title: Chromoblastomycosis after a leech bite complicated by myiasis: a case report.
abstract: BACKGROUND
  Chromoblastomycosis is a chronic mycotic infection, most common in the tropics and subtropics, following traumatic fungal implantation.
  
  
  METHODS
  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.
authors.affiliation: SFE Medical Project, Luang Namtha, Lao PDR. guentherslesak@web.de
authors.forename: Günther
authors.initials: G
authors.lastname: Slesak
authors.forename: Saythong
authors.initials: S
authors.lastname: Inthalad
authors.forename: Michel
authors.initials: M
authors.lastname: Strobel
authors.forename: Matthias
authors.initials: M
authors.lastname: Marschal
authors.forename: Martin
authors.initials: M
authors.lastname: Hall
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
mesh_terms: D000368:Aged; D000818:Animals; D001203:Ascomycota / Q000235:genetics / Q000302:isolation & purification; D001733:Bites and Stings / Q000150:complications* / Q000469:parasitology; D002862:Chromoblastomycosis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D004175:Diptera / Q000502:physiology; D005260:Female; D006801:Humans; D007865:Leeches / Q000502:physiology; D009198:Myiasis / Q000150:complications* / Q000469:parasitology