Chromoblastomycosis 2029171 216112531 2008-05-31T03:26:08Z DumZiBoT 6085301 robot Adding: [[pl:Chromoblastomikoza]] {{Infobox_Disease | Name = Chromoblastomycosis | Image = | Caption = | DiseasesDB = 29799 | ICD10 = {{ICD10|B|43||b|35}} | ICD9 = {{ICD9|117.2}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = derm | eMedicineTopic = 855 | MeshID = D002862 | }} '''Chromoblastomycosis''' is a long-term [[mycosis|fungal infection]] of the skin and [[subcutaneous]] tissue (a [[chronic (medicine)|chronic]] [[subcutaneous mycosis]]). The infection occurs most commonly in tropical or subtropical climates, often in rural areas. It can be caused by many different type of [[fungi]] which become implanted under the [[skin]], often by thorns or splinters. Chromoblastomycosis spreads very slowly; it is rarely fatal and usually has a good [[prognosis]], but it can be very difficult to cure. There are several treatment options, including medication and surgery. ==Features== The initial trauma causing the infection is often not noticed or forgotten. The infection builds at the site over a period of years, and a small red [[papule]] (skin elevation) appears. The lesion is usually not painful and there are few, if any symptoms. Patients rarely seek medical care at this point. Several complications may occur. Usually, the infection slowly spreads to the surrounding tissue while still remaining localized to the area around the original wound. However, sometimes the fungi may spread through the [[blood vessels]] or [[lymphatic system|lymph vessels]], producing [[metastatic]] lesions at distant sites. Another possibility is secondary infection with [[bacteria]]. This may lead to [[lymph stasis]] (obstruction of the lymph vessels) and [[elephantiasis]]. The nodules may become [[ulcer]]ated, or multiple nodules may grow and coalesce, affecting a large area of a limb. ==Diagnosis== The most informative test is to scrape the lesion and add [[potassium hydroxide]] (KOH), then examine under a microscope. (KOH scrapings are commonly used to examine fungal infections.) The [[pathognomonic]] finding is observing [[Medlar bodies]], sclerotic cells. Scrapings from the lesion can also be [[microbiological culture|cultured]] to identify the organism involved. Blood tests and imaging studies are not commonly used. ==Pathophysiology== Chromoblastomycosis is believed to originate in minor trauma to the skin, usually from vegetative material such as thorns or splinters; this trauma implants fungi in the subcutaneous tissue. In many cases the patient will not notice or remember the initial trauma, as symptoms often do not appear for years. The fungi most commonly observed to cause chromoblastomycosis are ''[[Fonsecaea]] pedrosoi'', ''[[Phialophora]] verrucosa'', ''[[Cladosporium]] carrionii'', and ''Fonsecaea compacta''. Over months to years, an erythematous papule appears at the site of inoculation. Although the mycosis slowly spreads, it usually remains localized to the skin and subcutaneous tissue. Hematogenous and/or lymphatic spread may occur. Multiple nodules may appear on the same limb, sometimes coalescing into a large plaque. Secondary bacterial infection may occur, sometimes inducing lymphatic obstruction. The central portion of the lesion may heal, producing a scar, or it may ulcerate. ==Treatment== Chromoblastomycosis is very difficult to cure. There are two primary treatments of choice. Itraconazole, an [[antifungal]] [[azole]], is given orally, with or without [[flucytosine]] (5-FC). Alternatively, [[cryosurgery]] with [[liquid nitrogen]] has also been shown to be effective. Other treatment options are the antifungal drug [[terbinafine]], an experimental drug [[posaconazole]], and [[heat therapy]]. [[Antibiotics]] may be used to treat bacterial superinfections. ==Prognosis== The prognosis for chromoblastomycosis is very good for small lesions. Severe cases are difficult to cure, although the prognosis is still quite good. The primary complications are ulceration, [[lymphedema]], and secondary bacterial infection. There have been a few cases reported of [[malignant]] transformation to [[squamous cell carcinoma]]. Chromoblastomycosis is very rarely fatal. ==Prevention== There is no known preventative measure aside from avoiding the traumatic inoculation of fungi. At least one study found a correlation between walking barefoot in [[endemic (epidemiology)|endemic]] areas and occurrence of chromoblastomycosis on the foot. ==Epidemiology== Chromoblastomycosis occurs around the world, but is most common in rural areas between approximately 30° N and 30° S [[latitude]]. [[Madagascar]] and [[Japan]] have the highest incidence. Over two thirds of patients are [[male]], and usually between the ages of thirty and fifty. A correlation with [[human leukocyte antigen|HLA]]-A29 suggests that genetic factors may play a role as well. ==References== *Bennet, John E. (2001). Miscellaneous Mycoses and Algal Infections. In Eugene Braunwald, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, & J. Larry Jameson (Eds.), ''Harrison's Principles of Internal Medicine'' (15th Edition), p. 1180. New York: McGraw-Hill *Castro, Luiz Guilherme M.; Scwartz, Robert A.; & Baran, Eugenusz (May 20, 2003). "[http://www.emedicine.com/derm/topic855.htm Chromoblastomycosis]." eMedicine. {{Mycoses}} [[Category:Diseases]] [[es:Cromomicosis]] [[pl:Chromoblastomikoza]]