Fig 1 - uploaded by Michael Hamblin
Content may be subject to copyright.
Clinical aspect of chromoblastomycosis lesions of patient before and after therapy. There is an itchy erythematous plaque surrounded with veracious hyperplasia on the right ankle of the second patient (a), the clinical is not improved after took
Source publication
Chromoblastomycosis, a chronic fungal infection of skin and subcutaneous tissue caused by dematiaceous fungi, is associated with low cure and high relapse rates. Among all factors affecting clinical outcome, etiological agents have an important position. In southern China, Fonsecaea pedrosoi and Fonsecaea monophora are main causative agents causing...
Contexts in source publication
Context 1
... 50-year-old male farmer residing in Guangzhou, China, presented to our outpatient clinic on March 29, 2011. He complained of an itchy erythematous plaque surrounded with veracious hyperplasia on the right ankle (Fig. 1a). The lesion started 30 years ago after local trauma and enlarged gradually. The patient had visited another hospital, and a clinical diagnosis of deep mycosis (without isolation of pathogen) was made. Before he came to our hospital, itraconazole and fluconazole had been employed for a long time (more than 1 year). In our hospital, both examination of potassium hydroxide mounts (Fig. 2a) and histopa- thology revealed dematiaceous muriform cells (Fig. 2b, c) and the diagnosis of chromoblastomycosis was supported. Based on mycological study and DNA sequencing, the etiological agent was identified as F. monophora. The family history or past medical history was unremarkable. Underlying diseases or immuno- compromised conditions were not present in this patient. In the treatment, terbinafine 500 mg/day oral was administered for 4 weeks, but no significant improvement was observed (Fig. 1b). Then, PDT of ALA (concentration of 20 %, duration time of 4 h) irradiation was adopted combined with terbinafine 250 mg/day oral, from April 26, 2011, to July 7, 2011, totally for nine times, at an interval of 1 week, but not improved previously. From September 1, 2011, to January 13, 2012, he received this therapy for another nine times, at an interval of 1 week, and combined with terbinafine 250 mg/day oral. In between, terbi- nafine 250 mg/day oral was given. The lesions were obviously improved clinically, and fungal examina- tion was negative (Fig. 1c). And there was no new lesions developed after ALA-PDT treatment cessation (Fig. 1d). One year later, the plaque disappeared and just left some ...
Context 2
... 50-year-old male farmer residing in Guangzhou, China, presented to our outpatient clinic on March 29, 2011. He complained of an itchy erythematous plaque surrounded with veracious hyperplasia on the right ankle (Fig. 1a). The lesion started 30 years ago after local trauma and enlarged gradually. The patient had visited another hospital, and a clinical diagnosis of deep mycosis (without isolation of pathogen) was made. Before he came to our hospital, itraconazole and fluconazole had been employed for a long time (more than 1 year). In our hospital, both examination of potassium hydroxide mounts (Fig. 2a) and histopa- thology revealed dematiaceous muriform cells (Fig. 2b, c) and the diagnosis of chromoblastomycosis was supported. Based on mycological study and DNA sequencing, the etiological agent was identified as F. monophora. The family history or past medical history was unremarkable. Underlying diseases or immuno- compromised conditions were not present in this patient. In the treatment, terbinafine 500 mg/day oral was administered for 4 weeks, but no significant improvement was observed (Fig. 1b). Then, PDT of ALA (concentration of 20 %, duration time of 4 h) irradiation was adopted combined with terbinafine 250 mg/day oral, from April 26, 2011, to July 7, 2011, totally for nine times, at an interval of 1 week, but not improved previously. From September 1, 2011, to January 13, 2012, he received this therapy for another nine times, at an interval of 1 week, and combined with terbinafine 250 mg/day oral. In between, terbi- nafine 250 mg/day oral was given. The lesions were obviously improved clinically, and fungal examina- tion was negative (Fig. 1c). And there was no new lesions developed after ALA-PDT treatment cessation (Fig. 1d). One year later, the plaque disappeared and just left some ...
