The treatment f coccidioidomycosis / Tratamento da coccidioidomicose

SUMMARYTherapy of coccidioidomycosis continues to evolve. For primary pulmonary disease, antifungal therapy is frequently not required while prolonged courses of antifungals are generally needed for those in whom extrathoracic disseminated has occurred. Intravenous amphotericin B should be reserved for those with severe disease. Oral triazole antifungals have had a great impact on the management of coccidioidomycosis. Both fluconazole and itraconazole at 400 mg daily have been effective for various forms of coccidioidomycosis, including meningitis, although relapse after therapy is discontinued is a problem. Individuals with suppressed cellular immunity are at increased risk for symptomatic coccidioidomycosis and they include those with HIV infection, those on immunosuppressive medications, and those who have received a solid organ transplant. Pregnant women and African-American men have been identified as two other groups who are at an increased risk for symptomatic and severe infection.

RESUMOA terapia da coccidioidomicose continua a evoluir. Para a doença pulmonar primária, o tratamento antifúngico frequentemente não é necessário, enquanto períodos prolongados de tratamento antifúngico são geralmente necessários para aqueles nos quais houve disseminação extratorácica. A anfotericina B intravenosa deve ser reservada para pacientes com doença grave. Antifúngicos triazólicos orais têm tido um grande impacto no manejo da coccidioidomicose. Tanto fluconazol quanto itraconazol em doses diárias de 400 mg foram eficazes contra várias formas de coccidioidomicose, incluindo a meníngea, embora recaídas após a interrupção da terapia ainda constituam um problema. Indivíduos com supressão da imunidade celular apresentam risco aumentado para a coccidioidomicose sintomática, incluindo pacientes infectados pelo HIV, em uso de medicações imunossupressoras, e os que receberam transplantes de órgãos sólidos. Mulheres grávidas e homens afro-americanos foram identificados como dois outros grupos que apresentam risco aumentado de infecção sintomática e grave.

Clinical and pathological findings of concurrent poxvirus lesions and aspergillosis infection in canaries

Objective:To investigate clinical, pathological and mycological findings in canaries, in which pox lesions and Aspergillus fumigatus (A. fumigatus) infection were observed simultaneously. Methods:This study was performed on a breeding colony (about 100 canaries) affected by fatal wasting disease. Necropsy was undertaken on 10 severely affected canaries, and gross lesions were recorded. Samples from internal organs displaying lesions were obtained for histopathological evaluation. Tracheal swap samples of internal organs of the all infected animals with lesions at necropsy were cultured in Sabouraud Dextrose Agar for mycological examination. Results: At necropsy, caseous foci were determined in the lungs, on the air sacs, liver, spleen, heart. Swelling of the eyelids, diffuse hemorrhages in the subcutaneous tissue with small papular lesions of the skin were other typical necropsy findings. Histopathologically, pathognomonic eosinophilic intracytoplasmic inclusion bodies, which called Bollinger bodies, in both skin cells and vacuolated air way epithelial cells confirmed canary pox infection. Moreover, histopathological examination of the white-yellowish caseous foci revealed necrotic granulomatous reaction consisting of macrophages, heterophil leukocytes and giant cells encapsulated with a fibrous tissue. After the culture of the tissue samples, the formation of bluish green colonies confirmed A. fumigatus infection. Conclusions:Canary pox has been known as the disease that can result in high losses in a short time, as a re-emerging disease that has not been present during recent years in canary flocks in Iran. So, the current paper provides useful information to prevent misdiagnosed of canary pox disease which can cause secondary mycotic infection.

