ABSTRACT
La esporotricosis es una micosis subcutánea poco frecuente en la población pediátrica, que resulta de la inoculación y penetración del moho del complejo Sporothrix schenckii a través de pequeñas heridas en la piel al entrar en contacto con la tierra, follaje, madera, paja o residuos vegetales contaminados y, algunas veces, por rasguños o mordeduras de animales. Según la cantidad del inóculo y el estado de inmunidad del huésped, se clasifica en esporotricosis tegumentaria fija, cutáneo-linfangítica, diseminada (cutánea y sistémica) y extracutánea (ósea, articular, otros órganos). El diagnóstico de la enfermedad se fundamenta en el aspecto morfológico de sus lesiones, apoyado en el examen directo y el cultivo, el estudio histopatológico o la prueba de intradermorreacción con polisacáridos purificados obtenidos de la fase de micelio del hongo (prueba de González- Ochoa). El tratamiento de elección es el yoduro de potasio por vía oral a razón de 1 a 3 g repartidos en tres dosis; son también de utilidad los imidazoles sistémicos y la terbinafina durante tres a cinco meses. Se presentan dos casos infantiles, enfatizando el reconocimiento clínico de las lesiones tegumentarias y las opciones terapéuticas disponibles.
Sporotrichosis is an uncommon subcutaneous disease in children. It is a fungal infection produced by Sporothrix schenckii mold, and it is generally associated with small skin injuries that become exposed to contaminated soil, hay, wood or vegetation, or sometimes by scratches or bites made by infected animals. According to the quantity of the inoculum and the host´s immunity, it is classified in fixed cutaneous form, lymphocutaneous presentation, disseminated (cutaneous and systemic) and extracutaneous form (osteoarticular, other organs). Diagnosis is based on the morphological characteristics of the skin lesions, supported by KOH examination and culture, histopathology analysis and sporotrichin skin test. When possible, the gold standard treatment for this mycosis is potassium iodine, 1-3 g in three doses; oral imidazol and terbinafine are also very effective. We present two cases of infected children, emphasizing its typical clinical course and presentation, as well as different therapeutic options available.
Subject(s)
Humans , Male , Adolescent , Sporotrichosis , Wounds and Injuries , Child , Fungi , MycosesABSTRACT
Os autores apresentam o caso de uma paciente de 42 anos,portadora de Retocolite Ulcerativa Inespecífica (RCUI) assintomática há 6 anos, sem tratamento adequado. Foi internada após surgirem sintomas da doença em atividade (febre, astenia, diarreia sanguinolenta), realizou tratamento e recebeu alta. Posteriormente, retornou com queixa de edema em panturrilha esquerda, sendo diagnosticada Trombose Venosa Profunda (TVP) e utilizado heparina, que após 24h foi suspensa pelo fato da paciente ter apresentado hematoquezia intensa. Três dias após, a paciente apresentou quadro de desconforto respiratório e dor torácica, recebendo o diagnóstico de Tromboembolismo Pulmonar (TEP). Foi colocado filtro de veia cava inferior e iniciado heparinização com Marevan®, que foi suspenso seis meses depois. Atualmente, encontra-se em acompanhamento no ambulatório de Gastroenterologia do Hospital das Clínicas (HC) UFPE, sem queixas, emuso de Sulfassalazina.
The authors present a case of a 42 year-old patient who developed Inespecifi c Ulcerative Rectocolitis, being asymptomatic for six years, without adequate treatment. She was interned after the appearance of symptoms of the disease in activity (fever, asthenia, bloody diarrhea). She underwent treatement and was discharged. Afterwards, she returned complaining about edema in the left calf, being diagnosed of a Deep Venous Thrombosis and using heparin that was suspended after 24 hours, because the patient developed intense hematochezia. After three days, the patient had respiratory discomfort and thoracic pain, and was diagnosed of a pulmonary thromboembolism, and was initialized a filter to the inferior vena cava and was used heparinezation with Marevan®, which was suspended six months later. Nowadays, the patient is accompanied by the Gastroenterology ambulatory of Hospital das Clinicas-Pernambuco, without complaints, using Sulfassalazin.