Fungemia following Saccharomyces cerevisiae var. boulardii probiotic treatment in an elderly patient / Fungemia posterior al tratamiento con Saccharomyces cerevisiae var. boulardii como probiótico en una paciente anosa

Abstract The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridium difficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories. © 2019 Asociación Argentina de Microbiología. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen Saccharomyces cerevisiae var. boulardii es un agente bioterapéutico usado en la prevención y el tratamiento de varias enfermedades gastrointestinales. Informamos de un caso de fungemia en una paciente con diarrea asociada a Clostridium difficile, y tratada con metron-idazol y un probiótico que contenía S. cerevisiae var. boulardii. Las levaduras aisladas a partir del hemocultivo y del contenido de las cápsulas tomadas por la paciente se identificaron como S. cerevisiae mediante MALDI-TOF MS y API® ID 32C, las colonias mostraron el mismo color y aspecto en el medio CHROMAgar™ Candida. Se instauró un tratamiento con fluconazol 400mg/día y se suspendió el probiótico. La paciente fue dada de alta del hospital en buenas condiciones, y remitida a un centro de rehabilitación. Sugerimos que el beneficio potencial del uso de S. cerevisiae var. boulardii debe ser evaluado en cada paciente, especialmente en personas añosas. El uso de probióticos debería incluirse en los interrogatorios orientados al diagnóstico y formar parte de la historia clínica. © 2019 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Prevalence and Etiological Agents of Onychomycosis.

Onychomycosis is a common nail infection caused by dermatophytes, yeast or other non-dermatophyte molds and have been known to be associated with significant physical and psychological morbidity. This study was performed to determine the prevalence and the etiologic agents of onychomycosis in patients attending RIMS, Imphal, Manipur for a period of two years (January 2010 to December 2012). Nail samples of 347 clinically suspected cases of onycomycosis attending dermatology OPD RIMS, Manipur were collected and were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud’s dextrose agar (SDA). The male female ratio of the participants was 1:1.81 (165 male and 302 female). Out of 467, 399 (85.44.%) were positive by culture and KOH mount. Young adults in the age group of 21-30 years were commonly affected. In female patients finger nail infection was more common than toe nail infection. Both toe and finger nails involvement were noticed in nine patients of which two were male and seven were female. The most frequently isolated fungus was dermatophytes, in 107 (40.38%) patients followed by Aspergillus spp in 101 (38.11%) and Candida spp in 17 (6.4%). This study demonstrated that dermatophytes, as well as moulds especially Aspergillus spp are commonly isolated from onychomycosis patients in our region.

Febrile neutropenia in the tropics: A description of clinical and microbiological findings and their impact on inappropriate therapy currently used at an oncological reference center in Colombia / Neutropenia febril en el trópico: una descripción de los hallazgos clínicos y microbiológicos y el impacto de la terapia inapropiada que utilizan en un centro de referencia oncológica en Colombia

Introduction. Febrile neutropenia is a common complication of chemotherapy treatment of malignant hematological diseases. However, there is insufficient information regarding the infectious complications of febrile neutropenia in our country. Objective. We will evaluate the microbial characteristics of bacterial and fungal isolates and the clinical outcome of patients with febrile neutropenia who received medical attention at an oncological reference center in Colombia. Materials and methods. A prospective case series included patients with histologically confirmed oncological disease, who were admitted because of febrile neutropenia or presented with febrile neutropenia during hospitalization. Patients with benign hematological diseases were excluded. Demographic, microbiological, and clinical features as well as treatment and outcome information from patients with febrile neutropenia were obtained. We performed univariate and multivariate analyses, with mortality defined as the outcome. Results. One hundred and thirty episodes of febrile neutropenia were identified in 104 patients. The mean patient age was 19, and 53% of the patients were male. Approximately 86% of the episodes occurred in patients with hematological disorders. An infectious site was identified in 65% of patients; 41% and 24% of the febrile neutropenia pateints´ episodes exhibited a localized infectious focus and developed bloodstream infections, respectively. The majority of infections were found in blood, urine, gastrointestinal tract, and soft tissue. Distribution analysis of microbiological isolates revealed 46.4% Gram-negative bacilli, 38.4% Gram-positive cocci, 8% fungi, and 7.1% parasites; there was a 7.7% mortality rate. Appropriate empirical antimicrobial therapy was a protection-related factor in multivariate analyses (OR= 0.17; 0.034 - 0.9 95% CI; p= 0.037). Conclusions. The mortality rate was relatively low and comparable to the rate reported by developed countries. Inappropriate empirical antimicrobial therapy was the main factor associated with mortality.

