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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
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Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2011 | Month : August | Volume : 5 | Issue : 4 | Page : 865 - 866

Chromoblastomycosis: A Case Report

Shanthala G.B., Rudresh S.M., Nagarathnamma T.

Dept of Microbiology, Victoria hospital campus, Fort, BMC & RI, Bangalore, India.

Correspondence Address :
Dr. Nagarathnamma T., Prof and HOD,
Dept of Microbiology, Victoria hospital campus, Fort,
BMC & RI, Bangalore 560002, Karnataka, India.
Phone: 9449802700; E-mail:


Chromoblastomycosis is a chronic fungal infection which is caused by the phaeoid fungi which are commonly seen in the tropical and subtropical climates. This infection is thought to be secondary to trauma or autoinoculation. The aetiological agent is a small group of dermatiaceous (pigmented) fungi. At least five species of fungi have been recognized to cause chromoblastomycosis: Cladosporium carrionii, Fonsecaea compacta, Fonsecaea pedrosoi, Phialophora verrucosa, and Rhinocladiella aquaspersa. Here, we report a case of chromoblastomycosis from Karnataka, India. A 72 years old male patient presented with a history of a vegetating ulcer with crusting. The diagnosis of chromoblastomycosis was made by a demonstration of sclerotic bodies on KOH and the isolation of Cladophialophora carionii on culture. The unique feature in this case is that it responded to the medical line of treatment with fluconazole.


Chromoblastomycosis, Sclerotic body, Cladophialophora carrionii, Karnataka

Chromoblastomycosis is a slowly progressing localized fungal infection of the skin and the subcutaneous tissues which is caused by several pigmented fungi. This disease is commonly seen in the rural workers working in the tropical and the sub-tropical climates (1). Medlar reported the first case of Chromoblastomycosis in 1915 from Boston, in an Italian immigrant. He described the characteristic sclerotic bodies, which were thereafter named as the Medlar bodies, the other synonyms being “copper penny” bodies or “muriform” cells. In India, such cases have been reported from the sub-Himalayan belt and the coastal areas due to the hot and humid climates in those areas (1)(2)(3).

Case Report

An 80 years male, an agriculturist by occupation, from the Ramanagara district of Karnataka, presented with history of verrucous ulcer, with crusting over the medial aspect of the left leg since one year. He gave a history of an injury which was caused by a coconut shell one year back. He developed a wound at the site of the injury which initially healed but it soon developed into an ulcer. He took medication from local practitioners, but the lesion did not heal. There is history of recurrent secondary infections which used to subside after a course of antibiotics but lesion remained same.

The examination revealed a solitary 5 x 5cm, well defined, painless ulcer with excoriation of the surrounding skin, the surface being covered with granulation tissue, with black crusts [Table/Fig-1a]. The regional lymph nodes were not palpable. The systemic examination was normal. The blood investigations and the chest x-ray were within normal limits. A differential diagnosis of tuberculosis verrucosa cutis or subcutaneous mycosis was made.

The ulcer was cleaned with sterile saline and the crusts were collected. Gram staining and ZN staining were done with the swabs which were taken from the ulcer and they did not reveal any pathology. A direct 10% KOH mount of the black crusts over theulcer showed 10–15 μm, golden-brown coloured sclerotic bodies with a pseudoseptate arrangement (a pathognomonic feature of chromoblastomycosis) (Table/Fig 1). The specimen was cultured onto Sabouraud’s dextrose agar (SDA) with and without actidione. After three weeks of incubation at 25oC, both the SDA tubes showed velvety black flat colonies with a raised center and a black reverse (Table/Fig 1) . Microscopy showed septate hyphae with a cladosporium type of conidiation [Table/Fig 1e]. The conidia were oval with smooth walls and variable sizes and shield cells were also seen. With this background, the case was diagnosed as Chromoblastomycosis which was caused by Cladophialophora carrionii.

The patient was put on 150mg of oral fluconazole (once a week) and Terbinafine local ointment was also prescribed for 12 weeks. The patient showed improvement with a decrease in the size of the lesions after 2 months.


