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Implantation mycoses (IM) are a group of fungal diseases which occur after a transcutaneous trauma. The World Health Organization has listed some of the IM, namely sporotrichosis, chromoblastomycosis and eumycetoma as one of the Skin Neglected Tropical Diseases targeted for control by 2030. There are no robust data on IM from Nepal since these diseases are not a part of routine disease surveillance. In this study, an online and in-person survey was conducted using a standard set of questionnaires among the registered dermatologists of Nepal. For this survey sporotrichosis, chromoblastomycosis and mycetoma were included. A total of 56 dermatologists responded to this survey. The result showed that sporotrichosis was the most diagnosed IM (46/56, 82.15%) whereas mycetoma was the least common (21/56, 37.5%). This study further explored the availability of the various diagnostics and treatment modalities among these IM in Nepal. It also showed a lack of uniformity in treatment modalities and in the availability of diagnostics as well as treatment options across the country. It showed that the diagnostics and treatment options were more in the capital as compared to rest of the country.

Chromoblastomycosis, an implantation mycosis, is a neglected tropical disease that causes decreased quality of life, stigma, and disability. The global burden of disease is unknown and data on disease epidemiology and outcomes are severely limited by a lack of access to needed diagnostic tools and therapeutics. The World Health Organization outlined targets for chromoblastomycosis in the Road Map for Neglected Tropical Diseases 2021–2030, but little progress has been made in initiating and implementing an effective control program globally. This lack of guiding policy and progress led to the recent formation of a Global Chromoblastomycosis Working Group which has developed a global chromoblastomycosis strategy. We describe this strategy, which outlines specific steps needed to improve technical progress, strategy and service delivery, and enablers. Clinicians, researchers, public and government officials, patients, and policy makers can align their time, expertise, and resources to improve the lives of communities affected by chromoblastomycosis through this strategy.

Background Chromoblastomycosis (CBM) is a chronic subcutaneous mycosis caused by dematiaceous fungi that mainly affects rural workers in tropical and subtropical regions. The disease poses a treatment challenge due to its refractory nature and high relapse rate. To date, few cases have been reported in Peru. Methods We retrospectively reviewed epidemiological, clinical, microbiological, and treatment data from CBM cases diagnosed between 2011 and 2024 at the Clinical Mycology Unit of the Instituto de Medicina Tropical Alexander von Humboldt (IMTAvH) in Lima, Peru. Diagnosis was confirmed by the identification of muriform cells either on direct microscopic examination or histopathology. Results Of the 15 identified cases, 13 had sufficient data for inclusion. In summary, 84% of the patients were men, 77% acquired the disease in the Peruvian Amazon jungle (predominantly in Ucayali and San Martin), the median age was 65.3 years (range: 33–85), and the average disease duration was 10.7 years (range: 1–25 years). The lower extremities were most frequently affected (53%), followed by the upper extremities (38%). Plaque-like and verrucous lesions were the most common (38% each), whereas tumoral and cicatricial forms were less frequent (15% each). The aetiological agent was identified by morphology in nine patients. Fonsecaea sp. was the most frequently identified pathogen (46%), followed by Cladophialophora sp. (15%) and Phialophora sp. (7%). Nine patients (69%) received oral itraconazole (200–400 mg/day) combined with cryosurgery; two (15%) received itraconazole alone; and two (15%) received itraconazole combined with terbinafine (500 mg/day). Treatment duration ranged from 5 to 136 months, with six patients (46%) achieving a cure. Conclusions CBM in Peru is likely underdiagnosed and underestimated due to low disease recognition, limited diagnostics in remote areas, and lack of mandatory reporting.

Chromoblastomycosis (CBM) and mycetoma, as implantation mycoses, have been listed as neglected tropical diseases (NTDs) by the World Health Organization. The concurrent occurrence of these two NTDs in a single patient is extremely rare. A 69-year-old female patient presented with papules on the dorsum of her left hand for over 5 months and nodules on the left lower limb accompanied by ulceration and pain for 20 days. Histopathological examination of the papule on the dorsum of the left hand revealed muriform cells and fungal culture of the tissue identified Fonsecaea monophora . Microscopic examination of the purulent secretion from the ulcer on the left lower calf revealed the presence of grains, and the tissue culture result was Scedosporium apiosperma complex, with metagenomic next-generation sequencing further identifying S. dehoogii as the predominant pathogen. The clinical diagnosis was CBM caused by F. monophora combined with eumycetoma due to S. dehoogii. The patient was treated with voriconazole at a dosage of 200 mg twice daily for 4 weeks, after which the papules on the dorsum of the left hand and the ulcer on the left lower calf showed gradual improvement. This case represents the first reported instance of concurrent CBM caused by F. monophora and eumycetoma due to S. dehoogii , providing a novel perspective on the clinical manifestations and early identification of neglected implantation mycoses.

Chromoblastomycosis (CBM) is a subcutaneous fungal infection caused by one of several dematiaceae molds with melanotic pigmentation in the cell walls. CBM is characterized by various clinical and dermatological features, leading to common misdiagnosis as several other infectious and noninfectious diseases. Histopathologically, in addition to the pathognomonic muriform cells or \"copper pennies,\" the causative agents of subcutaneous and systemic mycosis lead to a granulomatous reaction due to the influx of mononuclear phagocytic cells and a suppurative infiltrate of neutrophils. Treatment of CBM can be challenging as no standard treatment has been established. This case highlights a rare presentation of subcutaneous chromoblastomycosis caused by Rhinocladiella species in the United States with satisfactory management. It emphasizes the role of occupational and exposure history, keeping a high index of suspicion in cases of verrucous nodules or plaques with new satellite lesions on extremities, and recognizing this entity's distinct dermatopathology characteristics.

