Chromoblastomycosis is a chronic fungal infection of the skin, usually on the lower extremities, that grows slowly over months and years to become large wart-like masses. It is mainly a hazard to barefoot farmers in tropical and subtropical regions of Latin America, the Caribbean, Asia, and Africa.
CASES/YEAR
500 (US); 10,000 (Global)
AGENT TYPE
Fungi (Opportunistic Molds)
OTHER NAMES
Chromomycosis; Dermatitis verrucosa;
INITIAL SYMPTOMS
Painless papule or nodule, usually on the lower extremities; Satellite nodules may appear; Usually grows 1-2 mm per year and may become pruritic; [Cohen, 3rd Ed, Ch. 179]
PRECAUTIONS
"Not transmitted from person to person." [CCDM, p. 135]
COMMENTS
This chronic fungal infection of the skin usually appears on the lower extremities after a minor puncture wound. Growing slowly for months and years, the lesions become large wart-like masses. [CCDM, p. 115] The five type of lesions described are nodular, tumorous, verrucous, plaque, and cicatricial. Secondary lesions may be spread by scratching or, rarely, by dissemination through lymphatic vessels. [ID, p. 2260] The most common fungal agents are Fonsecaea pedrosoi, Cladophialophora carrionii, and Phialophora verrucosa. Barefooted, outdoor laborers are commonly affected. The lesion progresses from a papule, to a red or purplish plaque, to a scaly or verrucous plaque, and finally to a verrucous nodule. [Guerrant, p. 569-70] Ulceration is generally limited to cases with secondary bacterial infection. [PPID, p. 3138] Rarely, chromoblastomycosis occurs as meningitis. [Cohen, p. 188] See "Phaeohyphomycosis."
DIAGNOSTIC
Microscopic exam of KOH prep or stained biopsy specimen (pathognomonic muriform cells, called "copper penny"); Culture;
SCOPE
Worldwide, but mainly barefoot farmers in tropical and subtropical areas of Latin America, the Caribbean, Asia, and Africa; [CCDM]
SIGNS & SYMPTOMS
-
S lymphangitis
-
S nodular lymphangitis
-
S papules or plaques
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S skin or subcutaneous nodule
-
S ulcer of skin
-
S warty growth of the skin
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*brain abscess or lesion
-
*meningitis
-
*osteomyelitis
ENTRY
Skin or Mucous Membranes (Includes Conjunctiva)
SOURCE
Soil or Dust (Ingesting or Inhaling)
RISK FACTORS
- Walk barefooted in contaminated soil
TREATMENT
Modalities include surgery, liquid nitrogen, topical heat, and antifungal agents. "Unfortunately, no single reproducible successful treatment strategy has been identified." [PPID, p. 3139]
REFERENCES FOR CASES/YEAR
1. (US) No data found; Assume same cases/yr as Mucormycosis;
2. (Global) A rare infection that usually affects barefooted farmers in tropical and subtropical countries; [Gorbach, p. 425] No data found; Assume same rate as Mucormycosis;