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a fungal infection characterized by itchy warty nodules on the skin

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/10/22 14:58:40」(JST)

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Chromoblastomycosis (also known as "Chromomycosis,"^[1] "Cladosporiosis,"^[1] "Fonseca's disease,"^[1] "Pedroso's disease,"^[1] "Phaeosporotrichosis,"^[1] "Verrucous dermatitis"^[1]) is a long-term fungal infection of the skin^[2] and subcutaneous tissue (a chronic subcutaneous mycosis).^[3] 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 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 ulcerated, or multiple nodules may grow and coalesce, affecting a large area of a limb.

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^[4]^[5]
Phialophora verrucosa^[6]
Cladosporium carrionii
Fonsecaea compacta^[7]

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.

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 cultured to identify the organism involved. Blood tests and imaging studies are not commonly used.

On histology, chromoblastomycosis manifests as pigmented yeasts resembling "copper pennies." Special stains, such as periodic acid schiff and Gömöri methenamine silver, can be used to demonstrate the fungal organisms if needed.

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,^[8] an experimental drug posaconazole, and heat therapy.

Antibiotics may be used to treat bacterial superinfections.

Amphotericin B has also been used.^[9]

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 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 HLA-A29 suggests that genetic factors may play a role as well.

References

^ ^a ^b ^c ^d ^e ^f Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
^ "chromoblastomycosis" at Dorland's Medical Dictionary
^ López Martínez R, Méndez Tovar LJ (2007). "Chromoblastomycosis". Clin. Dermatol. 25 (2): 188–94. doi:10.1016/j.clindermatol.2006.05.007. PMID 17350498. http://linkinghub.elsevier.com/retrieve/pii/S0738-081X(06)00069-1.
^ Bonifaz A, Carrasco-Gerard E, Saúl A (2001). "Chromoblastomycosis: clinical and mycologic experience of 51 cases". Mycoses 44 (1-2): 1–7. doi:10.1046/j.1439-0507.2001.00613.x. PMID 11398635. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0933-7407&date=2001&volume=44&issue=1-2&spage=1.
^ de Andrade TS, Cury AE, de Castro LG, Hirata MH, Hirata RD (March 2007). "Rapid identification of Fonsecaea by duplex polymerase chain reaction in isolates from patients with chromoblastomycosis". Diagn. Microbiol. Infect. Dis. 57 (3): 267–72. doi:10.1016/j.diagmicrobio.2006.08.024. PMID 17338941. http://linkinghub.elsevier.com/retrieve/pii/S0732-8893(06)00339-7.
^ Park SG, Oh SH, Suh SB, Lee KH, Chung KY (March 2005). "A case of chromoblastomycosis with an unusual clinical manifestation caused by Phialophora verrucosa on an unexposed area: treatment with a combination of amphotericin B and 5-flucytosine". Br. J. Dermatol. 152 (3): 560–4. doi:10.1111/j.1365-2133.2005.06424.x. PMID 15787829. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0007-0963&date=2005&volume=152&issue=3&spage=560.
^ Attapattu MC (1997). "Chromoblastomycosis--a clinical and mycological study of 71 cases from Sri Lanka". Mycopathologia 137 (3): 145–51. doi:10.1023/A:1006819530825. PMID 9368408. http://www.kluweronline.com/art.pdf?issn=0301-486X&volume=137&page=145.
^ Bonifaz A, Saúl A, Paredes-Solis V, Araiza J, Fierro-Arias L (February 2005). "Treatment of chromoblastomycosis with terbinafine: experience with four cases". J Dermatolog Treat 16 (1): 47–51. doi:10.1080/09546630410024538. PMID 15897168. http://www.informaworld.com/openurl?genre=article&doi=10.1080/09546630410024538&magic=pubmed%7C%7C1B69BA326FFE69C3F0A8F227DF8201D0.
^ Paniz-Mondolfi AE, Colella MT, Negrín DC, et al. (March 2008). "Extensive chromoblastomycosis caused by Fonsecaea pedrosoi successfully treated with a combination of amphotericin B and itraconazole". Med. Mycol. 46 (2): 179–84. doi:10.1080/13693780701721856. PMID 18324498. http://www.informaworld.com/openurl?genre=article&doi=10.1080/13693780701721856&magic=pubmed%7C%7C1B69BA326FFE69C3F0A8F227DF8201D0.

UpToDate Contents

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1. 真菌性菌腫 eumycetoma
2. ブドウ菌腫 botryomycosis
3. フサリウム感染の臨床症状および診断 clinical manifestations and diagnosis of fusarium infection
4. フルシトシン（5-FC）の薬理 pharmacology of flucytosine 5 fc
5. アムホテリシンBの薬理 pharmacology of amphotericin b

English Journal

Cutaneous Chromoblastomycosis Mimicking Tuberculosis Verrucosa Cutis: Look for Copper Pennies!

