Paracoccidoidomicosis: Reporte de 4 casos

La paracoccidioidomicosis (PCM) es una infección causada por hongos patógenos humanos del género Paracoccidioides. Es una micosis sistémica que puede afectar cualquier órgano. Se describen con este reporte cuatro casos de paracoccidioidomicosis con diferentes presentaciones clínicas, tiempo de evolución, con afectación mucocutánea, pulmonar, glándulas suprarrenales, sistema nervioso entre otros, principalmente en adultos varones de diferentes edades y profesiones, tanto inmunosuprimidos como inmunocompetentes, teniendo en común el contacto con el suelo. Se demuestra de esta manera la importancia de considerar esta patología ante una sospecha clínica de micosis sistémica para así realizar una confirmación temprana y tratamiento oportuno ya que presenta buena respuesta terapéutica antimicótica y mejoría clínica.

Paracoccidioidomycosis (PCM) is an infection caused by human pathogenic fungi of the genus Paracoccidioides. This report describes: 4 cases of paracoccidioidomycosis diagnosed with different clinical presentations, different times of evolution, with mucocutaneous, pulmonary, adrenal gland, and nervous system involvement, among others, mainly in male adults of different ages and professions, both immunosuppressed and immunocompetent, having in common contact with the ground. In this way, PCM is a systemic mycosis that can affect any organ and therefore the importance of considering this pathology when a diagnostic suspicion of systemic mycosis is presented in order to make an early diagnosis and timely treatment since it presents a good therapeutic response, antifungal and clinical improvement.

Diagnóstico micológico de paracoccidioidomicosis en un hospital de área no endémica: metodología clásica y molecular

Introducción. La paracoccidioidomicosis es una micosis sistémica y endémica en Latinoamérica. El cambio climático y el movimiento migratorio del huésped enfatizan la necesidad de optimizar el diagnóstico de esta infección. Objetivo. Evaluar la implementación de la detección de ADN de Paracoccidioides spp. al diagnóstico micológico de pacientes con sospecha de paracoccidioidomicosis. Materiales y métodos. Estudio retrospectivo con datos de laboratorio de pacientes con sospecha de paracoccidioidomicosis en un hospital de área no endémica. Resultados. Se analizaron los resultados de las muestras de 19 pacientes con sospecha clínica de paracoccidioidomicosis. El 90 % de los pacientes había nacido o visitado un área endémica de esta micosis en Latinoamérica. En 14 pacientes varones adultos se confirmó paracoccidioidomicosis por diagnóstico convencional. El examen directo fue positivo en 12 pacientes con enfermedad comprobada y en 4 de ellos se obtuvo crecimiento del hongo. Se detectaron anticuerpos contra Paracoccidioides spp. en ocho pacientes con la enfermedad. Se realizó PCR anidada con muestras de 14 pacientes para detectar ADN de Paracoccidioides spp. En 9 de los 10 pacientes con diagnóstico convencional de paracoccidioidomicosis se obtuvo una prueba de PCR positiva. Conclusiones. La implementación de técnicas moleculares para detectar ADN de Paracoccidioides spp. complementa el diagnóstico convencional de paracoccidioidomicosis y permite instaurar el tratamiento antifúngico, sobre todo en los casos clínicos donde no se observa la presencia del hongo en las muestras clínicas. La migración actual de poblaciones humanas dificulta el diagnóstico de paracoccidioidiomicosis y otras infecciones endémicas, por lo que se requiere optimizar el diagnostico micológico en los laboratorios clínicos para tratar pacientes con este tipo micosis desatendida.

Introduction. Paracoccidioidomycosis is a systemic mycosis endemic in Latin America. Climate change and host migration emphasize the need to optimize this infection diagnosis. Objective. To evaluate the implementation of Paracoccidioides spp. DNA detection in the mycological diagnosis of patients with suspected paracoccidioidomycosis. Materials and methods. It is a retrospective study with laboratory data from patients with clinical suspicion of paracoccidioidomycosis, who consulted a university hospital from a non-endemic area. Results. We analyzed the laboratory results of samples from 19 patients with suspected paracoccidioidomycosis. Seventeen out of 19 patients were born in or had visited an endemic area in Latin America. Fourteen adult male patients were confirmed to have paracoccidioidomycosis by conventional diagnosis: the direct examination was positive in 12 samples while fungal growth was found only in 4. Anti-Paracoccidioides spp. antibodies were detected in 10 patients, 8 of them with proven paracoccidioidomycosis. Nested PCR for Paracoccidioides spp. detection was performed on clinical samples from 14 patients, and positive results were obtained for 9 out of 10 patients with the conventional diagnosis of paracoccidioidomycosis. Conclusions. The incorporation of molecular techniques to detect Paracoccidioides spp. DNA complements the conventional diagnosis of paracoccidioidomycosis. This tool allows the prescription of antifungal treatment in those cases where the fungus is not observed in the clinical samples. Current human migrations difficult the mycological diagnosis of paracoccidioidomycosis and other fungal infections. For this reason, it is necessary to improve mycological diagnosis in clinical laboratories to adequately treat patients with this neglected mycosis.