Context 3
... 50-year-old male farmer residing in Guangzhou, China, presented to our outpatient clinic on March 29, 2011. He complained of an itchy erythematous plaque surrounded with veracious hyperplasia on the right ankle (Fig. 1a). The lesion started 30 years ago after local trauma and enlarged gradually. The patient had visited another hospital, and a clinical diagnosis of deep mycosis (without isolation of pathogen) was made. Before he came to our hospital, itraconazole and fluconazole had been employed for a long time (more than 1 year). In our hospital, both examination of potassium hydroxide mounts (Fig. 2a) and histopa- thology revealed dematiaceous muriform cells (Fig. 2b, c) and the diagnosis of chromoblastomycosis was supported. Based on mycological study and DNA sequencing, the etiological agent was identified as F. monophora. The family history or past medical history was unremarkable. Underlying diseases or immuno- compromised conditions were not present in this patient. In the treatment, terbinafine 500 mg/day oral was administered for 4 weeks, but no significant improvement was observed (Fig. 1b). Then, PDT of ALA (concentration of 20 %, duration time of 4 h) irradiation was adopted combined with terbinafine 250 mg/day oral, from April 26, 2011, to July 7, 2011, totally for nine times, at an interval of 1 week, but not improved previously. From September 1, 2011, to January 13, 2012, he received this therapy for another nine times, at an interval of 1 week, and combined with terbinafine 250 mg/day oral. In between, terbi- nafine 250 mg/day oral was given. The lesions were obviously improved clinically, and fungal examina- tion was negative (Fig. 1c). And there was no new lesions developed after ALA-PDT treatment cessation (Fig. 1d). One year later, the plaque disappeared and just left some ...
Context 4
... 50-year-old male farmer residing in Guangzhou, China, presented to our outpatient clinic on March 29, 2011. He complained of an itchy erythematous plaque surrounded with veracious hyperplasia on the right ankle (Fig. 1a). The lesion started 30 years ago after local trauma and enlarged gradually. The patient had visited another hospital, and a clinical diagnosis of deep mycosis (without isolation of pathogen) was made. Before he came to our hospital, itraconazole and fluconazole had been employed for a long time (more than 1 year). In our hospital, both examination of potassium hydroxide mounts (Fig. 2a) and histopa- thology revealed dematiaceous muriform cells (Fig. 2b, c) and the diagnosis of chromoblastomycosis was supported. Based on mycological study and DNA sequencing, the etiological agent was identified as F. monophora. The family history or past medical history was unremarkable. Underlying diseases or immuno- compromised conditions were not present in this patient. In the treatment, terbinafine 500 mg/day oral was administered for 4 weeks, but no significant improvement was observed (Fig. 1b). Then, PDT of ALA (concentration of 20 %, duration time of 4 h) irradiation was adopted combined with terbinafine 250 mg/day oral, from April 26, 2011, to July 7, 2011, totally for nine times, at an interval of 1 week, but not improved previously. From September 1, 2011, to January 13, 2012, he received this therapy for another nine times, at an interval of 1 week, and combined with terbinafine 250 mg/day oral. In between, terbi- nafine 250 mg/day oral was given. The lesions were obviously improved clinically, and fungal examina- tion was negative (Fig. 1c). And there was no new lesions developed after ALA-PDT treatment cessation (Fig. 1d). One year later, the plaque disappeared and just left some ...
Similar publications
Background
Chromoblastomycosis is a chronic skin and subcutaneous fungal infection caused by dematiaceous fungi and is associated with low cure and high relapse rates. In southern China, Fonsecaea monophora and Fonsecaea pedrosoi are the main causative agents.
Principal findings
We treated 5 refractory and complex cases of chromoblastomycosis with...
Citations
... 57 Two in vitro experiments have shown that ALA-PDT and MB-PDT significantly decreased fungal CFUs in CBM by 2-4 and 4 orders of magnitude, respectively. 58,59 Clinical trials have reported that muriform cells pose a therapeutic challenge; following tissue invasion, fungi are transformed into muriform cells, which aid with immune system evasion and antifungal drug resistance. PDT may directly destroy muriform cells or stimulate the host immune response. ...
