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Volume 26, Number 6—June 2020
Research

Endemic Chromoblastomycosis Caused Predominantly by Fonsecaea nubica, Madagascar1

Tahinamandranto Rasamoelina, Danièle Maubon, Malalaniaina Andrianarison, Irina Ranaivo, Fandresena Sendrasoa, Njary Rakotozandrindrainy, Fetra A. Rakotomalala, Sébastien Bailly, Benja Rakotonirina, Abel Andriantsimahavandy, Fahafahantsoa Rakato Rabenja, Mala R. Andrianarivelo, Muriel CornetComments to Author , and Lala S. Ramarozatovo
Author affiliations: Université d’Antananarivo, Antananarivo, Madagascar (T. Rasamoelina, N. Rakotozandrindrainy, F.A. Rakotomalala, B. Rakotonirina, A. Andriantsimahavandy, M.Rakato Andrianarivelo); Université Grenoble Alpes, Grenoble, France (D. Maubon, S. Bailly, M. Cornet); Hôpital Universitaire Joseph Raseta Befelatanana, Antananarivo (M. Andrianarison, I. Ranaivo, F. Sendrasoa, F.R. Rabenja, L.S. Ramarozatovo); Centre Hospitalier Universitaire de Befelatanana, Antananarivo (L.S. Ramarozatovo)

Main Article

Table 2

Characteristics of chromoblastomycosis cases in patients with chronic cutaneous and subcutaneous lesions, Madagascar, March 2013–June 2017*

Characteristic Chromoblastomycosis
Other,‡ n = 98 p value
Severe,† n = 27 Moderate,† n = 21 NA, n = 2 All, n = 50
Period of recruitment
2013, starting March 1 NS NS NS 6 (12.0) 10 (10.2) 0.12
2014 NS NS NS 6 (12.0) 22 (22.4) NS
2015 NS NS NS 12 (24.0) 35 (35.7) NS
2016 NS NS NS 17 (34.0) 19 (19.5) NS
2017, through May 31
NS
NS
NS
9 (18.0)
12 (12.2)
NS
Mean age, y, (SD)
NS
NS
NS
47.9 (15.7)
37.5 (19.4)
0.0005
Age range, y
3–17 NS NS NS 1 (2.0) 16 (16.3) 0.001
18–32 NS NS NS 5 (10.0) 26 (26.5) NS
33–47 NS NS NS 21 (42.0) 26 (26.5) NS
48–62 NS NS NS 10 (20.0) 19 (19.4) NS
63–80
NS
NS
NS
13 (26.0)
11 (11.2)
NS
Sex
M NS NS NS 46 (92.0) 65 (66.3) 0.001
F
NS
NS
NS
4 (8.0)
33 (33.7)
NS
Occupation NS
Farmer 17 (63.0) 12 (57.1) 2 (100.0) 31 (62.0) 45 (45.9) 0.006
Services sector 7 (25.9) 7 (33.3) 0 14 (28.0) 17 (17.4) NS
Student 1 (3.7) 1 (4.8) 0 2 (4.0) 18 (18.4) NS
Merchant-artisan 1 (3.7) 0 0 1 (2.0) 13 (13.3) NS
Unemployed
1 (3.7)
1 (4.8)
0
2 (4.0)
5 (5.1)
NS
Anatomic location
Lower limb 21 (77.8) 17 (81.0) 2 (100.0) 40 (80.0) 53 (54.1) 0.005
Upper limb 3 (11.1) 3 (14.3) 0 6 (12.0) 36 (37.7) NS
Other§
3 (11.1)
1 (4.7)
0
4 (8.0)
9 (9.2)
NS
Duration of the lesion, y
<1 2 (7.4) 1 (4.8) 0 3 (6.0) 56 (57.1) <0.0001
1–2 1 (3.7) 1 (4.8) 0 2 (4.0) 14 (14.3) NS
>2
24 (88.9)
19 (90.4)
2 (100.0)
45 (90.0)
28 (28.6)
NS
Clinical form
Nodular 1 (3.7) 3 (14.3) 0 4 (8.0) NS NS
Verrucous 1(3.7) 4 (19.0) 0 5 (10.0) NS NS
Tumorous 5 (18.5) 0 0 5 (10.0) NS NS
Cicatricial 3 (11.1) 1 (4.8) 0 4 (8.0) NS NS
Plaque 3 (11.1) 7 (33.3) 0 10 (20.0) NS NS
Mixed 8 (29.6) 3 (14.3) 0 11 (22.0) NS NS
Mixed on the face
2 (7.4)
0
0
2 (4.0)
NS
NS
Modified by previous therapy 4 (14.8) 3 (14.3) 0 7 (14.0) NS NS
NA 0 0 2 (100.0) 2 (4.0) NS NS