Hiperplasia pseudoepiteliomatosa: carcinoma escamocelular versus paracoccidioidomicosis oral, un caso con mirada dermatológica / Pseudoepitheliomatous hyperplasia: Squamous cell carcinoma versus oral paracoccidioidomycosis, a case from a dermatological perspective

La paracoccidioidomicosis es una micosis sistémica endémica en Latinoamérica. La presentación más frecuente compromete crónicamente los pulmones, la piel y las mucosas. Al inicio, este paciente presentó, por varios años, una lesión única en la mucosa oral que, en ausencia de otros síntomas, se relacionó con una neoplasia maligna, específicamente con un carcinoma escamocelular. La diferenciación entre los dos diagnósticos se hace mediante un examen directo, un estudio histopatológico y cultivos iniciales y subsecuentes. Sin embargo, tales estudios no fueron concluyentes. Después de varias consultas y pruebas, con los resultados del examen directo, la inmunodifusión y la PCR en tiempo real se confirmó el diagnóstico de paracoccidioidomicosis crónica multifocal. Este caso alerta sobre la ausencia de sospecha clínica de micosis endémicas, dada la presencia de lesiones mucocutaneas que pueden ser producidas por hongos como Paracoccidioides spp, y la importancia de considerarlas entre los diagnósticos diferenciales.

Paracoccidioidomycosis is a systemic mycosis endemic in Latin America. The most frequent form involves a chronic compromise of the lungs, skin, and mucosa. The patient started with a single oral lesion that lasted for several years. The absence of other symptoms pointed out a possible malignant neoplasm, specifically a squamous cell carcinoma. Differentiation between both diagnoses-fungal infection and carcinoma-depends on the results of the direct examination, the histopathological study, and the initial and subsequent cultures. However, in this case, those findings were not conclusive. The coexistence of both diagnoses is frequent and increases the diagnostic challenge. After several consultations and tests, direct examination, immunodiffusion and real-time PCR findings the multifocal chronic paracoccidioidomycosis diagnosis was confirmed. This case warns about a systematical absence of clinical suspicion of endemic mycoses before the appereance of mucocutaneous lesions, which can be produced by fungi like Paracoccidioides spp, and the importance of considering those mycoses among the differential diagnoses.

Esporotricosis en Argentina: análisis clínico y epidemiológico / Sporotrichosis in Argentina: clinical and epidemiological analysis

Introducción. La esporotricosis es una micosis de implantación causada por Sporothrix spp. Este se encuentra distribuido mundialmente y se puede encontrar en la vegetación y en el suelo. La ruta más frecuente de adquisición de la infección es por traumatismos con elementos contaminados con propágulos del hongo. Los gatos domésticos son los animales más afectados y pueden transmitirla a los humanos, por lo que es considerada una zoonosis. Las formas clínicas incluyen: la linfangítica nodular, la cutánea fija, la pulmonar (poco habitual) y la diseminada (excepcional). Objetivo. Analizar la epidemiología de la esporotricosis en Argentina entre los años 2010 y 2022. Describir la presentación clínica, los métodos de diagnóstico y el tratamiento de los casos diagnosticados en este período. Conocer los genotipos circulantes y observar su relación con el lugar geográfico de adquisición de la infección. Materiales y métodos. Se llevó a cabo un estudio analítico, retrospectivo y observacional, en el que se analizaron las historias clínicas de los pacientes con esporotricosis de 12 instituciones de salud de Argentina, entre los años 2010 y 2022. Resultados. Se presentan 54 casos en los que la forma clínica más frecuente fue la linfangítica nodular y el tratamiento de elección fue el itraconazol. En todos los casos se realizó diagnóstico convencional. El cultivo de las muestras clínicas resultó más sensible que el examen directo, ya que permitió el desarrollo de Sporothrix spp. en los 54 casos. En 22 casos se hizo identificación molecular y Sporothrix schenkii sensu stricto fue la especie más frecuentemente aislada. Conclusiones. Este estudio permitió conocer la epidemiología de esta micosis en Argentina, así como la disponibilidad de métodos diagnósticos y el tratamiento de elección.

