Primeras recomendaciones de consenso SLANH - COLABIOCLI / Primeiras Recomendações de Consenso SLANH - COLABIOCLI / (Sociedad Latinoamericana de Nefrología e Hipertensión - Confederación Latinoamericana de Bioquímica Clínica) / Informe de la tasa de filtración glomerular estimada junto a la determinación de la creatininemia en población adulta / First SLANH-COLABIOCLI Consensus Recommendations

Resumen La enfermedad renal crónica (ERC) es de alta prevalencia en América Latina y en todo el mundo. Se estima que entre 10 y 20% de la población adulta es portadora de ERC y su prevalencia va en aumento. La ERC progresa en forma silenciosa. Su diagnóstico temprano y oportuno permite iniciar un tratamiento efectivo, en la mayoría de los casos, para detener la enfermedad. Desde hace mucho tiempo, el análisis de la creatininemia es la principal prueba utilizada para valorar la función renal, pero su confiabilidad es limitada. De acuerdo con las recomendaciones de las GUIAS KDOQI del año 2002 la tasa de filtración glomerular estimada (TFGe) obtenida a través de fórmulas, se estableció como una de las herramientas principales para detectar la enfermedad renal de manera precoz, ya que alerta de forma precisa al médico y al equipo de salud sobre el nivel de función renal del paciente. La detección de una TFGe disminuida (menor de 60 mL/min/1,73 m2) es clínicamente relevante, ya que permite establecer el diagnóstico de enfermedad renal en adultos. En el año 2022, en una encuesta realizada por SLANH y COLABIOCLI dirigida a los laboratorios de análisis clínicos de América Latina (n: 237), el 49% de los mismos no informaban la TFGe rutinariamente. En base a esta realidad SLANH y COLABIOCLI elaboraron estas recomendaciones de consenso en referencia al uso de la TFGe.

Abstract Chronic kidney disease (CKD) has a high prevalence worldwide and in Latin America (10 to 20% of the adult population) and is increasing. CKD progresses silently. Opportune diagnosis and treatment are effective in most cases to improve outcomes. Serum creatinine was the main test to assess kidney function, but its reliability is limited. Through the KDOQI Guidelines 2002, the estimated glomerular filtration rate (eGFR) obtained from equations was established as one of the main tools for the early detection of kidney disease in clinical practice. The detection of a decreased eGFR (less than 60 mL/min/1.73 m2) is clinically relevant. This cut-off level establishes the diagnosis of kidney disease in adults. In 2022 SLANH and COLABIOCLI conducted a survey among the clinical laboratories from Latin America. The survey included 237 laboratories, 49% of which did not routinely report the eGFR. Based on this situation, SLANH and COLABIOCLI have elaborated the following consensus recommendations regarding the use of eGFR.

Resumo A doença renal crônica (DRC) é altamente prevalente na América Latina e em todo o mundo. Estima-se que entre 10 e 20% da população adulta seja portadora de DRC e sua prevalência esteja aumentando. A DRC progride silenciosamente. Seu diagnóstico precoce e oportuno permite iniciar um tratamento eficaz, na maioria dos casos, para estancar a doença. Faz muito tempo, a análise da creatinina tem sido o principal teste usado para avaliar a função renal mas sua confiabilidade é limitada. De acordo com as recomendações dos GUIAS KDOQI do ano de 2002, a estimativa da taxa de filtração glomerular (eGFR), obtida por meio de fórmulas, consolidou-se como uma das principais ferramentas para a detecção precoce da doença renal, visto que alerta com precisão ao médico e ao equipe de saúde sobre o nível de função renal do paciente. A detecção de uma eGFR diminuída (inferior a 60 mL/min/1,73 m2) é clinicamente relevante, pois permite estabelecer o diagnóstico de doença renal em adultos. No ano de 2022, em pesquisa realizada pela SLANH e COLABIOCLI dirigida a laboratórios de análises clínicas da América Latina (n: 237), 49% deles não relataram rotineiramente eGFR. Com base nessa realidade, SLANH e COLABIOCLI prepararam essas recomendações de consenso sobre o uso de eGFR.

