Chromoblastomycosis

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)
CATEGORY
AGENT TYPE
Fungi (Opportunistic Molds)
OTHER NAMES
Chromomycosis; Dermatitis verrucosa;
ACUITY
Subacute/Chronic
INCUBATION
Months
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
  • S skin or subcutaneous nodule
  • S ulcer of skin
  • S warty growth of the skin
  • *brain abscess or lesion
  • *meningitis
  • *osteomyelitis
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Skin or Mucous Membranes (Includes Conjunctiva)
SOURCE
Soil or Dust (Ingesting or Inhaling)
RESERVOIR
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;