Introduction. Sporotrichosis is an implantation mycosis caused by Sporothrix spp. It is distributed worldwide and can be found in vegetation and soil. The most frequent route of infection is by trauma with elements contaminated with fungal propagules. Since domestic cats are the most affected animals and can transmit this infection to humans, sporotrichosis is considered a zoonosis. Clinical presentations include nodular lymphangitis, fixed cutaneous, pulmonary (rare), and disseminated (exceptional). Objective. To analyze the epidemiology of sporotrichosis in Argentina during 2010 and 2022. To describe the clinical presentation, diagnostic methods, and treatment of cases diagnosed during this period. To know the circulating genotypes and to observe possible associations with the geographic location where the infection was acquired. Materials and methods. Analytical, retrospective, and observational study. We analyzed the medical records of patients with sporotrichosis from 12 health institutions in Argentina, between 2010 and 2022. Results. We present 54 cases in which the most frequent clinical form was nodular lymphangitis, and the treatment of choice was itraconazole. Conventional diagnosis was made in all cases. Culture of clinical samples was more sensitive than direct examination because it allowed the isolation of Sporothrix spp. in all 54 cases. Molecular identification was performed in 22 cases, with Sporothrix schenkii sensu stricto being the most frequently isolated species. Conclusions. This study allowed to know the epidemiology of this mycosis in Argentina, as well as the availability of diagnostic methods and the treatment of choice.

Computed tomography findings of pulmonary histoplasmosis: pictorial essay / Aspectos tomográficos da histoplasmose pulmonar: ensaio iconográfico

Abstract Endemic systemic mycoses are prevalent in specific geographic areas of the world and are responsible for high rates of morbidity and mortality in the populations of such areas, as well as in immigrants and travelers returning from endemic regions. Pulmonary histoplasmosis is an infection caused by Histoplasma capsulatum, a dimorphic fungus. This infection has a worldwide distribution, being endemic in Brazil. Histoplasmosis can affect the lungs, and its diagnosis and management remain challenging, especially in non-endemic areas. Therefore, recognition of the various radiological manifestations of pulmonary histoplasmosis, together with the clinical and epidemiological history of the patient, is essential to narrowing the differential diagnosis. This essay discusses the main computed tomography findings of pulmonary histoplasmosis.

Resumo As micoses sistêmicas endêmicas são prevalentes em áreas geográficas específicas do mundo e são responsáveis por altas taxas de morbidade e mortalidade nessas populações e em imigrantes e viajantes que retornam de regiões endêmicas. A histoplasmose pulmonar é uma infecção causada pelo Histoplasma capsulatum, um fungo dimórfico. Essa infecção tem distribuição mundial, apresentando-se de forma endêmica no Brasil. A histoplasmose pode afetar os pulmões de pacientes, e seu diagnóstico e manejo permanecem desafiadores, especialmente em áreas não endêmicas. Portanto, o reconhecimento das várias manifestações radiológicas da histoplasmose pulmonar associadas a história clínica e epidemiológica dos pacientes é fundamental para estreitar o diagnóstico diferencial. Este ensaio discute os principais achados tomográficos da histoplasmose pulmonar.

Paraccocidiomicosis sistémica en consumidor crónico de corticoides

La Paracoccidiomicosis es una infección endémica. Junto con la histoplasmosis, son las infecciones micóticas más frecuentes en Latinoamérica. Esta micosis puede ser de afección local o sistémica, con un marcado trofismo por los pulmones, órganos linfoides, hígado, glándulas suprarrenales, piel y mucosa. Presentamos el caso de un varón adulto, consumidor crónico de corticoides, que desarrolla una paracoccidiomicosis sistémica con afección pulmonar y de glándulas suprarrenales con buena repuesta a la terapéutica antifúngica.

Paracoccidiomycosis is an endemic infection, together with histoplasmosis, they are the most frequent fungal infections in Latin America. This mycosis can be of local or systemic affection, with a marked trophism by the lungs, lymphoid organs, liver, adrenal glands, skin and mucosa. We present the case of an adult male, chronic steroid user, who develops systemic paracoccidiomycosis with pulmonary and adrenal gland involvement with good response to antifungal therapy.

