Abstract
Chromoblastomycosis (CBM) is a chronic, progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi. The disease has worldwide prevalence with predominant cases reported from humid tropical and subtropical regions of America, Asia, and Africa. Diagnosis is often delayed or misdirected either due to poor degree of clinical suspicions or clinical simulation of dermatological conditions. The infection is not uncommon in India and several case reports from the sub-Himalayan belt and western and eastern coasts of India have been published; however, very few have reviewed the cases. We reviewed 169 cases published in English literature from India during 1957 through May 2016, including 2 recent cases from our institute. A tremendous increase in the number of reported cases was noticed since 2012, since which, more than 50% of the cases had been published. A majority of the patients (74.1%) were involved in various agricultural activities directly or indirectly. The mean age at presentation was 43.3 years ± 16.0, with male to female ratio of 4.2:1. The duration of disease at the time of presentation varied from 20 days to 35 years. Any history of trauma was recalled only in 33.8% of the studied cases. The lower extremity was the most common site afflicted, followed by the upper extremity. The culture was positive in 80.3% of the cases with Fonsecaea pedrosoi, isolated as the most common fungal pathogen, followed by Cladophialophora carrionii. Although all the commercially available antifungals were prescribed in these cases, itraconazole and terbinafine were the most commonly used, either alone or in combination with other drugs/physical methods, with variable degrees of outcome. Combinations of different treatment modalities (chemotherapy and physical methods) yielded a cure rate of 86.3%. CBM is refractory to treatment and no single antifungal agent or regimen has demonstrated satisfactory results. Increased awareness with early clinical suspicion of the disease and adequate therapy are necessary to improve the outcome. However, depending upon the causative agent, disease severity, and the choice of antifungals, variable outcomes can be observed.
Highlights
Chromoblastomycosis (CBM) is a chronic, progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi through the skin of exposed body parts
The literature search was done in Medline (National Library of Medicine, Bethesda, Maryland, United States) and Google for the period of 1957 to May 2016 using the following terms: “chromoblastomycosis,” “chromomycosis,” “chromoblastomycosis dissemination,” “melanised fungi,” “dematiaceous fungi,” “Fonsecaea,” “Phialophora,” “Cladophialophora,” “Exophiala,” “Hormodendrum,” and “India.” Combinations such as “chromoblastomycosis in India,” “chromoblastomycosis and India,” “chromomycosis in India,” “chromomycosis and India,” “chromoblastomycosis dissemination in India,” and “chromomycosis dissemination and India” were used to retrieve the articles
A case reported by Deshpande et al with submandibular discharging sinus lacked sufficient evidence for the diagnosis of CBM and was excluded [10]
Summary
Chromoblastomycosis (CBM) is a chronic, progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi through the skin of exposed body parts. The fungi causing CBM are ubiquitous, found in soil and decaying plant debris, including wood. As CBM is an implantation mycosis, occupation seems to play an important role [2]. A small, single, localized papule, nodule, plaque, or verrucous lesion is seen at the site of inoculation. Severe clinical forms and dissemination via lymphatics/hematogeneous/ contiguous spread are rarely seen. Phialophora verrucosa, and Cladophialophora carrionii are the most frequent etiological agents of CBM. E. jeanselmei and E. spinifera do produce muriform cells in CBM [4]. Various other agents of CBM such as F. monophora [5], F. nubica [6], and P. richardsiae [7] have been reported. Though known for 100 years, CBM still poses a therapeutic challenge to clinicians due to its recalcitrant nature and common relapse after treatment
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