Introducción. La neutropenia febril es una complicación frecuente de la quimioterapia para las neoplasias hematológicas. Se dispone de escasa información de sus complicaciones infecciosas en nuestro medio. Objetivo. Evaluar las características clínicas y microbiológicas de pacientes con neutropenia febril, así como su resultado clínico en una institución de referencia oncológica en Colombia. Materiales y métodos. Se conformó prospectivamente una serie de casos con pacientes con enfermedad oncológica confirmada, que consultaron o presentaron neutropenia febril durante la hospitalización. Se excluyeron aquellos con enfermedad hematológica benigna. Se recolectaron datos sobre variables demográficas, microbiológicas, clínicas, de tratamiento y de resultado de los pacientes. Se llevaron a cabo un análisis univariado y uno multivariado, con la mortalidad como resultado. Resultados. Se identificaron 130 episodios de neutropenia febril en 104 pacientes, con una edad media de 19 años y 53 % masculinos. El 86 % de los episodios ocurrieron en pacientes con alteraciones hematológicas. Se demostró infección en 65 % de los casos: 41 % con un foco infeccioso localizado y 27,7 % con bacteriemia. Los principales focos infecciosos se localizaron en el torrente sanguíneo, el aparato urinario, el sistema gastrointestinal, la piel y los tejidos blandos. De los aislamientos microbiológicos, 46,4 % fueron bacilos Gram negativos, 38,4 %, cocos Gram positivos, 9 %, hongos y, 7,1%, parásitos. La mortalidad global fue de 7,7 %. En el análisis multivariado la utilización de un tratamiento empírico apropiado se correlacionó con una menor mortalidad, de forma independiente (OR=0,17; IC 95% 0,034-0,9; p=0,037). Conclusiones. La tasa de mortalidad fue relativamente baja y fue comparable con lo reportado en países desarrollados. El tratamiento antimicrobiano inapropiado fue el principal factor asociado con mortalidad.

Fungal infections of the oral mucosa.

Fungal infections in humans occur as a result of defects in the immune system. An increasing emergence in oral Candidal and non-Candidal fungal infections is evident in the past decade owing to the rise in the immunodeficient and immunocompromised population globally. Oral Candidal infection usually involves a compromised host and the compromise may be local or systemic. Local compromising factors include decreased salivation, poor oral hygiene, wearing dentures among others while systemic factors include diabetes mellitus, nutritional deficiency, HIV infection/AIDS and others. Oral candidiasis is generally a localized infection and rarely appears as a systemic fungal disease whereas oral non-Candidal fungal infections are usually signs of disseminated disease. Some of the non-Candidal fungi that were once considered exotic and geographically restricted are now seen worldwide, beyond their natural habitat, probably attributed to globalization and travels. Currently infections from these fungi are more prevalent than before and they may present either as primary oral lesions or as oral manifestations of systemic mycoses. This review discusses the various predisposing factors, clinical presentations, clinical differential diagnosis, diagnosis and management of oral candidiasis, as well as briefly highlights upon a few of the more exotic non-Candidal fungi that infect the oral mucosa.

Trichosporon peritonitis following duodenal perforation

Fungal peritonitis, which was once a rare entity, is becoming increasingly common due to various immunocompromised conditions. Candida species are considered the common cause of fungal peritonitis in most cases. However, at present, other yeasts and filamentous fungi are replacing the dominance of Candida albicans as well as other Candida species. Trichosporon species are widely distributed in nature and are normal flora in the gastrointestinal tract of humans. Ever since the report of disseminated trichosporonosis in 1970, several cases of infections by various Trichosporon species in different clinical patients have been published. Here, we present a patient with Trichosporon peritonitis after duodenal perforation. To the best of our knowledge, this is the first case report of its kind from India

Fungal peritonitis in patients on peritoneal dialysis: Twenty five years of experience in a teaching hospital in Argentina / Peritonitis fúngica en pacientes en diálisis peritoneal: la experiencia de 25 años en un hospital universitario de la Argentina

