Câncer de colo uterino associado a fatores de risco ocupacional* / Cervical cancer related to occupational risk factors: review

Introdução: Fatores de risco associados ao trabalho podem causar, entre outros, câncer de colo uterino. Objetivo: Identificar na literatura especializada a associação entre câncer de colo de útero e a exposição aos fatores ocupacionais de risco. Métodos: Realizou-se um levantamento bibliográfico em bases de dados eletrônicos com os seguintes descritores: câncer de colo uterino e riscos ocupacionais. Resultados: Trabalhadores expostos ao tabaco nas fábricas de cigarro, fluidos de motores, exposição ocupacional a fungos e bactérias e ao tetracloroetileno, presente em produtos de limpeza usados em lavanderias e para desengraxar metais, estariam mais susceptíveis ao desenvolvimento de câncer de colo uterino. Conclusão: Há poucos estudos que identificam a relação entre o câncer de colo de útero e os fatores de risco ocupacional, dificultando a associação entre o carcinogênese e o fator de risco.

Background: Occupational risk factors are associated with many types of neoplasms including cervical cancer. Objective: To review the specialized literature for evidence on the relationship between cervical cancer and exposure to occupational hazards. Methods: Literature search in electronic databases using keywords cervical cancer and occupational risk. Results: Workers occupationally exposed to tobacco, fungi or bacteria, metalworking fluids and tetrachloroethylene used in dry cleaning and for metal degreasing exhibited higher susceptibility to cervical cancer. Conclusion: Few studies sought to investigate relationships between cervical cancer and occupational hazards, which hinders the attempts at establishing a causal link.

Infección rino-sinusal por Exserohilum rostratum en un niño con leucemia mieloide aguda / Sinus infection caused by Exserohilum rostratum in a pediatric patient with acute myeloid leukemia

Resumen Los episodios de neutropenia febril son cuadros graves, que requieren un estudio etiológico exhaustivo y un inicio rápido de antimicrobianos. Dentro de los posibles microorganismos causales se encuentran los de origen fúngico, los que, dependiendo de su grado de invasión tisular, pueden llegar a presentar una alta mortalidad. Presentamos el caso de un niño con una leucemia mieloide aguda, que tras su quimioterapia de inducción, presentó un episodio de neutropenia febril, con una infección rino-sinusal por Exserohilum rostratum, hongo filamentoso que raramente se asocia a cuadros patológicos. Se inició rápidamente terapia antifúngica, lo cual, asociado a un aseo quirúrgico precoz, lograron una respuesta clínica favorable, sin complicaciones. Luego del seguimiento, y tras recibir profilaxis secundaria durante los episodios de neutropenia, no ha vuelto a presentar nuevas lesiones ni compromiso rino-sinusal.

Abstract The episodes of febrile neutropenia are severe cases that require an exhaustive etiological study and a quick start of antimicrobial agents. Within the possible microorganisms, fungal origins are also found, and depending on its tissue invasion, they can reach a high mortality rate. A case of a pediatric patient who suffered from acute myeloid leukemia is reported, and after his induction chemotherapy, the patient showed an episode of febrile neutropenia, which matches a rhinosinusal infection caused by Exserohilum rostratum, a filamentous fungi that is uncommonly associated with pathological cases. An antifungal therapy and an early surgical treatment were started, which lead to a positive response, without complications to the patient. After the monitoring and receiving secondary prophylaxis during the episodes of neutropenia, the patient hasn't presented new injuries nor rhinosinusal damage.