Enfermedad renal crónica en mujeres embarazadas / Chronic kidney disease in pregnant women

Resumen La enfermedad renal crónica (ERC), definida como una alteración estructural o funcional renal que persiste por más de 3 meses con o sin deterioro de la función renal o como un filtrado glomerular (FG) <60 mL/min/1,73 m2 sin otros signos de enfermedad renal, es una condición prevalente en la población general; sin embargo, no es tan frecuente en mujeres embarazadas. A pesar de su baja frecuencia en gestantes, el antecedente de enfermedad renal se asocia con peores desenlaces maternos y fetales cuando se presenta ERC. Las fórmulas estándar (CKD-EPI, Cockroft-Gault y MDRD) utilizadas para determinar la tasa de filtrado glomerular en población no obstétrica tienen poca precisión en las embarazadas debido a que subestiman la función renal en aproximadamente un 20 %. Ante esto, el aclaramiento de creatinina medido utilizando recolecciones de orina de 24 horas y la estimación de creatinina sérica que se correlaciona estrechamente con el aclaramiento de inulina (estándar de oro) son opciones que pueden utilizarse durante el embarazo. Asimismo, el reconocimiento temprano de la enfermedad, la optimización de las estrategias de nefroprotección, el evitar las drogas nefrotóxicas y la instauración de un tratamiento específico para la etiología garantizan una mayor sobrevida y un menor número de complicaciones derivadas de la enfermedad renal.

Abstract Chronic Kidney Disease, defined as a renal structural or functional alteration that persists for more than 3 months, with or without deterioration of renal function, or a glomerular filtration rate (GFR) <60 ml / min / 1.73 m2 without other signs of Kidney disease is a prevalent condition in the general population, however, it is not so common to find it in pregnant women. However, a history of kidney disease is associated with worse maternal and fetal outcomes. The standard formulas (CKD-EPI, Cockroft-Gault, and MDRD) used in the non-obstetric population have poor precision in determining glomerular filtration rate, because they underestimate kidney function by approximately 20 %. Creatinine clearance measured using 24-hour urine collections and serum creatinine estimate closely correlates with inulin clearance ("gold standard") and can be used during pregnancy. Early recognition of the disease, optimization of nephroprotection strategies, avoiding nephrotoxic drugs and specific treatment of the etiology, will guarantee a longer survival and fewer complications derived from kidney disease.

El costo de la belleza: Comunicación de seis casos clínicos con infección por micobacterias atípicas secundario a inyecciones intradérmicas y reacción a un dermoimplante de origen desconocido / The cost of beauty: six cosmetological clinical cases due to atypical mycobacterial infection secondary to intradermal injections plus reaction to foreign dermal implant

Resumen Comunicamos seis casos de mujeres quienes, tras la aplicación mediante mesoterapia con plasma rico en plaquetas, así como de un material de relleno intradérmico de origen desconocido, desarrollaron una infección en los sitios de inyección asociada a Mycobacterium massiliense, así como granulomas con reacción a cuerpo extraño. Aunque los cultivos fueron negativos, se logró la identificación del microorganismo por extracción de ADN de tejidos blandos obtenido por biopsia y posterior secuenciación del producto obtenido. Debido a la gran similitud en los cultivos de M. massiliense con la especie relacionada Mycobacterium abscessus, y a que tienen diferente respuesta terapéutica, las técnicas moleculares de diagnóstico son una opción real a considerar para administrar en forma precoz el tratamiento específico contra el patógeno y evitar la progresión de la infección.

We report six cases of female patients who, after the application by mesotherapy with platelet-rich plasma, as well as of an intradermal filler material of unknown origin, developed infection at the injection sites associated to Mycobacterium massiliense, as well as granuloma with reaction to foreign body. Although the cultures were negative, the identification of the microorganism was achieved by extraction of soft tissue DNA obtained by biopsy and sequencing the obtained product, with which the therapy was redirected against the particular species. Due to the great similarity in the culture between M. massiliense with the related species M. abscessus, to the required time for its growth, and to the different therapeutic response of each strain, molecular diagnostic techniques are a real option to consider to administer in an early way the appropriate treatment against the pathogen and prevent infection progression.

