subcutaneous tissues. The standard antifungal drug...
Chromoblastomycosis (CBM) is a chronic granulomatous mycosis caused by dematiaceous fungi that affects cutaneous and subcutaneous tissues. The standard antifungal drug for treatment is itraconazole, followed by terbinafine. However, cure rates vary from 15% to 80% when these drugs are used as monotherapy. A systematic review of the in vitro susceptibility of CBM agents to antifungal drugs, alone and in combination, was conducted using the Cochrane methodology. Forty-seven search terms were included in the PICOS method of searching electronic databases. The search resulted in 35 studies, of which 8 evaluated antifungal drugs in combination. Based on minimum inhibitory concentrations (MICs), posaconazole, terbinafine, itraconazole and voriconazole were, in descending order, the most effective antifungal drugs against CBM agents in vitro. In drug combination studies, only terbinafine-voriconazole and itraconazole-caspofungin showed 100% synergy for Fonsecaea pedrosoi, Exophiala jeanselmei and Phialophora verrucosa. However, none of the combinations studied showed antagonism.
Topics: Antifungal Agents; Ascomycota; Drug Synergism; Drug Therapy, Combination; Humans; Microbial Sensitivity Tests; Mycoses
PubMed: 30266638
DOI: 10.1016/j.jgar.2018.09.010