Xuelin Wu,1,2 Yongxuan Hu1,2 1Department of Dermatology and Venereology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People’s Republic of China; 2Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, People’s Republic of ChinaCorrespondence: Yongxuan Hu, Department of Dermatology and Venereology, The Third Affiliated Hospital of Southern Medical University, 183 West Zhongshan Road, Guangzhou, People’s Republic of China, Tel + 86 20 62784560, Email huyongxuan2003@163.comAbstract: Cutaneous fungal infections are common in humans and are associated with significant physical and psychological distress to patients. Although conventional topical and/or oral anti-fungal medications are commonly recommended treatments, drug resistance has emerged as a significant concern in this patient population, and safer, more efficacious, and cost-effective alternatives are warranted. Recent studies have reported effectiveness of photodynamic therapy (PDT) against fungal infections without severe adverse effects. In this review, we briefly discuss the mechanisms underlying PDT, current progress, adverse effects, and limitations of this treatment in the management of superficial and deep fungal infections.Keywords: photodynamic therapy, fungal infection, review
... Candida species, dermatophytes, A. fumigatus and F. monophora In vitro: reduction/improvement of lesions, disappearance of plaque [401] Photodithazine + Nystatin Fluconazole-resistant C. albicans In vitro: reduction of fungal viability, decrease in oral lesions and inflammatory reaction; in vivo: decrease in tongue lesions [54] 5-ALA + Itraconazole Trichosporon asahii In vitro: better elimination of planktonic and biofilms fungi than single therapy [402] ...
... Moreover, other antifungals (e.g., terbinafine, itraconazole and voriconazole) combined to ALA reported promising results. These combinations could be alternative methods for the treatment of refractory and complex cases of chromoblastomycosis [401,439]. ...
Antimicrobial photodynamic therapy (aPDT) has become a fundamental tool in modern therapeutics, notably due to the expanding versatility of photosensitizers (PSs) and the numerous possibilities to combine aPDT with other antimicrobial treatments to combat localized infections. After revisiting the basic principles of aPDT, this review first highlights the current state of the art of curative or preventive aPDT applications with relevant clinical trials. In addition, the most recent developments in photochemistry and photophysics as well as advanced carrier systems in the context of aPDT are provided, with a focus on the latest generations of efficient and versatile PSs and the progress towards hybrid-multicomponent systems. In particular, deeper insight into combinatory aPDT approaches is afforded, involving non-radiative or other light-based modalities. Selected aPDT perspectives are outlined, pointing out new strategies to target and treat microorganisms. Finally, the review works out the evolution of the conceptually simple PDT methodology towards a much more sophisticated, integrated, and innovative technology as an important element of potent antimicrobial strategies.
... Importantly, in both described cases, the used treatment did not cause any adverse effects, even though it was performed on elderly patients [182]. Hu et al., on the other hand, reported a case where chromoblastomycosis caused by Fonsecaea monophora was successfully treated with the ALA PACT combined with terbinafine chemotherapy [183]. Before PACT was implemented, the infection had been treated over prolonged period of time with itraconazole and fluconazole. ...
... In the following in vitro studies, the F. monophora was found susceptible to each antifungal drug that was used by the patient-itraconazole, fluconazole, and terbinafine. This suggests that the in vitro effect cannot be simply translated to clinical practice and strongly depends on other factors affecting the drug efficacy in vivo [183]. The group continued their research on the topic and reported further five cases of Fonascea infections (one F. nubica, two F. pedrosoi, and two F. monophora) treated with simultaneous ALA PACT and antifungal chemotherapy with clinical improvements but full recovery only in three cases [184]. ...
Superficial and systemic fungal infections are essential problems for the modern health care system. One of the challenges is the growing resistance of fungi to classic antifungals and the constantly increasing cost of therapy. These factors force the scientific world to intensify the search for alternative and more effective methods of treatment. This paper presents an overview of new fungal inactivation methods using Photodynamic Antimicrobial Chemotherapy (PACT). The results of research on compounds from the groups of phenothiazines, xanthanes, porphyrins, chlorins, porphyrazines, and phthalocyanines are presented. An intensive search for a photosensitizer with excellent properties is currently underway. The formulation based on the existing ones is also developed by combining them with nanoparticles and common antifungal therapy. Numerous studies indicate that fungi do not form any specific defense mechanism against PACT, which deems it a promising therapeutic alternative.
... It is a chronic skin and subcutaneous fungal infection with low cure and high relapse rates. Hu et al. (2015) treated five refractory and complex cases of chromoblastomycosis with 5-ALA-aPDT combined with oral antifungal drugs. The isolates were evaluated for susceptibility to terbinafine, itraconazole, and voriconazole and 5-ALA-aPDT in vitro, revealing sensitivity to the antifungals, with 5-ALA-aPDT altering the cell wall and increasing ROS production. ...