COVID-19 associated rhinomaxillary mucormycosis: a case series and review of literature

During COVID-19 pandemic, fulminant deep fungal infection started emerging in India, known as Mucormycosis. This type of mucormycosis was termed as COVID-19 associated mucormycosis (CAM). These patients had previous history of COVID-19 infection. Such cases were mainly reported in immunocompromised patients such as patients with poorly controlled diabetes and chronic renal diseases etc. Rhinomaxillary mucormycosis is an aggressive, fulminant, fatal deep fungal infection of head and neck region. Early diagnosis and prompt treatment can reduce the mortality and morbidity associated with the disease; hence we present case series of rhinomaxillary mucormycosis to create awareness amongst dental surgeons

Aspergilosis pulmonar crónica necrotizante

Introducción: La aspergilosis crónica necrotizante es una enfermedad infrecuente que se caracteriza por ser un proceso destructivo y crónico en el parénquima pulmonar. Se clasifica en cavitaria, necrotizante y fibrosante. Objetivo: Presentar una paciente con aspergilosis crónica necrotizante, sus características clínicas, diagnósticas y procedimiento terapéutico empleado. Caso clínico: Paciente femenina de 20 años de edad con antecedentes de asma bronquial que hace 6 meses presenta tos con expectoración amarrilla; realizó varios ciclos de antibióticos con poca mejoría clínica, un mes atrás comenzó con fiebre de 38 ºC, falta de aire y hemoptisis. Se ingresó en la sala de neumología con la sospecha de tuberculosis pulmonar o micosis pulmonar. Se estableció el diagnóstico definitivo de aspergilosis crónica necrotizante, a través de la tinción de Grocott y ácido peryódico de Schiff, los esputos micológicos y la tomografía axial computarizada. Se instauró tratamiento con anfotericina B liofilizada, por 21 días y luego itraconazol por vía oral, por 3 meses; la evolución fue satisfactoria. Conclusiones: La sospecha clínica y la confirmación, tanto radiológica como micológica en todo paciente con manifestaciones clínicas de evolución insidiosa y escasa respuesta a los antibióticos, es fundamental para llegar al diagnóstico de aspergilosis pulmonar.

Introduction: Chronic necrotizing aspergillosis is a rare disease that is characterized by being a destructive and chronic process in the lung parenchyma. It is classified as cavitary, necrotizing and fibrosing. Objective: To present a patient with chronic necrotizing aspergillosis, her clinical and diagnostic characteristics and the therapeutic procedure used. Clinical case: A 20-year-old female patient with a history of bronchial asthma who had a cough with yellow expectoration 6 months ago; she underwent several cycles of antibiotics with little clinical improvement, a month ago she started with a fever of 38 ºC, shortness of breath and hemoptysis. She was admitted to the pulmonology ward with suspected pulmonary tuberculosis or pulmonary mycosis. The definitive diagnosis of chronic necrotizing aspergillosis was established through Grocott and Schiff periodic acid staining, mycological sputum, and computerized axial tomography. Treatment with lyophilized amphotericin B was established for 21 days and then oral itraconazole for 3 months; the evolution was satisfactory. Conclusions: Clinical suspicion and confirmation, both radiological and mycological in all patients with clinical manifestations of insidious evolution and poor response to antibiotics, is essential to reach the diagnosis of pulmonary aspergillosis.

Síndrome destructivo de línea media secundario a infección por Paracoccidioides sp. Reporte de un caso

El síndrome destructivo de línea media es un grupo de enfermedades inflamatorias y tumorales destructivas del área centrofacial, entre las cuales la paracoccidioidomicosis es una de las etiologías a considerar en los países del trópico. La paracoccidioidomicosis es causada por hongos del género Paracoccidioides. Su forma de blastoconidia favorece la diseminación hematógena, afectando diversos tejidos como glándulas suprarrenales, tejido retículo-endotelial o mucosa oral, esta última donde puede manifestarse como un síndrome destructivo de línea media. Presentamos un caso de paracoccidioidomicosis con afección en cavidad oral, el cual debutó como un síndrome destructivo de línea media crónico, asociado a compromiso grave de la vía aérea que requirió manejo quirúrgico por riesgo de obstrucción y presentó mejoría con manejo antimicótico sistémico.

Summary Midline destructive disease is a group of severe and destructive inflammatory and tumor diseases of the midface area, among which paracoccidioidomycosis is one of the main etiologies in tropical countries. Paracoccidioidomycosis is an endemic mycosis caused by fungi of the genus Paracoccidioides. Its blastoconidia form favors hematogenous spread, affecting various tissues such as adrenal glands, reticulo-endothelial tissue, or oral mucosa, where it can manifest as a destructive midline syndrome. We present a case of paracoccidioidomycosis with affection in the oral cavity, which debuted as a chronic midline destructive disease with sever airway compromise that required surgical treatment for the risk of obstruction of the airway. The patient received systemic treatment with good response.

