clove and Chromoblastomycosis

Chromoblastomycosis and sporotrichosis are endemic fungal infections of tropical and subtropical regions, including Madagascar. The causal fungi develop in the soil or on plants and infect humans through wounds, either directly (wounding by the plant, through thorns, for example), or through the contact of an existing wound with contaminated soil. For this reason, the lesions predominantly occur on the limbs, and these fungi principally infect people working outside with bare hands and/or feet. The subcutaneous lesions of chromoblastomycosis are initially nodular, subsequently becoming warty, tumoral, cauliflower-like and pruriginous, which promotes dissemination. The chronic nature of the infection and its progression over long periods lead to highly disabling lesions in essentially rural and agricultural populations. The lesions of sporotrichosis are also nodular, but more ulcerous, and they form an extended chain following the route of the lymph vessels. Pus, squamous or skin biopsy specimens are used for the mycological examination of these mycoses. Treatment depends on the severity and form of the lesions and is based on antifungal drugs sometimes combined with physical methods. There has been no study of these infections for more than two decades in Madagascar, despite the large numbers of cases seen by doctors in all parts of the island. The nature, diversity and distribution of the plants responsible for contamination have not been described in Madagascar. In this review, we described these two endemic mycoses in terms of their epidemiological, mycological, clinical and therapeutic characteristics, focusing particularly on Madagascar, which is one of the leading foci of these two infections worldwide.

Topics: Antifungal Agents; Chromoblastomycosis; Endemic Diseases; Humans; Madagascar; Neglected Diseases; Sporotrichosis; Wound Infection

Madagascar is the principal area of endemic chromomycosis in the world with 1 400 cases registered from 1955 to 1996. Malignant transformation is rare and only 12 cases have been reported. We describe herein two new cases of squamous carcinoma arising from chronic lesions of chromomycosis. These carcinomas which develop slowly and are non invasive, are similar to those arising from burns, tropical phagedenic ulcers and chronic leprosy ulcers. Epidemiological aspects, histopathology and treatment are described.

Topics: Adult; Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; Chromoblastomycosis; Female; Humans; Madagascar; Male; Middle Aged; Skin Neoplasms

The natural history of chromoblastomycosis was studied in Madagascar by analysing the characteristics of 1323 confirmed cases observed since 1955, including 45 patients receiving a new antifungic drug (terbinafine) during a multicentric study organized in 1995. The surveys data, conserved by the histopathology laboratory in the Institut Pasteur of Madagascar during 40 years, permit this retrospective analysis. The description of two ecosystems, one in the North with Fonsecaea pedrosoi evolving in the tropical rainforest and one in the South with Cladophialophora carrionii (41% of the whole sample) isolated in the spiny desert, demonstrates that the deforestation, in order to product charcoal and to build houses, is the primary factor associated with this disease. The epidemiologic (87% of patients are male and 96% are more than 16 years old, with more than 74% of the lesions located on feet and legs), mycologic (62% of the isolated strains belong to the F. pedrosoi species) and therapeutic (low efficiency of thiabendazole in long-term lesions, high efficiency of terbinafine especially on recent lesions and on Cladophialophora-infected patients) aspects of the natural history of chromomycosis confirmed that Madagascar is the most important focus in the world (global prevalence of about 1 for 8500 inhabitants), with few sporadic cases in the other islands of the Indian Ocean (La Reunion, Comoro islands and Mayotte). In the difficult context of Madagascar, the need for a non-specialized laboratory-applicable diagnostic technique that provides infection and species identification led the Institut Pasteur de Madagascar to develop an ELISA-based technique. A large-scale control throughout the country, with the assessment of effective oral chemotherapy with terbinafine, is seen as possible by the authors with the help of the manufacturer.

Topics: Antifungal Agents; Chromoblastomycosis; Female; Humans; Indian Ocean; Madagascar; Male; Naphthalenes; Terbinafine

A longitudinal study was carried out in Madagascar, the most important focus of chromoblastomycosis (P. Esterre, A. Andriantsimahavandy, E. Ramarcel, and J. L. Pecarrere, Am. J. Trop. Med. Hyg. 55:45-47, 1996), to investigate natural immunity to this disease. Sequential blood samples were obtained before, during, and at the end of a successful therapeutic trial with terbinafine, a new antifungal drug. Using enzyme-linked immunosorbent assay and immunoblot methods, detailed analyses of antibody concentration and antigen mapping were conducted for 136 serum samples and tentatively correlated to epidemiological and pathobiological data. Two different cytoplasmic antigens, corresponding to the two fungal species involved (Fonsecaea pedrosoi and Cladophialophora carrionii), were used to analyze the distribution of different classes of immunoglobulins. This was done with respect to the origin of the isolates, clinical and pathobiological. Although strong individual variations were noticed, some major antigens (one of 18.5 kDa specific for F. pedrosoi and two of 23.5 and 33 kDa, respectively, specific for C. carrionii) corresponded to high antibody prevalence and concentration. As some antigenic components were also detected by immunoglobulin M (IgM) and IgA antibodies, the role that these specific antibodies could play in the immune response is discussed.

Topics: Adult; Antibodies, Fungal; Antibody Formation; Antifungal Agents; Chromoblastomycosis; Cladosporium; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoblotting; Immunoglobulin A; Immunoglobulin M; Longitudinal Studies; Madagascar; Male; Middle Aged; Naphthalenes; Species Specificity; Terbinafine

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chromoblastomycosis; Cladosporium; Combined Modality Therapy; Humans; Madagascar; Middle Aged; Phialophora; Thiabendazole; Treatment Outcome

Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue caused by several pigmented fungi. It is frequently found in tropical and subtropical areas like Madagascar. This study primarily discusses the effects of antifungal therapy while also describing the epidemiological, clinical, and pathological features of CBM in our patients.. From March 2013 to January 2019, a descriptive prospective study on CBM patients was undertaken. The study included patients with CBM who had received antifungal treatment for at least 3 months. Itraconazole 200 mg was given to patients every day for ˃3 months. Results were assessed at the 6th and 12th months and classified as major responses, minor responses to treatment, or failure.. A total of 29 cases of CBM were included. The mean age of patients was 42.02 years. They primarily worked in rural areas. Infected men were more prevalent. At the end of the 12th month of itraconazole therapy, 3 patients presented major responses, 14 patients had minor responses to treatment, and 12 had been lost to follow-up. The clinical response of CBM to treatment was correlated to the severity and the long course of CBM. When compared with CBM caused by Cladophialophora, CBM caused by Fonsecaea showed a greater clinical response.. These findings demonstrated that CBM lesions are recalcitrant and difficult to treat.. Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue commonly seen in tropical and subtropical areas. This study mainly discusses the therapeutic while also describing the epidemiological, clinical, and pathological features of CBM in Madagascar.

Topics: Animals; Antifungal Agents; Chromoblastomycosis; Itraconazole; Madagascar; Prospective Studies

Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. CBM lesions are recalcitrant and extremely difficult to eradicate. We report three cases of CBM with difficulties in therapeutic management.. Three men aged 36, 50 and 67 years, all farmers, presented for between three and ten years with hyperkeratotic, scaly plaques with black dots on the right thigh and left leg, respectively. For all patients, mycological examination showed fumagoid cells, all of which were pathognomonic for CBM. PCR identified Fonsecaeanubica in one patient and Cladophialophoracarrionii in two patients. All patients received itraconazole 200mg/day for over 18 months. Two patients required combined therapy with terbinafine for seven months, which improved lesions; however, relapse occurred in one patient during the 5th month of this combined therapy and five months after the end of this treatment in the other. The patient on monotherapy (itraconazole) also presented recurrence of lesions five months after the end of treatment.. Itraconazole is the standard therapy for CBM, with cure rates ranging from 15 to 80%. Success with itraconazole after eight to twelve months was reported by several authors. Fonsecaea and Cladophialophora are the most common species found in Madagascar, and while these organisms are susceptible to triazoles in vitro, clinical response is not so clear-cut.. Although unavailable in Madagascar, posaconazole and isavoconazole appear to be effective in treating chromoblastomycosis.

Topics: Adult; Aged; Ascomycota; Chromoblastomycosis; Fonsecaea; Health Resources; Humans; Madagascar; Male; Middle Aged

Chromoblastomycosis is an implantation fungal infection. Twenty years ago, Madagascar was recognized as the leading focus of this disease. We recruited patients in Madagascar who had chronic subcutaneous lesions suggestive of dermatomycosis during March 2013-June 2017. Chromoblastomycosis was diagnosed in 50 (33.8%) of 148 patients. The highest prevalence was in northeastern (1.47 cases/100,000 persons) and southern (0.8 cases/100,000 persons) Madagascar. Patients with chromoblastomycosis were older (47.9 years) than those without (37.5 years) (p = 0.0005). Chromoblastomycosis was 3 times more likely to consist of leg lesions (p = 0.003). Molecular analysis identified Fonsecaea nubica in 23 cases and Cladophialophora carrionii in 7 cases. Of 27 patients who underwent follow-up testing, none were completely cured. We highlight the persistence of a high level of chromoblastomycosis endemicity, which was even greater at some locations than 20 years ago. We used molecular tools to identify the Fonsecaea sp. strains isolated from patients as F. nubica.

