What is deep tropical mycosis? An underestimated entity with serious problems

Karzan A. Abdulla, Rebeen R. Saeed


There are many fungal infections which have been described in the literature but only a small number of them causes diseases in human being. The clinical manifestation is diverse and the spectrum of severity ranges from simple localized infections to severe systemic disease. Some of these fungal infections characteristically occur more frequently in tropical countries and hence they are called tropical mycosis; however even these kinds of mycotic infections may be seen outside the tropical countries due to migration and travel. In this article we try to review the deep tropical mycosis and highlight the important aspects of diseases classified under this entity, we also try to address some of the issues related to these illnesses and demonstrating their management in summary.


Deep Tropical Mycosis, Fungal Infection

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Hawksworth D. The magnitude of fungal diversity: the 1.5 million species estimate revisited. Mycological Research. 2001;105(12):1422-32.

Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16): 1546-54.

Hay RJ. Fungal infections. Manson’s tropical diseases. 22nd edition. Philadelphia: WB Saunders. 2008;71:1169-89.

IOM International Organization for Migration. World migration report 2010 the future of migration: Building capacities for change. Available at:http://publications.iom.int/bookstore/free/WMR_2010_english.pdf. Accessed 2013, August 13.

World Tourism Organization. Historical perspective of world tourism. Available at: http://www.unwto.org/facts/eng/historical.htm. Accessed 2013, August 16.

Baron S. Medical Microbiology. 4th edition.Galveston (TX): University of Texas Medical Branch at Galveston.1996.

Walsh TJ & Dixon DM. Spectrum of Mycoses. In: Baron S, editor. Medical microbiology. 4th edition. Galveston (TX): The University of Texas Medical Branch. 1996, 75. Available at: http://www.ncbi.nlm.nih.gov/books/NBK7902/. Accessed August 29, 2013.

Rivitti EA, Aoki V. Deep fungal infections in tropical countries. Clin Dermatol.1999;17(2):171-90.

Gross ML, Millikan LE. Deep fungal infections in the tropics. Dermatol Clin.1994;12(4):695-700.

Magana M. Mycetoma. Int J Dermatol. 1984;23(4):221-36.

Sran HS, Narula IM, Agarwal RK, Joshi KR. History of mycetoma. Indian J Hist Med.1972;17:1-7.

Lupi O, Tyring SK, Mc Ginnis MR. Tropical dermatology: fungal tropical diseases. J Am Acad Dermatol. 2005;53(6):931-51.

Queiroz-Telles F, McGinnis MR, Salkin I, Graybill JR. Subcutaneous mycoses. Infect Dis Clin North Am. 2003;17(1):59-85.

Garnica M, Nucci M, Queiroz-Telles F. Difficult mycoses of the skin: advances in the epidemiology and management of eumycetoma, phaeohyphomycosis and chromoblastomycosis. Curr Opin Infect Dis. 2009;22(6):559-63.

Maslin J, Morand JJ, Civatte M. The eumycetomas (fungal mycetomas with black or white grains). Med Trop (Mars). 2001;61(2):111-4.

Ahmed AO, van Leeuwen W, Fahal A, van de Sande W, Verbrugh H, van Belkum A. Mycetoma caused by Madurella mycetomatis: a neglected infectious burden. Lancet Infect Dis. 2004;4(9):566-74.

Gupta PK, Hollander DH, Frost JK. Actinomycetes in cervico-vaginal smears: an association with IUD usage. Acta Cytol. 1976;20(4):295-7.

Henderson SR. Pelvic actinomycosis associated with an intrauterine device. Obstet Gynecol. 1973;41(5):726-32.

Wayne Grayson .Pathology of the skin with clinical correlations Vol.2. Infectious diseases of the skin. In: Phillip H. Mckee, Eduardo Calonje, Scott R. Granter, eds. Elsevier mosby, 3rd ed. Philadelphia: Elsevier Limited.2005;965-7.

Minotto R, Bernardi CD, Mallmann LF, Edelweiss MI, Scroferneker ML. Chromoblastomycosis: a review of 100 cases in state of Rio Grande do sul, Brazil. J Am Acad Dermatol. 2001;44(4):585-92.