Infección fúngica invasiva por Saprochaete capitata en un niño con aplasia medular / Invasive fungal infection by Saprochaete capitata in a child with bone marrow aplasia

RESUMEN Saprochaete capitata es una causa rara de infección fúngica invasiva en pacientes inmunocomprometidos con alta mortalidad y resistencia antifúngica. Presentamos el caso de un niño de cinco años con diagnóstico de aplasia medular, sometido a trasplante de progenitores hematopoyéticos (TPH), que cursó con neutropenia febril persistente, dolor abdominal intenso, aparición de lesiones maculopapulares en piel y deterioro de la función renal. Se identificó la presencia de S. capitata, en hemocultivos transcatéter venoso central. Esta infección fúngica invasiva resulta ser rara, pero emergente y potencialmente mortal, en pacientes con neutropenia febril persistente y uso prolongado de dispositivos invasivos intravasculares como catéter venoso central.

ABSTRACT Saprochaete capitata is a rare cause of invasive fungal infection in immunocompromised patients with high mortality and antifungal resistance. We present the case of a 5-year-old boy with bone marrow aplasia, who underwent hematopoietic stem cell transplantation (HSCT) and presented persistent febrile neutropenia, abdominal pain, appearance of maculopapular lesions on the skin, and impaired renal function. The presence of S. capitata was identified by blood culture from a central venous catheter. This invasive fungal infection is rare but emergent and life-threatening, especially in immunocompromised patients with persistent febrile neutropenia and prolonged use of invasive devices such as central venous catheters.

Phenotypic Characterization of Fungal Pathogens Associated with the Main Mycoses of Cashew (Anacardium occidentale L.)

Aims: To study the diversity of fungal pathogens associated with cashew mycoses in Togo. Study Design: This research project was initiated by the Mycology Research and Applications Unit of the Botany and Plant Ecology Laboratory (LBEV) in order to have adequate information on cashew mycoses in Togo. Place and Duration of Study: Laboratory of Botany and Plant Ecology (LBEV) of the University of Lome (UL) and of Crop Protection and Biosafety Laboratory of Togolese Institute of Agronomic Research (ITRA), February to August 2020. Methodology: A total of 148 symptomatic samples (leaves, buds, inflorescences, nuts, and apples) were collected from cashew trees in the East Mono prefecture of Togo. Malt-agar medium supplemented with chloramphenicol at 0.5 g/l was used for the isolation of fungal pathogens. The characterization of these fungal pathogens was carried out from the 7th day based on their macroscopic (texture, color, diameter of growth) and microscopic (hypha, spore, fruiting body) characters. Results: This study revealed the presence of five mycoses in cashew orchards in the East Mono prefecture. These are leaf anthracnose, bud’s dieback, black rust, leaf yellowing, and powdery mildew. In total, 12 fungal genera were encountered and 14 species of fungal pathogens were identified on all the samples collected: Rhizopus sp., Penicillium sp., Mucor sp., Sporotrichum sp., Fusarium nivale, Fusarium moliniforme, Fusarium moliniforme var. subglutinans, Curvularia lunata, Curvularia geneculata, Alternaria tenuissima, Alternaria brassicisola, Beltrania rhombica Penz., Thielavia coactilis Nicot, Helminthosporium avenae, Helminthosporium siccans, Phoma eupyrena, Aspergillus flavus, Aspergillus niger. Conclusion: It would be of great interest to train cashew producers in the East Mono prefecture on the recognition of the symptoms of these mycoses and their management.

Cromoblastomicosis: primer caso alóctono tratado en Chile / Chromoblastomycosis: first allochthonous case treated in Chile

Resumen La cromoblastomicosis es una infección fúngica de la piel y del tejido subcutáneo, de evolución crónica, causada por hongos dematiáceos que se caracterizan por presentar melanina en su pared celular. La enfermedad se presenta en todo el mundo, principalmente en regiones tropicales y subtropicales. En Chile, solo hay un reporte de caso humano hace más de 30 años. Se presenta el caso de un varón de 46 años, haitiano, residente en Chile, con placas verrucosas en la zona tibial anterior de un año de evolución. El diagnóstico de cromoblastomicosis se confirmó al observar células muriformes en la histopatología y colonias dematiáceas en el cultivo micológico; además, en la miscroscopía directa se observaron conidias compatibles con Fonsecaea spp. Luego de seis meses de tratamiento con antimicóticos sistémicos y crioterapia, se logró la remisión completa de las lesiones.

