Chromoblastomycosis in an Endemic Area of Brazil: A Clinical-Epidemiological Analysis and a Worldwide Haplotype Network

• Main Authors: Daniel Wagner C. L. Santos, Vania Aparecida Vicente, Vinicius Almir Weiss, G. Sybren de Hoog, Renata R. Gomes, Edith M. M. Batista, Sirlei Garcia Marques, Flávio de Queiroz-Telles, Arnaldo Lopes Colombo, Conceição de Maria Pedrozo e Silva de Azevedo
• Format: Article
• Language: English
• Published: MDPI AG 2020-10-01
• Series: Journal of Fungi
• Subjects: chromoblastomycosis; Brazil; <i>Fonsecaea</i> spp.; haplotype network
• Online Access: https://www.mdpi.com/2309-608X/6/4/204

Chromoblastomycosis (CBM) is a neglected implantation mycosis prevalent in tropical climate zones, considered an occupational disease that affects impoverished rural populations. This retrospective study described clinical aspects of CBM in a hyperendemic area in Brazil and constructed a worldwide haplotype network of <i>Fonsecaea</i> spp. strains. The variables were collected from medical records using a standard report form, reporting 191 patients with CBM from Maranhão, Brazil. The mean age was 56.1 years, 168 (88%) patients were male and predominantly farmers (85.8%). The mean time of evolution of the disease until diagnosis was 9.4 years. Lower limbs (81.2%) and upper limbs (14.2%) were the main sites affected. Most patients exhibited verrucous (55%) and infiltrative plaque (48.2%). <i>Fonsecaea</i> spp. were identified in 136 cases and a haplotype network constructed with ITS sequences of 185 global strains revealed a total of 59 haplotypes exhibiting high haplotypic and low nucleotide diversities. No correlation was observed between the different haplotypes of <i>Fonsecaea</i> species and dermatological patterns, severity of disease or geographic distribution inside Maranhão. Data from this area contributed to better understanding the epidemiology of CBM. For the first time, a robust haplotype network with <i>Fonsecaea</i> strains reveals an evolutionary history with a recent population expansion.