Isolation of Malassezia spp. in HIV-positive patients with and without seborrheic dermatitis

Abstract Background Malassezia, a skin saprophyte, is frequently isolated from patients with seborrheic dermatitis, which is one of the most common dermatoses in HIV-infected patients. Its role in pathophysiology has not been defined. Objective To determine whether patients living with HIV and seborrheic dermatitis have more Malassezia than those without seborrheic dermatitis. Method This is an descriptive, observational, prospective cross-sectional study to which all adult patients living with HIV that attend the infectious disease outpatient clinic at the Dr. Manuel Gea González General Hospital were invited. Patients presenting with scale and erythema were included in Group 1, while patients without erythema were included in Group 2. Samples were taken from all patients for smear and culture. Results Thirty patients were included in each group. All patients with seborrheic dermatitis had a positive smear, with varying amounts of yeasts. In the control group, 36.7% of patients had a negative smear. The results are statistically significant, as well as the number of colonies in the cultures.Study limitations The study used a small sample size and the subspecies were not identified. Conclusions Patients with clinical manifestations of seborrheic dermatitis have larger amounts of Malassezia. Further studies need to be performed to analyze if the greater amount is related to imbalances in the microbiota of the skin.

Chromoblastomycosis caused by Rhinocladiella aquaspersa: first case report in Guatemala

Abstract The authors report a case of 40-year-old male patient with a five-year history of chromoblastomycosis on his right leg. Diagnosis was performed by direct 40% KOH exam of skin scales, culture with micro- and macromorphologic analysis, and genotypic characterization (sequencing of a fragment of the ITS region and phylogenetic analysis) of the isolated fungus. Rhinocladiella aquaspersa was identified as the etiological agent. Initially, the treatment was with oral itraconazole 200 mg/day for one year. However, the presence of "sclerotic cells" with filaments ("Borelli spiders") resulted in a change of medical treatment: a higher dose of itraconazole (400 mg/day) and surgery, achieving clinical and mycological cure in one year. This is the first report of chromoblastomycosis caused by R. aquaspersa in Guatemala.

Rosácea infantil / Childhood rosácea

Resumen Introducción: La rosácea es una enfermedad inflamatoria crónica de la piel que generalmente afecta adultos. Rara vez se ha reportado en niños, aunque ambos subtipos comparten las mismas características clínicas. Caso clínico: Se reporta el caso de una paciente de 10 años de edad con dermostosis que afecta las mejillas y la nariz. La lesión está caracterizada por eritema, pápulas, pústulas, cicatrices de 2 años de evolución, así como conjuntivitis bilateral, blefaritis y opacidad corneal. Presentó exacerbaciones recurrentes de las lesiones cutáneas y síntomas oculares relacionados con la exposición solar. La paciente respondió muy bien a la terapia con antibióticos tópicos y sistémicos. Conclusiones: La rosácea infantil debe distinguirse de otros trastornos faciales eritematosos con mayor frecuencia, como el acné, la dermatitis perioral granulomatosa y la sarcoidosis. La distribución de las lesiones faciales papulopustulares junto con la presencia de telangiectasias, rubor y los hallazgos oculares permiten la diferenciación de la rosácea de otras erupciones faciales.

Abstract Background: Rosacea is a chronic inflammatory skin condition that usually occurs in adults and rarely has been reported in children, although both subtypes share the same clinical characteristics. Case report: A 10-year-old female presented dermostosis on the face, affecting cheeks and nose, characterized by erythema, papules, pustules, scars of two years of evolution, as well as bilateral conjunctivitis, blepharitis and corneal opacity. She referred recurrent exacerbations and partial remission of cutaneous lesions and ocular symptoms related to sun exposure. She responded dramatically to systemic and topical antibiotics. Conclusions: Childhood rosacea should be distinguished from other most common erythematous facial disorders, such as acne, granulomatous perioral dermatitis, and sarcoidosis. The distribution of papulopustular facial lesions together with the presence of telangiectasia, flushing and the ocular findings allow the differentiation of rosacea from other facial eruptions.