... This idea was also previously defended by the same authors in a previous clinical case of chromoblastomycosis caused by F. monophora that was successfully treated with terbinafine plus 5-ALA-aPDT. This study was also supported by in vitro experiments where they showed the good outcome of 5-ALA-aPDT applied for the inhibition of F. monophora [65]. ...
The present review covers combination approaches of antimicrobial photodynamic therapy (aPDT) plus antibiotics or antifungals to attack bacteria and fungi in vitro (both planktonic and biofilm forms) focused on those microorganisms that cause infections in skin and soft tissues. The combination can prevent failure in the fight against these microorganisms: antimicrobial drugs can increase the susceptibility of microorganisms to aPDT and prevent the possibility of regrowth of those that were not inactivated during the irradiation; meanwhile, aPDT is effective regardless of the resistance pattern of the strain and their use does not contribute to the selection of antimicrobial resistance. Additive or synergistic antimicrobial effects in vitro are evaluated and the best combinations are presented. The use of combined treatment of aPDT with antimicrobials could help overcome the difficulty of fighting high level of resistance microorganisms and, as it is a multi-target approach, it could make the selection of resistant microorganisms more difficult.
... It has been used in the treatment of bacteria, viruses and parasites infections [29]. Nonetheless, the application of PDT to control fungal growth is limited to dermatophytes and to black yeasts affections [30]. So far, there are no reports on the development of resistance to PDT by microbes [31]. ...
... The interaction between PDT, antifungal drugs (AMB, FLU or SMX), HDACi (NaBut), or DNMTi (HLZ) was evaluated. Yeasts were firstly exposed to different concentrations of drugs and then exposed to PDT, as it was described for the evaluation of synergism between antifungal drugs and PDT for controlling the Fonsecaea monophora infection in vivo [30]. Cells were exposed to 50 or 70% of the MIC value for each antifungal drug, for 48 h at 30 • C, 50 rpm, and exposed to PDT. ...
... We observed that AMB, FLU, NaBut (HDACi), or HLZ (DNMTi), potentiated the antimicrobial activity of PDT in all the strains. Previously, photodynamic therapy in combination with itraconazole, terbinafine, or voriconazole was successfully employed for the treatment of human chromoblastomycosis [30,48]. ...
Cryptococcus is a globally distributed fungal pathogen that primarily afflicts immunocompromised individuals. The therapeutic options are limited and include mostly amphotericin B or fluconazole, alone or in combination. The extensive usage of antifungals allowed the selection of resistant pathogens posing threats to global public health. Histone deacetylase genes are involved in Cryptococcus virulence, and in pathogenicity and resistance to azoles in Candida albicans.
Aiming to assess whether histone deacetylase genes are involved in antifungal response and in synergistic drug interactions, we evaluated the activity of amphotericin B, fluconazole, sulfamethoxazole, sodium butyrate or trichostatin A (histone deacetylase inhibitors), and hydralazine or 5- aza-2′-deoxycytidine (DNA methyl-transferase inhibitors) against different Cryptococcus neoformans strains, C. neoformans histone deacetylase null mutants and Cryptococcus gattii NIH198. The drugs were employed alone or in different combinations. Fungal growth after photodynamic therapy mediated by an aluminium phthalocyanine chloride nanoemulsion, alone or in combination with the aforementioned drugs, was assessed for the C. neoformans HDAC null mutant strains. Our results showed that fluconazole was synergistic with sodium butyrate or with trichostatin A for the hda1Δ/hos2Δ double mutant strain. Sulfamethoxazole was synergistic with sodium butyrate or with hydralazine also for hda1Δ/hos2Δ. These results clearly indicate a link between HDAC impairment and drug sensitivity. Photodynamic therapy efficacy on controlling the growth of the HDAC mutant strains was increased by amphotericin B, fluconazole, sodium butyrate or hydralazine. This is the first study in Cryptococcus highlighting the combined effects of antifungal drugs, histone deacetylase or DNA methyltransferase inhibitors and photodynamic therapy in vitro.