Causes of equine abortion, stillbirth, and perinatal mortality in Brazil / Causas de abortamento, natimortalidade e mortalidade em equinos no Brasil

Abortion and complications in reproduction are important causes of economic loss in horse breeding. Studies of its causal agents can help to identify the primary pathogens or other factors involved and define appropriate measures to reduce its occurrence. This research aimed to investigate the primary causes of equine abortion, stillbirth, and perinatal mortality in regions of Brazil. Tissue from aborted fetuses, stillbirths, neonates and foals submitted to the Biological Institute of São Paulo, Brazil, from January 2010 to July 2013 were processed for viral and bacterial isolation, polymerase chain reaction (PCR), histology, and immunohistochemistry. Bacterial infection was the primary detected cause of abortion, found in 16 of the 53 animals submitted for bacterial analysis followed by viruses analysis in 2 of 105 animals, and noninfectious causes (neonatal isoerythrolysis) in 2 of 105 animals. Fungi were found in a single sample of 53 tested. The most frequent bacteria recovered were Escherichia coli, Enterobacter aerogenes, combined E. coli and Streptococcus spp., Staphylococcus spp., and Bacillus spp. The following agents were each observed in a single sample: Arcanobacterium pyogenes, Streptococcus spp., Corynebacterium spp., Actinobacillus spp., and Rhodococcus equi. The predominant identification of fecal and other opportunistic bacteria as opposed to pathogens commonly associated with equine abortion, such as Leptospira spp. and equine herpesvirus type 1 (EHV-1), suggests the need of improving hygiene management of breeding mares to prevent bacterial infection that may cause fetal loss, stillbirth, and perinatal mortality.(AU)

Abortamento e complicações na reprodução são importantes causas de perda econômica na equideocultura. Estudos dos agentes causais podem ajudar a identificar patógenos ou outros fatores envolvidos e definir medidas apropriadas para reduzir sua ocorrência. Esta pesquisa investigou as causas primárias de aborto, natimortalidade e mortalidade perinatal em equinos de diversas regiões do Brasil. Tecidos de fetos abortados, natimortos e potros submetidos ao Instituto Biológico de São Paulo, Brasil, no período de janeiro de 2010 a julho de 2013, foram processados por meio de técnicas de isolamento viral e bacteriano, PCR, histologia e imuno-histoquímica. Infecção bacteriana foi a causa mais detectada, encontrada em 16 de 53 amostras submetidas à análise bacteriana, seguida de causa viral em 2 de 105 amostras, e causas não infecciosas (isoeritrólise neonatal) em 2 de 105 amostras. Fungo foi encontrado em uma única amostra de 53 testadas. As bactérias isoladas mais frequentemente foram Escherichia coli, Enterobacter aerogenes, E. coli associada a Streptococcus spp., Staphylococcus spp. associado a Bacillus spp. Os seguintes agentes foram observados em uma única amostra cada: Arcanobacterium pyogenes, Streptococcus spp., Corynebacterium spp., Actinobacillus spp. e Rhodococcus equi. A identificação predominante de bactérias fecais e outras bactérias oportunistas, ao invés de outros patógenos comumente associados a quadros de abortamento equino, tais como Leptospira spp. e Herpesvírus equino tipo 1, sugere a necessidade de maior atenção no manejo higiênico das éguas em reprodução, a fim de prevenir infecções bacterianas que possam causar perda fetal, natimortalidade e mortalidade perinatal.(AU)

Caracterización clínico epidemilógica de la aspergilosis / Clinical Epidemiological Characterization of Aspergillosis

La aspergilosis es una infección o respuesta alérgica debida al hongo Aspergillus spp. El hongo comúnmente crece en hojas muertas, granos almacenados, pilas de estiércol o abono u otra vegetación en descomposición. Implica un amplio espectro de entidades que requieren de alto grado de sospecha por mantener altas tasas de mortalidad, especialmente en el paciente inmunosupreso, estas pueden ser modificadas con el tratamiento temprano. Objetivo: actualizar las características clínicas y epidemiológicas de la aspergilosis incluyendo el diagnóstico y manejo, así como los factores presentes en general y en particular en los inmunosupresos. Material y Métodos: se realiza selección bibliográfica de revisiones y guías de manejo en las bases de datos bibliográficas PUBMED (últimos 5 años), SciELO y Revistas Hondureñas (BVS); se incluyen 21 referencias sobre diferentes aspectos de diagnóstico, manejo y tratamiento de aspergilosis. Conclusión: la sospecha de aspergilosis en cualquier cuadro respiratorio atípico con manifestaciones similares a tuberculosis o asma, debe ser mandatorio en los protocolos hospitalarios de manejo, especialmente en individuos con factores de riesgo conocidos, que implican riesgo ocupacional de contacto con conidias de Aspergillus spp...(AU)

Infección pulmonar por Arthrographis kalrae en un paciente con enfermedad granulomatosa crónica / Pulmonary infection by Arthrographis kalrae in patient with chronic granulomatous disease

Antecedentes: Arthrographis kalrae es un hongo hialino de crecimiento lento que, en su desarrollo, forma artroconidios. Es un patógeno oportunista que causa infecciones en personas inmunocomprometidas e inmunocompetentes, y ha sido aislado muy raramente en muestras clínicas de seres humanos. Caso clínico: Se describe el caso de un paciente con inmunodeficiencia primaria y afectación pulmonar con evolución tórpida. Presentó compromiso de ambos pulmones a pesar del tratamiento antibiótico y antifúngico instaurado. Durante su seguimiento, se realizaron múltiples biopsias pulmonares y se aisló A. kalrae en el cultivo de tejido pulmonar. Recibió tratamiento con posaconazol, con buena respuesta y remisión de las lesiones. Conclusión: Este es el primer caso reportado de infección pulmonar por A. kalrae en un paciente pediátrico con enfermedad granulomatosa crónica en Argentina.

Background: Arthrographis kalrae is a hyaline fungus that grows forming arthroconidia. It is an opportunistic pathogen that causes infections in immunocompromised as in immunocompetent people and has been rarely isolated from human clinical samples. Case report: We describe the case of a male child with primary immunodeficiency who initially presented unilateral pneumonia and progressed to bilateral involvement despite antibiotic, antifungal treatment. A. kalrae was diagnosed by pulmonary biopsy. He received posaconazole with resolution of disease. Conclusions: This is the first case of A. kalrae pulmonary infection in a pediatric patient with chronic granulomatous disease in Argentina.

Agentes patógenos responsables de trastornos gastrointestinales en sujetos infectados con VIH / Enteropathogens responsible of gastrointestinal disorders in HIV patients

Los trastornos gastrointestinales o TGI son afecciones debilitantes muy comunes en individuos infectados con el virus de inmunodeficiencia humana (VIH), que pueden conducir a muerte. Numerosos agentes etiológicos y mecanismos patofisiológicos han sido propuestos causar esta afección. A pesar del uso de terapia antirretroviral, que ha reducido enormemente la prevalencia de TGI en estos pacientes, patógenos entéricos como virus, bacterias, parásitos y hongos logran actuar todavía como agentes oportunistas. Citomegalovirus, adenovirus, calicivirus, astrovirus, rotavirus, enterovirus, picobirnavirus y algunos más recientemente descritos, como bocavirus y Aichi virus han sido detectados en pacientes con VIH. Sin embargo, a excepción del citomegalovirus, hay muy poca certeza acerca del papel que juegan algunos de ellos en estas afecciones. Varias especies de Criptosporidium, microsporidos, Salmonella, micobacterias atípicas y Campylobacter jejuni han sido reconocidos también como una importante causa de TGI en estos pacientes. La progresiva incorporación de técnicas inmunoenzimáticas y moleculares, cada vez más sensibles para la detección de antígenos, anticuerpos y agentes patógenos en heces ha mejorado el diagnóstico de las diarreas y contribuido a esclarecer la importancia etiológica de algunos microorganismos en los pacientes inmunocompetentes. En Venezuela existen algunos datos acerca de la prevalencia de patógenos entéricos en pacientes inmunodeficientes infectados con VIH. La identificación del agente etiológico responsable de TGI podría ser de gran utilidad para el manejo y tratamiento de estos pacientes, para quienes la enteritis viral es una manifestación morbosa que reduce la calidad de vida y ocasiona un elevado gasto en salud pública.

Gastrointestinal disorders or GID are debilitating conditions common in individuals infected by the human immunodeficiency virus (HIV), capable of leading to death. Numerous etiological agents and pathophysiological mechanisms have been involved in this status. Although the use of highly active antiretroviral therapy (HAART) in many countries has greatly reduced the prevalence of gastrointestinal infections, enteric pathogens such as bacteria, parasites, fungi and viruses may still act as opportunist agents in these patients. Cytomegalovirus, adenovirus, calicivirus, astrovirus, rotavirus, enterovirus, picobirnavirus and some more recently described, like bocavirus and Aichi virus, have been detected in HIV patients. However, except for cytomegalovirus, which is an established etiological agent of GID in these patients, the role of the other viruses remains unclear. Several species of Cryptosporidium, microsporidia, Salmonella, atipical mycobacteria and Campylobacter jejuni, have also been recognized as important causes of GID in HIV patients. The progressive incorporation of increasingly sensitive immunological and molecular assays for antigen, antibody and pathogens detection from faeces, has improved the diagnosis of diarrhea and contributed to clarify the etiological significance of some microorganisms in immunocompetent patients. In Venezuela, some information is available about the prevalence of enteric pathogens in immunocompromised patients infected with HIV. The identification of the etiologic agent responsible for this condition may be useful for the management and treatment of these patients, for whom viral enteritis is a disease, which reduces their quality of life and causes a high public health spending.

Epidemiological Markers of Fungi and its Clinical Application.

The risk factors for opportunistic fungal infections are progressive HIV infection, Diabetes mellitus or patient on antibiotics, steroid or antimalignant therapy. Though with the development of Medical sciences, fungal infections are gaining importance, the field of epidemiology of fungal infection has not expanded that much. The different epidemiological markers for fungal infection have been discussed in this article. Ideally epidemiological marker should be standardized, reproducible, sensitive, easy to perform and inexpensive.

Epidemiology of febrile diseases in the emergency department of a Caribbean Island: the Curaçao experience / Epidemiología de las enfermedades febriles en el departamento de emergencias de una Isla Caribeña: la experiencia de Curazao

OBJECTIVE: The aetiology of febrile diseases in tropical countries often remains poorly characterized. We aim to describe the aetiology and outcome of febrile illnesses at the Emergency Department (ED) in Curaçao. METHODS: From April 2008 - April 2009, all adult febrile patients (T > 38.5°C) at the ED of the St Elisabeth Hospital, Curaçao, Netherlands Antilles, were included. Clinical data were recorded, routine laboratory measurements and blood cultures were taken. Final diagnoses were made at discharge by an independent physician and in retrospect by the main investigator. RESULTS: Four hundred and three patients were included: 223 patients (55.6%) were hospitalized, 32 patients (7.9%) died and 18 patients (4.5%) were admitted to the Intensive Care Unit. In 129 febrile patients (32.0%), infection was proven; 84.4% of patients had bacterial (29.0% urinary tract infection, 23.2% pneumonia infection), 5.6% viral and 10.0% parasitic or fungal infections. Twenty-one patients (5.2%) were discharged with a non-infectious diagnosis and 172 patients (42.7%) without a clear diagnosis. CONCLUSION: A high mortality rate of 7.9% was observed. We found a high prevalence of bacterial infections, with pneumonia and urinary tract infections as the most common causes of fever. One in 20 patients did not have an infectious disease.

