Photodynamic therapy combined with antifungal drugs against chromoblastomycosis and the effect of ALA-PDT on Fonsecaea in vitro

• Published in: PLoS neglected tropical diseases 2019-10, Vol.13 (10), p.e0007849-e0007849
• Main Authors: Hu, Yongxuan, Qi, Xinyu, Sun, Hengbiao, Lu, Yan, Hu, Yanqing, Chen, Xuyang, Liu, Kangxing, Yang, Yemei, Mao, Zuhao, Wu, Zhong, Zhou, Xianyi
• Format: Article
• Language: English
• Subjects: Acids; Aminolevulinic acid; Aminolevulinic Acid - therapeutic use; Antifungal agents; Antifungal Agents - therapeutic use; Ascomycota - drug effects; Ascomycota - radiation effects; Biology and Life Sciences; Cell walls; China; Chromoblastomycosis - drug therapy; Chromoblastomycosis - pathology; Chromoblastomycosis - radiotherapy; Chromomycosis; Chronic infection; Combination drug therapy; Dermatology; Disease; DNA, Fungal; Drugs; Family medical history; Female; Fungal infections; Fungi; Fungicides; Health aspects; Hospitals; Humans; Infection; Itraconazole; Itraconazole - therapeutic use; Lesions; Male; Medicine and Health Sciences; Microbial Sensitivity Tests; Middle Aged; Mycoses; Pathogens; Photochemotherapy; Photochemotherapy - methods; Photodynamic therapy; Physical Sciences; Reactive oxygen species; Skin; Skin - metabolism; Terbinafine; Terbinafine - therapeutic use; Therapy; Tropical diseases; Voriconazole; Voriconazole - therapeutic use
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0007849

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. 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. 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.