Chromoblastomycosis (CBM) is a chronic subcutaneous mycosis caused by traumatic implantation of many species of black fungi. Due to the refractoriness of some cases and common recurrence of CBM, a more effective and less time-consuming treatment is mandatory. The aim of this study was to identify compounds with in vitro antifungal activity in the Pathogen Box® compound collection against different CBM agents. Synergism of these compounds with drugs currently used to treat CBM was also assessed. An initial screening of the drugs present in this collection at 1 μM was performed with a Fonsecaea pedrosoi clinical strain according to the EUCAST protocol. The compounds with activity against this fungus were also tested against other seven etiologic agents of CBM (Cladophialophora carrionii, Phialophora verrucosa, Exophiala jeanselmei, Exophiala dermatitidis, Fonsecaea monophora, Fonsecaea nubica, and Rhinocladiella similis) at concentrations ranging from 0.039 to 10 μM. The analysis of potential synergism of these compounds with itraconazole and terbinafine was performed by the checkerboard method. Eight compounds inhibited more than 60% of the F. pedrosoi growth: difenoconazole, bitertanol, iodoquinol, azoxystrobin, MMV688179, MMV021013, trifloxystrobin, and auranofin. Iodoquinol produced the lowest MIC values (1.25-2.5 μM) and MMV688179 showed MICs that were higher than all compounds tested (5 - >10 μM). When auranofin and itraconazole were tested in combination, a synergistic interaction (FICI = 0.37) was observed against the C. carrionii isolate. Toxicity analysis revealed that MMV021013 showed high selectivity indices (SI ≥ 10) against the fungi tested. In summary, auranofin, iodoquinol, and MMV021013 were identified as promising compounds to be tested in CBM models of infection.

Chromoblastomycosis (CBM) is a chronic, progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi. The disease has worldwide prevalence with predominant cases reported from humid tropical and subtropical regions of America, Asia, and Africa. Diagnosis is often delayed or misdirected either due to poor degree of clinical suspicions or clinical simulation of dermatological conditions. The infection is not uncommon in India and several case reports from the sub-Himalayan belt and western and eastern coasts of India have been published; however, very few have reviewed the cases. We reviewed 169 cases published in English literature from India during 1957 through May 2016, including 2 recent cases from our institute. A tremendous increase in the number of reported cases was noticed since 2012, since which, more than 50% of the cases had been published. A majority of the patients (74.1%) were involved in various agricultural activities directly or indirectly. The mean age at presentation was 43.3 years ± 16.0, with male to female ratio of 4.2:1. The duration of disease at the time of presentation varied from 20 days to 35 years. Any history of trauma was recalled only in 33.8% of the studied cases. The lower extremity was the most common site afflicted, followed by the upper extremity. The culture was positive in 80.3% of the cases with Fonsecaea pedrosoi, isolated as the most common fungal pathogen, followed by Cladophialophora carrionii. Although all the commercially available antifungals were prescribed in these cases, itraconazole and terbinafine were the most commonly used, either alone or in combination with other drugs/physical methods, with variable degrees of outcome. Combinations of different treatment modalities (chemotherapy and physical methods) yielded a cure rate of 86.3%. CBM is refractory to treatment and no single antifungal agent or regimen has demonstrated satisfactory results. Increased awareness with early clinical suspicion of the disease and adequate therapy are necessary to improve the outcome. However, depending upon the causative agent, disease severity, and the choice of antifungals, variable outcomes can be observed.

Hyalohyphomycosis and phaeohyphomycosis are groups of mycoses caused by several agents and show different clinical manifestations. We report a case of an immunocompromised patient who presented rare manifestations of opportunistic mycoses: mycetoma-like hyalohyphomycosis on his right foot caused by Colletotrichum gloeosporioides, followed by cutaneous phaeohyphomycosis on his right forearm caused by Exophiala oligosperma. Further to the rarity of this case, the patient's lesion on the foot shows that the clinical aspects of mycetomas could falsely appear in other fungal infections similar to hyalohyphomycosis. We also show that the muriform cells that were seen in the direct and anatomopathological examination of the skin are not pathognomonic of chromoblastomycosis, as observed in the lesion of the patient's forearm.

Once incurable and chronic devastating diseases of chromomycosis is now curable with, debulking, intralesional amphotericin B and oral terbinafine (DAT). Debulking methods ranged from electrocautery to total surgical excision according to the size and the site of the lesion; a diluted solution of 1 mg/mL of amphotericin B (AMB) was injected weekly at the edge of the lesion; and simultaneous treatment with daily 500 mg oral terbinafine. Voriconazole 200 mg twice daily was added in one patient who had infection spread along the right lower limb for more than 20 years. DAT therapy was continued until complete clinical clearance where 14 out of 16 (87.5%) were cured using intralesional AMB 4-8 weeks (mean 5.8, mode 7) and oral terbinafine 6-12 weeks (mean 9.6, mode 12). Two patients who had lesions for 10 years and 20 years had to continue treatments for 14 weeks and 34 weeks, respectively, leaving scarring, chronic lymphedema, or depigmentation to a lesser degree. Early initiation of treatment gives an optimal outcome in a shorter period of time without residual sequelae.

Chromoblastomycosis is a chronic skin and subcutaneous fungal infection caused by dematiaceous fungi and is associated with low cure and high relapse rates. In southern China, Fonsecaea monophora and Fonsecaea pedrosoi are the main causative agents. We treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The isolates were assayed for susceptibility to antifungal drugs and ALA-PDT in vitro, revealing sensitivity to terbinafine, itraconazole and voriconazole, with ALA-PDT altering the cell wall and increasing reactive oxygen species production. These results provide the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis.