Dermatofitosis por Microsporum gypseum en un niño con inmunodeficiencia primaria / Microsporum gypseum dermatophytosis in a child with primary immunodeficiency

El Microsporum gypseum es un hongo geofílico que puede producir lesiones cutáneas inflamatorias en personas sanas. Se han descripto lesiones más extensas en pacientes inmunocomprometidos. Se presenta el caso de un paciente con dermatofitosis, con exámenes micológicos positivos para Candida sp, Epidermophytom floccosum y Trichophyton tonsurans, al que, ante la mala respuesta al tratamiento con griseofulvina e itraconazol a dosis habituales, se le realizó biopsia cutánea para cultivo que evidenció la presencia de M. gypseum. Debido a la extensión y a la mala respuesta al tratamiento, se realizó evaluación inmunológica y se diagnosticó un defecto en STAT1 con ganancia de función (STAT1-GOF). Los pacientes que tienen esta inmunodeficiencia primaria son susceptibles a las infecciones micóticas, especialmente por Candida, pero también, aunque en menor medida, a virus y bacterias. El paciente aquí presentado recibió tratamiento prolongado con antimicóticos imidazólicos sistémicos, con resolución de las lesiones.

Microsporum gypseum is a geophilic fungus that can cause inflammatory skin lesions in heathy people. More extensive lesions have been described in immunocompromised patients. We present a patient with extensive dermatophytosis, which mycological examination led the identification of Candida sp, Epidermophyton Floccosum and Trichophyton tonsurans and showed poor response to treatment with griseofulvina and itraconazol at usual doses. When skin biopsy was performed, it had positive culture for M. gypseum. Due to the extension and poor response to treatment, immunological assessment was performed and it showed a defect of STAT1 with gain of function (STAT 1-GOF). Patients with primary immunodeficiency are susceptible to fungal infections, especially Candida but also virus and bacteria, although to a lesser extent. The patient received long-term treatment with systemic imidazole antifungal recovering for the lesions.

Primary cutaneous cryptococcosis: the importance of early diagnosis

Abstract The species of the Cryptococcus neoformans complex show different epidemiological patterns in the infection of immunosuppressed or immunocompetent individuals, and a common tropism peculiarity for the central nervous system. Primary cutaneous cryptococcosis is a rare clinical entity, with manifestations that are initially restricted to the skin through fungal inoculation, and the absence of systemic disease. The authors report in the present study the case of a 61-year-old immunocompetent man, with a rapidly evolving mucoid tumor on abrasions in contact with bird droppings on the forearm. The early identification of the polymorphic skin manifestations and treatment are crucial for the favorable prognosis of the infection, which can be life-threatening.

Dermatomicosis superficiales: cuando el diagnóstico lo entrega la histología / Superficial dermatomycosis: when the diagnosis is provided by histology

Superficial dermatomycosis are prevalent pathologies in the medical field and their diagnosis is fundamentally clinical. Histopathology is not considered part of his study, however, the diagnosis is exceptionally obtained by biopsy, when dermatomycosis was not suspected. Unpublished retrospective work is carried out on patients who had the histopathological diagnosis of superficial dermatomycosis between the years 2000-2019 at the HCUCH, based on selection criteria, obtaining 19 patients, in which the following were analyzed: age, gender, clinical characteristics, location, presumptive diagnosis and mycological and histological examinations. He stressed, as was our hypothesis, that dermatomycosis was not clinically suspected, since the presumptive diagnoses were various dermatoses. The most suspected dermatosis was psoriasis, as a result that 57.8% of the dermatoses studied had erythematous scaly plaques on examination. Another relevant fact is that only 21% of the cases underwent a direct mycological prior to the biopsy, which was negative ('' false negative''). It is concluded, then, that superficial dermatomycosis should be considered clinical simulators of other dermatoses, so clinical suspicion and support of mycological examination and fungal culture is essential. (AU)

Neoscytalidium dimidiatum un raro agente de onicomicosis no dermatofítica en Chile / Neoscytalidium dimidiatuma rare agent ofnon dermatophyticonychomycosisin Chile

El término de onicomicosis se emplea para describir las infecciones de las uñas causadas por diferentes grupos taxonómicos fúngicos ya sea filamentosos como levaduriformes. A pesar de que estas patologías son causadas en los vertebrados principalmente por integrantes de la Familia Artrodermatáceae (Onygenales), la micología médica aplicó para ellos la terminología más específica de dermatofitosis, por ser un grupo ecológico de mayor importancia y presencia clínica. Las dermatomicosis de piel y fanéreos, representan un conjunto de infecciones producidas por especies fúngicas distribuidas en ambientes diversos, capaces de crecer a temperaturas de 37° y que actúan usualmente como patógenos oportunistas cuando existe generalmente un factor predisponente en el huésped. Se destaca la colonización en una uña de los pies en un hombre de 49 años por Neoscytalidium dimidiatum(Penz.) Crous & Slippers, un reconocido fitopatógeno de rápido crecimiento, común en zonas tropicales y subtropicales, que presentó la capacidad de invadir tejidos queratinizados con un aspecto clínico indistinguible de los causadas por dermatofitos. Por la rara presencia de este hongo en nuestra zona geográfica (provincia de Valparaíso, Chile), se aportan los principales datos morfofisiológicos,taxonómicos y moleculares utilizados en su diagnóstico. (AU)

The term onychomycosis is used to describe nail infections caused by different fungal taxonomic groups, either filamentous or yeast. Despite the fact that these pathologies are caused in vertebrates mainly by members of the Artrodermatáceae Family (Onygenales), medical mycology applied the more specific terminology of dermatophytosis for them, as it is an ecological group of greater importance and clinical presence. Skin and pharynx dermatomycosis represent a set of infections produced by fungal species distributed in diverse environments, capable of growing at temperatures of 37° and that usually act as opportunistic pathogens when there is a predisposing factor in the host. The colonization on a toenail in a 49-year-old man by Nesoscytalidium dimidiatumis highlighted (Penz.) Crous & Slippers, a recognized fast-growing phytopathogen, common in tropical and subtropical areas, which presented the ability to invade keratinized tissues with a clinical appearance indistinguishable from those caused by dermatophytes. Due to the rare presence of this fungus in our geographical area (Valparaíso province, Chile), the main morphophysiological, taxonomic and molecular data used in its identificationare provided. (AU)

Padronização de uma PCR para diagnóstico molecular de Microsporum canis em amostras de pelos e crostas de cães e gatos / Standardization of a pcr for molecular diagnosis of microsporum canis in samples of fur and crusts of dogs and cats

Objetivou-se neste estudo padronizar um protocolo de reação em cadeia da polimerase (PCR) para detecção de Microsporum canis em amostras de pelos e/ou crostas de cães e gatos. Foram selecionadas 48 amostras previamente identificadas por meio de cultura. Destas, 23 foram positivas para dermatófitos no cultivo. Padronizou-se a PCR a partir de primers desenhados para o alvo M. canis. Sessenta e um por cento (14/23) das amostras positivas para dermatófitos foram identificadas como M. canis em cultura. Desse total, 71,4% (10/14) apresentaram um fragmento de 218pb compatível com o esperado para a espécie fúngica alvo dessa reação. Observou-se uma sensibilidade de 71,4% e especificidade de 100% na PCR, além de uma boa concordância entre essas técnicas de diagnóstico (Kappa: 0,78; P<0,0001). O protocolo utilizado neste estudo apresentou alta especificidade na detecção de M. canis diretamente de amostras de pelos e/ou crostas de cães e gatos, viabilizando um diagnóstico mais rápido e específico, podendo esse protocolo ser empregado como um método confirmatório para agilizar a detecção de M. canis.(AU)

The aim of this study was to standardize a Polymerase Chain Reaction protocol (PCR) for the detection of Microsporum canis in fur and/or crusts of dogs and cats. 48 samples previously identified by culture were selected. Of these, 23 were positive for dermatophytes in culture. PCR was standardized from drawn primers whose target is M. canis. A total of 61% (14/23) of the dermatophyte positive samples were identified as M. canis in culture. Of this total, 71.4% (10/14) presented a fragment of 218bp compatible with that expected for the fungal species target of the reaction. A sensitivity of 71.4% and specificity of 100% in the PCR were observed, in addition to a good agreement between the techniques (Kappa: 0.78; P<0.0001). The protocol used in this study showed high specificity in the detection of M. canis directly from fur and/or crusts of dogs and cats, making possible a faster and more specific diagnosis. This protocol could be used as a confirmatory method, speeding the detection of M. canis.(AU)

Dermatitis facial por Malassezia pachydermatis / Facial dermatitis caused by Malassezia pachydermatis

Se presenta un caso de dermatitis facial por Malassezia pachydermatis en un paciente de 34 años de edad, diagnosticado mediante clínica y estudio micológico. M. pachydermatis es una levadura que forma parte de la microbiota de mamíferos domésticos y animales salvajes, donde frecuentemente puede provocar dermatitis y otitis externa. En humanos, son escasas las infecciones por este agente, describiéndose desde infecciones superficiales hasta fungemias. En Chile se la ha encontrado como agente causal de pitiriasis versicolor y dermatitis seborreica principalmente en pacientes inmunocomprometidos.

We present a clinical case of facial dermatitis due to Malassezia pachydermatis in a patient of 34 years old, diagnosed by clinical and micology study. M. pachydermatis is a zoofilic yeast that is part of the microbiota of domestic mammals and wild animals, frequently causing dermatitis and external otitis. In humans, infections by this agent are very scarce, describing from superficial infections to fungemias. In Chile it has been found as causal agent of pitiriasis versicolor and seborrheic dermatitis mainly in inmunocompromised patients.

Histoplasmosis en pacientes con SIDA sin manifestaciones cutáneo-mucosas / Histoplasmosis in AIDS patients without tegumentary manifestations

Resumen Antecedentes: La histoplasmosis es una micosis de gran relevancia en pacientes con SIDA. El cuadro clínico puede ser muy variado y, en enfermos que no desarrollan lesiones cutáneas, el diagnóstico suele demorar varias semanas. Objetivo: Establecer pautas que permitan emplear un tratamiento empírico y precoz en pacientes con histoplasmosis asociada al SIDA sin manifestaciones tegumentarias y determinar las características clínicas, microbiológicas y algunos parámetros bioquímicos en los casos de difícil diagnóstico. Métodos: Se analizaron las historias clínicas de 86 pacientes con histoplasmosis. Fueron seleccionados 31 enfermos con histoplasmosis asociada con SIDA sin lesiones cutáneas. Resultados: La fiebre fue el síntoma más frecuente (96,7%), el compromiso pulmonar se comprobó en 22 enfermos (70,9%). El patrón radiológico más frecuentemente hallado en las radiografías de tórax fue el miliar o micronodulillar bilateral [(12/22), 54,5%]. Diecinueve enfermos presentaron esplenomegalia. Los hemocultivos demostraron una sensibilidad de 93,3% (28/30) y la serología fue positiva en 23,5% de los casos. Fallecieron ocho pacientes (25,8%). Los pacientes con recuentos de linfocitos T CD4+ menores a 50 céls/μl, albúmina menor a 2,5 g/dl y pancitopenia evidenciaron un pronóstico desfavorable. Conclusiones: En los pacientes con infección por VIH, fiebre asociada a esplenomegalia y lesiones micronodulillares bilaterales en la radiografía de tórax debe considerarse el tratamiento empírico con anfotericina B cuando existan signos o síntomas de mal pronóstico, debido al tiempo de demora hasta el diagnóstico definitivo. Previo a iniciar el tratamiento deben tomarse todas las muestras para los estudios microbiológicos que permitan confirmar luego la presunción diagnóstica.

