[Tropical mycoses]

The most common tropical subcutaneous and deep mycoses include chromomycosis, sporotrichosis and mycetoma. All are commonly found in Natal and in other sub-tropical countries. Although blastomycosis is endemic in North America, only four cases have been identified in Natal during the last 25 years and all presented with atypical clinical features. African histoplasmosis caused by H. capsulatum var. duboisii and limited mainly to central and western Africa has been found in only one patient in Natal. Paracoccidioidomycosis, although the most common deep mycosis in Latin America, is limited to that area and we have no experience of this disease in South Africa. Over the past eight years itraconazole has been used in clinical trials for all these 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 C. carrionii. However, where F. pedrosoi is the causal agent and in mycetomas, successful management still remains a therapeutic problem. In our own experience and that of other using itraconazole, even over prolonged periods, this drug has an impressive safety profile. In our present series of 42 patients, no side effects were observed, no adverse reactions occurred and serum chemistry values remained within normal limits. It appears, therefore, that itraconazole, although not the final answer to management of the deep mycoses, is certainly a major improvement on previous drugs.