Tropical mycoses.
The most common tropical subcutaneous and deep mycoses include chromomycosis, sporotrichosis and mycetoma. All are commonly found in Natal and in other subtropical countries. Although blastomycosis is endemic in North America, only 4 cases have been identified in Natal during the last 25 years, and all presented with atypical clinical features. African histoplasmosis, caused by Histoplasma capsulatum var. duboisii and limited mainly to central and western Africa, has been found in only 1 patient in Natal. Paracoccidioidomycosis, though the most common deep mycosis in Latin America, is limited to that area and there is no experience of this disease in South Africa. Over the past 8 years, itraconazole has been used in clinical trials for all 3 mycoses. The results in sporotrichosis, non-meningeal blastomycosis and paracoccidioidomycosis suggest that for these diseases itraconazole may be the drug of choice. The results in histoplasmosis are encouraging, as are the results in chromomycosis, particularly those cases associated with Cladosporium carrionii. Where Fonsecaea pedrosoi is the causal agent and in mycetomas, however, successful management still remains a therapeutic problem. Enhanced efficacy by combining flucytosine and itraconazole was seen in 3 patients. Even over prolonged periods, itraconazole has an impressive safety profile. In the present series of 41 patients, no side-effects were observed, no adverse reactions occurred, and serum chemistry values remained within normal limits. It appears, therefore, that itraconazole, though not the final answer to management of deep mycoses, is certainly a major improvement on previous drugs.