Hospitalizações e óbitos relacionados à esporotricose no Brasil (1992-2015) / Hospitalizations and deaths related to sporotrichosis in Brazil (1992-2015) / Hospitalizaciones y óbitos relacionados con la esporotricosis en Brasil (1992-2015)

Resumo: A esporotricose é uma micose subcutânea de distribuição global e, em geral, os pacientes são tratados ambulatorialmente. Desde 1998, observa-se aumento dos casos no Estado do Rio de Janeiro, Brasil, especialmente por transmissão zoonótica envolvendo gatos. Os pacientes coinfectados pelo vírus da imunodeficiência humana (HIV), muitas vezes, necessitam de hospitalizações e evoluem a óbito. Este estudo analisa e descreve dados de 1992 a 2015, provenientes de bancos de dados do Sistema Único de Saúde. No Brasil, ocorreram 782 hospitalizações e 65 óbitos. Em 6% das hospitalizações e 40% dos óbitos, havia coinfecção pelo HIV. No Rio de Janeiro, foram 250 hospitalizações e 36 óbitos, com aumento progressivo, ao longo do período. Destacaram-se, ainda, São Paulo e Goiás. Homens, não brancos, com baixa escolaridade evoluíram mais frequentemente a óbito. Conclui-se que a esporotricose está associada a hospitalizações e óbitos em todo o Brasil, com destaque para o Rio de Janeiro.

Abstract: Sporotrichosis is a subcutaneous mycosis with global distribution, and patients generally receive outpatient treatment. Since 1998 there has been an increase in cases in the state of Rio de Janeiro, Brazil, mainly via zoonotic transmission involving cats. Patients coinfected with the human immunodeficiency virus (HIV) often require hospitalization and evolve to death. This study analyzes and describes data from 1992 to 2015 obtained from the database of the Brazilian Unified National Health System (SUS). There were 782 hospitalizations and 65 deaths in Brazil. Six percent of the hospitalizations and 40% of the deaths involved coinfection with HIV. There were 250 hospitalizations and 36 deaths in Rio de Janeiro, with a progressive increase over the course of the period. The states of São Paulo and Goiás also showed high numbers. Men, non-whites, and individuals with low schooling evolved more frequently to death. In conclusion, sporotrichosis is associated with hospitalizations and deaths throughout Brazil, especially in the state of Rio de Janeiro.

Resumen: La esporotricosis es una micosis subcutánea de distribución global y, en general, los pacientes son tratados ambulatoriamente. Desde 1998, se observa un aumento de los casos en el estado de Río de Janeiro, Brasil, principalmente por transmisión zoonótica implicando gatos. Los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH), muchas veces, necesitan de hospitalizaciones y evolucionan a óbito. Este estudio analiza y describe datos de 1992 a 2015, provenientes de bancos de datos del Sistema Único de Salud (SUS). En Brasil, se produjeron 782 hospitalizaciones y 65 óbitos. En un 6% de las hospitalizaciones y 40% de los óbitos, había coinfección por el VIH. En Río de Janeiro, fueron 250 hospitalizaciones y 36 óbitos, con un aumento progresivo a lo largo del período. Se destacaron, incluso, São Paulo y Goiás. Hombres, no blancos, con baja escolaridad evolucionaron más frecuentemente a óbito. Se concluye que la esporotricosis está asociada a hospitalizaciones y óbitos en todo Brasil, destacando Río de Janeiro.

Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 plus HIV co-infection

BACKGROUND Paracoccidioidomycosis (PCM) is one of the most important systemic mycoses in Latin America and the leading fungal cause of mortality in non-immunosuppressed individuals in Brazil. However, HIV/PCM co-infection can increase the clinical severity in these co-infected patients. This co-infection is rarely reported in the literature mainly because of the different epidemiological profiles of these infections. Furthermore, PCM is a neglected and non-notifiable disease, which may underestimate the real importance of this disease. The advent of molecular studies on the species of the genus Paracoccidioides has expanded the knowledge regarding the severity and the clinical spectrum in PCM. In this context, the development of studies to describe the association of the Paracoccidioides phylogenetic cryptic species in vulnerable populations, such as HIV-infected patients, appears relevant. OBJECTIVE To describe the clinical, epidemiological, therapeutic and prognostic aspects in HIV/PCM co-infected patients, along with the molecular identification of the Paracoccidioides species involved in these cases. METHODS The investigators performed a molecular and clinical retrospective study involving HIV/PCM co-infected patients, from a reference centre for PCM care in the endemic area of Rio de Janeiro, Brazil, from 1998 to 2015. Molecular identification of the fungal strains was done by amplification of partial sequences of arf and gp43 genes. FINDINGS Of 89 patients diagnosed with PCM by fungal isolation in the culture, a viable isolate was recovered for molecular analysis from 44 patients. Of these 44 patients, 28 (63.6%) had their serum samples submitted for enzyme immunoassay tests for screening of HIV antibodies, and 5 (17.9%) had a positive result. All cases were considered severe, with a variable clinical presentation, including mixed, acute/subacute clinical forms and a high rate of complications, requiring combination therapy. Paracoccidioides brasiliensis S1 was the species identified in all cases. CONCLUSIONS HIV/PCM co-infection can change the natural history of this fungal disease. The authors reinforce the need to include HIV screening diagnostic tests routinely for patients with PCM.

Fatal septic shock caused by Paracoccidioides brasiliensis phylogenetic species S1 in a young immunocompetent patient: a case report

Abstract The authors report the first case of fatal septic shock, a rare clinical presentation of paracoccidioidomycosis (PCM) caused by Paracoccidioides brasiliensis S1. We also provide an immunological evaluation of the patient. Severe clinical signs such as organ dysfunction and digital gangrene occurred in this case. The patient presented a remarkable cell activation profile and diminished percentage of peripheral blood T regulatory cells. A decrease in anti-inflammatory IL-1RA plasma level showed the potential for endothelium damage, probably contributing to a vasculitis process. Together with P. lutzii, P. brasiliensis appears to be involved in severe cases of PCM.

Immune reconstitution inflammatory syndrome in HIV and sporotrichosis coinfection: report of two cases and review of the literature

We report 2 cases of patients with immune reconstitution inflammatory syndrome (IRIS) associated with cutaneous disseminated sporotrichosis and human immunodeficiency virus (HIV) coinfection. The patients received specific treatment for sporotrichosis. However, after 4 and 5 weeks from the beginning of antiretroviral therapy, both patients experienced clinical exacerbation of skin lesions despite increased T CD4+ cells (T cells cluster of differentiation 4 positive) count and decreased viral load. Despite this exacerbation, subsequent mycological examination after systemic corticosteroid administration did not reveal fungal growth. Accordingly, they were diagnosed with IRIS. However, the sudden withdrawal of the corticosteroids resulted in the recurrence of IRIS symptoms. No serious adverse effects could be attributed to prednisone. We recommend corticosteroid treatment for mild-to-moderate cases of IRIS in sporotrichosis and HIV coinfection with close follow-up.

Acute dacryocystitis: another clinical manifestation of sporotrichosis

Sporotrichosis associated with exposure to domestic cats is hyperendemic in Rio de Janeiro, Brazil. A review of the clinical records at our institute revealed four patients with clinical signs of dacryocystitis and a positive conjunctival culture for Sporothrix who were diagnosed with Sporothrix dacryocystitis. Three patients were children (< 13 years of age) and one patient was an adult. Two patients reported contact with a cat that had sporotrichosis. Dacryocystitis was associated with nodular, ulcerated lesions on the face of one patient and with granulomatous conjunctivitis in two patients; however, this condition manifested as an isolated disease in another patient. All of the patients were cured of the fungal infections, but three patients had chronic dacryocystitis and one patient developed a cutaneous fistula. Sporotrichosis is usually a benign disease, but may cause severe complications when the eye and the adnexa are affected. Physicians, especially ophthalmologists in endemic areas, should be aware of the ophthalmological manifestations and complications of sporotrichosis.

Eumycetoma by Madurella mycetomatis with 30 years of evolution: therapeutic challenge / Eumicetoma por Madurella mycetomatis com 30 anos de evolução: desafio terapêutico

We report a case of eumycetoma by Madurella mycetomatis on the buttocks and thighs in an adult immunocompetent patient, diagnosed after 30 years of clinical development. He was treated over four years with fluconazol and itraconazol associated with five times surgical excisions of subcutaneous nodules. At the eighth year of follow-up, one nodule recurred on the right infragluteal region, which was excised surgically and has remained asymptomatic ever since.