Fungal peritonitis is a rare but serious complication of peritoneal dialysis. The aim of this study was to analyze peritonitis rates, associated factors, clinical course, microbiological aspects, therapeutic regimens, and outcome of patients with fungal peritonitis in the dialysis center of a teaching hospital over the last 25 years. A hundred and eighty three episodes of peritonitis were detected and microbiologically documented in 57 patients. Fungi were identified in eight episodes (4.37%) occurring in seven female patients. The fungal peritonitis rate was 0.06 episodes/patient-year. Gram and Giemsa stains were positive in five out of eight dialysate fluids. The causative microorganisms were: Candida albicans in five episodes, and Candida parapsilosis, Candida glabrata, and Neosartorya hiratsukae in the remaining three. Antibiotics were administered to all but one patient, within 3 months before fungal peritonitis was detected. All patients required hospitalization, and antifungal therapy was administered in all episodes. The Tenckhoff catheter was removed in seven out of eight fungal peritonitis. All patients recovered from the fungal episodes. In the group of patients studied, it is concluded that recent exposure to antibiotics and female sex, were strongly associated with the development of fungal peritonitis by yeasts. The peritonitis caused by the environmental filamentous fungus did not require antibiotic pressure. Direct microscopy of the dialysate pellet was extremely useful for the prompt management of the fungal episode. Fungal peritonitis preceded by multiple episodes of bacterial peritonitis always determined the definitive dropout of the patient from the peritoneal dialysis program. Patients with de novo yeastrelated peritonitis could continue on the program.

La peritonitis fúngica es una complicación infrecuente pero grave de la diálisis peritoneal. Los objetivos de este trabajo fueron el análisis de las tasas de peritonitis, factores asociados, aspectos clínicos y microbiológicos, esquemas terapéuticos y evolución de los pacientes afectados. Se detectaron y documentaron microbiológicamente 183 episodios de peritonitis en 57 pacientes. Se identificaron hongos en ocho episodios (4,37%) en siete pacientes, todos ellos de sexo femenino. La tasa de peritonitis fúngica fue 0,06 episodios/paciente-año. Las coloraciones de Gram y Giemsa revelaron la presencia de microorganismos en cinco de los ocho líquidos de diálisis evaluados. Los microorganismos causales fueron Candida albicans en cinco episodios y Candida parapsilosis, Candida glabrata y Neosartorya hiratsukae en los otros tres. Todos estos pacientes, excepto uno, habían recibido antibióticos en los tres meses previos al episodio de peritonitis fúngica. El catéter de Tenckhoff fue extraído en siete de los ocho episodios. Todos los pacientes evolucionaron favorablemente. Concluimos que en la población estudiada el sexo femenino y la administración reciente de antibióticos estuvieron estrechamente relacionados con el desarrollo de peritonitis fúngicas por levaduras. Sin embargo, la peritonitis causada por el hongo filamentoso ambiental no requirió de la presión antibiótica. La microscopía del sedimento del líquido de diálisis fue útil en el manejo precoz del episodio. La peritonitis fúngica precedida por múltiples episodios de peritonitis bacteriana determinó siempre la exclusión definitiva del paciente del programa de diálisis peritoneal. Los pacientes con peritonitis de novo por levaduras, en cambio, pudieron continuar en él.

Casos clínicos: Microsporum praecox y Acremonium strictum nuevos agentes de micosis cutáneas oportunistas en la zona central de Chile / Clinical reports: Microsporum praecox and Acremonium strictum new agents of opportunistic cutaneous mycoses in the central zone of Chile