Frequency of mixed onychomycosis with total nail dystrophy in patients attended in a Guatemalan Dermatology Center / Frecuencia de onicomicosis mixta con distrofia ungueal total en pacientes atendidos en un Centro de Dermatología de Guatemala

Introduction: Onychomycosis are fungal nail infections that can be caused by dermatophytes, non-dermatophytic molds and yeasts, which are capable of breaking down keratin. Mixed onychomycosis are a controversial subject and they are the outcome of the combination of two dermatophytes, dermatophytes/nondermatophytic molds or dermatophytes/yeast. Objetives: To determine the frequency of total dystrophic onychomycosis caused by more than one etiological agent (mixed onychomycosis) in outpatients from a Dermatologic Center in Guatemala and to establish the characteristics associated with this fungal infection. Methods: Prospective observational study from August to December of 2012. Nail samples were obtained from patients with total dystrophic onychomycosis to identify the causal agents by culture in Sabouraud dextrose and Mycosel® agar. Results: 32 of 130 patients had mixed onychomycosis. 68.5% were associated to tinea pedis. The most common association was between T. rubrum + Candida, T. rubrum + M. canis and T. rubrum + opportunist fungi. Conclusions: Mixed onychomycosis represent 25% of the total dystrophic onychomycosis in Guatemala. We observed an important relationship between diabetes and the main association was T. rubrum with Candida spp.

Introducción: Las onicomicosis son infecciones fúngicas de las uñas que pueden ser causadas por dermatofitos, mohos no dermatofitos y levaduras, que son capaces de degradar la queratina. Las onicomicosis mixtas son un tema polémico y es el resultado de la combinación de dos dermatofitos, dermatofitos / mohos no dermatofitos o dermatofitos / levadura. Objetivos: Determinar la frecuencia de la onicomicosis distrófica total causada por más de un agente etiológico (onicomicosis mixta) en pacientes ambulatorios de un Centro Dermatológico en Guatemala y establecer las características asociadas a esta infección fúngica. Métodos: Estudio observacional prospectivo de agosto a diciembre de 2012. Se obtuvieron muestras de uñas de pacientes con onicomicosis distrófica total para identificar los agentes causales en cultivo de agar dextrosa Sabouraud y Mycosel®. Resultados: 32 de 130 pacientes tenían onicomicosis mixta. 68.5% se asociaron a tinea pedis. La asociación más común fue entre T. rubrum + Candida, T. rubrum + M. canis y T. rubrum + hongos oportunistas. Conclusiones: La onicomicosis mixta representa el 25% de la onicomicosis distrófica total en Guatemala. Observamos una relación importante entre la diabetes y la asociación principal fue T. rubrum con Candida spp.

Tiña incógnita y granuloma de Majocchi adquirido de un erizo. Un caso mexicano / Mexican case of tinea incognito and granuloma de Majocchi acquired from a hedgehog

Resumen Las mascotas exóticas, como el erizo de tierra, son capaces de transmitir al ser humano diferentes infecciones, como salmonelosis, micobacterias, protozoos como Cryptosporidium parvum, y dermatofitosis. Presentamos el caso de un paciente adulto masculino, que recientemente había adquirido un erizo de tierra, que presentó en la mano una lesión de tiña incógnita y un granuloma de Majocchi. Se identificó el agente etiológico como Trichophyton erinacei, por cultivo micológico y biología molecular. El paciente se trató con terbinafina por vía oral, por seis meses, con excelente respuesta.

Exotic pets, such as the ground hedgehog, are capable of transmitting to the human being different zoonoses, such as salmonellosis, mycobacteria, protozoa such as Cryptosporidium parvum, and dermatophytosis. We present the case report of a male adult patient, who had recently acquired a ground hedgehog, who presented in his hand a ringworm lesion incognito and a Majocchi granuloma. The etiological agent was identified as Trichophyton erinacei by mycological culture and molecular biology. The patient was treated with terbinafine oral, with excellent response.