Abstract Chromoblastomycosis is a fungal infection of the skin and subcutaneous tissue, of chronic evolution, caused by dematiaceous fungi. The disease occurs worldwide, mainly in tropical and subtropical regions, but in regions like Chile there is only one report of a human case more than 30 years ago. We present the case of a 46-year-old Haitian man, resident in Chile, with verrucous plaques in the right anterior tibial area of one year of evolution. The diagnosis of chromoblastomycosis was confirmed when muriform cells and dematiaceous colonies were observed in the histopathological analysis and the direct microscopy, respectively. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.

The Epidemiological and Mycological Profile of Superficial Mycoses in India from 2015 to 2021: A Systematic Review

Background: The epidemiological and mycological patterns of superficial mycoses across various geographic regions of India across the last few years are changing. Objective: This study was performed to evaluate the epidemiological and mycological profile of superficial mycoses in India between 2015 and 2021. Methods: In this systematic review, the PubMed database was searched for all observational studies published between January 1, 2015, and December 31, 2021, which had evaluated the clinico‑mycological profile of superficial mycoses among outpatients from various parts of India. Descriptive statistics was used to represent the results. Results: Forty studies(21 from the north, three from the northeast, five from the east, seven from the south, one from the west, and three from multiple regions of India) were included. Male patients and those of the age group of 21–40 years were most commonly affected. The proportion of dermatophytes as causative organisms was consistently high across all regions and throughout the study period (23.6%–100%). Among dermatophytes, the proportion of Trichophyton mentagrophyte (14.0%–97.2%) and Trichophyton rubrum (0%–69.1%) was consistently high across all regions. The prevalence of T. mentagrophyte showed a rising trend, while that T. rubrum showed a declining trend from 2015 to 2021. Conclusions: The epidemiological and mycological pattern of superficial mycoses showed a fairly similar trend across various regions of India from 2015 to 2021. Dermatophytes were the main causative agents of superficial mycoses; the most common species were T. mentagrophyte and T. rubrum. A rising trend of T. Mentagrophyte infection was found.

Paracoccidioidomicosis diseminada en paciente inmunocompetente: reporte de caso / Disseminated Paracoccidioidomycosis in immunocompetent patient: case report

Resumen La Paracoccidioidomicosis (PCM) es una infección micótica endémica en Latinoamérica que se caracteriza por compromiso multiorgánico. El diagnóstico tardío y la diseminación sistémica favorecen complicaciones como falla respiratoria e insuficiencia suprarrenal que condicionan el desenlace del paciente. Se presenta el caso de un paciente de 51 años de edad, procedente de la costa pacífica colombiana, inmunocompetente con PCM diseminada a sistema nervioso central (SNC), pulmones y glándulas suprarrenales con debut clínico de síndrome neurológico. Durante estancia hospitalaria presenta pico febril, colapso hemodinámico, aci dosis metabólica severa e hiperlactatemia. Se hemocultivó e inició tratamiento antimicrobiano de amplio espectro con piperacilina-tazobactam (4.5 gr/IV cada 8 horas), vancomicina (15 mg/kg) más anfotericina B desoxicolato (1 mg/kg/dia) y se trasladó a unidad de cuidado intensivo. En la muestras de tejido suprarrenal se identificaron levaduras multigemantes de Paracoccidioides spp e inflamacion crónica granulomatosa. A los seis días posteriores a su ingreso, el paciente continuó con deterioro hemodinámico, desequilibrio electrolítico, shock séptico e insuficiencia suprarrenal que conllevó a su deceso a pesar de las medidas terapéuticas establecidas. Se intenta exponer el desafío que representa el diagnóstico de PCM sistémica y promover su sospecha clínica para poder identificar la enfermedad de forma oportuna y evitar complicaciones que conduzcan a un desenlace fulminante.

