Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review.

Background: Chromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries.

Objectives: The primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test.

Methods: MEDLINE, LILACS and Scielo databases were consulted using the terms "chromoblastomycosis" AND "diagnosis". The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods.

Results: Considering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S =  50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S  of 36% - 99%; and Sp  of 80% - 100%; while the intradermal test showed S  of 83.3% - 100% and Sp  of 99.4% - 100%.

Study Limitations: The small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis.

Conclusions: Direct mycological examination, culture, intradermal test and serology show sensitivity and specificity values ​​for the diagnosis of chromoblastomycosis with no significant difference between the studies.