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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, 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.

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.

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 (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.

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.

Chromoblastomycosis (CBM) is a chronic, neglected tropical fungal infection. Its immunopathogenesis, particularly the mechanism underlying its chronicity, remains poorly understood. We performed single-cell RNA sequencing (scRNA-seq) on lesional skin from a CBM patient, followed by comprehensive bioinformatics analyses. We then used multiplex immunofluorescence (mIF) to validate CD4 T cell exhaustion in CBM patient lesions and the mouse model of infection. We identified a significantly expanded population of exhausted CD4 T cells within the patient's lesions, which exhibited high co-expression of inhibitory receptors (PD-1, TIM-3, LAG-3) and functional impairment. Trajectory inference suggested a differentiation path from naive towards exhaustion within the chronic inflammatory environment. Cell-cell communication analysis implicated monocytes/macrophages (MoMacs) as key drivers of this process via persistent antigen presentation and ligand-receptor interactions such as CTLA4-CD80/86 and LGALS9-CD44. The accumulation of exhausted CD4 T cells was confirmed in human CBM lesions by multiplex immunofluorescence (mIF), and the progressive development of exhaustion was recapitulated in the mouse model of infection. Our findings establish CD4 T cell exhaustion as an important mechanism underlying the chronicity of chromoblastomycosis, revealing a new immunopathological perspective for this neglected disease.

Chromoblastomycosis in intracranial locations is extremely rare in immunocompetent hosts. Neurotropism of fungal elements has been reported in the literature mostly in immunocompromised individuals. We report a case of a 36-year-old industrial worker with disseminated untreated skin lesions and presenting with cerebellar symptoms and space-occupying lesion in the left cerebellar hemisphere. Histopathological examination revealed a diagnosis of cerebellar chromoblastomycosis. To our knowledge, this is the first reported case of cerebellar chromoblastomycosis in an immunocompetent individual.

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 and progressive subcutaneous mycosis caused mainly by the fungus . The infection is characterized by erythematous papules and histological sections demonstrating an external layer of fibrous tissue and an internal layer of thick granulomatous inflammatory tissue containing mainly macrophages and neutrophils. Several groups are studying the roles of the innate and adaptive immune systems in infection; however, few studies have focused on the role of neutrophils in this infection. In the current study, we verify the importance of murine neutrophils in the killing of conidia and hyphae. We demonstrate that phagocytosis and reactive oxygen species during infection with conidia are TLR-2- and TLR-4-dependent and are essential for conidial killing. Meanwhile, hyphal killing occurs by NET formation in a TLR-2-, TLR-4-, and ROS-independent manner. In vivo experiments show that TLR-2 and TLR-4 are also important in chromoblastomycosis infection. TLR-2KO and TLR-4KO animals had lower levels of CCL3 and CXCL1 chemokines and impaired neutrophil migration to the infected site. These animals also had higher fungal loads during infection with conidia, confirming that TLR-2 and TLR-4 are essential receptors for recognition and immune system activation. Therefore, this study demonstrates for the first time that neutrophil activation during is conidial or hyphal-specific with TLR-2 and TLR-4 being essential during conidial infection but unnecessary for hyphal killing by neutrophils.