Topics: Antifungal Agents; Ascomycota; Chromoblastomycosis; Fonsecaea; Humans; Madagascar

To describe the clinical aspects of chromoblastomycosis (CBM) presented by patients who had received incomplete antifungal treatment before consultation.. A prospective study of patients with clinically suspected CBM was performed between 2013 and 2018 in the Department of Dermatology at the University Hospital Antananarivo, and during consultation campaigns.. Patients develop CBM over a period of more than 10 years, and many will have already received antifungals prescribed by general practitioners before consulting with a dermatologist. Such treatment obviously modifies the clinical presentation. From the 63 CBM patients in this large study, we describe 12 patients who received oral antifungals (terbinafine, griseofulvine, itraconazole, fluconazole) before consultation. The most frequent clinical aspect presented by these patients was cicatricial lesions, which are characteristically smooth and non-elevated, and enlarge by peripheral extension, with atrophic scarring at the center.. Our study is the first to show that cicatricial lesions are a clinical aspect presented by CBM patients who received antifungals before presentation.

Topics: Adult; Aged; Antifungal Agents; Chromoblastomycosis; Female; Humans; Itraconazole; Madagascar; Male; Middle Aged; Prospective Studies; Terbinafine

Madagascar has the highest number of cases of chromoblastomycosis in the world, but the areas of highest incidence have limited affordable access and knowledge of first line medications to treat this long-term fungal infection of the skin and subcutaneous tissue. The impact of a multifocal training targeting medical doctors who live in the area of the country with the highest prevalence of this disease has not been clearly reported. The purpose of this project was to determine the effect of a multifocal training on chromoblastomycosis for Malagasy medical doctors in the SAVA (Sambava, Andapa, Vohemar, and Antalaha) province of Madagascar (in the country's northeast) about diagnosis, staging, patient education poster, and treatment options of chromoblastomycosis versus common treatment practices to increase participant's knowledge and utilization of current treatment recommendations for chromoblastomycosis. Medical doctors in the SAVA province of Madagascar enrolled in the multifocal trainings.

Topics: Chromoblastomycosis; Environment; Humans; Madagascar; Physicians; Prevalence; Rural Health

Confirmed cases of chromoblastomycosis in Madagascar from 1955 through 1994 were studied retrospectively. The total number of cases reported was 1,343, of which 98.5% were confirmed by histopathology. Only 30.8% of the cases showed a positive cultivation on mycologic media, and Fonsecaea pedrosoi was identified from 61.8% of the fungal strains. Two distinct areas of endemic chromoblastomycosis, each with a characteristic ecosystem and a single species, are identified. Madagascar represents the most important focus of this fungal disease described to date in the world.

Topics: Chromoblastomycosis; Clinical Trials as Topic; Ecology; Female; Humans; Madagascar; Male; Mitosporic Fungi; Prevalence; Retrospective Studies

In an open trial, long courses (6-12 months) of terbinafine at a dosage of 500 mg/day were administered orally to 43 patients with a diagnosis of chromomycosis. Sixteen patients (37.2%) had previously relapsed after one or two courses of thiabendazole. A spectacular improvement in the lesions, including disappearance of bacterial superinfections and of associated oedema and elephantiasis, was observed as soon as 2-4 months after the beginning of treatment. The mean number of fungal cells in skin scrapings fell by about 70% in 4 months. Mycological cure, as judged by skin scrapings, was observed in 41.4, 74.1 and 82.5% of patients infected with Fonsecaea pedrosoi after 4, 8 and 12 months of therapy, respectively. For the first time with this disease, total cure was observed even in imidazole-refractory patients or chronic cases (47.2% with a lesion present for longer than 10 years). The efficacy of terbinafine in Cladosporium carrionii-infected patients seemed higher, as indicated by the examination at 4 months.

Topics: Antifungal Agents; Chromoblastomycosis; Cladosporium; Female; Humans; Madagascar; Male; Mitosporic Fungi; Naphthalenes; Pilot Projects; Skin; Terbinafine; Tropical Climate

Topics: Adolescent; Adult; Child; Child, Preschool; Chromoblastomycosis; Ethnicity; Female; Humans; Infant; Madagascar; Male; Middle Aged; Sex Factors