Background: Histoplasmosis is a mycosis with a high prevalence in HIV/AIDS patients. Clinical presentation includes a wide spectrum of manifestations and diagnosis usually takes up to several weeks in patients who do not present cutaneous lesions. Aim: To determine the clinical and microbiological characteristics as well as some biochemical parameters in patients with AIDS-associated histoplasmosis without tegumentary lesions, in order to develop a guideline which enables an early empiric treatment in cases of difficult diagnosis. Methods: Medical records of 86 patients with histoplasmosis were reviewed; 31 patients with diagnosis of AIDS-associated histoplasmosis without cutaneous lesions were analyzed. Results: Fever was the most frequent symptom (96.7%), lung involvement was observed in 22 patients (70.9%), the most commonly radiological pattern was miliary pattern [(12/22), 54.5%]. Nineteen patients presented with splenomegaly. Blood culture sensitivity was 93.3% (28/30) and serology was positive only in 23.5% of the cases. Eight patients died (25.8%). Patients in which CD4+ T cell lymphocytes count was < 50 cells/μl, albumin levels < 2.5 g/dl and who presented with pancytopenia had an unfavorable outcome. Conclusions: In HIV seropositive patients with fever associated to splenomegaly and bilateral miliar pattern in chest radiography, the empiric treatment with amphotericin B must be considered if signs and symptoms of unfavorable outcome are present and due to the time that it takes to arrive at an accurate diagnosis. In order to confirm the diagnosis, all microbiological samples should be collected prior to initiating therapy.

Cutaneous mucormycosis

Abstract Cutaneous mucormycosis is an emerging fungal infection caused by opportunistic fungi of the phylum Glomeromycota. It is frequent in poorly controlled diabetic patients and individuals with immunosuppression. It is usually acquired by direct inoculation through trauma. The clinical presentation is nonspecific, but an indurated plaque that rapidly evolves to necrosis is a common finding. Diagnosis should be confirmed by demonstration of the etiological agent and new molecular diagnostic tools have recently been described. It is an invasive life-threatening disease and in order to improve survival, a prompt diagnosis and multidisciplinary management should be provided. The treatment of choice is amphotericin B, but new azoles, such as posaconazole and isavuconazole, must be considered.

Facial botryomycosis-like pyoderma in an HIV-infected patient: remission after initiation of darunavir and raltegravir

Abstract Botryomycosis is an uncommon, chronic, suppurative, bacterial infection that primarily affects the skin and subcutaneous tissues. It has long been associated with defects of cellular immunity. We report a 28-year-old woman who presented with a chronic, ulcerated lesion with draining sinuses in the right malar region. Predisposing factors were HIV infection with poor immunological control, alcoholism, and a previous trauma to the right cheek. Several courses of antimicrobial therapy provided only partial and temporary remission. Complete clinical remission was only achieved 5 years later when a novel antiretroviral regimen composed of darunavir and raltegravir was initiated.

Aspergilosis diseminada con importante afectación cutánea / Disseminated aspergillosis with significant skin involvement

La Aspergilosis es una infección micótica oportunista que afecta principalmente a pacientes inmunodeprimidos con neutropenia, en quienes produce a menudo enfermedad invasiva de curso fulminante. Las manifestaciones cutáneas de la Aspergilosis son infrecuentes, apareciendo en el 5 a 10% de los casos diseminados. Comunicamos un caso de Aspergilosis en una mujer adulta con neutropenia severa por enfermedad hematológica, con afectación pulmonar y sinusal, que presenta múltiples lesiones ulceronecróticas en piel y mucosas, con evolución fatal. Las lesiones mucocutáneas de la Aspergilosis no son específicas, obligan a varios diagnósticos diferenciales y, como en este caso, la biopsia para estudio histopatológico y micológico es necesaria para el diagnóstico.