Relatamos o caso de um paciente adulto, imunocompetente, com eumicetoma por Madurella mycetomatis, localizado nos glúteos e coxas, diagnosticado após 30 anos de evolução clínica. Tratado no decorrer de quatro anos com fluconazol e itraconazol, associado a cinco tempos cirúrgicos de exérese dos nódulos subcutâneos. No oitavo ano de follow-up ocorreu recidiva de apenas um nódulo na região infraglútea, o qual foi excisado cirurgicamente, mantendo-se assintomático desde então.

Use of the bilobed flap in the pubic region after tumoral lesion excision / Utilizacao do retalho bilobado na regiao pubiana apos exerese de lesao tumoral

Reconstruction of surgical defects in the pubic region is a challenge to any surgeon. Our goal was to demonstrate the use of the bilobed flap to reconstruct the pubic region skin after the excision of a recurrent HPV lesion, resistant to conventional treatments. In spite of its classical use in nasal reconstructions, the bilobed flap has applications in extranasal defects, with excellent functional and aesthetic results.

A reconstrução de defeitos cirúrgicos na região pubiana é um desafio para qualquer cirurgião. Objetivamos demonstrar a aplicação do retalho bilobado na reconstrução da região pubiana, após excisão de HPV recidivante aos tratamentos convencionais. Apesar da utilização clássica deste retalho ser na região nasal, aplicações em áreas distintas também se mostraram com excelentes resultados funcionais e estéticos.

Acute dacryocystitis: another clinical manifestation of sporotrichosis

Sporotrichosis associated with exposure to domestic cats is hyperendemic in Rio de Janeiro, Brazil. A review of the clinical records at our institute revealed four patients with clinical signs of dacryocystitis and a positive conjunctival culture for Sporothrix who were diagnosed with Sporothrix dacryocystitis. Three patients were children (< 13 years of age) and one patient was an adult. Two patients reported contact with a cat that had sporotrichosis. Dacryocystitis was associated with nodular, ulcerated lesions on the face of one patient and with granulomatous conjunctivitis in two patients; however, this condition manifested as an isolated disease in another patient. All of the patients were cured of the fungal infections, but three patients had chronic dacryocystitis and one patient developed a cutaneous fistula. Sporotrichosis is usually a benign disease, but may cause severe complications when the eye and the adnexa are affected. Physicians, especially ophthalmologists in endemic areas, should be aware of the ophthalmological manifestations and complications of sporotrichosis.

Esporotricose urbana: epidemia negligenciada no Rio de Janeiro, Brasil / Urban sporotrichosis: a neglected epidemic in Rio de Janeiro, Brazil

Na literatura científica, a esporotricose esteve associada por anos a profissionais que lidam com a terra, local onde o fungo causador habita. Recentemente, numa área urbana tem sido registrada a ocorrência relacionada à transmissão zoonótica. Este trabalho objetivou contribuir para o conhecimento sobre a esporotricose em área urbana, por intermédio da analise exploratória de sua distribuição socioespacial no Rio de Janeiro, Brasil, entre 1997 e 2007, identificando os espaços de transmissão mais intensos. Utilizando-se base de dados do Serviço de Vigilância em Saúde, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, foram realizadas análises de frequência da doença e sua distribuição espacial. No período estudado, foram registrados 1.848 casos de esporotricose, com predomínio em mulheres adultas fora do mercado de trabalho. A fonte de contaminação predominante foi ferimento causado pelo gato doméstico, o que contribuiu para a disseminação da esporotricose em área urbana. O georreferenciamento de 1.681 casos evidenciou um cinturão de transmissão ao longo da divisa entre a capital e os municípios da região metropolitana.

