Micosis

Medical Mycology April 2011, 49, 225–236

Review Article

Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment
FLAVIO QUEIROZ-TELLES*, MARCIO NUCCI†, ARNALDO LOPES COLOMBO‡, ANGELA TOBÓN§ & ANGELA RESTREPO§ *Division of Infectious Diseases, Department of Public Health, Hospital de Clinicas, Universidade Federal do Paraná,Curitiba, Brazil, †University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, ‡Division of Infectious Diseases, Department of Medicine, São Paulo, Brazil, and §Corporación para Investigaciones Biológicas, Medellín, Colombia
Med Mycol Downloaded from informahealthcare.com by HINARI on 04/09/11 For personal use only.

Implantation or subcutaneous mycoses are a frequenthealth problem in Latin American countries and other tropical and subtropical areas. Although such infections rarely cause disseminated or invasive disease, they have an important impact on public health, and timely diagnosis and appropriate treatment remain important. Although some implantation mycoses are found in immunocompromised persons, the immunocompetent population is the principal target inLatin America. Most etiologic agents are found in soil, vegetation, and decaying matter in tropical, subtropical, and humid environments and infection is commonly the result of penetrating injury. Infections primarily occur (1) among low socioeconomic groups, (2) among those living in rural areas or involved in farming, hunting, or other outdoor activities, and (3) particularly among adult men.This review focuses on the epidemiology of the most clinically significant implantation mycoses in Latin America, i.e., sporotrichosis, eumycetoma, chromoblastomycosis, subcutaneous phaeohyphomycosis, subcutaneous zygomycosis, and lacaziosis. Main epidemiologic findings, clinical manifestations, diagnosis, and treatment options are also discussed. Keywords subcutaneous mycoses, endemic mycoses,posaconazole, itraconazole

Introduction
Implantation mycoses include a heterogeneous group of fungal diseases that develop at the site of transcutaneous trauma. They are also known as ‘subcutaneous mycoses’, but some of them (sporotrichosis and mycetoma) may also involve muscles, fascia, cartilage and bones, beyond the skin and the subcutaneous tissues. These infections are a frequent healthproblem in Latin American countries and other tropical and subtropical areas [1]. Although such infec-

tions rarely cause disseminated or invasive disease, they have an important impact on public health, may be difficult to control, and often recur [2,3]. The objective of this paper was to review the epidemiology of the most clinically significant implantation mycoses in Latin America, i.e.,sporotrichosis, eumycetoma, chromoblastomycosis, subcutaneous phaeohyphomycosis, subcutaneous zygomycosis, and lacaziosis. An overview of these implantation mycoses with respect to the populations typically affected, main clinical manifestations, and suggestions for diagnosis and treatment is presented in Table 1. Data particularly supporting the potential use of some newer antifungal agents in thetreatment of some of these infections are presented in Table 2.

Received 8 September 2010; Received in final revised form 25 October 2010; Accepted 9 November 2010 Correspondence: Flavio Queiroz-Telles, Infectious Diseases Unit, Hospital de Clinicas, Universidade Federal do Paraná, Rua General Carneiro, 181, Curitiba, PR, Brazil, 80060-90. Tel: 55 41 3360 1809; fax: 55 41 3363 6090; E-mail:Queiroz.telles@uol.com.br

Sporotrichosis
Sporotrichosis is caused by Sporothrix schenckii, a thermally dimorphic fungus that grows optimally in the presence of
DOI: 10.3109/13693786.2010.539631

© 2011 ISHAM

Med Mycol Downloaded from informahealthcare.com by HINARI on 04/09/11 For personal use only.

Table 1 Subcutaneous mycoses prevalent in Latin America. Main clinical manifestations...