Summary about Disease
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue. It is characterized by slow-growing, warty nodules or plaques, primarily on the lower extremities. The disease typically results from traumatic inoculation of the skin with fungi found in soil and decaying vegetation. It is more prevalent in tropical and subtropical regions.
Symptoms
The primary symptoms include:
Small, raised, wart-like lesions at the site of inoculation.
Slowly enlarging nodules or plaques that can be verrucous (warty), ulcerated, or crusted.
Lesions usually appear on the feet, legs, or hands.
Lesions may be itchy or painful.
Secondary bacterial infections can occur.
Elephantiasis (swelling and thickening of the skin) can develop in advanced cases.
"Copper pennies" or sclerotic bodies (characteristic fungal cells) within the lesions.
Causes
Chromoblastomycosis is caused by several species of dematiaceous (darkly pigmented) fungi, most commonly:
Fonsecaea pedrosoi
Phialophora verrucosa
Cladophialophora carrionii
Fonsecaea monophora
Rhinocladiella aquaspersa The infection occurs when these fungi enter the skin through cuts, scrapes, or puncture wounds, typically while working outdoors or walking barefoot in contaminated soil or vegetation.
Medicine Used
Treatment typically involves a combination of:
Antifungal Medications:
Itraconazole: Often the first-line oral treatment.
Terbinafine: Another common oral antifungal.
Posaconazole or Voriconazole: Used in more severe or resistant cases.
Fluconazole: Can be used but less effective than itraconazole or terbinafine.
Adjunctive Therapies:
Surgical excision: Removal of small, localized lesions.
Cryotherapy: Freezing the lesions with liquid nitrogen.
Heat therapy (thermotherapy): Applying heat to the affected area.
Topical antifungals: Often used in conjunction with systemic treatment.
Laser therapy: In some cases.
Is Communicable
Chromoblastomycosis is not communicable from person to person or from animals to humans. It is acquired through direct inoculation of the fungus into the skin.
Precautions
Wear protective clothing (gloves, long sleeves, and pants) when working in soil or vegetation, especially in tropical or subtropical regions.
Wear shoes or sandals to avoid skin injuries when walking in potentially contaminated areas.
Clean and disinfect any cuts, scrapes, or puncture wounds immediately.
Avoid walking barefoot in areas known to be contaminated.
How long does an outbreak last?
Chromoblastomycosis is a chronic infection, and without treatment, it can persist for years or even decades. Treatment duration varies depending on the severity and extent of the infection, as well as the individual's response to antifungal medications. Treatment courses can range from several months to years.
How is it diagnosed?
Diagnosis typically involves:
Clinical Examination: Visual assessment of the characteristic lesions.
Skin Biopsy: A tissue sample is taken from the lesion and examined under a microscope to identify the characteristic sclerotic bodies ("copper pennies").
Fungal Culture: The tissue sample is cultured to identify the specific fungal species causing the infection.
Polymerase Chain Reaction (PCR): Can be used to identify the specific fungal species
Timeline of Symptoms
Initial Infection: A small papule or nodule develops at the site of inoculation (days to weeks).
Progression: The lesion slowly enlarges and becomes verrucous or ulcerated (months to years).
Satellite Lesions: New lesions may appear around the primary lesion (months to years).
Advanced Disease: Elephantiasis, secondary bacterial infections, and lymphatic obstruction can develop (years to decades).
Important Considerations
Early diagnosis and treatment are crucial to prevent the progression of the disease.
Treatment can be lengthy and may require a combination of therapies.
Relapses are common, even after successful treatment.
Patients with weakened immune systems may be more susceptible to severe infections.
Surgical excision is most effective for small, localized lesions.
Resistance to antifungal medications can occur, necessitating alternative treatment options.