In the scientific literature, sporotrichosis has traditionally been associated with agricultural work, since the causative agent is found naturally in the soil. However, cases have been reported recently in an urban area, related to zoonotic transmission. The current study aimed to contribute to knowledge on sporotrichosis in an urban area through an exploratory analysis of its socio-spatial distribution in Rio de Janeiro, Brazil, from 1997 to 2007, identifying the areas with the heaviest transmission. The database from the Health Surveillance Service at the Evandro Chagas Institute for Clinical Research, Oswaldo Cruz Foundation, was used to estimate incidence rates and spatial distribution. During the study period, 1,848 cases of sporotrichosis were reported, predominantly in adult women not currently in the labor market. The leading source of infection was wounds caused by domestic cats, which contributed to the spread of sporotrichosis in this urban area. Georeferencing of 1,681 cases showed a transmission belt along the border between the city of Rio de Janeiro and the adjacent municipalities in the Greater Metropolitan Area.

Long-term outcome of neuroparacoccidioidomycosis treatment / Resultado de longo prazo no tratamento da neuroparacoccidioidomicose

INTRODUCTION: Neuroparacoccidioidomycosis (NPCM) is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up. METHODS: All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009. RESULTS: Fourteen (3.8 percent) cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM). A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP) was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up. CONCLUSIONS: All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.

INTRODUÇÃO: Neuroparacoccidioidomicose (NPCM) é um termo utilizado para descrever a invasão do sistema nervoso central pelo fungo patogênico Paracoccidioides brasiliensis. NPCM é descrita, esporadicamente, em relatos de casos ou pequenas séries de casos com pouco ou nenhum enfoque no tratamento ou acompanhamento de longo prazo. MÉTODOS: Todos os pacientes com diagnóstico de NPCM entre janeiro de 1991 a dezembro de 2006 foram acompanhados até dezembro de 2009. RESULTADOS: Foram identificados 14 (3,8 por cento) casos de NPCM de 367 pacientes com paracoccidioidomicose (PCM). Regime combinando fluconazol oral e sulfamethoxazol/trimetoprim (SMZ/TMP) foi o tratamento de escolha. Não houve nenhum caso de óbito causado pelo fungo Paracoccidioides brasiliensis.Sequela neurológica foi identificada em 8 pacientes. Durante o seguimento, calcificação residual foi um achado comum de neuroimagem. CONCLUSÕES: Todos os pacientes deste estudo responderam de forma favorável a associação do fluconazol com o sulfamethoxazol/trimetoprim, um esquema terapêutico que deve ser considerado nos casos de NPCM. Sequela neurológica foi um achado relativamente comum, desta forma, a utilização de anticonvulsivantes, assim como foi necessário suporte fisioterápico para um manejo adequado destes pacientes.

Clinical characteristics and evolution of syphilis in 24 HIV+ individuals in Rio de Janeiro, Brazil

Foram tratados 24 indivíduos com sífilis e infecção pelo HIV, de Março de 1997 a Janeiro de 2003, no ambulatório de Dermatologia Infecciosa do Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. Foram 20 homens (83,3%) e quatro mulheres (16,7%) com idade média de 38,04 anos e contagem média de linfócitos T CD4 de 389,5 céls/mm3. A sífilis foi classificada como secundária em 16 pacientes (62,5%), latente tardia em oito (33,3%) e terciária em uma paciente (4,2%). As manifestações de sífilis secundária foram de lesões cutâneas eritematopapulosas em regiões palmar e plantar em nove (37,5%), exantema papuloso em quatro (16,7%), alopecia em clareira em três (12,5%) e osteocondrite em um paciente (4,2%). A sífilis terciária apresentou-se como lesão verrucosa. Cinco pacientes (20,8%) apresentavam neurossífilis, sendo a cefaléia a única manifestação presente em dois pacientes. As drogas utilizadas foram penicilina benzatina, ceftriaxone, eritromicina e penicilina. A cura ocorreu em 18 pacientes (75%). Seis pacientes (25%) foram retratados, sendo que três apresentavam história de re-exposição. Este estudo confirmou a importância de se estabelecer o diagnóstico de neurossífilis em pacientes com infecção pelo HIV, assim como de se realizar seguimento clínico e laboratorial após o tratamento da sífilis.

