CROMOBLASTOMICOSE: apresentação clínica, evolução terapêutica e associação com achados histopatológicos.

Abstract

Introduction: Chromoblastomycosis is a chronic and slowly evolving disease that affects the cutaneous and subcutaneous cellular tissue. Its main etiological agent is Fonsecaea pedrosoi. It may present polymorphic aspect, of slow evolution, reaching mainly the lower limbs of rural workers. Objective: To analyze the histopathological findings correlating with lesion type, severity and therapies performed in patients with CBM agents. Methodology: This is a descriptive, analytical, longitudinal study of confirmed cases with a convenience sample, conducted at the Infectious and Parasitic Reference Center of the Federal University of Maranhão from February / 2017 to August / 2018. The direct research, fungal culture and microculture tests were used to confirm the diagnosis and histopathology to perform the correlations and analyzes of this study. Treatment was with itraconazole for patients with mild disease (200mg / day) and for moderate and severe itraconazole (400mg / day). In patients with infiltrative lesions, imiquimod, topical, was associated 3 times a week and in patients with low therapeutic response and those who could attend the outpatient clinic every 15 days, was associated with liquid nitrogen. Results: The clinical and epidemiological investigation of the 52 cases presented age variation between 50 and 60 years (n = 21; 40%); predominance: male (n = 48; 92%), rural workers, moderate severity (n = 25; 48%), plaque injury (n = 38; 73.08%), suppurative granulomas (n = 20; 38.46%) and mostly from the Baixada Maranhense. In the associations of histopathological findings and lesions, there were higher percentages for polymorphonuclear, lymphocytes and pseudoepitheliomatous hyperplasia, pointing to an attempt to eliminate the fungus (p <0.0001). In the correlation between the histopathological findings and the treatment, vascular proliferation presented in smaller quantity in the lesion sites, which may impair the concentration of the antifungal used in the treatment. The fungal load decreased in treatments with itraconazole and itraconazole associated with liquid nitrogen. Discussion: Itraconazole is a drug used in CBM therapies that can achieve cures and improvements in the clinical condition of most patients, especially those with mild to moderate severity after long periods of treatment. In patients with severe lesions, there is a differentiated response, perhaps caused by the decrease in tissue concentrations of itraconazole. Factors that may be involved in these reductions in tissue concentrations are tissue fibroses, edema, and bacterial co-infections, which are commonly found in subcutaneous tissues. It is at this time that other therapeutic strategies can be used such as associations with local liquid nitrogen or imiquimod. Conclusion: Chromoblastomycosis has endemic behavior in the state of Maranhão. Itraconazole alone had the best results in terms of cure and reduction of fungal load intensity than in association with liquid nitrogen. Liquid nitrogen, despite presenting reductions in fungal load intensity, must be evaluated its cost benefit. And the association of itraconazole with imiquimod did not show a good evolution, being evidenced with increased fungal load intensity.