Chromoblastomycosis is a chronic disease of the skin and subcutaneous tissues which is caused by the phaeoid fungi of the genera Fonsecaea, Phialophora, Cladophialophora and Rhinocladiella, the commonest causative agent being Fonsecaea pedrosoi (2). Rarely may the Wangiella, Exophiala and the Chaetomium species cause the disease.

This disease affects the exposed parts of the body, generally the lower extremities and it is more common in males. It is most commonly seen in agricultural workers, following a traumatic implantation of the aetiologic agent beneath the epidermis (2)(3). The disease spreads to the adjacent skin, thus causing satellite lesions and it rarely metastasizes to other organs (4). The lesions are polymorphic or verrucoid. Secondary bacterial infections are common and repeated infections may lead to lymphatic fibrosis and elephantiasis of the legs (1). Recurrences are common and this disease has a potential to predispose for the development of squamous cell carcinoma.

Chromoblastomycosis must be differentiated from tuberculosis verrucosa cutis, leprosy, leishmaniasis, mycetoma and tertiary syphilis. The diagnosis is based on a demonstration of sclerotic bodies in the tissue sections/KOH mounts and on the isolation and identification of the causative agent.

There are various reports of chromoblastomycosis from different parts of India. Sharma A et al have reported 2 cases of chromoblastomycosis which were caused by Cladosporium carionii, from Assam, India.(6) To the best of our knowledge, this is the first report of Chromoblastomycosis from Karnataka, south India.

Various treatment modalities like cryotherapy, thermotherapy, laser therapy and surgical excision are available (1), (5). Generally, the disease responds poorly to the medical line of treatment (3), (4). Newer azoles like itraconazole and fluconazole have been tried, with success (1).

Physical treatment modalities like local thermotherapy, cryotherapy, electrosurgery and radiation have the advantage of reducing the duration of the therapy and these are also nonexpensiveTheir efficacies are largely anecdotal. But the evidence of clinical studies on these treatments is lacking.

Triazole derivatives and terbinafine are more effective in treating Fonsecaea pedrosoi and Cladosporium carrionii. Rui Yao et al have reported a case of chromoblastomycosis which was successfully treated with flucanozole (7). Sayal et al have reported a case of chromoblastomycosis which was treated with itraconazole, with significant improvement (4).The efficacy of these newer anti-fungal agents is based on case reports and open labeled trials. The optimal dose and the duration of the treatment are still to be defined.

The therapeutic success is related to the causative agent (C. carrionii is more sensitive than Fonsecaea pedrosoi), as well as to the clinical form and the severity of the chromoblastomycosis (8). In the present case, the size of the lesion was small and it was superficial and less severe. Hence, with early intervention, we were able to achieve a favourable therapeutic response. An early diagnosis of the cases and appropriate treatment helps in preventing the morbidity which is caused by this disease.


Chromoblastomycosis. In: Jagdish Chander author. Textbook of Medical Mycology, 3rd ed. New Delhi: Mehta publishers; 2009. pp.175-186.
Mohanty L, Mohanty P, Padhi T, Samantray S. Verrucous growth on leg. Indian J Dermatol Venereol Leprol 2006; 72:399-400.
Pradhan SV, Talwar OP, Ghosh A, Swami RM, Shiva RKC, Gupta S. Chromoblastomycosis in Nepal: A study of 13 cases. Indian J Dermatol Venereol Leprol 2007; 73:176-8.
Sayal SK, Prasad GK, Jawed KZ, Sanghi S, Satyanarayana S. Chromoblastomycosis. Indian J Dermatol Venereol Leprol 2002; 68:233-4.
Bonifaz A, Martinez-Soto E, carrasco-Gerard E, et al. Treatment of Chromoblastomycosis with itraconazole, cryosurgery, and a combination of both. Int Dermatol 1997; 36:542-547.
Sharma A, Hazarika NK, Gupta D. Chromoblastomycosis in Sub-Tropical regions of India. Mycopathologia. May 2010; Vol 169(5):381-6.
Yu YR, Gao L. Chromoblastomycosis successfully treated with fluconazole. Int J Dermat 1994;33(10):716-19.
Pe´Rez-Blanco M, Herna’ Ndez Valles R, Garci’A-Humbri’A L, Yegres F. Chromoblastomycosis in children and adolescents in the endemic area of the Falco´n State, Venezuela. Medical Mycology 2006;1-5.

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