Forty years of chromoblastomycosis in Madagascar: a review.

Confirmed cases of chromoblastomycosis in Madagascar from 1955 through 1994 were studied retrospectively. The total number of cases reported was 1,343, of which 98.5% were confirmed by histopathology. Only 30.8% of the cases showed a positive cultivation on mycologic media, and Fonsecaea pedrosoi was identified from 61.8% of the fungal strains. Two distinct areas of endemic chromoblastomycosis, each with a characteristic ecosystem and a single species, are identified. Madagascar represents the most important focus of this fungal disease described to date in the world.