Aspergillosis is an opportunistic fungal infection that primarily affects immunocompromised patients with neutropenia, in whom invasive disease often results in fulminant course. Cutaneous manifestations of aspergillosis are rare, occurring in 5-10% of cases scattered. We report a case of aspergillosis in an adult woman with severe neutropenia for hematologic disease, lung and sinus disease, having multiple ulceronecróticas skin lesions and mucous membranes, with fatal outcome. The mucocutaneous lesions of aspergillosis are nonspecific, forcing several differential diagnoses, and as in this case, the biopsy for histopathological and mycological study is required for diagnosis.

Paracoccidioidomycosis: acute-subacute clinical form, juvenile type

Abstract: The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.

Importance of multidisciplinary approach in diagnosis of histoplasmosis

Abstract: A patient with systemic involvement, initially treated as tuberculosis, is presented in this report. There were only two painful subcutaneous nodules, from which we arrived at the correct diagnosis of histoplasmosis. The patient was attended by several experts in the fields of infectious diseases, nephrology and internal medicine, but the diagnosis was only possible after dermatological examination and skin biopsy. This case values multidisciplinary interaction between dermatologists and other medical areas for diagnosis of cases with atypical manifestations.

Micosis superficiales: casuística del Departamento de Micología del Instituto Nacional de Higiene “Rafael Rangel”, Caracas,Venezuela (2001-2014) / Superficial mycoses: casuistry of the Mycology Department of the Instituto Nacional de Higiene “Rafael Rangel”, Caracas, Venezuela (2001-2014)

Las micosis superficiales son muy comunes y por ello son motivo de consulta médica frecuente. El objetivo de este trabajo fue conocer la frecuencia de diagnóstico de las micosis superficiales en el Departamento de Micología del Instituto Nacional de Higiene “Rafael Rangel” en Caracas, Venezuela, durante 14 años (2001-2014). Se realizó un estudio transversal y retrospectivo de revisión de historias micológicas de pacientes con diagnóstico presuntivo de micosis superficial. Las muestras procesadas fueron uñas, pelos y escamas epidérmicas. La identificación de los hongos se realizó mediante observación macro y microscópica de las colonias y pruebas de identificación bioquímicas y fisiológicas, según requerimiento del agente aislado. Para la investigación de Malassezia spp. solo se realizó examen directo. De las 3228 muestras procesadas, 1098 (34%) resultaron positivas y su distribución según el agente etiológico fue: 79,5% dermatofitos; 10,9% levaduras; 5,1% hongos no dermatofitos y 4,5% Malassezia spp. El dermatofito más aislado fue el Complejo Trichophyton rubrum (70,1%), seguido del Complejo T. mentagrophytes (15,1%), Microsporum canis (9,4%) y Epidermophyton floccosum (4%). Las tiñas más frecuentes fueron: Tinea unguium (66,8%), seguida de Tinea pedis (16,4%) y Tinea capitis (8,1%). En el grupo de levaduras el Complejo Candida parapsilosis (37,5%) fue el más aislado y entre los hongos no dermatofitos el más frecuente fue Fusarium spp. (53,6%), seguido de Aspergillus spp. (19,6%) y Acremonium spp. (10,7%). La identificación del agente etiológico es fundamental para orientar un tratamiento adecuado. Esta casuística constituye un aporte importante para el conocimiento de la epidemiología de las micosis superficiales en nuestro país.