Clinical and pathological findings of concurrent poxvirus lesions and aspergillosis infection in canaries

<p><b>OBJECTIVE</b>To investigate clinical, pathological and mycological findings in canaries, in which pox lesions and Aspergillus fumigatus (A. fumigatus) infection were observed simultaneously.</p><p><b>METHODS</b>This study was performed on a breeding colony (about 100 canaries) affected by fatal wasting disease. Necropsy was undertaken on 10 severely affected canaries, and gross lesions were recorded. Samples from internal organs displaying lesions were obtained for histopathological evaluation. Tracheal swap samples of internal organs of the all infected animals with lesions at necropsy were cultured in Sabouraud Dextrose Agar for mycological examination.</p><p><b>RESULTS</b>At necropsy, caseous foci were determined in the lungs, on the air sacs, liver, spleen, heart. Swelling of the eyelids, diffuse hemorrhages in the subcutaneous tissue with small papular lesions of the skin were other typical necropsy findings. Histopathologically, pathognomonic eosinophilic intracytoplasmic inclusion bodies, which called Bollinger bodies, in both skin cells and vacuolated air way epithelial cells confirmed canary pox infection. Moreover, histopathological examination of the white-yellowish caseous foci revealed necrotic granulomatous reaction consisting of macrophages, heterophil leukocytes and giant cells encapsulated with a fibrous tissue. After the culture of the tissue samples, the formation of bluish green colonies confirmed A. fumigatus infection.</p><p><b>CONCLUSIONS</b>Canary pox has been known as the disease that can result in high losses in a short time, as a re-emerging disease that has not been present during recent years in canary flocks in Iran. So, the current paper provides useful information to prevent misdiagnosed of canary pox disease which can cause secondary mycotic infection.</p>

Coloración de Papanicolaou y su importancia en el diagnóstico de las infecciones cervicovaginales / Papanicolaou-stained smears: its importance in the diagnosis of cervicovaginal infections

La coloración de Papanicolaou, además de la detección temprana del carcinoma de cuello uterino, brinda información sobre el estado hormonal y es orientativa al diagnóstico de infecciones cervicovaginales. La importancia de su detección y tratamiento radica en que pueden evitarse complicaciones posteriores, como enfermedad pélvica inflamatoria, ruptura prematura de membranas, abortos, sepsis del recién nacido, esterilidad. Se procesaron 251 muestras. Se estudió la correlación entre la información brindada por la coloración de Papanicolaou y el examen microbiológico (observación en fresco y coloración de Gram), con el fin de verificar la utilidad que puede brindar la coloración de Papanicolaou como alerta de las infecciones cervicovaginales. Para clasificar las muestras como vaginosis bacterianas se aplicaron los criterios de Amsel. Sobre el total de las muestras se obtuvo para las vaginosis 80% de correlación. En el caso de las infecciones micóticas el porcentaje representa 69%, valor que asciende a 75% si se consideran las muestras inflamatorias. Para Trichomonas vaginalis se obtuvo 100% de concordancia. La comparación de estos dos procedimientos revela un alto porcentaje de correlación, siendo el examen de Papanicolaou un valioso auxiliar para el diagnóstico de ciertas infecciones cervicovaginales.

The Papanicolaou (Pap) smearis not only a mean of early detection of cervical cancer, but also a cytologic screening which reports on the hormonal condition and helps in the diagnosis of cervicovaginal infections. The importance of the early detection and management of this kind of infections is based on the possibility of preventing from later complications such as pelvic inflammatory disease, early breaking of water, abortions, neonatal sepsis and infertility. In order to prove the uses of the Pap-stained smears as a way of diagnosis on potential cervicovaginal infections, 251 samples have been studied focusing on the correlation between the results of Pap-stained smears and those of wet preparations and Gram-stained. The Amsel criteria has been used to classify the samples as Bacterial Vaginosis cases. Taking the Vaginosis cases, 80% of them showed correlation between cytologic and bacteriological techniques. Mycotic infections were detected in 69% of the samples, rate which increased to 75% considering the inflammatory samples. The correlation between the Pap-stained smears and wet preparations/Gram-stained was of 100% for Trichomonas vaginalis samples. In conclusion, there is a high correlation between these two methods that proves the importance of the Pap-stained smears as an auxiliary process for diagnosing specific cervicovaginal infections.