OBJETIVO: La etiología de las enfermedades febriles en los países tropicales posee aún una pobre caracterización. El presente trabajo se propone describir la etiología y la evolución clínica de las enfermedades febriles en el Departamento de Emergencias (DE) de Curazao. MÉTODOS: De abril 2008 - abril 2009, todos los pacientes febriles adultos (T > 38.5°C) en el DE del Hospital Saint Elisabeth, de Curazao, Antillas Holandesas, fueron incluidos. Se registraron los datos clínicos, se tomaron las medidas de rutina de laboratorio y los cultivos de sangre. Los diagnósticos finales se hicieron a la hora del alta por un médico independiente y en retrospectiva por el investigador principal. RESULTADOS: Se incluyeron cuatrocientos tres pacientes: 223 pacientes (55.6%) fueron hospitalizados, 32 pacientes (7.9%) murieron, y 18 pacientes (4.5%) fueron ingresados en la Unidad de Cuidados Intensivos. En 129 pacientes febriles (32.0%) se comprobó la infección; 84.4% de los pacientes tenían infección bacteriana (29.0% infección de las vías urinarias, 23.2% infección por pneumonia), 5.6% viral y 10.0% infección parasitaria o fúngica. Veintiún pacientes (5.2%) fueron dados de alta con un diagnóstico no infeccioso, y 172 pacientes (42.7%) sin un diagnóstico claro. CONCLUSIÓN: Se observó una alta tasa de mortalidad de 7.9%. Se halló una alta prevalencia de infecciones bacterianas, siendo la pneumonía y las infecciones de las vías urinarias las causas más comunes de fiebre. Uno de cada 20 pacientes no tenía una enfermedad infecciosa.

Infection of the lymphatic system by Aureobasidium pullulans in a patient with erythema nodosum leprosum

Aureobasidium pullulans is a causal agent of phaeohyphomycosis, occasionally found in men and animals. As an agent of different opportunistic fungal processes, it may cause fungemia, systemic infections and abscesses in different viscera. This paper aims to report a case of a patient with infection of the lymphatic system by A. pullulans. A 23-year-old patient being treated for erythema nodosum leprosum presented a 60-day complaint of daily fever, hoarseness, odynophagia and weight loss. Laboratory tests showed pancytopenia with severe neutropenia, cervical adenomegaly and solid contrast uptake lesion in the oropharyngeal region. Due to neutropenia and sepsis the patient was initially treated with cefepime and vancomycin, but there was no clinical improvement. Lymph node puncture-aspiration showed yeast-form fungus identified as A. pullulans by sequencing ITS region. The patient was treated with amphotericin B deoxycholate, leading to complete recovery of bone marrow function and regression of adenomegaly and the oropharyngeal lesion.

Otitis externa micótica y perforación timpánica: reporte de dos casos / Otomycosis and perforated tympanic membrane: two cases

La otitis externa constituye entre el 5 por ciento y 30 por ciento de las consultas de urgencia ORL y afecta al 10 por ciento de la población al menos 1 vez en la vida. La gran mayoría son de causa bacteriana, sólo el 15 por ciento a 20 por ciento son atribuidas a hongos. Las complicaciones son poco frecuentes alcanzando el 10 por ciento a 20 por ciento de los casos según la serie, siendo la perforación timpánica la más frecuente. Se presenta la evolución y tratamiento de 2 casos.

External otitis constitutes among 5 percent-30 percent of urgency ORL consultations and affects 10 percent of the population at least 1 time in their life. Most of them had a bacterial origin, only 15 percent to 20 percent are attributed to fungi. Otomycosis complications are slightly frequent reaching 10 percent to 20 percent of the cases according to diferent series, being the tympanic perforation the most frequent. We present 2 cases, their evolution and treatment.

Infecciones gastrointestinales y VIH / Gastrointestinal infections and HIV

El sistema gastrointestinal debe ser considerado parte de la infección por virus de inmunodeficiencia humana (VIH), tanto por su rol en la patogénesis de la enfermedad como por ser blanco de infecciones en etapas avanzadas de la enfermedad (bajo 200 linfocitos CD4/ul). A nivel orofaríngeo y esofágico la infección predominante es candidiasis, en caso de descartarse o no responder a tratamiento, el estudio con endoscopía digestiva alta y biopsia será lo más atingente para guiar el tratamiento. A nivel gástrico, las manifestaciones infecciosas son más infrecuentes y habitualmente encontradas durante el estudio endoscópico. El intestino delgado y grueso pueden sufrir lesiones focales asociadas a distintas infecciones, pero la manifestación más habitual será diarrea, ésta debe ser objeto de estudio etiológico no invasivo con cultivos para enteropatógenos, leucocitos fecales y coproparasitológico. Es recomendable también el estudio con toxina de Clostridium difficile, y en pacientes muy avanzadas (bajo 50 CD4 por ul), realizar tinción ácido alcohol resistente modificada en deposiciones y estudio de Microsporidia con tinción tricrómica. Si los síntomas persisten y el estudio es negativo, se debe realizar colonoscopía y biopsia. Si no se encuentra causa, debe considerarse la posibilidad de una enteropatía asociada a VIH. Varios agentes etiológicos descritos en distintos segmentos tienen tratamiento específico, pero la terapia antirretroviral es lo que logra erradicar el cuadro en la mayoría de los casos. No obstante, las reacciones adversas digestivas asociadas a terapia antirretroviral constituyen un diagnóstico diferencial de las infecciones gastrointestinales.

