We report a case of chromoblastomycosis caused by , which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with strain KX078407. The susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.
Animals ; Chromoblastomycosis ; Humans ; Laser Therapy ; Lasers, Solid-State ; Male ; Middle Aged ; Rats ; Rats, Wistar ; Terbinafine ; Treatment Outcome

Chromoblastomycosis is an endemic mycoses which has been misdiagnosed or underdiagnosed in the past. This may be due to the clinicopathologic characteristics that it shares with other neglected tropical diseases such as leprosy and cutaneous tuberculosis. Correlating clinical findings with histopathologic cues will lead clinicians to correct diagnosis and subsequent treatment success.
Chromoblastomycosis ; Invasive Fungal Infections ; Itraconazole

Chromoblastomycosis is a chronic subcutaneous mycotic infections caused by dermatiaceous fungi. Clinically, chromoblastomycosis presents frequently with erythematous or nodular plaque. In Korea, 10 cases of chromoblastomycosis have been reported and Fonsecaea pedrosoi is the most common agent. A 61-year-old woman who was diagnosed as chronic inflammatory demyelinating polyneuropathy 3 years ago, and had been treated with systemic corticosteroids and azathioprine, presented with pruritic, scaly erythematous plaques on the right forearm for 3 years. She had no history of trauma. Histological examination showed pseudoepitheliomatous hyperplasia, mixed granulomatous inflammatory cell infiltrate and multinucleated giant cells with sclerotic cells in the dermis. Tissue culture showed slowly growing, dark brown, velvety colony. DNA was extracted from the cultured colonies and the DNA sequence of the internal transcribed spacer (ITS) region of the clinical sample was matched for that of Fonsecaea monophora. The patient was treated with local heat therapy and topical terbinafine application.
Adrenal Cortex Hormones ; Azathioprine ; Base Sequence ; Chromoblastomycosis* ; Dermis ; DNA ; Female ; Forearm ; Fungi ; Giant Cells ; Hot Temperature ; Humans ; Hyperplasia ; Korea ; Middle Aged ; Polyneuropathies

Medical mycology has gone through five distinct eras: 1) Fungi causing dermatophytoses, 2) Discovery of rare and fatal systemic mycoses, 3) Realization that fungi cause common and subclinical diseases, 4) AIDS and the era of the compromised host, 5) Broad-spectrum antifungals with few side effects. Chromoblastomycosis caused by a group of dematiaceous fungi is a common disease in china. To date almost 500 cases have been repoted. This article aims to introduce epidemiology, microbiology, clinical features, laboratory diagnosis and treatment of chromoblastomycosis in china.
China ; Chromoblastomycosis ; Clinical Laboratory Techniques ; Fungi ; Mycology ; Mycoses ; Tinea

We report herein a case of chromoblastomycosis caused by Fonsecaea (F.) pedrosoi in a 39-year-old male, who showed multiple, asymptomatic, scaly erythematous plaques on the left shin for 12 months. Histopathologically, chronic granulomatous inflammation and either sclerotic or muriform cells were observed. The fungal culture produced typical black colonies of F. pedrosoi. The DNA sequence of the internal transcribed spacer (ITS) region of the clinical sample was 100% match to that of F. pedrosoi IFM 47061 (GenBank accession number AB240943). The patient was treated with 200 mg of itraconazole daily, for 3 months. Skin lesions were improved. In Korea, only 9 cases of chromoblastomycosis, including this case, have been reported until now. The etiologic agent was F. pedrosoi in the majority of cases (6/9;67%). The incidence of chromoblastomycosis was slightly higher in female, and the upper limbs were more affected than the lower limbs in patients.
Adult ; Base Sequence ; Chromoblastomycosis ; Female ; Humans ; Incidence ; Inflammation ; Itraconazole ; Korea ; Lower Extremity ; Male ; Skin ; Upper Extremity

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

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

BACKGROUND: Despite the increase of infections caused by dematiaceous fungi, the antifungal susceptibility of these fungi has been the little study. It is necessary to perform antifungal susceptibility testing of dematiaceous fungi. Etest (AB Biodisk, Sweden) is a rapid, easy-to-perform in-vitro antifungal susceptibility test. OBJECTIVE: The purpose of the study was to investigate the minimal inhibitory concentration (MICs) of dematiaous fungi isolated from skin lesion using Etest. METHODS: The dematiaceous fungal strains studied were nine clinical isolates of chromoblastomycosis and phaeohyphomycosis agents (3 strains of Exophiala dermatitidis, 4 strains of Fonsecaea pedrosoi, 2 strains of Exophiala jeanselmei) and two standard strains (Aspergillus flavus KCTC 6905, Aspergillus fumigatus KCTC 6145). MIC endpoints of Etest for amphotericin B (AMB) and itraconazole (ITZ) susceptibility were read after 72, 96, and 120 hours incubation for each isolates on RPMI 1640 agar. RESULTS: MIC of AMB was 0.125~1.0 microgram/mL on E. dermatitidis & F. pedrosoi, and 0.19~0.25 microgram/mL on E. jeanselmei. MIC of ITZ was 0.38~1.5 microgram/mL on E. dermatitidis, 0.016~0.125 microgram/mL on F. pedrosoi, and 0.064~0.25 microgram/mL on E. jeanselmei. Two strains of E. dermatitidis isolated from Korean patients with phaeohyphomycosis showed ITZ-resistant. CONCLUSION: This study showed that Etest represented a simple and efficacious method for antifungal susceptibility testing of dematiaceous fungi.
Agar ; Amphotericin B ; Aspergillus fumigatus ; Chromoblastomycosis ; Exophiala ; Fungi ; Humans ; Itraconazole ; Phaeohyphomycosis ; Skin

In recent years, there has been a rapid decrease in amphibian populations worldwide, and infectious diseases have been associated with this decline. Diseased frogs inhabiting Korea were collected from fields, and the diseases were identified by morphological and molecular analyses. Two fungal diseases-saprolegniasis and chromomycosis-were detected in the frogs. Saprolegniasis caused by Saprolegnia spp. was found in Rana plancyi chosenica from Gangwon-do and Rana huanrenensis from Chungbuk. Chromomycosis, which is caused by infection with Cladosporium cladosporioides, was detected in Rana catesbeiana from Busan.
Amphibians ; Chromoblastomycosis ; Cladosporium ; Communicable Diseases ; Korea ; Rana catesbeiana ; Ranidae ; Saprolegnia

The subcutaneous mycoses are infections caused by fungi that have been introduced directly into the dermis or subcutaneous tissue from puncture wounds, abrasions, or other trauma. The skin lesion of subcutaneous mycosis is a verrucous plaque or abscess that forms at the site of probable trauma in an exposed area of the body. The most commom subcutaneous mycosis in Korea is sporotrichosis. In recent years the dematiaceous fungi, characterized by having melanin in their cell walls, have become significant due to increasing cause of subcutaneous mycoses in Korea. The subcutaneous mycoses caused by demataceous fungi contain chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma.
Abscess ; Cell Wall ; Chromoblastomycosis ; Dermis ; Fungi ; Korea* ; Melanins ; Mycetoma ; Mycoses* ; Phaeohyphomycosis ; Punctures ; Skin ; Sporotrichosis ; Subcutaneous Tissue ; Wounds and Injuries