ABSTRACT
The Conidiobolus coronatus-related rhinoentomophthoromycosis in immunocompetent and immunocompromised (HIV negative) individuals has been treated successfully with antifungal drugs. However, C. coronatus infections in first-line antiretroviral therapy (ART)-resistant (HIV infected) individuals particularly with rhinoentomophthoromycosis have not been reported previously. Here, we describe a case of itraconazole non-responding rhinoentomophthoromycosis in an HIV-infected patient with first-line antiretroviral (ART) drug resistance which was successfully managed through systematic diagnostic and therapeutic approaches in dermatologic setting. A 32-year-old HIV-1-infected man presented with painless swelling, nasal redness and respiratory difficulty. The patient was receiving first-line ART and had a history of traumatic injury before the onset of nasopharyngeal manifestations. The patient's previous history included oral candidiasis and pulmonary tuberculosis.
ABSTRACT
The present study aimed to report the occurrence as well as the clinical, laboratorial, pathological and mycological findings of three outbreaks of rhinocerebral and rhinopharyngeal conidiobolomycosis in sheep from Rio Grande do Norte state, Brazil. A total of six sheep with clinical signs of conidiobolomycosis were evaluated, and information on history was obtained from ranchers. Clinical signs included depression, progressive emaciation, sero-sanguinolent nasal discharge, tachycardia, dyspnea, miosis and unilateral exophthalmia with increased ocular globe volume, corneal ulceration and nervous system signs. The main hematological alteration was neutrophilia. Serum biochemical evaluation revealed increased values for AST, GGT, creatinine, urea, and glucose, and decreased total proteins and albumin levels. Cerebrospinal fluid analysis showed the presence of fibrin reticules and pleocytosis. Upon necropsy, longitudinal sections of the head revealed the presence of a nodular mass with a friable consistency and a white-yellowish coloration. Microscopic findings included meningitis, cortex necrosis and encephalitis with the presence of eosinophilic Splendore-Hoeppli substance. Histopathology of the lungs revealed a Splendore-Hoeppli-like material and hyperplasia of alveolar and bronchiolar epithelium. Renal lesions were suggestive of amyloidosis.
O presente estudo objetivou relatar a ocorrência e os achados clínicos, laboratoriais, patológicos e micológicos de três surtos de conidiobolomicose rinocerebral e rinofaríngea em ovinos do estado do Rio Grande do Norte, Brasil. Um total de seis ovinos com sinais clínicos de conidiobolomicose foi avaliado, e informações sobre o histórico foram obtidas dos proprietários. Os sinais clínicos incluíram depressão, emaciação progressiva, descarga nasal serossanguinolenta, taquicardia, dispneia, miosite e exoftalmia unilateral com aumento do volume do globo ocular, ulceração da córnea e sinais nervosos. A principal alteração hematológica foi neutrofilia. A avaliação bioquímica sérica revelou aumento nos valores de AST, GGT, creatinina, ureia e glicose, e redução nos níveis de proteínas totais e albumina. A análise do fluido cerebrospinal revelou presença de retículos de fibrina e pleocitose. À necropsia, secções longitudinais da cabeça revelaram presença de uma massa nodular com consistência friável e coloração branco-amarelada. Os achados microscópicos incluíram meningite, necrose do córtex e encefalite com presença da substância eosinofílica de Splendore-Hoeppli. A histopatologia dos pulmões revelou uma substância similar à de Splendore-Hoeppli e hiperplasia do epitélio alveolar e bronquiolar. As lesões renais foram sugestivas de amiloidose.
ABSTRACT
São descritos dois casos de zigomicose nasofacial, procedentes de Belém, PA. O achado indica não ser tão rara, como se poderia supor, pela falta de registros, a ocorrência dessa micose na Região Norte do Brasil. Em ambos os pacientes, o tratamento pelo cetoconazol determinou involução rápida das manifestações clínicas, principalmente a obstrução nasal. Com o presente relato, sobe para cinco o número de casos da infecção referidos até agora do Estado do Pará.
Two new cases of nasofacial zygomycosis from the state of Pará, Brazil, are reported. Both cases were treated with ketoconazole and the response to the drug was considered to be good; the patients improved rapidly and the nasal obstruction was the first manifestation to disappear. As five cases have been described in recent years from the state of Pará, this form of zygomycosis can no longer be considered as a rare disease in northern Brazil.