Gastrointestinal tract plays an important role in Human Immunodeficiency Virus (HIV) infection, both for its participation in the pathogenesis of the disease as for being affected by different infections at late stages of disease (under 200 CD4/ul). In oropharinx and esophagus, candidiasis is the most common infection. If it is discarded or does not improve with appropriate treatment, endoscopic study and biopsy is the most adequate approach to guide the treatment. In the stomach, infections are not so important and frequently found during endoscopic studies. Small and large bowel can be the target of different focal infections, but diarrhea will be the most common clinical picture. Diarrhea must be assessed with stool leukocyte examination, stool cultures for enteric bacterial pathogens, examination for ova and parasites. Assay for Clostridium difficile toxin is recommended and, in patients under 50 CD4/ul, modified acid-fast stain and special trichrome staining may be useful. In patients with persistent symptoms and negative non-invasive study, endoscopic and hystologic studies must be performed, if not any cause is identified; HIV-associated enteropathy has to be considered. Some etiologies have specific therapy, but antiretroviral therapy is the most effective treatment in most cases. Nonetheless, gastrointestinal side effects of antiretroviral therapy are now part of differential diagnosis of intestinal infections.

Infecciones diferentes a la peritonitis bacteriana espontánea en pacientes con cirrosis / Infections other than spontaneous bacterial peritonitis in patients with cirrhossis

Patients with cirrhosis are regularly infected with a plethora of bacteria, fungi and mycobacteria. A high index of suspicion of infection and a low threshold for culturing, ascitic fluid, blood, urine, pleural fluid, spinal fluid, joint fluid, etc will lead to a rapid diagnosis of infection and perhaps prolong survival of these very fragile patients.

Diferencias en la sensibilización a aeroalergenos en pacientes con poliposis nasosinusal / Different patterns of sensitization to airborne allergens in patients with nasal polyposis

Introducción: La poliposis nasosinusal (PN) es una enfermedad inflamatoria crónica de la mucosa. Apoyado en los hallazgos clínicos, histológicos e inmunológicos, se postula a la alergia como un factor etiopatogénico, lo cual no ha sido plenamente demostrado. Objetivo: Evaluar la presencia de hipersensibilidad a aeroalergenos en pacientes con PN y compararla con pacientes normales. Material y método: Se realizó prick test a aeroalergenos a todos los pacientes utilizando 30 alérgenos frecuentes en el área metropolitana de Santiago, incluyendo pólenes de árboles, malezas y pastos, ácaros, epitelio de animales y hongos habituales. Este test se amplió con el uso de tres hongos habitualmente no evaluados (Stemphyllium, Pullularia, Helminthosporium). Se utilizó la prueba de Chi cuadrado con una significancia de 0,05. Resultados: El 71 por ciento de los pacientes con PN (n =73) y el 66 por ciento del grupo control (n =44) presentaban un test cutáneo positivo, sin diferencia estadística significativa. El patrón de sensibilización a aeroalergenos fue similar, salvo para los alérgenos fúngicos: los pacientes con PN estaban sensibilizados en 40 por ciento a Pullularia, 30 por ciento a Stemphyllium, y 10 por ciento a Helminthosporium. En tanto que los controles no presentaron sensibilización a estos hongos no habituales. Discusión y conclusiones: Existe una alta tasa de sensibilización a aeroalergenos en pacientes normales y con PN, lo que sugiere un probable rol de la alergia en la patogénesis de la poliposis nasal. Destaca un patrón diferente de sensibilización a alérgenos fúngicos, cuya relevancia clínica debe ser evaluada a futuro.