Kuttner Bj, Siegle RJ.Treatment of chromomycosis with CO2 laser. J Dermatol Surg Oncol.1986;12(9):965-8.

Bopp C. Healing of chromoblastomycosis by new method of treatment. Med Cut ILA.1974;4:285-92.

Astorga E, Bonilla E, Martínez C, Mura W. Treatment of chromoblastomycosis with amphotericin B and 5-fluorocytosine. Med Cutan Ibero Lat Am. 1981;9(2):125-8.

López-Romero E, Reyes-Montes Mdel R, Pérez-Torres A, Ruiz-Baca E, Villagómez-Castro JC, Mora-Montes HM, et al. Sporothrix schenckii complex and sporotrichosis, an emerging health problem. Future Microbiol. 2011;6(1):85-102.

Kauffman CA, Bustamante B, Chapman SW, Pappas PG; Infectious Diseases Society of America. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(10):1255-65.

Köhler A, Weber L, Gall H, Peter RU. Sporotrichosis-fixed cutaneous and lymphocutaneous form. Hautarzt. 2000;51(7):509-12.

Mahajan VK, Sharma NL, Sharma RC, Gupta ML, Garg G, Kanga AK. Cutaneous sporotrichosis in Himachal Pradesh, India. Mycoses. 2005;48(1):25-31.

Singh P, Sharma RC, Gupta ML, Mahajan VK. Sporotrichosis in Himachal Pradesh (India). Indian J Med Sci. 1983;37(6):101-3.

Kwon-Chung KJ, Bennett JE. Medical Mycology. Sporotrichosis. Kwon-Chung KJ, Bennett JE, editors. Philadelphia: Lea & Febiger.1991;707-29.

Talhari S, Talhari C. Lobomycosis. Clin Dermatol. 2012;30(4):420-4.

Paniz-Mondolfi A, Talhari C, Sander Hoffmann L, Connor DL, Talhari S, Bermudez-Villapol L et al. Lobomycosis: an emerging disease in humans and delphinidae. Mycoses. 2012;55(4):298-309.

Rodriguez-Toro G. Lobomycosis. Int J Dermatol. 1993;32(5):324–32.

Taborda PR, Taborda VA, McGinnis MR. Lacazia loboi gen. nov, comb. nov, the etiologic agent of lobomycosis. J Clin Microbiol. 1999;37(6):2031-3.

Burdett Hart L, Rotstein DS, Wells RS, Bassos-Hull K, Schwacke LH. Lacaziosis and lacaziosis-like prevalence among wild, common bottlenose dolphins Tursiops truncatus from the west coast of Florida, USA. Dis Aquat Organ. 2011;95(1):49-56.

Francesconi F, Francesconi V. Images in clinical medicine. Lobomycosis. N Engl J Med. 2011;364(1):e2.

Baruzzi RG, Marcopito LF, Michalany NS, Livianu J, Pinto NR. Early diagnosis and prompt treatment by surgery in Jorge Lobo’s disease (keloidal blastomycosis). Mycopathologia. 1981;74(1):51-4.

Paniz-Mondolfi AE, Reyes Jaimes O, Dávila Jones L. Lobomycosis in Venezuela. Int J Dermatol. 2007;46(2):180-5.

Talhari S, Talhari C. Lobomycosis. Clin Dermatol 2012;30:420-4.

Paniz-Mondolfi A, Talhari C, Sander Hoffmann L, Connor DL, Talhari S, Bermudez-Villapol L, et al. Lobomycosis: an emerging disease in humans and delphinidae. Mycoses. 2012 Jul;55(4):298-309.

Fischer M, Chrusciak Talhari A, Reinel D, Talhari S. [Sucessful treatment with clofazimine and itraconazole in a 46 year old patient after 32 years duration of disease]. Hautarzt. 2002;53(10):677-81.

Elsayed S, Kuhn SM, Barber D, Church DL, Adams S, Kasper R. Human case of lobomycosis. Emerg Infect Dis. 2004;10(4):715-8.

Walker SD, Clark RV, King CT, Humphries JE, Lytle LS, Butkus DE. Fatal disseminated Conidiobolus coronatus infection in a renal transplant patient. Am J Clin Pathol. 1992;98(6):559-64.

