Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, PA, Brazil.
Arch Med Res. 2013 May;44(4):302-6. doi: 10.1016/j.arcmed.2013.04.008. Epub 2013 May 14.
Chromoblastomycosis is a chronic fungal infection caused by species of the family Dematiaceae. Fonsecaea pedrosoi is the most common etiological agent. The objective of this study was to describe the epidemiological and mycological profile of patients with chromoblastomycosis from the Amazon region of Brazil and to correlate the clinical forms with the histopathological findings and severity criteria.
Sixty-five patients were submitted to mycological (direct, culture, and microculture) and histopathological (hematoxylin-eosin staining) examination. Severity of the disease was classified according to the criteria proposed by Carrión in 1950.
Most patients were males (93.8%) and laborers (89.2%). There was a predominance of verrucous lesions (55.4%), which were mainly found on the lower limbs (81.5%). Two major types of tissue reaction were observed: a granulomatous reaction characterized by the formation of suppurative granulomas rich in fungal cells, which were almost always seen in verrucous lesions, and a reaction characterized by the formation of tuberculoid granulomas with few parasites, which were mainly found in well-delimited erythematous plaque-like and cicatricial lesions (p = 0.0001). A peculiar type of organized mycotic granuloma was observed in 20 subjects. Suppurative granulomas were more frequently detected in severe lesions (p = 0.0189) and in lesions with a duration of >10 years (p = 0.0408).
These results suggest that verrucous lesions present a less competent inflammatory tissue response than patients who develop a well-formed tuberculoid reaction. The latter is associated with a more effective immune response as observed in the limited clinical forms of chromoblastomycosis.
着色芽生菌病是一种由暗色真菌科真菌引起的慢性真菌感染。佩德罗索外瓶霉是最常见的病因。本研究的目的是描述巴西亚马逊地区着色芽生菌病患者的流行病学和真菌学特征，并将临床类型与组织病理学发现和严重程度标准相关联。
对 65 名患者进行了真菌学（直接检查、培养和微培养）和组织病理学（苏木精-伊红染色）检查。根据 Carrión 在 1950 年提出的标准对疾病的严重程度进行分类。
大多数患者为男性（93.8%）和劳动者（89.2%）。疣状病变（55.4%）占主导地位，主要发生在下肢（81.5%）。观察到两种主要的组织反应类型：一种是化脓性反应，其特征是形成富含真菌细胞的化脓性肉芽肿，这种反应几乎总是在疣状病变中出现；另一种是结核样肉芽肿反应，其特征是形成含有少量寄生虫的结核样肉芽肿，这种反应主要发生在界限清楚的红斑样斑块状和瘢痕性病变中（p=0.0001）。在 20 名患者中观察到一种特殊类型的有组织的真菌性肉芽肿。化脓性肉芽肿在严重病变（p=0.0189）和病程>10 年的病变（p=0.0408）中更常被发现。
这些结果表明，疣状病变表现出的炎症组织反应能力低于形成良好的结核样反应的患者。后者与有限的着色芽生菌病临床类型中观察到的更有效的免疫反应相关。
