From molecular advances to limited clinical impact: The persistent gap in chromoblastomycosis
5 affiliations
- 1Division of Infectious Diseases of Hospital Universitário Presidente Dutra da Universidade Federal do Maranhão (UFMA), Ebserh, São Luís, Maranhão, Brazil
- 2Instituto D’Or de Pesquisa e Ensino, IDOR, São Paulo, Brazil
- 3Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- 4Microbiology, Parasitology, and Pathology Post Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
- 5Department of Medicine, Federal University of Maranhão, São Luís, Maranhão, Brazil
Abstract
Background: Chromoblastomycosis (CBM) is a chronic implantation mycosis of considerable morbidity, first described more than a century ago, predominantly affecting rural populations in tropical and subtropical regions. Although historically associated with impoverished settings, an increasing number of cases have been reported in both endemic and non-endemic areas, including high-income countries, reflecting an underrecognized epidemiological landscape. Despite its burden, key metrics such as disability-adjusted life years (DALYs) remain undefined, as highlighted by recent global health initiatives. While advances in diagnosing and treating patients with CBM have been made, new technologies have not been incorporated into broader clinical and public health interventions. Methodology/principal findings: Herein, we synthesize recent advances in CBM, focusing on the expanding biodiversity of etiological agents driven by molecular taxonomy, the growing role of molecular diagnostics, and emerging therapeutic strategies. Novel genera and species have been identified, particularly among immunocompromised hosts, reshaping our understanding of host–pathogen interactions. Molecular tools, including PCR-based and genomic approaches, have improved species-level identification, although their availability remains largely restricted to reference centers. Therapeutically, extended-spectrum triazoles and terbinafine have shown the most consistent activity, while adjunctive immunomodulatory strategies, such as imiquimod, are emerging as promising alternatives. Conclusions and significance: CBM exemplifies a neglected tropical disease in which substantial progress in basic science has not translated into improved patient outcomes. Strengthening public health strategies, expanding access to simple and effective diagnostic tools, and prioritizing implementation-focused research are urgently needed to bridge this persistent gap. Author summary: Chromoblastomycosis (CBM) is a chronic fungal infection that mainly affects people living in rural and low-resource settings in tropical regions. Although it has been known for over a century, cases are increasingly reported in new geographic areas, including high-income countries, suggesting that its true distribution is underestimated. Despite its impact on patients’ quality of life, the overall burden of disease remains poorly quantified.
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BibTeX
@article{santos2026from,
title = {{From molecular advances to limited clinical impact: The persistent gap in chromoblastomycosis}},
author = {Daniel Wagner C. L. Santos and Dallas J. Smith and Vania Aparecida Vicente and Bruno Paulo Rodrigues Lustosa and Conceição de Maria Pedrozo e Silva de Azevedo},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014801},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014801},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From molecular advances to limited clinical impact: The persistent gap in chromoblastomycosis
AU - Daniel Wagner C. L. Santos
AU - Dallas J. Smith
AU - Vania Aparecida Vicente
AU - Bruno Paulo Rodrigues Lustosa
AU - Conceição de Maria Pedrozo e Silva de Azevedo
PY - 2026
DA - 2026/10/01
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014801
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014801
AB - Background: Chromoblastomycosis (CBM) is a chronic implantation mycosis of considerable morbidity, first described more than a century ago, predominantly affecting rural populations in tropical and subtropical regions. Although historically associated with impoverished settings, an increasing number of cases have been reported in both endemic and non-endemic areas, including high-income countries, reflecting an underrecognized epidemiological landscape. Despite its burden, key metrics such as disability-adjusted life years (DALYs) remain undefined, as highlighted by recent global health initiatives. While advances in diagnosing and treating patients with CBM have been made, new technologies have not been incorporated into broader clinical and public health interventions. Methodology/principal findings: Herein, we synthesize recent advances in CBM, focusing on the expanding biodiversity of etiological agents driven by molecular taxonomy, the growing role of molecular diagnostics, and emerging therapeutic strategies. Novel genera and species have been identified, particularly among immunocompromised hosts, reshaping our understanding of host–pathogen interactions. Molecular tools, including PCR-based and genomic approaches, have improved species-level identification, although their availability remains largely restricted to reference centers. Therapeutically, extended-spectrum triazoles and terbinafine have shown the most consistent activity, while adjunctive immunomodulatory strategies, such as imiquimod, are emerging as promising alternatives. Conclusions and significance: CBM exemplifies a neglected tropical disease in which substantial progress in basic science has not translated into improved patient outcomes. Strengthening public health strategies, expanding access to simple and effective diagnostic tools, and prioritizing implementation-focused research are urgently needed to bridge this persistent gap. Author summary: Chromoblastomycosis (CBM) is a chronic fungal infection that mainly affects people living in rural and low-resource settings in tropical regions. Although it has been known for over a century, cases are increasingly reported in new geographic areas, including high-income countries, suggesting that its true distribution is underestimated. Despite its impact on patients’ quality of life, the overall burden of disease remains poorly quantified.
SN - 1935-2735
SN - 1935-2727
ER -