Bigliazzi C, Poletti V, Dell'Amore D, Saragoni L, Colby TV. Disseminated basidiobolomycosis in an immunocompetent woman. J Clin Microbiol. 2004;42(3):1367-9.

Chaturvedi VP, Randhawa HS, Khan ZU, Singh N, Kini S. Prevalence of Basidiobolus ranarum Eidam in the intestinal tract of an insectivorous bat, Rhinopoma hardwickei hardwickei Gray in Delhi. Sabouraudia. 1984;22(3):185-9.

Kontoyiannis DP, Lewis RE. Principles and practice of infectious diseases. Agents of mucormycosis and entomophthoramycosis. In: Mandell GL, Bennett JE, Dolin R, editors. 7th ed.2010;3257-69.

Khan ZU, Khoursheed M, Makar R, Al-Waheeb S, Al-Bader I, Al-Muzaini A, et al. Basidiobolus ranarum as an etiologic agent of gastrointestinal zygomycosis. J Clin Microbiol. 2001;39(6):2360-3.

Jaffey PB, Haque AK, el-Zaatari M, Pasarell L, McGinnis MR. Disseminated Conidiobolus infection with endocarditis in a cocaine abuser. Arch Pathol Lab Med. 1990;114(12):1276-8.

Walker SD, Clark RV, King CT, Humphries JE, Lytle LS, Butkus DE. Fatal disseminated Conidiobolus coronatus infection in a renal transplant patient. Am J Clin Pathol. 1992;98(6):559-64

Walsh TJ, Renshaw G, Andrews J, Kwon-Chung J, Cunnion RC, Pass HI et al. Invasive zygomycosis due to Conidiobolus incongruus. Clin Infect Dis. 1994 Sep;19(3):423-30.

Rippon JW. Medical Mycology: The pathogenic fungi and actinomycestes, 3rd edn, Philadelphia: WB Saunders.1988;681-713.

Kwon-Chung KJ & Bennet JE. Medical mycology. Philadelphia: Lebiger and Febiger.1992;447-463.

Busapakum R, Youngchaiyud U, Sriumpai S, Segretain G, Fromentin H. Disseminated infection with Conidiobolus incongruus. Sabouraudia. 1983;21(4):323-30.

Vismer HF, Debeer HA, Dreyer. Subcutaneous phycomycosis caused by Basidiobolus haptosporus (Drechsler, 1947). S Afr Med J. 1980;58:644-67.

Pasha TM, Leighton JA, Smilack JD, Heppell J, Colby TV, Kaufman L. Basidiobolomycosis: an unusual fungal infection mimicking inflammatory bowel disease. Gastroenterology. Gastroenterology. 1997;112(1):250-4.

Kamalam A, Thambia AS. Entomophthoromycosis basidiobolae-successfully treated with KI. Mykosen. 1979;22(3):82-4.

Van Cutsem J, Van Gerven F, Janssen PA. Activity of orally and parentally administered itraconazole in the treatment of superficial and deep mycoses: animal models. Rev Infect Dis. 1987;9 Suppl 1:S15-32.

Gugnani HC. A review of zygomycosis due to Basidiobolus ranarum. Eur J Epidemiol. 1999;15(10):923-9.

Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML. Rev Soc Bras Med Trop. 2006;39(3):297-310.

Ameen M, Talhari C, Talhari S. Advances in paracoccidioidomycosis. Clin Exp Dermatol. 2010;35(6):576-80.

Teixeira MJ, Fonoff ET, Machado Ldos R, Nobrega JP, Sterman-Neto H, Amorim RL. Paracoccidioidomycosis: intralesional therapy. Arq Neuropsiquiatr. 2010;68(3):458-9.

Buitrago MJ, Bernal-Martínez L, Castelli MV, Rodríguez-Tudela JL, Cuenca-Estrella M. Histoplasmosis and paracoccidioidomycosis in a non-endemic area: a review of cases and diagnosis. J Travel Med. 2011;18(1):26-33.