Onychomycosis due to opportunistic molds

Abstract BACKGROUND: Onychomycosis are caused by dermatophytes and Candida, but rarely by non- dermatophyte molds. These opportunistic agents are filamentous fungi found as soil and plant pathogens. OBJECTIVES: To determine the frequency of opportunistic molds in onychomycosis. METHODS: A retrospective analysis of 4,220 cases with onychomycosis, diagnosed in a 39-month period at the Institute of Dermatology and Skin surgery "Prof. Dr. Fernando A. Cordero C." in Guatemala City, and confirmed with a positive KOH test and culture. RESULTS: 32 cases (0.76%) of onychomycosis caused by opportunistic molds were confirmed. The most affected age group ranged from 41 to 65 years (15 patients, 46.9%) and females were more commonly affected (21 cases, 65.6%) than males. Lateral and distal subungual onychomycosis (OSD-L) was detected in 20 cases (62.5%). The microscopic examination with KOH showed filaments in 19 cases (59.4%), dermatophytoma in 9 cases (28.1%), spores in 2 cases (6.25%), and filaments and spores in 2 cases (6.25%). Etiologic agents: Aspergillus sp., 11 cases (34.4%); Scopulariopsis brevicaulis, 8 cases (25.0%); Cladosporium sp., 3 cases (9.4%); Acremonium sp., 2 cases (6.25%); Paecilomyces sp., 2 cases (6.25%); Tritirachium oryzae, 2 cases (6.25%); Fusarium sp., Phialophora sp., Rhizopus sp. and Alternaria alternate, 1 case (3.1%) each. CONCLUSIONS: We found onychomycosis by opportunistic molds in 0.76% of the cases and DLSO was present in 62.5%. The most frequent isolated etiological agents were: Aspergillus sp. and Scopulariopsis brevicaulis. .

Coccidioidomicosis cutánea: Comunicación de seis casos mexicanos / Cutaneous coccidioidomycoses: Six mexican cases report

Coccidioidomycosis is a systemic airborne mycosis that may involve secondarily other organs through systemic dissemination. Fungi Coccidioides immitis and C. posadasii are the etiologic agents. The former is ubiquitous from the area of California in North America, and the latter is found elsewhere in the world. Primary cutaneous infection is rare. We present six Mexican male cases, residents of Tijuana B.C. Three of them with primary pulmonary infection and further cutaneous dissemination, and three cases of primary cutaneous coccicioidomycosis. In half the cases C. posadasii was isolated. The clinical suspicion is basic for reaching the diagnosis, and we must always keep in mind that the cutaneous manifestations are widely varied and that the lesions are more severe when systemic dissemination occurs.

La coccidioidomicosis es una micosis con vía de entrada inhalatoria que puede tener manifestaciones secundarias en otros órganos, y diseminación sistèmica. Se han identificado como agentes etiológicos a Coccidioides immitis y C. posadasii, El primero está presente en California de Norteamérica y el segundo en cualquier otra región del mundo. La infección cutánea primaria es una presentación poco común. Presentamos seis casos clínicos mexicanos, de sexo masculino, residentes de la ciudad de Tijuana, B.C. Tres de ellos con infección pulmonar primaria y diseminación cutánea y tres cutáneos primarios. En la mitad de los casos se logró aislar C. posadasii. La sospecha clínica es fundamental para llegar al diagnóstico ya que las manifestaciones cutáneas son muy variadas, y ante diseminación sistèmica las lesiones cutáneas son más graves.

Microsporum spp. onychomycosis: disease presentation, risk factors and treatment responses in an urban population

BACKGROUND: Dermatophytes are the main causative agent of all onychomycosis, but genus Microsporum is infrequent and the risk of acquiring the infection is often associated with exposure to risk factors. OBJECTIVES: To describe clinical characteristics of onychomycosis due to Microsporum onychomycosis in an urban population. METHODS: This was a retrospective analysis of the epidemiological and clinical features of 18Microsporum onychomycosis cases of a total of 4220 of onychomycosis cases diagnosed between May 2008 and September 2011 at the tertiary referral center for mycology in Guatemala. RESULTS: Eighteen cases of Microsporum onychomycosis (M. canis, n=10; M. gypseum, n=7; M. nanum, n=1) were identified (prevalence=0.43%). Infection was limited to nails only and disease duration ranged from 1 month to 20 years (mean=6.55 years). The toenails were affected in all cases except for a single M. gypseum case of fingernail. The most common clinical presentation was distal lateral subungual onychomycosis (12/18) followed by total dystrophic onychomycosis (5/18), and superficial white onychomycosis (1/18). M. gypseumpresented in 6 cases as distal lateral subungual onychomycosis and in 1 case like total dystrophic onychomycosis. Five cases (27.78%) were associated with hypertension, diabetes, and psoriasis. Treatment with terbinafine or itraconazole was effective. Two cases of M. canisdistal lateral subungual onychomycosis responded to photodynamic therapy. CONCLUSION: This is the largest reported series of Microsporum onychomycosis and demonstrates such a disease in an urban population. In 27.78% of the cases risk factors for infection were associated to comorbid states. We also report the first 2 cases of successfully treated M. canis onychomycosis with photodynamic therapy and a rare case of M. canis associated dermatophytoma. .