The superficial mycoses are very common infectious diseases and therefore are a frequent reason for medical consultation. The aim of this study was to determine the diagnostic frequency of superficial mycoses in the Mycology Department of the Instituto Nacional de Higiene “Rafael Rangel” during 14 years (2001-2014). A retrospective cross-sectional study was performed to review the mycological records of patients with presumptive diagnosis of superficial mycosis. Nails, hairs and epidermal scales were the processed samples. The identification of fungi was performed by macro and microscopic observation of colonies and biochemical and physiological tests, as required of the isolated agent. For the investigation of Malassezia spp. only direct examination was performed. Of the 3 228 samples processed, 1 098 (34%) were positive and their distribution according to the etiological agent was: dermatophytes 79.5%; 10.9% yeasts; non-dermatophytes fungi 5.1% and 4.5% Malassezia spp. The most frequently isolated dermatophyte was Trichophyton rubrum Complex (70.1%), followed by T. mentagrophytes complex (15.1%), Microsporum canis (9.4%) and Epidermophyton floccosum (4%). The most frequent ringworms were: Tinea unguium (66.8%), followed by Tinea pedis (16.4%) and Tinea capitis (8.1%). Candida parapsilosis complex (37.5%) was the most frequently isolated yeast and Fusarium spp. (53.6%) was the most isolated among non-dermatophyte fungi, followed by Aspergillus spp. (19.6%) and Acremonium spp. (10.7%). The identification of the etiological agent is essential to guide appropriate treatment. This study constitutes an important contribution to the knowledge of the epidemiology of superficial mycoses in our country.

Coccidioidomicosis cutánea: Comunicación de seis casos mexicanos / Cutaneous coccidioidomycoses: Six mexican cases report

Coccidioidomycosis is a systemic airborne mycosis that may involve secondarily other organs through systemic dissemination. Fungi Coccidioides immitis and C. posadasii are the etiologic agents. The former is ubiquitous from the area of California in North America, and the latter is found elsewhere in the world. Primary cutaneous infection is rare. We present six Mexican male cases, residents of Tijuana B.C. Three of them with primary pulmonary infection and further cutaneous dissemination, and three cases of primary cutaneous coccicioidomycosis. In half the cases C. posadasii was isolated. The clinical suspicion is basic for reaching the diagnosis, and we must always keep in mind that the cutaneous manifestations are widely varied and that the lesions are more severe when systemic dissemination occurs.

La coccidioidomicosis es una micosis con vía de entrada inhalatoria que puede tener manifestaciones secundarias en otros órganos, y diseminación sistèmica. Se han identificado como agentes etiológicos a Coccidioides immitis y C. posadasii, El primero está presente en California de Norteamérica y el segundo en cualquier otra región del mundo. La infección cutánea primaria es una presentación poco común. Presentamos seis casos clínicos mexicanos, de sexo masculino, residentes de la ciudad de Tijuana, B.C. Tres de ellos con infección pulmonar primaria y diseminación cutánea y tres cutáneos primarios. En la mitad de los casos se logró aislar C. posadasii. La sospecha clínica es fundamental para llegar al diagnóstico ya que las manifestaciones cutáneas son muy variadas, y ante diseminación sistèmica las lesiones cutáneas son más graves.

Manifestaciones cutáneas en donantes de sangre portadores de HTLV-1 en comparación con donantes de sangre no portadores de HTLV-1 / Cutaneous manifestations detected in human T cell lymphotropic virus type 1 infected Chilean blood donors

Background: Most human T cell lymphotropic virus type 1 (HTLV-1) infected individuals are asymptomatic, but they commonly present cutaneous lesions that could be considered warning signs of the disease. Aim: To identify the main cutaneous manifestations present in HTLV-1 infected blood donors and compare them with healthy donors. Materials and Methods: Two blood donor groups from the blood bank of an emergency hospital were matched according to gender and age. One group was formed by HTLV-1 (+) (cases) and the other by HTLV-1 (-) donors (controls). A blind examiner to the serologic condition, evaluated their cutaneous manifestations. Results: Twenty five cases and 25 controls aged 18 to 60 years (24 females) were evaluated. One or more cutaneous manifestations were found in 24 (96%) cases and in 15 (60%) controls (p < 0.01). Inflammatory cutaneous diseases were found in 19 (76%) cases and in 9 (36%) controls (p < 0.01). Dermatophytosis was found in 18 (72%) cases and in 12 (48%) controls (NS). Conclusions: HTLV-1 infected Chilean subjects have a higher frequency of dermatoses than their healthy counterparts.

