Fig 1.
Clinical aspect of chromoblastomycosis lesions of patients before and after therapy.
The clinical aspect of chromoblastomycosis lesions of patients (a, c, e, g, i) improved after ALA-PDT irradiation combined with antifungal drugs (b, d, f, h, j).
Fig 2.
KOH examination of scales, histopathological examination of biopsies, and culture of isolates obtained from patient.
KOH wet mount of the sample from a lesion, showing muriform cells (×400) (a). Macroscopic appearance of a Fonsecaea colony (b). Microculture of F. nubica (×400) (c). Muriform cells on histopathological examination of a biopsy (hematoxylin-eosin stain) (d: ×100; e: ×400). Periodic acid-Schiff (PAS) stain revealed muriform cells (f).
Table 1.
MICs and FICIs of ITZ/TBF and VOR/TBF against isolates obtained from patients.
Table 2.
Photodynamic therapy combined with antifungal drugs for 5 cases of chromoblastomycosis.
Fig 3.
Antifungal effect of ALA-PDT/Itraconazole on F. monophora by transmission electron microscopy.
Before ALA-PDT and/or Itraconazole treatment, the fungal spores presented a round-shape morphology with a homogenous cytoplasm, linear plasma membrane (pm) and a cell wall (cw) with two distinct layers: an inner electron dense and outer fibrillar layer. (a) 0 M ALA, and without light irradiation; (b) 10 M ALA, and without light irradiation; (c) 0 M ALA, and with light irradiation; (d) 10 M ALA, and with light irradiation; (e) 1μg/mL Itraconazole; (f) 1μg/mL Itraconazole, and 10 M ALA with light irradiation.
Fig 4.
Antifungal effect of ALA-PDT/Itraconazole on F. monophora by ROS.
The fluorescence intensity of ROS was measured by flow cytometry, and ROS increased significantly after ALA-PDT and/or Itraconazole. (a) 0 M ALA, and without light irradiation; (b) 10 M ALA, and without light irradiation; (c) 0 M ALA, and with light irradiation; (d) 10 M ALA, and with light irradiation; (e) 1μg/mL Itraconazole; (f) 1μg/mL Itraconazole, and 10 M ALA with light irradiation.
Fig 5.
Plate counts to quantify the number of dead verses live cells.
Plates of F. monophora were evaluated for killing effects of ALA-PDT and/or Itraconazole, and CFU counting was made. (a) 0 M ALA, and without light irradiation; (b) 10 M ALA, and without light irradiation; (c) 0 M ALA, and with light irradiation; (d) 10 M ALA, and with light irradiation; (e) 1μg/mL Itraconazole; (f) 1μg/mL Itraconazole, and 10 M ALA with light irradiation; (g) the statistics of the antifungal effect of ALA-PDT and/or Itraconazole in F. monophora (***P<0.01).