Oral Candida spp carriers: its prevalence in patients with type 2 Diabetes Mellitus / Portadores de Candida spp na cavidade oral: a sua prevalência em pacientes com diabetes mellitus tipo 2

BACKGROUND: Prevalence of oral candidiasis in diabetic patients is 13.7-64%. Candida albicans was the most frequently isolated species (75-86.5%). OBJECTIVE: To obtain the prevalence of Candida carriers among patients with type 2 diabetes mellitus to identify the species of the yeast. Study design: It is an open, observational, descriptive, cross-sectional, and prospective study. METHODS: We included voluntary patients from the National Diabetes Marathon and performed a blood glucose measurement, sialometry test, Gram-stained exfoliative cytology, and culture on Sabouraud dextrose agar and CHROMagar Candida TM. Results were analyzed using descriptive statistics. RESULTS: We examined 141 patients (mean age 57 years): 103 women (73%) and 38 men (26.9%). Exfoliative cytology was positive in 32 cases (23 with oral lesions); 78 had oral lesions but no Candida (93.9%). Candida was isolated in 58 patients (41.1%), 21 (45.6 %) had blood glucose greater than 126 mg/dl, and 37 (38.9%) had less than 126 mg/dl. The most frequent species was C. albicans (82.7%). Forty-two Candida carriers had salivary flow greater than 20 mm (72.4%), and 16 (27.5%) had hyposalivation. Candida was isolated in 25 of 79 patients with dental prosthesis (31.6%), 9 of 15 were smokers (60%), and 22 of 71 had symptoms (30.9%). CONCLUSIONS: Prevalence of oral Candida carriers in patients with type 2 diabetes mellitus in Mexico was similar to that found in other countries; exfoliative cytology was effective in finding Candida; salivary flow rate, use of prosthesis, and presence of oral lesions and symptoms were similar in oral Candida carriers and negative patients. Most smokers were Candida carriers. .

FUNDAMENTOS: A prevalência de candidíase oral em pacientes diabéticos é de 13,7- 64%. A espécie mais frequentemente isolada é Candida albicans(75-86,5%). OBJETIVO: Obter a prevalência de portadores de Candida em pacientes com diabetes mellitus tipo 2 para identificar as espécies da levedura. Desenho do estudo: Aberto, observacional, descritivo, transversal e prospectivo. MÉTODOS: Incluímos pacientes voluntários dentro da Maratona Nacional do Diabetes e realizamos medida da glicose sanguínea, teste sialométrico, coloração de Gram da citologia esfoliativa, cultura em ágar Sabouraud dextrose e CHROMagar Candida TM. Os resultados foram analisados com estatística descritiva. RESULTADOS: Foram examinados 141 pacientes (média de idade de 57 anos), 103 mulheres (73%) e 38 homens (26,9%). A citologia esfoliativa foi positiva em 32 casos (23 com lesão oral), 78 tinham lesão oral, mas não tinham Candida (93,9%). Candida foi isolado em 58 pacientes (41,1%), 21(45,6%) tiveram glicemia superior a 126 mg / dl e 37 (38,9%) tiveram glicemia inferior a 126 mg / dl. A espécie mais frequente foi C. albicans (82,7%). 42 portadores de Candida tinham fluxo salivar maior que 20 mm(72,4%) e 16(27,5%) tinham hiposalivação. Candida foi isolado em 25 de 79 pacientes com prótese dentária (31,6%), 9 de 15 fumantes (60%), e 22 de 71 com sintomas (30,9%). CONCLUSÕES: A prevalência de portadores de Candida oral em pacientes com diabetes mellitus tipo 2 no México foi semelhante a outros países; citologia esfoliativa foi efetiva em encontrar Candida; fluxo salivar, uso de prótese, presença de lesão oral ...

