100 years of chromoblastomycosis -3 day symposium opens in Sao Luis, Brazil Oct 8-10th, 2014
October 08 2014
Chromoblastomycosis (CBM) is a cutaneous and subcutaneous mycosis which was first described by Dr Max Rudolph, a German Doctor working in Brazil, a century ago in 1914. It is principally an occupational disease following traumatic injury with contaminated material. Experts from across the world are now gathering in Brazil to review the latest knowledge on understanding and managing this difficult fungal disease. (Link 100 years of Chromoblastomycosis)
It is a global disease with highest frequency in tropical and sub-tropical Africa, Central and South America, Asia and Australia - characterized by the appearance of proliferating chronic skin lesions following traumatic implantation of the fungus. Sites most commonly affected are the lower limbs with upper limbs and buttocks frequently involved. The causative agents are melanised or black fungi - often found growing on thorns or undergrowth usually Fonsecaea in tropical areas, Cladophialophora in semi-arid areas and to a lesser extent of Rhinocladiella species.
In the of the State of Maranhao, on the fringes of the Amazon rainforest in Brazil, thousands of families are involved in harvesting the babassu nut (Orbignya phalerata) from a palm tree. Babassu oil is an important component for local and international beauty products. The industry is an important source of income for the local population and helps to cover the cost of providing their children with an education. But it could be largely prevented by the provision of protective clothing - eg. gloves and footwear - to the workers whilst handling the tough nut shells. The education of agricultural workers- of the mode of transmission of this disease is critical.
Lower limb chromoblastomycosis
The fungal species Fonsecaea has been isolated from babassu shell fragments and is a risk factor for developing CBM after skin trauma sustained whilst working.
This disease presents the following characteristics: primary lesion beginning at the site of inoculation; chronic involvement of cutaneous and subcutaneous tissues associated with a granulomatous, purulent and fibrotic tissue response and a non-protective humoral immune reaction. Lesions are very hard to eradicate and their chronic nature means possible neoplastic transformation leading to skin cancers. Therapeutically - small lesions can be excised but the remainder are challenging to treat.
No gold standard therapy exists but systemic antifungals such as itraconazole are the most effective or terbinafine as an alternative option.
Chromoblastomycosis is an orphan neglected disease recognised by the WHO - the only other disease in this category is mycetoma, but CBM should be considered as a true- neglected mycosis.
Collecting the Babassu nuts