Chromoblastomycosis is a chronic fungal disease of the skin and subcutaneous tissues caused by a group of dematiaceous (black) fungi. The most common etiologic agents are Fonsecaea pedrosoi and Cladophialophora carrionii, both of which can be isolated from plant debris. The infection usually follows traumatic inoculation by a penetrating thorn or splinter wound. Several months after the injury, painless papules or nodules appear on the affected area; these papules then progress to scaly and verrucose plaques. We report a case of chromoblastomycosis caused by Phialophora richardsiae, which has been rarely associated with chromoblastomycosis. The case involved a 43-year-old male, who for the past 2 months had noted an erythematous, pustulous plaque that was somewhat dark brown in color on his right shin; the plaque also had intermittent purulent discharge and crust formation. On histopathological examination, chronic granulomatous inflammation and sclerotic cells were seen. The tissue fungus culture grew out the typical black fungi of P. richardsiae, which was confirmed by polymerase chain reaction. The patient has been treated with a combination of terbinafine and itraconazole for 3 months with a good clinical response.
Adult ; Chromoblastomycosis ; Fungi ; Humans ; Inflammation ; Itraconazole ; Male ; Naphthalenes ; Phialophora ; Plants ; Polymerase Chain Reaction ; Skin ; Subcutaneous Tissue

Chromoblastomycosis is a rare disease in Korea and a total of 7 cases have been reported until now. The causative agents were Fonsecaea pedrosi in 5 cases and Phialophora verrucosa in 1 case. Rhinocladiella (R.) aquaspersa is a very rare etiologic agent and only a few cases of chromoblastomycosis due to this fungus have been reported in the Central and South Americas. We report a case of chromoblastomycosis caused by R. aquaspersa in a 52-year-old woman. The lesion was an erythematous, verrucous plaque on the abdomen, 2x1.3 cm in size, and had developed for 6 months before presentation without a traumatic history. She was successfully treated with itraconazole 200 mg/day for 4 months together with surgical excision without recurrence.
Abdomen ; Chromoblastomycosis* ; Female ; Fungi ; Humans ; Itraconazole ; Korea ; Middle Aged ; Phialophora ; Rare Diseases ; Recurrence ; South America

BACKGROUND: There are three kinds of diseases caused by dematiaceous fungi: chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma. The dematiaceous fungi have been identified and classified by morphological, biochemical and physiological tests. Recently molecular analysis has been introduced to the field of medical mycology. OBJECTIVE: We investigated the genetic diversity of dematiaceous fungi using random amplified polymorphic DNA (RAPD). METHODS: The dematiaceous fungal strains studied were eight clinical isolates of chromoblastomycosis and phaeohyphomycosis agents (3 strains of Fonsecaea pedrosoi, 2 strains of Exophiala dermatitidis, 1 strain of Exophiala jeanselmei, 1 strain of Phialophora verrucosa, 1 strain of Rhinocladiella aquaspersa) and 4 standard strains (F. pedrosoi IFM 4889, E. dermatitidis IFM 4828, P. verrucosa IFM 4928, R. aquaspersa IFM 4930). Total twelve strains of dematiaceous fungi were cultured on Sabouraud's dextrose broth and their DNA were extracted by bead-beating method. RESULTS: The optimal condition for PCR was template DNA 0.025 mg and annealing temperature 39 degrees C. The RAPD analysis using OPA 10 primer (5'-GTGATCGCAG-3') of Operon kit showed different patterns among dematiaceous fungi. But one clinical isolate of F. pedrosoi showed intra-specific variability. CONCLUSION: The RAPD analysis is considered a rapid and reliable method for identification and classification of dematiaceous fungi if the procedure is carefully standardized with adequate primer.
Chromoblastomycosis ; Classification ; DNA* ; Exophiala ; Fungi* ; Genetic Variation* ; Glucose ; Mycetoma ; Mycology ; Operon ; Phaeohyphomycosis ; Phialophora ; Polymerase Chain Reaction

BACKGROUND: There are three kinds of diseases caused by dematiaceous fungi: chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma. The dematiaceous fungi have been identified and classified by morphological, biochemical and physiological tests. Recently molecular analysis has been introduced to the field of medical mycology. OBJECTIVE: Ribosomal DNA gene analysis of dematiaceous fungi using polymerase chain reaction(PCR)-restriction fragment length polymorphism(RFLP) is investigated. METHODS: The dematiaceous fungal strains studied were eight clinical isolates of chromoblastomycosis and phaeohyphomycosis agents(3 strains of Fonsecaea pedrosoi, 2 strains of Exophiala dermatitidis, 1 strain of Exophiala jeanselmei, 1 strain of Phialophora verrucosa, 1 strain of Rhinocladiella aquaspersa) and 4 standard strains(F. pedrosoi IFM 4889, E. dermatitidis IFM 4828, P. verrucosa IFM 4928, R. aquaspersa IFM 4930). Total twelve strains of dematiaceous fungi were cultured on Sabouraud dextrose broth and their DNA was extracted by bead-beating method. PCR-RFLP of ribosomal gene small subunit(SSU rDNA) and internal transcribed spacer(ITS)1-ITS2 ribosomal regions using the primer pairs NS1-NS2 and ITS1-ITS4, respectively were done. RESULTS: The PCR product obtained from the SSU rDNA amplification was of approximately 603 bp and restriction profile was clustered into two genetically heterogenous groups, the first one formed by F. pedrosoi and the second one formed by other dematiaceous fungi. In contrast, the amplified PCR products of ITS regions ranged in sized from 580 to 620 bp and restriction profile was clustered into five genetically heterogenous groups and it can be possible to differentiate dematiaceous fungi. But one clinical isolate of F. pedrosoi showed intra-specific variability. CONCLUSION: The PCR-RFLP analysis of SSU rDNA and ITS regions provided useful information for identification and classification of dematiaceous fungi.
Chromoblastomycosis ; Classification ; DNA ; DNA, Ribosomal* ; Exophiala ; Fungi* ; Glucose ; Mycetoma ; Mycology ; Phaeohyphomycosis ; Phialophora ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

The dematiaceous fungi, characterized by having melanin in their cell walls, have become significant due to an increasing cause of human skin disease in Korea. Chromoblastomycosis is subcutaneous mycotic disease that contains sclerotic cells or muriform cells and histologically show pseudoepitheliomatous hyperplasia with microabscess, and phaeohyphomycosis is a group of mycotic infections that contain dematiaceous yeast-like cells, pseudohypae-like elements, hyphae or combination of these form in tissue. Ten Korean cases of subcutaneous chromoblastomycosis have been reported to date, four males and five females, ranging in age from 37~68 (mean 53.8 years). Causative organisms of subcutaneous chromoblastomycosis were eight of Fonsecaea pedrosoi and one of Phialophora verrucosa. Nine cases of erythematous or verrucous plaque and one case of ulcer were present skin lesion, and most of exposed areas of the body except one case. Patients were treated with itraconazole, terbinafine, 5-flucytocine or amphotericin B.
Amphotericin B ; Cell Wall ; Chromoblastomycosis ; Female ; Fungi ; Humans ; Hyperplasia ; Hyphae ; Itraconazole ; Korea ; Male ; Melanins ; Naphthalenes ; Phaeohyphomycosis ; Phialophora ; Skin ; Skin Diseases ; Ulcer