... This also suggests that the transfer of F. monophora contaminated The treatment of CBM is difficult to perform due to the different clinical forms, and usually the patients are susceptible to recurrence. Treatment comprises a variety of methods, including long periods of mono or combined antimycotic therapy, local surgery, cryotherapy and thermotherapy [22]. Diverse therapeutic strategies using antifungals are reported, however, the best results have been observed with the combination of itraconazole (200-400 mg/day) and terbinafine (500-1000 mg/day) for at least 12 months, depending on the size of the injury [23]. ...
Chromoblastomycosis is a chronic subcutaneous fungal infection caused by melanized fungi. It is usually an occupational mycosis affecting people in rural areas in tropical and subtropical regions. We present two cases of chromoblastomycosis in Mexican farmers, characterized by skin verrucous plaques. Direct examination with KOH 10% showed the presence of muriform cells. The fungal isolation was carried out in Sabouraud dextrose agar and molecular identification was achieved by 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. Fonseca monophora was identified in both cases. A therapy with itraconazole and terbinafine was used with a partial favorable response. However, patients did not return for medical examination after 4 months. The current status of the patients is unknown. We reported the first two cases of chromoblastomycosis caused by F. monophora in Mexico.
... Recently, the application of antimicrobial photodynamic therapy (PDT) has proved to be efficient in relieving CBM lesions. We previously reported two cases of CBM cured by 5-aminolevulinic acid (ALA)-mediated PDT combined with antifungal agents [2,3], and verified ALA-PDT had fungicidal effects on Fonsecaea monophora in vitro. Moreover, some researchers employed macrophages as a study model and found that ALA-PDT could enhance the fungicidal ability of macrophages stimulated by fungal conidia [4]. ...
... Clinical application of PDT in dermatology has been developed recently and focused on skin infection caused by many types of pathogens [11]. Especially, in our clinical practice, we observed that ALA-mediated PDT was working well in removing CBM lesions [2,3]. Here, we proved that treatment of ALA-mediated PDT, comparing with MB-mediated PDT, is safe for G. mellonella larvae. ...
Background:
New therapeutics are urgently needed for infectious diseases, especially for the fungal infection like Fonsecaea monophora. Photodynamic therapy has been showing antimicrobial activity on some pathogens. The combination of antimicrobial medicines and photodynamic therapy (PDT) might be a practical approach. However, whether the treatment of PDT could do benefits to the host immunity remains poorly documented.
Results:
In this study, Galleria mellonella larvae were employed as a model organism to evaluate the activity of PDT, and also to investigate the regulation of humoral immunity by PDT. Photosensitizer 5-aminolevulinic acid (ALA) was applied to the G. mellonella infection model. It was found that ALA-mediated PDT was non-toxic to G. mellonella, and could extend the median survival of infected larvae from 3 days to 5.5 days. We observed that larval hemocytes inhibited the growth of Candida albicans and Staphylococcus aureus, without any contribution by ALA-PDT. Furthermore, the application of ALA-PDT demonstrated the immunomodulation of larval innate immunity as increased hemocyte density counting, cell morphological transformation, and sensitivity to pathogens.
Conclusions:
G. mellonella could be considered as a useful model to study the immunoregulation of PDT. This model revealed that ALA-PDT positively defense against infections through inducing humoral immune responses of larvae.
... 141 There are also two reports of refractory chromoblastomycosis successfully treated with a combination of 5-ALA-PDT plus terbinafine or itraconazole, although new lesions developed after cessation of PDT. 142,143 A complete clinical and microbiological response was reached in two patients with cutaneous sporotrichosis. In one patient, intralesional PDT was combined with low doses of itraconazole, whilst the other patient received intralesional PDT using daylight illumination. ...
