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Chromoblastomycosis in India: Review of 169 cases.

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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos neglected tropical diseases
Publication Year Start




PMID- 28771470
OWN - NLM
STAT- MEDLINE
DA  - 20170803
DCOM- 20170809
LR  - 20170813
IS  - 1935-2735 (Electronic)
IS  - 1935-2727 (Linking)
VI  - 11
IP  - 8
DP  - 2017 Aug
TI  - Chromoblastomycosis in India: Review of 169 cases.
PG  - e0005534
LID - 10.1371/journal.pntd.0005534 [doi]
AB  - 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.
FAU - Agarwal, Reshu
AU  - Agarwal R
AD  - Department of Microbiology, All India Institute of Medical Sciences, Ansari
      Nagar, New Delhi, India.
FAU - Singh, Gagandeep
AU  - Singh G
AUID- ORCID: http://orcid.org/0000-0002-3169-8419
AD  - Department of Microbiology, All India Institute of Medical Sciences, Ansari
      Nagar, New Delhi, India.
FAU - Ghosh, Arnab
AU  - Ghosh A
AD  - Department of Microbiology, All India Institute of Medical Sciences, Ansari
      Nagar, New Delhi, India.
FAU - Verma, Kaushal Kumar
AU  - Verma KK
AD  - Department of Dermatology & Venereology, All India Institute of Medical Sciences,
      Ansari Nagar, New Delhi, India.
FAU - Pandey, Mragnayani
AU  - Pandey M
AD  - Department of Microbiology, All India Institute of Medical Sciences, Ansari
      Nagar, New Delhi, India.
FAU - Xess, Immaculata
AU  - Xess I
AD  - Department of Microbiology, All India Institute of Medical Sciences, Ansari
      Nagar, New Delhi, India.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20170803
PL  - United States
TA  - PLoS Negl Trop Dis
JT  - PLoS neglected tropical diseases
JID - 101291488
RN  - 0 (Antifungal Agents)
RN  - 304NUG5GF4 (Itraconazole)
SB  - IM
MH  - Adult
MH  - Africa/epidemiology
MH  - Antifungal Agents/*therapeutic use
MH  - Ascomycota/classification/*isolation & purification/pathogenicity
MH  - Asia/epidemiology
MH  - Chromoblastomycosis/*drug therapy/*epidemiology/microbiology
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - India/epidemiology
MH  - Itraconazole/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Mycoses/epidemiology/microbiology
PMC - PMC5542425
EDAT- 2017/08/05 06:00
MHDA- 2017/08/10 06:00
CRDT- 2017/08/04 06:00
AID - 10.1371/journal.pntd.0005534 [doi]
AID - PNTD-D-17-00157 [pii]
PST - epublish
SO  - PLoS Negl Trop Dis. 2017 Aug 3;11(8):e0005534. doi: 10.1371/journal.pntd.0005534.
      eCollection 2017 Aug.