Adult T-cell leukemia/lymphoma associated with HTLV-1 infection in a Brazilian adolescent

We present the case of a 15-year-old patient infected with HTLV-1 who developed a cutaneous T-cell lymphoma, confirmed by histopathological and immunohistochemical examination, as well as clinically and hematologically confirmed leukemia. The patient died 3 months after initial presentation of the disease. The rarity of the disease in this age group justifies the present report

Sporotrichosis: an emergent zoonosis in Rio de Janeiro

During the period from 1987 to 1998, 13 cases of human sporotrichosis were recorded at the Research Center Evandro Chagas Hospital (CPqHEC) in Rio de Janeiro. Two of these patients related scratch by a sick cat. During the subsequent period from July 1998 to July 2000, 66 human, 117 cats and 7 dogs with sporotrichosis were diagnosed at the CPqHEC. Fifty-two humans (78.8 percent) reported contact with cats with sporotrichosis, and 31 (47 percent) of them reporting a history of a scratch or bite. This epidemic, unprecedented in the literature, involving cats, dogs and human beings may have started insidiously before 1998

Entomophthoramycosis by Conidiobolus coronatus. Report of a case successfully treated with the combination of itraconazole and fluconazole

Rhinoentomophthoramycosis caused by Conidiobolus coronatus in a 61-year old woman was unsuccessfully treated during 8 years with all the antifungals available in the Brazilian market, including potassium iodide for 1 month, sulfamethoxazole plus trimethoprim for 2 months, amphotericin B, total dose of 1130 mg, cetoconazole, 400 mg/day for 6 months, fluconazole, 200 mg/day, for at least 2 months and, itraconazole, 400 mg/day for 2 months, followed by 200 mg/day for 4 more months. Complete clinical and mycological cure was achieved using itraconazol 400 mg/day in association with fluconazol 200 mg/day during 24 months. After cure she was submitted to plastic surgery to repair her facial deformation. Today she remains clinically and mycologically cured after 59/60 months (5 years!) without any specific antifungal. We thus suggest the use of the combination of itraconazole and fluconazole as an additional option for the treatment of this mycosis

Case report of intraspinal paracoccidioidomycosis

Os autores registram um caso de paraplegia causada por uma lesao granulomatosa de PCM intramedular. O diagnostico clinico neurologico de uma lesao compressiva intramedular foi confirmado pelo exame de ressonancia nuclear magnetica da coluna, que mostrou lesao captante de contraste a nivel de T12. O paciente foi operado e a lesao totalmente retirada. O exame histopatologico da peca operatoria confirmou o diagnostico de PCM. O doente esta em uso de SMZ/TMP e fluconazol com boa recuperacao neurologica

Clinical and endoscopic findings in the mucosae of the upper respiratory and digestive tracts in post-treatment follow-up of paracoccidioidomycosis patients

Foi realizado sistematicamente o exame das vias aereas-digestivas superiores (VADS) em grupo e 80 pacientes de paracoccidioidomicose (PCM) acompanhados apos o tratamento especifico por periodo que variou de 8 a 17 anos. A musoca das VADS estava comprometida antes do tratamento especifico em 74 pacientes, assim distribuidos: orofaringe, 50 (41 isoladamente, 7 em associacao com o laringe e 2 com a mucosa nasal); laringe, 30 (23 isoladamente e 7 em associacao) e nasal, 3 ( 1 isoladamente e 2 em associacao). Em todos os 50 que apresentavam lesoes inativas, 3 com cicatriz viciosa (1 com retracao de lingua e 2 diminuicao de orificio oral). Houve lesao destrutiva em 1 caso com perfuracao do palato. Nos 46 casos restantes, o exame mostrou cicatriz estriada branco nacarada em alguns quase iperceptivel e em outros com retracao parcial de estruturas anatomicos sem alteracoes de suas caracteristicas. Houve grande numero de falhas dentarias...

