Aspectos epidemiológicos, clínicos e laboratoriais da cromoblastomicose no estado de Mato Grosso

Abstract

Chromoblastomycosis is a chronic disease produced by melanized fungi that affects the skin and subcutaneous cellular tissue and mainly affects people who work with plants and soil products such as farmers. Brazil is one of the countries most affected by chromoblastomycosis, but the incidence and prevalence of this disease are still unknown. This study aimed to determine the epidemiological, clinical and laboratory characteristics of chromoblastomycosis in patients treated at the Júlio Müller University Hospital (HUJM), Cuiabá-MT, from January 2015 to December 2020. A retrospective study was carried out that included analysis of medical records of patients affected by chromoblastomycosis. Demographic, clinical and laboratory data were obtained through the application of the form created specifically for this purpose. The preserved isolates were identified by micromorphology and sequencing of the ITS (rDNA Internal Transcribed Spacer) and βtubulin (BT2) genes. Susceptibility to antifungal agents was determined by the broth microdilution technique. Eleven patients with isolates preserved in the FM-UFMT Research Laboratory were included. Mean age was 63.2 years (49-91 years), mostly male. Occupations related to rural work predominated in this group of patients. The most frequent location of the lesions was in the lower limbs, with a predominance of verrucous and scarring lesions. In 5 patients the disease was classified as severe. The only reported complication was bacterial infection. The most frequent comorbidities were systemic arterial hypertension, type II diabetes mellitus and leprosy. Five patients received treatment with itraconazole combined with cryotherapy and four with itraconazole in monotherapy, almost all of them with improvement of the lesions. Ten of the preserved fungi were identified as Fonsecaea pedrosoi and one as belonging to the Neodevriesia genus, the first description of this genus as an etiological agent of chromoblastomycosis. Terbinafine, voriconazole and itraconazole were the drugs with the greatest antifungal activity. Low MIC values were obtained for itraconazole, voriconazole and terbinafine, confirming their importance as therapeutic alternatives for chromoblastomycosis. The chromoblastomycosis-leprosy co-infection was evidenced, affecting mainly elderly patients, which could be influenced by immunosenescence.