Abstract Paracoccidioidomycosis (PCM) is an endemic fungal infection in Latin America characterized by multi-organ involvement. Late diagnosis and systemic dissemina tion favor complications such as respiratory failure and adrenal insufficiency, which determine the outcome of the patient. We present the case of a 51-year-old patient from the Colombian Pacific coast, immunocompetent with PCM spread to the central nervous system (CNS), lungs, and adrenal glands with a clinical debut of the neurological syndrome. During a hospital stay, he presented fever peak, hemodynamic collapse, severe metabolic acidosis, and hyperlactatemia. Blood culture and began broad-spectrum antimicrobial treatment with piperacillin-tazobactam (4.5 gr / IV every 8 hours), vancomycin (15 mg/kg) plus amphotericin B deoxycholate (1 mg/kg/day) and was transferred to the intensive care unit. Paracoccidioides spp multigene yeasts and chronic granulomatous inflammation were identified in adrenal tissue samples. Six days after admission, the patient continued with hemodynamic deterioration, electrolyte imbalance, septic shock, and adrenal insufficiency that led to death despite the established therapeutic measures. The aim is to expose the challenge posed by the diagnosis of systemic PCM and promote its clinical suspicion to identify the disease promptly and avoid complications that lead to a fulminant outcome.

Radiological patterns of pulmonary fungal infection in pediatric hematology and oncology patients

Abstract Objective: To describe the radiological findings in pediatric patients with hematological or oncological diseases who also have an invasive fungal infection (IFI). Materials and Methods: This was a retrospective study of all patients with IFI admitted to a pediatric hematology and oncology hospital in Brazil between 2008 and 2014. Clinical and demographic data were collected. Chest computed tomography (CT) scans of the patients were reviewed by two independent radiologists. Results: We evaluated the chest CT scans of 40 pediatric patients diagnosed with an IFI. Twenty-seven patients (67.5%) had nodules with the halo sign, seven (17.5%) had cavities, two (5.0%) had nodules without the halo sign, and seven (17.5%) had consolidation. The patients with the halo sign and cavities were older (123 vs. 77 months of age; p = 0.03) and had less severe disease (34% vs. 73%; p = 0.04). Ten patients had a proven IFI: with Aspergillus sp. (n = 4); with Candida sp. (n = 5); or with Fusarium sp. (n = 1). Conclusion: A diagnosis of IFI should be considered in children and adolescents with risk factors and abnormal CT scans, even if the imaging findings are nonspecific.

Resumo Objetivo: O objetivo deste estudo é descrever os achados radiológicos de infecções fúngicas invasivas em crianças com doenças onco-hematológicas em um único centro, de acordo com a classificação antiga e a atual de imagens típicas e atípicas. Materiais e Métodos: Foram revisados os prontuários de todos os pacientes com infecção fúngica invasiva que foram internados em um hospital pediátrico de oncologia e hematologia de 2008 a 2014. Foram coletados dados clínicos e demográficos. As tomografias de tórax dos pacientes foram laudadas por dois radiologistas independentes. Resultados: Foram identificados 40 pacientes com infecção fúngica invasiva que realizaram tomografias de tórax. Vinte e sete pacientes apresentaram nódulos com sinal do halo (67,5%), sete tiveram cavitações (17,5%), dois tiveram nódulos sem halo (5,0%) e sete apresentaram consolidações (17,5%). Os pacientes que apresentavam achados de nódulos com sinal do halo e cavitações eram mais velhos (123 versus 77 meses; p = 0,03) e tinham menos sinais de doença grave (34% versus 73%; p = 0,04) do que os outros pacientes. Dez crianças apresentaram infecção confirmada (Aspergillus sp., n = 4; Candida sp., n = 5; Fusarium sp., n = 1). Conclusão: O diagnóstico de infecção fúngica invasiva deve ser considerado em crianças com fatores de risco e tomografias de tórax alteradas, mesmo que os achados das imagens sejam inespecíficos.

Sporotrichosis: hyperendemic by zoonotic transmission, with atypical presentations, hypersensitivity reactions and greater severity

Abstract In recent decades, an alarming increase in the number of sporotrichosis cases has been reported in southern and southeastern Brazil, especially in the state of Rio de Janeiro, has been considered a long-term hyperendemic condition associated with feline transmission. According to phenotypic classifications, the Sporothrix species recovered from cats were classified as S. brasiliensis in 96.5% of the studied cases. This finding has also been demonstrated in humans, which confirms the zoonotic transmission associated with this predominant species in Brazil. The zoonotic transmission of the fungus and its important virulence in the context of the hyperendemic situation in Rio de Janeiro have changed the approach to the disease, which in its classic form was restricted to certain professional groups and very specific regions in the Brazilian territory, into a public health challenge of scientific interest. Its atypical manifestations and hypersensitivity reactions are increasingly frequent, constituting a new sporotrichosis aspect, which deserves attention from the medical community, as well as from other health professionals.

