Sendrasoa F-A, Rakotoarisaona M-F, Ranaivo I-M, Razanakoto N-H, Sata M, Raharolahy O, Andrianarison M, Ratovonjanahary V, Rasamoelina T, Rapelanoro Rabenja F, Ramarozatovo L-S
USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar.
USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar.
Ann Dermatol Venereol. 2020 May;147(5):377-382. doi: 10.1016/j.annder.2020.01.018. Epub 2020 Mar 24.
Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. CBM lesions are recalcitrant and extremely difficult to eradicate. We report three cases of CBM with difficulties in therapeutic management.
Three men aged 36, 50 and 67 years, all farmers, presented for between three and ten years with hyperkeratotic, scaly plaques with black dots on the right thigh and left leg, respectively. For all patients, mycological examination showed fumagoid cells, all of which were pathognomonic for CBM. PCR identified Fonsecaeanubica in one patient and Cladophialophoracarrionii in two patients. All patients received itraconazole 200mg/day for over 18 months. Two patients required combined therapy with terbinafine for seven months, which improved lesions; however, relapse occurred in one patient during the 5th month of this combined therapy and five months after the end of this treatment in the other. The patient on monotherapy (itraconazole) also presented recurrence of lesions five months after the end of treatment.
Itraconazole is the standard therapy for CBM, with cure rates ranging from 15 to 80%. Success with itraconazole after eight to twelve months was reported by several authors. Fonsecaea and Cladophialophora are the most common species found in Madagascar, and while these organisms are susceptible to triazoles in vitro, clinical response is not so clear-cut.
Although unavailable in Madagascar, posaconazole and isavoconazole appear to be effective in treating chromoblastomycosis.
着色芽生菌病（CBM）是一种由暗色真菌引起的皮肤和皮下组织的慢性真菌感染。CBM病变顽固且极难根除。我们报告三例CBM治疗管理困难的病例。
三名男性，年龄分别为36岁、50岁和67岁，均为农民，分别在右大腿和左腿出现角化过度、鳞屑性斑块伴黑点，病程为三至十年。对所有患者进行真菌学检查均显示烟曲霉样细胞，这些细胞均为CBM的特征性表现。聚合酶链反应（PCR）在一名患者中鉴定出裴氏着色霉，在两名患者中鉴定出卡氏枝孢瓶霉。所有患者均接受每日200mg伊曲康唑治疗超过18个月。两名患者需要联合特比萘芬治疗七个月，病变有所改善；然而，一名患者在联合治疗的第5个月复发，另一名患者在该治疗结束后5个月复发。接受单一疗法（伊曲康唑）的患者在治疗结束后5个月也出现病变复发。
伊曲康唑是CBM的标准治疗药物，治愈率为15%至80%。几位作者报告伊曲康唑治疗八至十二个月后取得成功。裴氏着色霉和枝孢瓶霉是马达加斯加最常见的菌种，虽然这些微生物在体外对三唑类药物敏感，但临床反应并不那么明确。
虽然泊沙康唑和艾沙康唑在马达加斯加无法获得，但它们似乎可有效治疗着色芽生菌病。