In addition to approved indications in non-melanoma skin cancer in immunocompetent patients, topical photodynamic therapy (PDT) has also been studied for its place in the treatment of, as well as its potential to prevent, superficial skin cancers in immune-suppressed patients, although sustained clearance rates are lower than for immune-competent individuals. PDT using a nanoemulsion of ALA in a daylight or conventional PDT protocol has been approved for use in field cancerization, although evidence of the potential of the treatment to prevent new SCC remained limited. High-quality evidence supports a strong recommendation for the use of topical PDT in photorejuvenation as well as for acne, refractory warts, cutaneous leishmaniasis and in onychomycosis, although these indications currently lack approvals for use and protocols remain to be optimized, with more comparative evidence with established therapies required to establish its place in practice. Adverse events across all indications for PDT can be minimized through the use of modified and low-irradiance regimens, with a low risk of contact allergy to photosensitizer prodrugs, and no other significant documented longer-term risks with no current evidence of cumulative toxicity or photocarcinogenic risk. The literature on the pharmacoeconomics for using PDT is also reviewed, although accurate comparisons are difficult to establish in different healthcare settings, comparing hospital/office-based therapies of PDT and surgery with topical ointments, requiring inclusion of number of visits, real-world efficacy as well as considering the value to be placed on cosmetic outcome and patient preference. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical photodynamic therapy in Dermatology prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.
... Typically, primary skin infection occurs after trauma and contact with contaminated materials. Photodynamic therapy (PDT) can be employed to treat superficial fungal infections [7][8][9]. PDT is usually based on the combination of a non-toxic photosensitizing agent (PS) with red light and molecular oxygen [10]. Our research group had previously developed an aluminum-phthalocyanine chloride nanoemulsion (NE-AlPcCl) which demonstrated inhibitory photodynamic activity on various human cancer cell lines [11] and on dogs hemangiosarcomas [12]. ...
... In C. neoformans H99 and in C. gattii NIH198, AlPcCl demonstrated a diffuse distribution pattern through the cytoplasm (Fig. 1-D5 and 1-F5). On the other hand, in the C. neoformans T1-5796 fluconazole resistant strain, the fluorescent signal was restricted to the periphery of the cells (Fig. 1-E5), possibly due to cell wall and membrane structural differences between these strains [7][8][9]. Photodynamic therapy led to a PS concentration-dependent cell inhibition when compared to control conditions (without PS and with PS but kept in the dark) for all the studied strains ( Fig. 2A-C). C. neoformans T1-5796 growth was only affected from 20 nM NE-AlPcCl (Fig. 2B), while C. gattii was responsive from the 5 nM concentration (Fig. 2C). ...
... Interestingly, in our study, the T1-5796 fluconazole resistant C. neoformans strain was more susceptible to the PDT-HDACi combination. This result can reflect the differences in gene expression and in cell metabolism the T1-5796 strain presents [7][8][9]. C. gattii normally is more resistant to conventional antifungal drugs, thus requiring a longer therapy regimen than C. neoformans [18]. Nonetheless, the former species was more responsive to PDT-HDACi than the C. neoformans strains. ...
Cryptococcosis is a disseminated infection caused mainly by C. neoformans and C. gattii. Limitations for the treatment involve the selection of isolates resistant to conventional antifungal drugs, prolonged treatment time and drugs side effects. This study evaluated the combined effect of histone deacetylase inhibitors (HDACi) and photodynamic therapy (PDT) on the growth of C. neoformans and C. gattii in vitro. Results showed that PDT inhibited yeasts proliferation and enhanced the HDACi-mediated cell viability impairment in Cryptococcus spp.
... A 50-year-old male farmer had complained of an itchy erythematous plaque surrounded with veracious hyperplasia on his right ankle ( Fig 1G) [18]. The lesion started 30 years ago after local trauma and grew over time. ...
... KOH examination of scales from lesions and histopathology of biopsy specimens were performed. Macroscopic and microculture of the isolates ensued [3,10,18]. DNA was extracted using 6% InStaGene Matrix (BioRad, Hercules, CA, USA). ...
... The clinical isolate was subjected to antifungal susceptibility testing according to CLSI guidelines (M38-A document), as previously described [3,18], and the MICs of antifungal combinations were determined according to previously described methods [3,18]. Itraconazole (Xian-Janssen Pharmaceutical Ltd. ...
Background
Chromoblastomycosis is a chronic skin and subcutaneous fungal infection caused by dematiaceous fungi and is associated with low cure and high relapse rates. In southern China, Fonsecaea monophora and Fonsecaea pedrosoi are the main causative agents.
Principal findings
We treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The isolates were assayed for susceptibility to antifungal drugs and ALA-PDT in vitro, revealing sensitivity to terbinafine, itraconazole and voriconazole, with ALA-PDT altering the cell wall and increasing reactive oxygen species production.
Conclusions
These results provide the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis.