Oral manifestations of systemic fungal infections: 25-year experience in an endemic region

Some mycoses are endemic. They develop through hematogenous spread, causing a generalized infection, usually with secondary mucosal involvement.The aim of this observational and retrospective study was to report the prevalence and characteristics of oral lesions in patients diagnosed with systemic fungal infections (SFI) over a 25-year period in southern Brazil. Demographic (age, sex, ethnicity, occupation) and clinical (anatomical location, symptoms,histopathological diagnosis and management) data from the medical records of patients with SFI were collected from 1995 to 2019. 34 cases of SFI were found, of which 31 (91.18%) were diagnosed as paracoccidioidomycosis (PCM) and 3 (8.82%) as histoplasmosis. Men were much more affected (n = 31; 91.18%), with an average age of 46.9 years. Most patients (n = 18; 58.06%) were Caucasian; 48% (n = 15) were farm/rural workers and the most affected region was the jugal mucosa (n = 13; 25.49%) followed by the alveolar ridge (n = 12; 23.52%). All patients with histoplasmosis were immunocompetent men (mean age: 52.67 years), and the palate was the most affected. All patients underwent incisional biopsy and were referred to an infectologist. The dentist has an essential role in the recognition of SFI, whose oral manifestations may be the first sign. SFI should be included in differential diagnosis in patients from endemic areas. In addition, the inevitable human mobility and globalization make knowledge of these mycosesnecessary worldwide, especially since advanced cases in immunocompromised patients can be fatal.

Investigation of medication adherence for superficial mycoses among students in a college based on Morisky Medication Adherence Scale / 药学实践杂志

Objective To investigate the medication adherence of military academy students with superficial mycoses. Methods A 8-item Morisky medication adherence scale (MMAS) was modified into 7-item scale to evaluate the compliance of antifungal drugs in the sick students. The reliability and validity of the scale were analyzed. Results A total of 243 questionnaires were collected, of which 242 were valid questionnaires. 90.08% of the students took topical medication and 8.68% were treated both with topical and systematic combination. High, medium and low medication adherence rates as assessed by the modified MMAS were 9.09%, 23.97% and 66.94%, respectively. The reliability analysis showed that the internal consistency coefficient (Cronbach’s α ) was 0.781，and the adjusted Cronbach’s α was 0.790, indicating the high reliability of the scale. The KMO value was 0.798, and the Bartlett’s spherical test value was 440.866, P=0.000. One factor was extracted by exploratory factor analysis. The factor loadings of the items were all above 0.5. Therefore, the high convergent validity was good. Conclusion The modified MMAS has good reliability and validity and is applicable for the evaluation of medication compliance for superficial mycoses. In this study, the military students have a low level of medication adherence for superficial mycoses. Effective measures should be taken to help students strengthen their daily medication management and improve compliance.

Clinical manifestations of pulmonary cryptococcosis: an analysis of 113 cases / 中华全科医师杂志

Objective:To analysis of clinical and imaging characteristics of pulmonary cryptococcosis.Methods:The clinical and imaging characteristics of 113 patients with pulmonary cryptococcosis who were admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to March 2019, were retrospectively analyzed.Results:Among 113 patients, 74 cases (65.5%) were males, and 71 cases (62.8%) were at a age of 40-60 years. The imaging manifestations showed a nodular-infiltrating patchy mixed type ( n=44,38.9%), accompanied by halo sign ( n=48, 42.5%) and bronchial air sign ( n=48, 42.5%). All patients were treated with fluconazole and the follow-up at 3 months after discharge showed their conditions were all improved. Subgroup analysis showed that patients with complications had older average age [(54.28±10.64)y vs. (46.52±12.12)y, t=-5.05, P<0.001], longer hospital stay [(10.42±6.11)d vs. (7.09±5.63)d, t=-4.28, P=0.007], lower white blood cell count [(6.02±2.16)×10 9/L vs. (6.96±2.29)×10 9/L, t=2.44, P=0.027]. The symptomatic group had fewer male patients [56.2% (45/80) vs. 87.9% (29/33), χ 2=19.54, P<0.001], and imaging was more likely to show infiltrative patchy [32.5%(26/80) vs. 9.1%(3/33), χ 2=18.25, P=0.031]. There was no significant difference in clinical and imaging manifestations between antigen positive group and antigen negative group(all P>0.05). Conclusions:Most of the patients with pulmonary cryptococcosis are middle-aged men, and have nodular-infiltrating patchy mixed type in imaging; the complications would prolong the length of hospital stay.