Introduction: Nasal polyposis (NP) is a chronic inflammatory disease that leads to tissue oedema and eventually polyps. The pathogenesis of NP has not been fully understood yet, but there are clinical, histological, and immunological findings that suggest that allergy plays a role. Aim: The aim of this study was to find out the prevalence of airborne allergen hypersensitivity in patients with nasal polyposis. Material and method: Skin prick test (SPT) was performed to patients with NP and to a control group (CRS). Thirty frequent airborne allergens of the Santiago de Chile metropolitan area, including tree, grass and weed pollens, house dust mites, animal dander and common fungal allergens were tested. This SPT was extended by using three fungal allergens that usually are not evaluated (Stemphyllium, Pullularia, Helminthosporium). Chi square test was used to compare both groups of patients. Results: 71 percent of NP patients (n=73) versus 66 percent of the controls (n=44) had a positive SPT, although there was no statistical significance. The only difference in sensitization was for fungal allergens. In NP patients, sensitization to Pullularia was about 40 percent>, 30 percent> to Stemphyllium, and 10 percent to Helminthosporium. CRS patients were not sensitized to uncommon fungal allergens. Conclusions: We found a high frequency of sensitization to airborne allergen in CRS and NP patients that suggest a probable role of allergic inflammation in the pathogenesis of nasal polyposis. Stands out a different pattern of sensitization to fungal allergens in the NP group; the clinical relevance of this finding awaits future evaluation.

Meningitis due to Rhodotorula glutinis in an HIV infected patient.

Rhodotorula spp, though considered a common saprophyte, recently has been reported as causative agent of opportunistic mycoses. We present a case of meningitis in an immunocompromised human immunodeficiency virus infected patient who presented with longstanding fever. He was diagnosed as a case of chronic meningitis. Diagnosis was confirmed by cell cytology, India ink preparation, Gram staining and culture of cerebrospinal fluid (CSF) sample. CSF culture grew Rhodotorula glutinis. Therapy with amphotericin B was successful in eliminating the yeast from CSF and the patient was discharged after recovery.

Penicillium marneffei--an indicator disease of AIDS: a case report.

Penicillium marneffei (PM), the only dimorphic species of the genus penicillium is the etiological agent of penicilliosis marneffei. This opportunistic fungal infection occurs among human immunodeficiency virus (HIV) infected and other immunocompromised patient in several regions of South-east Asia, where the infection is considered as an indicator disease of AIDS. A case of penicilliosis marneffei is reported in a patient whose HIV status was unknown and later turned to be in the late stage of AIDS. This demonstrates that it is indeed an indicator disease of AIDS. In India, penicilliosis has been reported among the inhabitants of Manipur state where the prevalence of HIV infection / AIDS is very high. The causative agent was first isolated from a captive bamboo rat. Investigation of the prevalence of the organism among bamboo rats of different countries of South East Asia revealed four species of bamboo rats to be harboring the organism. These four species of bamboo rats are Rhizomys sinensis, R. pruinosus, R. sumatrensis and Cannomys badius. In Manipur, Penicillium marneffei has been isolated from Cannomys badius. Any patient presenting with penicilliosis marneffei should be subjected to HIV counselling and testing if the HIV status is not known and further study regarding the ecology and epidemiology of the fungus is needed.

Chromoblastomycosis: two cases of a disfiguring deep mycosis

Chromoblastomycosis is a chronic cutaneous and subcutaneous mycotic infection caused mostly by traumatic implantation of pigmented saprophytic moulds ubiquitous in the environment. If not diagnosed earlier, it has a chronic evolutional course that may cause several problems. We present two cases [father and a son] who were simultaneously infected with this uncommon fungal infection. Both had extensive face involvement. Diagnosis was considerably delayed and they were subjected to a myriad of empirical treatments