Odashiro AN, Odashiro PR, Fernandes PI, Leite LV, Odashiro M, Maloney S. Eyelid and conjunctival paracoccidioidomycosis simulating carcinoma. Int Ophthalmol. 2011;31(1):63-7.

Paganini CB, Ferreira AB, Minanni CA, Lopes de Pontes FE, Ribeiro C, Silva RA et al. Blastomycosis: a differential diagnosis of periampullary tumors. Pancreas. 2010;39(7):1120-2.

Wanke B, Aide MA. Chapter 6-paracoccidioidomycosis. J Bras Pneumol. 2009 Dec;35(12):1245-9.

Franco M, Montenegro MR, Mendes RP, Marques SA, Dillon NL, Mota NGDS. Paracoccidioidomycosis: a recently proposed classification of its clinical forms. Rev Soc Bras Med Trop. 1987;20(2):129-32.

Barrios JC. Blastomicose sulamericana com localizacao ossea. Relato de dois casos. Rev Bras Ortop.1984;19:117–123.

Ferreira MS. Paracoccidioidomycosis. Paediatr Respir Rev. 2009;10(4):161-5.

Queiroz-Telles F, Goldani LZ, Schlamm HT, Goodrich JM, Espinel-Ingroff A, Shikanai-Yasuda MA. An open- label comparative pilot study of oral voriconazole and itraconazole for long-term treatment of paracoccidiodomycosis Clin Infect Dis. 2007;45(11):1462-9.

Gugnani HC. Histoplasmosis in Africa: a review. Indian J Chest Dis Allied Sci. 2000;42(4):271-7.

Nethercott JR, Schachter RK, Givan KF, Ryder DE. Histoplasmosis due to Histoplasma capsulatum var. duboisii in a Canadian immigrant. Arch Dermatol. 1978;114(4):595-8.

Loulergue P, Bastides F, Baudouin V, Chandenier J, Mariani-Kurkdjian P, Dupont B, et al. Literature review and case histories of Histoplasma capsulatum var. duboisii infections in HIV-infected patients. Emerg Infect Dis. 2007;13(11):1647-52.

Gugnani HC, Muotoe-Okafor F. African histoplasmosis: a review. Rev Iberoam Micol. 1997;14(4):155-9.

Dubois A, Janssens PG, Brutsaert P, Vanbreuseghem R. [A case of African histoplasmosis; with a mycological note on Histoplasma duboisii n.sp]. Ann Soc Belg Med Trop. 1952;32(6):569-84.

Gugnani HC, Muotoe-Okafor F. African histoplasmosis: a review. Rev Iberoam Micol. 1997;14(4):155-9.

Minta DK, Dembele M, Lorre G, Diallo DA, Traore HA, Chabasse D. African histoplasmosis (Histoplasma capsulatum var. duboisii): a case report from Mali. Sante. 2005;15(3):195-9.

Binford CH & Dooley JR. Pathology of Tropical and Extraordinary Diseases.Vol. 2. African histoplasmosis.Washington DC: Armed Forces Institute of Pathology. Binford CH, Connor DH, eds;1972;581-3.

Weedon D. Weedon’s Skin Pathology. 3rd ed. London: Churchill Livingstone Elsevier. 2010 Dermatol Pract Concept. 2012; 2(1): 79–82.

McKee PH. Infectious diseases of the skin. In: Pathology of the Skin with Clinical Correlations. Third edition. McKee PH, Calonje E, Granter SR, editors. Vol.1. Philadephia, PA: Elsevier Mosby.2005;837-992.

Francis W. Chandler, William Kaplan, Libero Ajello. A Colour Atlas and Textbook of the Histopathology of Mycotic Diseases. 1st edition. London: Wolfe Medical Publications Ltd. 1980; 67-69.

Kradin RL. In: Diagnostic Pathology of Infectious Disease.Skin infections. Saunders Elsevier Ed. 1st Edition.2010;519-616.

Suvarna KS, Layton C, Bancroft JD. In: Bancroft's Theory and Practice of Histological Techniques. (Immunohistochemistry applications in pathology). Churchill Livingstone Elsevier eds. 2012;493-516.

Wheat LJ, Fre ifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, et al. Clinical practice guidelines for the management of patients with histoplasmosis, update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(7):807-25.