Esterre P, Andriantsimahavandy A, Raharisolo C
Unité de parasitologie, Institut Pasteur, Madagascar.
Bull Soc Pathol Exot. 1997;90(5):312-7.
The natural history of chromoblastomycosis was studied in Madagascar by analysing the characteristics of 1323 confirmed cases observed since 1955, including 45 patients receiving a new antifungic drug (terbinafine) during a multicentric study organized in 1995. The surveys data, conserved by the histopathology laboratory in the Institut Pasteur of Madagascar during 40 years, permit this retrospective analysis. The description of two ecosystems, one in the North with Fonsecaea pedrosoi evolving in the tropical rainforest and one in the South with Cladophialophora carrionii (41% of the whole sample) isolated in the spiny desert, demonstrates that the deforestation, in order to product charcoal and to build houses, is the primary factor associated with this disease. The epidemiologic (87% of patients are male and 96% are more than 16 years old, with more than 74% of the lesions located on feet and legs), mycologic (62% of the isolated strains belong to the F. pedrosoi species) and therapeutic (low efficiency of thiabendazole in long-term lesions, high efficiency of terbinafine especially on recent lesions and on Cladophialophora-infected patients) aspects of the natural history of chromomycosis confirmed that Madagascar is the most important focus in the world (global prevalence of about 1 for 8500 inhabitants), with few sporadic cases in the other islands of the Indian Ocean (La Reunion, Comoro islands and Mayotte). In the difficult context of Madagascar, the need for a non-specialized laboratory-applicable diagnostic technique that provides infection and species identification led the Institut Pasteur de Madagascar to develop an ELISA-based technique. A large-scale control throughout the country, with the assessment of effective oral chemotherapy with terbinafine, is seen as possible by the authors with the help of the manufacturer.
通过分析1955年以来确诊的1323例病例的特征，对马达加斯加着色芽生菌病的自然史进行了研究，其中包括在1995年组织的一项多中心研究中接受新抗真菌药物（特比萘芬）治疗的45例患者。马达加斯加巴斯德研究所组织病理学实验室保存了40年的调查数据，使得本次回顾性分析得以进行。对两个生态系统的描述表明，为了生产木炭和建造房屋而进行的森林砍伐是与该病相关的主要因素。这两个生态系统，一个位于北部，裴氏着色霉在热带雨林中生长；另一个位于南部，卡氏枝孢瓶霉（占整个样本的41%）在多刺沙漠中被分离出来。着色芽生菌病自然史的流行病学（87%的患者为男性，96%的患者年龄超过16岁，超过74%的皮损位于足部和腿部）、真菌学（62%的分离菌株属于裴氏着色霉物种）和治疗学（噻苯达唑对长期皮损疗效低，特比萘芬疗效高，尤其是对近期皮损和卡氏枝孢瓶霉感染的患者）方面证实，马达加斯加是世界上最重要的疫源地（全球患病率约为每8500名居民中有1例），在印度洋的其他岛屿（留尼汪岛、科摩罗群岛和马约特岛）有少数散发病例。在马达加斯加困难的背景下，由于需要一种适用于非专业实验室的诊断技术来提供感染和菌种鉴定，马达加斯加巴斯德研究所开发了一种基于酶联免疫吸附测定（ELISA）的技术。作者认为，在制造商的帮助下，在全国范围内进行大规模控制以及评估特比萘芬有效的口服化疗是可行的。