Tratamento da paracoccidioidomicose: estudo retrospectivo de 500 casos. II - Avaliaçäo dos resultados terapêuticos com sulfanilamídicos, anfotericina B, associaçäo sulfametoxazol/trimetoprim, cetoconazol e miconazol / Treatment of paracoccidioidomycosis; retrospective: retrospective study of 500 cases. II - Evaluation of therapeutic results with sulfonamides, amphotericin B, ketoconazole and miconazole

Säo analisados rretrospectivamente 500 pacientes com paracoccidioidomicose antendidos no Hospital Evandro Chagas da Fundaçäo Oswaldo Cruz, Rio de janeiro, no período de 1960 a 1986. Os resultados ao término do tratamento com o emprego dos sulganilamídicos, anfotericina B, associaçäo sulfametoxazol/trimetoprim, cetoconazol e miconazol mostraram eficácia semelhante. A sulfamidoterapia curou a doença, principalmente da forma clínica tipo adulto; a anfotericina B, eficaz em todas as formas clínicas da doença, mostrou-se comparativamente melhor quando complementadas com sulfanilamídicos ou imidazólico do que a aplicaçäo isolada. A associaçäo sulfametoxazol/trimetoprim cura a doença, mas näo foi útil nos casos resistentes aos sulfamídicos. O cetoconazol foi eficáz, inclusive em casos resistentes aos outros tratamentos; encontramos os piores resultados na forma clínica tipo juvenil e o miconazol cura a doença na forma clínica tipo adulto. As drogas foram bem toleradas mas em todos os casos tratados com a anfotericina B ocorreram efeitos cerebrais

Tratamento da paracoccidioidomicose: estudo retrospectivo de 500 casos; análise clínica laboratorial e epidemiológica / Treatment of paracoccidioidomycosis: retrospective study of 500 cases

Säo analisados retrospectivamente 500 protocolos clínicos de pacientes com paracoccidioidomicose do Hospital Evandro Chagas, Fundaçäo Oswaldo Cruz, Rio de Janeiro observados no período de 1960 a 1986. A amostra estudada consta de 466 homens e 34 mulheres, com idades que variaram de quatro a 83 anos, tendo predominado a doença ema dultos masculinos, entre 30 e 60 anos, que exerciam ou exerceram atividades na lavoura. Os órgäos mais atingidos foram mucosa, pulmöes e linfonodos. Quanto à forma clínica, 465 casos do tipo adulto e 35 do juvenil, sendo neste tipo o sexo feminino proporcionalmente mais atingido

Aspectos radiológicos torácicos na paracoccidioidomicose / Thoracic radiologic aspects in paracoccidioidomycosis

In this paper the authors analyse 159 radiographs from paracoccidioidomycosis patients seen at the Evandro Chagas Hospital/Fiocruz in the period between January 1960 to December 1988. Twenty four cases (15.09) of association with tuberculosis were observed; one with pneumoconiosis; one with aspergillosis, and two with carcinoma. Twenty cases were excluded from the radiologic analysis: in 8 of these the diagnosis of tuberculosis occurred concomitantly, and in 12 patients, lung fibrosis due to previous treatment for tuberculosis or paracoccidioidomycosis was present in the 139 remaining cases, the radiographic abnormalities encountered were grouped according to the predominance of lesions at the various lung sites, if alveolar or interstitial, according to Magalhães' (1982) classification modified by the authors: infiltrate 55 cases (39.6); mist 28 (20.1); pneumonic 23 (16.6); nodular 16 (11.5); micronodular 10 (7.2), and fibrotic 7 (5.0). In 113 cases it was possible to follow the regression of the pulmonary process radiologically. In 85 (75.2) patients, regression took place within 6 months; in 17 (15.0) cases between 7 and 12 months; in 4 (3.5) between 13 and 24 months, and in 7 (6.1) cases no changes in the radiographic pattern were noted.

Paracoccidioidomicose entre o grupo indigena Surui de Rondonia, Amazonia, Brasil: registro de caso / Paracoccidioidomycosis among the Surui Indian group of Rondonia, Amazonia, Brazil: a case report

Os autores apresentam um caso de paracoccidioidomicose em indigena da tribo Surui, Estado de Rondonia. Trata-se de paciente adulto, sexo masculino, tendo sido o diagnostico confirmado com base em exame micologico, sorologico e radiografico. Foi instituida terapeutica com a associacao sulfametoxazol 800 mg + trimetoprima 160 mg a cada 12 horas. A avaliacao do paciente realizada seis meses apos o inicio do tratamento revelou melhora no estado geral, regressao do quadro radiologico, negativacao da prova de precipitacao em tubo capilar e positivacao da intradermoreacao com paracoccidioidina. Os autores tambem reveem os casos de paracoccidioidomicose descritos na regiao, em particular no que se refere ao grupo indigena Surui.