Preliminary ReportRevisiting the Clinical and Histopathological Aspects of Patients with Chromoblastomycosis from the Brazilian Amazon Region
Introduction
Chromoblastomycosis (CBM) is a chronic fungal disease that affects the skin and subcutaneous tissue. Classified as a deep mycosis, infection occurs by traumatic implantation into the skin of pigmented fungi of different species of the family Dematiaceae, which are found in soil and plants 1, 2, 3, 4, 5.
The Amazon region concentrates the largest number of cases of CBM in Brazil (2). This fact can be explained by social and environmental factors that contribute to maintain the fungus viable in nature, as well as by work activities during which individuals have frequent contact with plants and fruits and thus remain exposed to the pathogen. Despite its chronic evolution, in the last 5 years few studies have characterized the clinical, histopathological and inflammatory features of CBM, and these investigations only involved small samples. In this respect, studies are needed to better understand the range of CBM and the clinical, mycological, inflammatory and histopathological features of the disease in the Amazon region where the number of cases is significant.
Therefore, the objective of the present study was to describe the clinical and histopathological profile of patients with CBM from the State of Para, Amazon region, and to correlate the clinical forms with the inflammatory and histopathological findings and severity criteria.
Section snippets
Patients
A descriptive study was conducted on 65 patients with CBM seen at the outpatient clinic of the Dermatology Service, Núcleo de Medicina Tropical, Universidade Federal do Pará (UFPA) between January 2000 and July 2007.
The criteria proposed by Carrión in 1950 were used for the clinical diagnosis, which divide CBM lesions into five different types: verrucous, nodular, plaque-like, cicatricial and tumorous (6).
We excluded patients with immunosuppressive diseases, negative mycological examination and
Results
In the present study, most patients were male (93.8%) and laborers (89.2%) from the countryside of Para State. Patient ages ranged from 45 to 65 years (49.2%). The lesions most frequently affected the lower limbs (81.5%).
According to the classification of Carrión (1950), there was a predominance of verrucous lesions found in more than half the cases (55.4%), followed by plaque-like (26.2%), nodular (7.7%), cicatricial (6.2%), and tumorous lesions (4.6%) (Figures 1A and 1B).
Direct mycological
Discussion
Analysis of aspects related to the prevalence of CBM showed a preference of the disease for male workers from rural areas. This finding might be related to the natural habitat of the pathogen, which is found in soil and vegetations, and to the activities of the population that mainly works in the agricultural sector. The lesions most frequently affected the lower limbs. These areas are classically more exposed to traumatic inoculation of the fungus into the skin, especially when unprotected,
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