Se presentan 2 casos clínicos de agentes de micosis cutáneas no descritos en el país. El primer caso corresponde a un paciente femenino de 18 años de edad, sin antecedentes mórbidos de importancia, ni viajes al exterior, que presenta una lesión pruriginosa en cara externa del brazo izquierdo de apariencia erito – pápulodescamativa de 2 semanas de evolución. Al examen directo, presentó micelios hialinos y en los cultivos micológicos un abundante desarrollo de Microsporum praecox. La lesión remitió completamente al tratamiento con Terbinafina tópica 2 veces al día por 21 días. Se comenta la rara presencia en Chile de M.praecox, especie presente en equinos y su hábitat, pero de dispersión restringida a Francia y Bélgica principalmente. Se discute el posible origen de este agente y las interrogantes en cuanto a su presencia en el país. El segundo caso corresponde a un paciente femenino de 24 años de edad, sin antecedentes mórbidos de importancia, que presenta alteraciones de la uña del primer ortejo derecho durante 2 años, caracterizadas por: engrosamiento subungueal, destrucción distal y cambios de coloración. Consulta con un dermatólogo, quien por su aspecto clínico típico, diagnostica onicomicosis e indica Terbinafina 250 mg diarios por 2 meses, sin embargo, el cuadro clínico se hace refractario en el tiempo frente a diversos antimicóticos usados.

Two clinical cases of agents of cutaneous mycoses not described in the country are reported in this paper. The first case deals with an 18-aged female patient, free from any significant morbid history, who has never traveled abroad, which bears a erytho-papule-descamative pruriginous lesion on the outside of her left arm and 2-week evolution. A direct exam revealed the presence of hyaline mycelia while an abundant development of Microsporum praecox was detected in the mycological cultures. The lesion had a favorable reaction to the treatment with topic Terbinafine twice a day for 21 days. The rare occurrence of M.praecox in Chile, a species commonly found in horses and their habitat yet with a restricted distribution mainly in France and Belgium and the possible origin of this agent in the country is commented. The second case is focused on a 24-age female patient, free from any significant morbid history, who exhibits variations in her first right toe since two years and which are characterized by the following: subungueal thickening, distal destruction and change in colour. She consults a dermatologist, who after considering a typical clinical aspect, determined an onimycosis and recommends 250mg Terbinafine for two months; however the clinical pattern becomes refractory in time due to the use of several antimycotic.

Sarcoidosis: presentación de un caso con lesiones orales / Sarcoidosis: report of a case with oral lesions

La sarcoidosis es una patología que se llega a su diagnóstico por exclusión de patologías importantes, como micosis profundas, linformas y carcinomas escamocelulares. En el presente trabajo se exponen las características clínicas e histológicas de un caso de sarcoidosis oral, con importante repercusión sistémica.

Subcutaneous phaeohyphomycosis caused by exophiala jeanselmei. A case report

Exophiala jeanselmei is a dematiaceous fungus causing black grain mycetoma, chromoblastomycosis and phaeohyphomycosis. It tends to involve cutaneous, subcutaneous tissues or visceral organs. We present a case of a previously healthy young male with a five year history of multiple soft tissue swellings of the body, as well as indolent soft tissue infection of his digits. He had received several courses of antibiotic and anti-tuberculous therapy without improvement. Two of the subcutaneous cystic masses were aspirated through fine needle and sent for histopathology and culture. Histopathology revealed acute on chronic inflammation with granuloma formation, and septate fungal hyphae with spores. The fungus was identified on culture as Exophiala jeanselmei and a diagnosis of subcutaneous phaeohyphomycosis was confirmed. He was treated with oral itraconazole along with incision and drainage and has shown marked clinical improvement. He continues to be on therapy at this time

Reporte clínico: histoplasmosis diseminada alóctona en un paciente con síndrome de inmunodeficiencia adquirida / Clinical report: Disseminated allocthonous histoplasmosis in a acquired immunodeficience syndrome patient

Se describe un caso de histoplamosis diseminada alóctona en un paciente con SIDA, de nacionalidad colombiana, quien ingresó al país en Marzo del 2006. Consultó por cuadro clínico de 2 meses de evolución, con dolor abdominal intenso, vómitos, baja de peso, diaforesis, fiebre vespertina, adenopatías múltiples y candidosis oral. De los exámenes destacó radiografía de tórax con infiltrado intersticial, pancitopenia, ELISA para VIH positivo y cultivos microbiológicos negativos. El paciente evolucionó desfavorablemente a pesar del tratamiento antimicrobiano empírico de amplio espectro; se tomó biopsia de ganglio cervical cuyo informe reveló presencia de levaduras gemantes en focos de necrosis, por lo que se inició tratamiento con anfotericina B y se repitió la biopsia para cultivo micológico cuyo informe fue Histoplasma capsulatum. Posteriormente evolucionó favorablemente, afebril y con parcial mejoría del estado general, sin embargo, el día 17/11/06 cursa con agitación, desaturación y un día después fallece por causa indeterminada. Se comenta este inhabitual caso nacional con algunos aportes epidemiológicos, de diagnóstico y sistemáticos.

