Chromoblastomycosis: Difference between revisions

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'''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.
__NOTOC__
{{Chromoblastomycosis}}
{{About1|Fonsecaea pedrosoi}}
{{CMG}};{{AE}} {{KS}}


==Features==
==[[Chromoblastomycosis overview|Overview]]==
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.
==[[Chromoblastomycosis historical perspective|Historical Perspective]]==


==Diagnosis==
==[[Chromoblastomycosis classification|Classification]]==
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.
===Physical Examination===
====Skin====
=====Extremities=====
<gallery>
Image:Chromomycosis01.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis02.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis03.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis04.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis05.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis06.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis07.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis08.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis09.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis10.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis11.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis12.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis13.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis14.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis15.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis16.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis17.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis18.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis01.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis01.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis01.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis19.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis20.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis21.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis22.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis23.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis24.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis25.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis26.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis27.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis28.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis29.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis30.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis31.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis32.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis33.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis34.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis35.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis36.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Chromomycosis37.jpg|Chromomycosis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


==[[Chromoblastomycosis pathophysiology|Pathophysiology]]==


</gallery>
==[[Chromoblastomycosis causes|Causes]]==


==Pathophysiology==
==[[Chromoblastomycosis differential diagnosis|Differentiating Chromoblastomycosis From Other Diseases]]==
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.
==[[Chromoblastomycosis epidemiology and demographics|Epidemiology and Demographics]]==


==Treatment==
==[[Chromoblastomycosis risk factors|Risk Factors]]==
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==
==[[Chromoblastomycosis natural history, complications and prognosis|Natural History, Complications and 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==
==Diagnosis==
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.
[[Chromoblastomycosis history and symptoms| History and Symptoms]] | [[Chromoblastomycosis physical examination | Physical Examination]] | [[Chromoblastomycosis laboratory findings|Laboratory Findings]] | [[Chromoblastomycosis other imaging findings|Other Imaging Findings]] | [[Chromoblastomycosis other diagnostic studies|Other Diagnostic Studies]]


==Epidemiology==
==Treatment==
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.
[[Chromoblastomycosis medical therapy|Medical Therapy]] |  [[Chromoblastomycosis surgery|Surgery]] | [[Chromoblastomycosis primary prevention|Primary Prevention]] | [[Chromoblastomycosis secondary prevention|Secondary Prevention]] | [[Chromoblastomycosis future or investigational therapies|Future or Investigational Therapies]]
 
==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}}
==Case Studies==
[[es:Cromomicosis]]
[[Chromoblastomycosis case study one|Case#1]]
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[[Category:Disease]]
==Related Chapters==
*

Latest revision as of 14:25, 7 August 2015

Chromoblastomycosis
ICD-10 B43
ICD-9 117.2
DiseasesDB 29799
eMedicine derm/855 
MeSH D002862

Chromoblastomycosis Microchapters

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This page is about clinical aspects of the disease.  For microbiologic aspects of the causative organism(s), see Fonsecaea pedrosoi.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chromoblastomycosis From Other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Future or Investigational Therapies

Case Studies

Case#1

Related Chapters

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