Aeromycological study at the intensive care unit of the "Dr. Manuel Gea Gonzalez" General Hospital

INTRODUCTION: An aeromycological study verifies the presence and quantifies the concentration of fungal propagules in the air. It is very important in the hospital setting because of the increasing numbers of immunosuppressed and severely ill patients. The objective of this study was to determine the concentration of fungi in the air of the intensive care unit (ICU) of "Dr. Manuel Gea González" General Hospital. METHODS: This is a descriptive, observational cross-sectional study. Air samples were obtained with a single stage Thermo-Andersen Viable Particle Sampler (Thermo Electron Corporation -Massachusetts, U.S.A.) in a Petri dish with potato dextrose agar for 15 minutes at two different times (morning and afternoon) and heights (1 and 1.5 meters). The Petri dishes were incubated for five to seven days at 27ºC, the number of colonies was counted, and the total CFU/m³ was determined. The isolated fungal genera were identified by morphological features. Epi Info v. 3.4.3 © was used for statistical analysis. RESULTS: The mean concentration of fungi in the air of the ICU was 85.08 ± 29.19 CFU/m³; while in the outside air it was 84.3 ± 17.23 CFU/m³ (p = 0.96). The fungi isolated were: Cladosporium spp., Penicillium spp., Aspergillus spp. (non-fumigatus), Fusarium spp., Exophiala spp., Syncephalastrum spp., and Acremonium spp. DISCUSSION: Fungal spores were found in the air of the ICU and Cladosporium spp. was the most frequently isolated fungi. There was no difference according to sampling time or height.

Dermatitis perioral en la infancia: presentación de dos casos e importancia de la correlación clínico patológica / Perioral dermatitis in childhood: report of two cases and importance of clinical pathological correlation

Con el nombre de dermatitis periororal se conocen a un grupo de dermatosis inflamatorias y eruptivas que predominan en mujeres jóvenes, y con menos frecuencia en niños. Se caracterizan por pápulas y pústulas pequeñas en una distribución periorificial, predominantemente alrededor de la boca. Puede estar relacionada con el uso de esteroides tópicos. Se presentan dos casos clínicos: Caso 1. Paciente de sexo masculino, de 12 años de edad, con lesiones papulopustulares periorales, de un mes de evolución. Se realizó el diagnóstico de foliculitis por Malassezia sp. en base a la histopatología y la tinción de Gram. Se dio tratamiento con Itraconazol, 200 mg, por vía oral, durante 14 días (5 mg/kg), y crema de ketoconazol al 2%, dos veces al día. Se obtuvo resolución completa en dos meses. Caso 2. Paciente de sexo femenino, de nueve años de edad, con dos meses de evolución con pápulas periorales tratadas con betametasona, con posterior diseminación a nariz y párpados. Se realizó diagnóstico de dermatitis granulomatosa periorificial en base a la histopatología y tinción de Gram. Se inició tratamiento con eritromicina, vía oral, y metronidazol, gel 1%. Se observó resolución casi completa en seis semanas. Ambos casos muestran que el diagnóstico, la etiología y el manejo de dermatitis periorales en niños son un verdadero reto, por lo tanto es de crucial importancia realizar una correlación clínico patológica.

Perioral dermatitis was described as an inflammatory rash in young women, but also present in children. It is characterized by periorificial papules and pustules predominantly around themouth. It can be related with the use of topical corticosteroids. We report two cases: A 12 year-old male patient, with a one month history of perioral papulopustular lesions. Diagnosis offolliculitis Malassezia sp. was supported on histopathology and Gram stain. Itraconazole therapy was given, 200 mg orally for 14 days (5 mg/kg) and ketoconazole cream 2% twice daily. Complete resolution was obtained within two months. A 9 year-old female patient, with a two months history of perioral papules treated with betamethasone, later spreading to nose and eyelids. Diagnosis of periorificial granulomatous dermatitis was based on histopathology and Gram stains. Treatment with oralerythromycin and metronidazole gel 1%, showed an important improvement after six weeks. Both cases show that the diagnosis, etiology and management of perioral dermatitis in children is a challenge, so it is crucial to make a clinic pathologic correlation.