*Values are no. (%) unless otherwise indicated. NA, not available; NS, not specified.
†For definitions, see Table 1.
‡Sporotrichosis (n = 63) (12); mycetoma (n = 4); carcinoma, eczema, and cutanesous tuberculosis (n = 2); carpitis, erysipela, fibrosarcoma, cutaneous lymphoma, porokeratosis of Mibelli, prurigo nodularis, pyoderma, and papillomavirus (n = 1); not specified (n = 17).
§Head and neck, thorax.

Main Article

References
  1. Queiroz-Telles  F, de Hoog  S, Santos  DW, Salgado  CG, Vicente  VA, Bonifaz  A, et al. Chromoblastomycosis. Clin Microbiol Rev. 2017;30:23376. DOIPubMedGoogle Scholar
  2. Rasamoelina  T, Raharolahy  O, Rakotozandrindrainy  N, Ranaivo  I, Andrianarison  M, Rakotonirina  B, et al. Chromoblastomycosis and sporotrichosis, two endemic but neglected fungal infections in Madagascar. J Mycol Med. 2017;27:31224. DOIPubMedGoogle Scholar
  3. Badali  H, Bonifaz  A, Barrón-Tapia  T, Vázquez-González  D, Estrada-Aguilar  L, Oliveira  NM, et al. Rhinocladiella aquaspersa, proven agent of verrucous skin infection and a novel type of chromoblastomycosis. Med Mycol. 2010;48:696703. DOIPubMedGoogle Scholar
  4. Bonifaz  A, Carrasco-Gerard  E, Saúl  A. Chromoblastomycosis: clinical and mycologic experience of 51 cases. Mycoses. 2001;44:17. DOIPubMedGoogle Scholar
  5. Queiroz-Telles  F, Esterre  P, Perez-Blanco  M, Vitale  RG, Salgado  CG, Bonifaz  A. Chromoblastomycosis: an overview of clinical manifestations, diagnosis and treatment. Med Mycol. 2009;47:315. DOIPubMedGoogle Scholar
  6. Queiroz-Telles  F, Nucci  M, Colombo  AL, Tobón  A, Restrepo  A. Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment. Med Mycol. 2011;49:22536. DOIPubMedGoogle Scholar
  7. Queiroz-Telles  F, Fahal  AH, Falci  DR, Caceres  DH, Chiller  T, Pasqualotto  AC. Neglected endemic mycoses. Lancet Infect Dis. 2017;17:e36777. DOIPubMedGoogle Scholar
  8. Vicente  VA, Najafzadeh  MJ, Sun  J, Gomes  RR, Robl  D, Marques  SG, et al. Environmental siblings of black agents of human chromoblastomycosis. Fungal Divers. 2014;65:4763. DOIGoogle Scholar
  9. Esterre  P, Andriantsimahavandy  A, Ramarcel  ER, Pecarrere  JL. Forty years of chromoblastomycosis in Madagascar: a review. Am J Trop Med Hyg. 1996;55:457. DOIPubMedGoogle Scholar
  10. Brygoo  ER. Chromoblastomycosis in Madagascar [in French]. Sem Hop Paris. 1957;33:77791.
  11. Coulanges  P, Locheron  P. Chromoblastomycosis in Madagascar. Epidemiological data on the most important outbreak currently known in the world (counting 891 cases diagnosed from 1955 to 1987) [in French]. Arch Inst Pasteur Madagascar. 1981;48:6995.PubMedGoogle Scholar
  12. Rasamoelina  T, Maubon  D, Raharolahy  O, Razanakoto  H, Rakotozandrindrainy  N, Rakotomalala  FA, et al. Sporotrichosis in the Highlands of Madagascar, 2013-20171. Emerg Infect Dis. 2019;25:1893902. DOIPubMedGoogle Scholar
  13. Irinyi  L, Lackner  M, de Hoog  GS, Meyer  W. DNA barcoding of fungi causing infections in humans and animals. Fungal Biol. 2016;120:12536. DOIPubMedGoogle Scholar
  14. Kurtzman  CP, Robnett  CJ. Identification of clinically important ascomycetous yeasts based on nucleotide divergence in the 5′ end of the large-subunit (26S) ribosomal DNA gene. J Clin Microbiol. 1997;35:121623. DOIPubMedGoogle Scholar
  15. Abliz  P, Fukushima  K, Takizawa  K, Nishimura  K. Identification of pathogenic dematiaceous fungi and related taxa based on large subunit ribosomal DNA D1/D2 domain sequence analysis. FEMS Immunol Med Microbiol. 2004;40:419. DOIPubMedGoogle Scholar
