Queiroz-Telles Flavio, Esterre Phillippe, Perez-Blanco Maigualida, Vitale Roxana G, Salgado Claudio Guedes, Bonifaz Alexandro
Departamento de Saude Comunitária e Serviço de Infectologia do Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
Med Mycol. 2009 Feb;47(1):3-15. doi: 10.1080/13693780802538001. Epub 2008 Dec 9.
Chromoblastomycosis is one of the most frequent infections caused by melanized fungi. It is a subcutaneous fungal infection, usually an occupational related disease, mainly affecting individuals in tropical and temperate regions. Although several species are etiologic agents, Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in the endemic areas. Chromoblastomycosis lesions are polymorphic and must be differentiated from those associated with many clinical conditions. Diagnosis is confirmed by the observation of muriform cells in tissue and the isolation and the identification of the causal agent in culture. Chromoblastomycosis still is a therapeutic challenge for clinicians due to the recalcitrant nature of the disease, especially in the severe clinical forms. There are three treatment modalities, i.e., physical treatment, chemotherapy and combination therapy but their success is related to the causative agent, the clinical form and severity of the chromoblastomycosis lesions. There is no treatment of choice for this neglected mycosis, but rather several treatment options. Most of the patients can be treated with itraconazole, terbinafine or a combination of both. It is also important to evaluate the patient's individual tolerance of the drugs and whether the antifungal will be provided for free or purchased, since antifungal therapy must be maintained in long-term regimens. In general, treatment should be guided according to clinical, mycological and histopathological criteria.
着色芽生菌病是由产黑色素真菌引起的最常见感染之一。它是一种皮下真菌感染，通常是一种与职业相关的疾病，主要影响热带和温带地区的人群。虽然有几种菌种是病原体，但裴氏着色真菌和卡氏枝孢霉在流行地区较为常见。着色芽生菌病的皮损具有多形性，必须与许多临床情况相关的皮损相鉴别。通过观察组织中的砖隔状细胞以及在培养物中分离和鉴定病原体来确诊。由于该病具有顽固性，尤其是在严重临床类型中，着色芽生菌病对临床医生来说仍然是一个治疗挑战。有三种治疗方式，即物理治疗、化学治疗和联合治疗，但其成功与否与病原体、着色芽生菌病皮损的临床类型和严重程度有关。对于这种被忽视的真菌病，没有首选的治疗方法，而是有几种治疗选择。大多数患者可以用伊曲康唑、特比萘芬或两者联合治疗。评估患者对药物的个体耐受性以及抗真菌药物是免费提供还是需要购买也很重要，因为抗真菌治疗必须长期维持。一般来说，治疗应根据临床、真菌学和组织病理学标准进行指导。