Mastitis tuberculosa / Tuberculosis of the breast

Se informa un caso de mastitis granulomatosa causada por Mycobacterium tuberculosis en una paciente inmunocompetente con lesiones inflamatorias crónicas de la mama, diagnosticada por la detección de ADN de la micobacteria mediante la técnica de reacción en cadena de la polimerasa de la secuencia de inserción IS6110 presente en el complejo M. tuberculosis , en una biopsia de mama embebida en parafina. La tuberculosis primaria de la mama es rara, incluso en países con alta prevalencia de tuberculosis, y debe sospecharse en pacientes con mastitis granulomatosa crónica de causa no clara. El pilar del tratamiento es la quimioterapia antituberculosa y, ocasionalmente, la cirugía.

We report a case of granulomatous mastitis caused by Mycobacterium tuberculosis in an immunocompetent woman with chronic inflammatory lesions of the breast. It was diagnosed by detection of mycobacteria DNA using polymerase chain reaction technique targeting IS6110 insertion element of M. tuberculosis complex in a paraffin-embedded histological specimen. The primary breast tuberculosis is rare, even in countries where the incidence and prevalence of pulmonary and extra pulmonary tuberculosis are high. It should be suspected in female patients with chronic granulomatous mastitis with no apparent cause. The cornerstone of treatment is antituberculous chemotherapy, and surgery is rarely required.

Phaeohyphomycosis: a clinical-epidemiological and diagnostic study of eighteen cases in Rio Grande do Sul, Brazil

The goal of this study was to review 18 cases of phaeohyphomycosis in Rio Grande do Sul. The records of all of the patients with a diagnosis of phaeohyphomycosis between 1995-2010 were reviewed. Twelve of the 18 patients (66.6%) were male. The average age of the patients was 50 years old (range: 16-74 years). Eleven patients (61%) presented with subcutaneous lesions. Seven patients (38.8%) had received a solid organ transplant. In all of the cases, the presence of melanin in the fungal cells was determined by Fontana-Masson staining of tissue sections and documented. Among the 18 patients, a total of 11 different fungal species were isolated. The causative organisms included Exophiala jeanselmei, Alternaria, Curvularia, Cladophialophora and Colletotrichum gloeosporioides. To our knowledge, this review reports the first case of subcutaneous phaeohyphomycosis caused by C. gloeosporioides in a lung transplant patient. The number of reported cases of phaeohyphomycosis has increased in the last decade. In a number of cases, this increased incidence may be primarily attributed to iatrogenic immunodeficiency.

Mucormicosis cutánea en un paciente inmunocomprometido / Cutaneous mucormycosis in an immunocompromised patient

Mucormycosis is an increasingly emerging life-threatening infection and is an important cause of morbidity and mortality in patients with leukemia. We present the case of a 4-year-old boy with an acute lymphoblastic leukemia complicated by severe and prolonged neutropenia during induction chemotherapy, who developed cutaneous mucormycosis of the elbow. Direct microscopy with KOH and the histopathologic observation of the skin revealed fungal hyphae without septations. The cultures were positive for Rhizopus microsporus var oligosporus. The patient was treated succefully with amphotericin B during 40 days, surgical debridement and dermoepidermic graft. Early recognition and prompt intervention with combined medical and surgical treatment may improve the outcome. The most common management strategy in survivors involves a combination of antifungal therapy with amphotericin B and surgical debridement.