  16. Abliz  P, Fukushima  K, Takizawa  K, Nieda  N, Miyaji  M, Nishimura  K. Rapid identification of the genus fonsecaea by PCR with specific oligonucleotide primers. J Clin Microbiol. 2003;41:8736. DOIPubMedGoogle Scholar
  17. Irinyi  L, Serena  C, Garcia-Hermoso  D, Arabatzis  M, Desnos-Ollivier  M, Vu  D, et al. International Society of Human and Animal Mycology (ISHAM)-ITS reference DNA barcoding database—the quality controlled standard tool for routine identification of human and animal pathogenic fungi. Med Mycol. 2015;53:31337. DOIPubMedGoogle Scholar
  18. Lau  AF, Drake  SK, Calhoun  LB, Henderson  CM, Zelazny  AM. Development of a clinically comprehensive database and a simple procedure for identification of molds from solid media by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2013;51:82834. DOIPubMedGoogle Scholar
  19. Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi. Approved standard (document M38–A2). Wayne (PA): The Institute; 2008.
  20. Madagascar in figures, population, and demography [in French] [cited 2020 Feb 7]. https://www.instat.mg
  21. Centers for Disease Control and Prevention. Epi Info 7 [cited 2020 Feb 7]. https://www.cdc.gov/epiinfo/pdfs/UserGuide/EI7Full.pdf
  22. Bivand  R, Lewin-Koh  N. Maptools: tools for reading and handling spatial objects. R package version 0.8–27 [cited 2020 Feb 7]. https://www.researchgate.net/publication/308748917_maptools_Tools_for_reading_and_handling_spatial_objects_R_package_version_08-27
  23. Tanabe  H, Kawasaki  M, Mochizuki  T, Ishizaki  H. Species identification and strain typing of Fonsecaea pedrosoi using ribosomal RNA gene internal transcribed spacer regions. Nippon Ishinkin Gakkai Zasshi. 2004;45:10512. DOIPubMedGoogle Scholar
  24. Esterre  P, Andriantsimahavandy  A, Raharisolo  C. [Natural history of chromoblastomycosis in Madagascar and the Indian Ocean] [Natural history of chromoblastomycosis in Madagascar and the [Natural history of chromoblastomycosis in Madagascar and the Indian Ocean]. [in French]. Bull Soc Pathol Exot. 1997;90:3127.PubMedGoogle Scholar
  25. Najafzadeh  MJ, Sun  J, Vicente  V, Xi  L, van den Ende  AH, de Hoog  GS. Fonsecaea nubica sp. nov, a new agent of human chromoblastomycosis revealed using molecular data. Med Mycol. 2010;48:8006. DOIPubMedGoogle Scholar
  26. Queiroz-Telles  F. Grades of severity and parameters for cure. Presented at: International Society for Human and Animal Mycology workshop on chromoblastomycosis; 2017 Dec 11; Havana, Cuba.
  27. Xi  L, Sun  J, Lu  C, Liu  H, Xie  Z, Fukushima  K, et al. Molecular diversity of Fonsecaea (Chaetothyriales) causing chromoblastomycosis in southern China. Med Mycol. 2009;47:2733. DOIPubMedGoogle Scholar
  28. Attapattu  MC. Chromoblastomycosis—a clinical and mycological study of 71 cases from Sri Lanka. Mycopathologia. 1997;137:14551. DOIPubMedGoogle Scholar
  29. Agarwal  R, Singh  G, Ghosh  A, Verma  KK, Pandey  M, Xess  I. Chromoblastomycosis in India: Review of 169 cases. PLoS Negl Trop Dis. 2017;11:e0005534. DOIPubMedGoogle Scholar

Main Article

1Preliminary results from this study were presented at the 20th International Society for Human and Animal Mycology Conference; June 29–July 5, 2018; Amsterdam, the Netherlands.

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Page updated: May 18, 2020
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