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Open Access Highly Accessed Case report

Chromoblastomycosis after a leech bite complicated by myiasis: a case report

Günther Slesak12*, Saythong Inthalad13, Michel Strobel4, Matthias Marschal5, Martin JR Hall6 and Paul N Newton78

Author Affiliations

1 SFE Medical Project, Luang Namtha, Lao PDR

2 Tropenklinik Paul-Lechler-Krankenhaus, 72076 Tübingen, Germany

3 Luang Namtha Provincial Hospital, Luang Namtha, Lao PDR

4 Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR

5 Interfakultäres Institut für Mikrobiologie und Infektionsmedizin, Tübingen, Germany

6 Department of Entomology, Natural History Museum, Cromwell Road, London, UK

7 Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR

8 Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, England, UK

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BMC Infectious Diseases 2011, 11:14  doi:10.1186/1471-2334-11-14

Published: 12 January 2011

Abstract

Background

Chromoblastomycosis is a chronic mycotic infection, most common in the tropics and subtropics, following traumatic fungal implantation.

Case presentation

A 72 year-old farmer was admitted to Luang Namtha Provincial Hospital, northern Laos, with a growth on the left lower leg which began 1 week after a forefoot leech bite 10 years previously. He presented with a cauliflower-like mass and plaque-like lesions on his lower leg/foot and cellulitis with a purulent tender swelling of his left heel. Twenty-two Chrysomya bezziana larvae were extracted from his heel. PCR of a biopsy of a left lower leg nodule demonstrated Fonsecaea pedrosoi, monophora, or F. nubica. He was successfully treated with long term terbinafin plus itraconazole pulse-therapy and local debridement.

Conclusions

Chromoblastomycosis is reported for the first time from Laos. It carries the danger of bacterial and myiasis superinfection. Leech bites may facilitate infection.