La mucormicosis es una enfermedad emergente grave, producida por hongos saprófitos del orden Mucorales, que afecta fundamentalmente a pacientes inmunocom-prometidos. La forma cutánea se origina por inoculación de esporas dentro de la dermis con el subsecuente desarrollo de una lesión tipo ectima, generalmente única y de evolución rápidamente progresiva, por las características angioinvasoras del hongo, que determina amplias zonas de infartos y necrosis en los tejidos. Presentamos el caso de un paciente con cuatro años de edad, con diagnóstico de leucemia linfoblástica aguda, en quimioterapia de inducción, que cursó con neutropenia profunda y prolongada, presentando una lesión cutánea en el codo compatible con ectima gangrenoso. Recibió tratamiento antimicrobiano y antifúngico, asociado a un aseo quirúrgico. El cultivo para hongos demostró crecimiento de Rhizopus microsporus var oligosporus, y la histología concluyó presencia de hifas no septadas. El estudio de extensión descartó compromiso óseo, sinusal y cerebral. Completó 40 días de terapia antifúngica con anfotericina B deoxicolato, evolucionando satisfactoriamente. Posteriormente requirió injerto dermo-epidérmico. Si bien esta patología es infrecuente, debemos sospecharla en pacientes con neoplasias hematológicas, para establecer un diagnóstico etiológico oportuno, ya que el tratamiento contempla el desbridamiento quirúrgico precoz asociado a antifúngicos sistémicos, siendo de elección anfotericina B.

Fungal agents in different anatomical sites in Public Health Services in Cuiabá, state of Mato Grosso, Brazil / Agentes fúngicos em diferentes sítios anatômicos nos Serviços de Saúde Pública em Cuiabá, Mato Grosso, Brasil

INTRODUCTION: A contribution to the regional epidemiological profile of the most common fungal agents in Public Health Services in Cuiabá, state of Mato Grosso, including university hospitals and polyclinics. METHODS: Clinical specimens (n = 1,496) from 1,078 patients were collected, submitted to direct mycological exam (potash or stick tape method) and cultured in specific mediums. Dermatophytic and non-dermatophytic agents were identified according to micromorphology (Ridell technique). RESULTS: The majority of the 1,496 specimens were skin (n = 985) and nail exams (n = 472). Of the 800 positive cultures, 246 (30.8 percent) corresponded to dermatophytes and 336 (42 percent) to yeasts of the genus Candida, 190 (23.7 percent) to other yeasts, 27 (3.4 percent) to non-dermatophytic filamentous fungi and one (0.1 percent) the agent of subcutaneous mycosis. Lesions considered primary occurred in greater numbers (59.5 percent) than recurrent lesions (37.4 percent), with a greater concentration of positivity occurring on the arms and legs. CONCLUSIONS: Comorbidities, allergies and diabetes mellitus were conditions associated with greater positivity in direct mycological exams and cultures. Positive culture was considered a definitive diagnosis of fungal infection and confirmed 47.8 percent of diagnostic hypotheses.

INTRODUÇÃO: Contribuição sobre o perfil epidemiológico regional referente aos agentes fúngicos mais freqüentes nos Serviços de Saúde Pública em Cuiabá-MT, incluindo policlínicas e hospitais universitários. MÉTODOS: Foram examinados 1.496 espécimes clínicos colhidos a partir de 1.078 pacientes, os quais foram submetidos ao exame direto (potassa e/ou fita gomada) e cultivos em meios específicos. Os agentes foram identificados segundo micromorfologia (técnica de Ridell). RESULTADOS: Os 1.496 espécimes foram relacionados na maioria a exames de pele (n = 985), e unhas (n = 472). Dos 800 cultivos positivos, 246 (30,8 por cento) corresponderam a dermatófitos, 336 (42 por cento) a leveduras do gênero Candida, 190 (23,7 por cento) a outras leveduras, 27 (3,4 por cento) a fungos filamentosos não dermatofíticos e um (0,1 por cento) a agente de micoses subcutâneas. Lesões consideradas primárias compareceram em maior número (59,5 por cento), comparadas as recidivantes (37,4 por cento). Foi observada maior positividade em membros inferiores e superiores. CONCLUSÕES: Co-morbidades, quadros alérgicos e diabetes mellitus representaram condições associadas à maior positividade em exames micológicos diretos e cultivos. O cultivo positivo foi considerado como diagnóstico definitivo de infecção fúngica, e confirmou 47,8 por cento de hipóteses diagnósticas.