Piedra blanca y efluvio telógeno: una rara asociación / White piedra and telogen effluvium: an unusual association

Antecedentes: La piedra blanca es una infección fúngica, superficial del tallo piloso que se describe como nódulos asintomáticos, en ocasiones numerosos, blandos adheridos a la superficie del pelo. Caso clínico: Se presenta paciente femenino de 30 años de edad, con caída de cabello de casi 1 año de evolución, asociado a puntos blancos adheridos al pelo. En el cultivo se aisló Trichosporon sp. Se realizó biopsia de piel cabelluda, en la cual se observó una infiltración de linfocitos e histiocitos alrededor de paredes foliculares altas y algunos folículos en fase telógena. Con estos hallazgos se estableció el diagnóstico de piedra blanca asociada a efluvio telógeno. El tratamiento fue con champú anti caída y de ketoconazol al 2% con mejoría del cuadro. Conclusión: Existe un subdianóstico de casos de piedra blanca, que podría deberse a la falta de conocimiento de esta entidad y más excepcional su asociación con efluvio telogénico.

Diagnóstico y tratamiento de dermatofitosis y pitiásis versicolor / Diagnosis and treatment of dermatophytosis and pityriasis versicolor

Antecedentes: Las micosis superficiales son una de las causas más frecuentes de consulta, tanto en los servicios de dermatología como en medicina general, ocasionando incomodidad y en algunos casos complicaciones, especialmente en pacientes diabéticos e inmunocomprometidos. Comprenden un grupo de afecciones comunes como dermatofitosis, candidiasis, pitiriasis versicolor, tiña negra y piedras. Fuente: se realizó una amplia revisión bibliográfica en las bases de datos de Hinari, Medline y Pudmed; con años de cobertura de 2001 a 2011. Desarrollo: con la presente revisión se pretende concientizar sobre la importancia del diagnóstico clínico y laboratorial específico de las micosis superficiales, para establecer el manejo pertinente en cada caso con la aplicación de la farmacológica y dosificación correcta.Conclusion: El diagnóstico de la mayoría de las micosis se realiza con la sospecha clínica y su comprobación a través del examen directo del material en fresco proveniente del sitio de la lesión y del aislamiento e identificación del hongo a partir del cultivo.

Minimicetoma por Nocordia brasiliensis: un caso infantil en Veracruz / Minimicetoma by Nocordia brasiliensis: a children's event in Veracruz

El término minimicetoma designa a los micetomas de pequeño tamaño, con morfología atípica y superficial, causados por Nocardia brasiliensis. Se comunica un paciente de sexo masculino, de 10 años de edad, originario y residente de Xalapa (Veracruz), que presentó un minimicetoma por N. brasiliensis, confirmado por estudio micológico e histopatológico. El tratamiento con penicilina procaínica durante 10 días, en conjunto con trimetoprima/sulfametoxazol y diaminodifenisulfona por 6 meses, tuvo resultados satisfactorios.

Minimycetoma is an atypical small mycetoma usually caused by Nocardia brasiliensis. We report a 10-year-old male from Xalapa (Veracruz) with a minimycetoma due to N. brasiliensis confirmed by mycological and histopathological studies. Simultaneous treatment with procainic penicillin for ten days and trimethoprim/sulfamethoxazol and dapsone showed satisfactory results after 6 months.

Larva migrans: una revisión / Larva migrans: a review

El síndrome de la larva migrans abarca las parasitosis causadas por los nematodos de los géneros Uncinaria, Ancylostoma, Necator y Gnathostoma. Se ha descrito más comúnmente en lugares con climas calurosos. Se estima que 1.200 millones de personas alrededor del mundo han adquirido la infección en algún momento. La larva migrans cutánea causada por Ancylostoma caninum y A. Vrasiliense se caracteriza por trayectos eritematosos, ligeramente elevados, lineales o serpiginosos en patrones irregulares. El diagnóstico es eminentemente clínico. Es útil la biometría hemática y herramientas auxiliares como la entodermoscopia, la microscopia confocal y la biología molecular. El tratamiento más efectivo son los antiparasitarios por vía oral en especial la ivermectina.

Larva migrans syndrome includes parasitic diseases caused by nematodes of gender Uncinaria, Ancylostoma, Necator and Gnathostoma. It has been reported in tropical countries with an estimated incidence of 1.2 billon infected people around the world.Cutaneous larva migrans due to Ancylostoma caninum and A. brasiliense is characterized by erythematous linear or serpiginous sinuous tracts. Diagnosis is always done by its typical clinical features, and it can also be useful the hemathologic counts, dermoscopy, confocal microscopy and molecular biology. The most effective treatments are oral antiparasitic drugs especially ivermectin.