Bandyopadhyay A, Majumdar K, Gangopadhyay M, Banerjee S.Author information Department of Pathology, North Bengal Medical College, WEST BENGAL, INDIA.AbstractChromoblastomycosis is a rare chronic fungal infection of skin and subcutaneous tissue. It is primarily a disease of tropical and subtropical regions and affects mainly the agricultural workers following trauma with vegetable matter. Cutaneous Chromoblastomycosis may clinically mimic cutaneous tuberculosis as both the condition usually presents with hyper pigmented verrucous lesion of skin. Here in we report a case of chronic cutaneous Chromoblastomycosis in a middle aged woman from north eastern part of India, who was initially misdiagnosed as Tuberculosis verrucosa cutis. In histopathology characteristic brown colored spores of the fungus (also known as copper pennies) were seen within dermal abscess. The organism isolated from culture of the biopsy material was Fonsecaea pedrosoi thus confirming our diagnosis of cutaneous chromoblastomycosis. The patient responded well to oral Itraconazole. The dermatologists and pathologists should be aware of this condition especially when dealing with verrucous lesion of the skin. The pathologists should search for fungal spores in cutaneous lesion with pseudoepitheliomatous hyperplasia and dermal abscess.
Turk patoloji dergisi.Turk Patoloji Derg.2013 Nov 7. doi: 10.5146/tjpath.2013.01197. [Epub ahead of print]
Chromoblastomycosis is a rare chronic fungal infection of skin and subcutaneous tissue. It is primarily a disease of tropical and subtropical regions and affects mainly the agricultural workers following trauma with vegetable matter. Cutaneous Chromoblastomycosis may clinically mimic cutaneous tuber
PMID 24272932

Cytokine profile of a self-healing Fonsecaea pedrosoi infection in murine model.

Wang H, Mu W, Ja Q, Zhang M, Chen R, Lv G, Shen Y, Liu W.Author information Department of Dermatology, Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250021, People's Republic of China, drhongwang2013@gmail.com.AbstractChromoblastomycosis is a chronic infectious disease of the skin and subcutaneous tissue. However, the host-defence response to this fungal infection has not been investigated thoroughly. This study was carried out to analyse the sequential events and the change of local cytokine release in a murine model infected with Fonsecaea pedrosoi in footpad. The anti-inflammatory Th2 cytokine IL-10 demonstrated an upward trend up to 7 days post infection followed by a steady decline. The titers of TNF-α (a pro-inflammatory Th1 cytokine) increased up to 7 days post infection followed by a relatively steady-state until full recovery. The anti-inflammatory cytokine IL-4 showed a similar pattern as TNF-α. The pro-inflammatory cytokine IFN-γ did not increased until 7 days post infection, while demonstrated an upward trend up to 30 days when the mice reached a full recovery from infection.
Cell biochemistry and biophysics.Cell Biochem Biophys.2013 Nov;67(2):599-605. doi: 10.1007/s12013-013-9547-2.
Chromoblastomycosis is a chronic infectious disease of the skin and subcutaneous tissue. However, the host-defence response to this fungal infection has not been investigated thoroughly. This study was carried out to analyse the sequential events and the change of local cytokine release in a murine
PMID 23479333

Chromoblastomycosis caused by Fonsecaea: clinicopathology, susceptibility and molecular identification of seven consecutive cases in Southern China.

Yang YP, Li W, Huang WM, Zhou Y, Fan YM.Author information Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China.AbstractThe clinicopathological and microbiological features of chromoblastomycosis caused by Fonsecaea pedrosoi or Fonsecaea monophora are summarized. Four F. monophora and three F. pedrosoi strains were isolated from seven consecutive chromoblastomycosis patients and identified by genetic analysis between 2004 and 2012 in a teaching hospital in southern China. Six strains were sensitive to voriconazole, itraconazole and terbinafine using E-test and Neo-Sensitabs. Six patients healed after oral itraconazole or terbinafine, and one was lost to follow up. Internal transcribed spacer sequence is sufficient for species delimitation of Fonsecaea, and the Neo-Sensitabs test and E-test are comparable in their susceptibility testing. Itraconazole and/or terbinafine may be the preferred treatment for this chromoblastomycosis.
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.Clin Microbiol Infect.2013 Nov;19(11):1023-8. doi: 10.1111/1469-0691.12067. Epub 2012 Nov 15.
The clinicopathological and microbiological features of chromoblastomycosis caused by Fonsecaea pedrosoi or Fonsecaea monophora are summarized. Four F. monophora and three F. pedrosoi strains were isolated from seven consecutive chromoblastomycosis patients and identified by genetic analysis betwe
PMID 23153454