A case of disseminated allocthonous histoplasmosis in a Colombian AIDS patient who came to the countryin March 2006 is described. He consulted for a clinic syndrome which had started two months before and which was characterized by intense abdominal pain, vomits, weight loss, diaphoresis, evening fever, multiple adenopathies and oral candidosis. Among the exams he was submittedto it is noteworthy a thorax X-rays with interstitial infiltrate, pancitopenia, ELISA to detect positive VIH and negative microbiological cultures. The patient reacted unsatisfactorily in spite of the empirical, broad spectrum antimicrobian treatment; the cervical ganglion was byopsed revealing the presence of gemant yeasts in necrosis focuses after which a treatment with anfotericine B was started, byopsia was repeated to get a mycological culture resulting Histoplasma capsulatum. Later on he reacted satisfactorily, he had no fever and showed a partial improvementin his general state, however on 11/17/06 he undergoes agitation, desaturation and he dies the followingday due to an undetermined cause. This rarely frequent national case is commented together with the delivery of some epidemiological as well as diagnostic and systematic information.

Estudio clínico doble ciego controlado para evaluar la respuesta terapéutica con terbinafina HCL 1 por ciento Panacap crema sin aceite comparado a crema placebo en el tratamiento de onicomicosis subungueal distal causada por T. rubrum en el lecho de la uña del primer dedo / Study clinical blind double controlled to evaluate the therapeutic answer with terbinafina HCL 1 percent Panacap it cremates without oil compared to cream placebo in the treatment of onicomicosis subungueal distal caused by T. rubrum in the channel o

Este es un estudio clínico piloto (experimental), doble ciego controlado para evaluar la respuesta terapeutica de terbinafina HCI 1 por ciento Panacap crema sin aceite en comparación con crema de placebo en el tratamiento de Onimicosis (OSD) por Tricophyton rubrum en el lecho de la uña del primer dedo. Este estudio se llevó a cabo en el Centro Nacional de Dermatología "Francisco José Gómez Urcuyo" con 11 pacientes.

Current Trends of Infectious Complications following Hematopoietic Stem Cell Transplantation in a Single Center

This study was to analyze the infectious complications after hematopoietic stem cell transplantation (HSCT) according to the recent changes of HSCT. Medical records of 379 adult patients who underwent HSCT consecutively at Catholic HSCT Center from January 2001 to December 2002 were reviewed retrospectively. Allogeneic HSCT accounted for 75.7% (287/379) and autologous HSCT for 24.3% (92/379). During pre-engraftment period, bacterial infection was predominant, and E. coli was still the most common organism. After engraftment, viral infection was predominant. The incidence of invasive fungal infection showed bimodal distribution with peak correlated with neutropenia and graft-versus-host disease (GVHD). The overall mortality and infection-related mortality rates according to 3 periods were as follows; during pre-engraftment, 3.16% (12/379) and 1.8% (7/379); during midrecovery period, 7.9% (29/367) and 4.1% (15/367); during late-recovery period, 26.9% (91/338), and 15.9% (54/338). Risk factors for infection-related mortality were as follows; during pre-engraftment period, fungal infection and septic shock; during the mid-recovery period, hemorrhagic cystitis and delayed engraftment; during the late-recovery period, fungal infection, chronic GVHD, and relapse. In conclusion, infection was still one of the main complications after HSCT and highly contributes to mortality. The early diagnosis and the effective vaccination strategy are needed for control of infections.

Microorganismos patógenos aislados en muestras respiratorias de niños con fibrosis quística / Isolated pathogen microorganisms in respiratory samples from children with cystic fibrosis

La fibrosis quística (FQ) se caracteriza por disfunciones en las glándulas de secreción exocrina del organismo. Las primeras manifestaciones suelen observarse en el sistema respiratorio, constituyendo una de las causas más importantes de morbimortalidad en los pacientes afectados. Los microorganismos patógenos que colonizan frecuentemente el tracto respiratorio de estos pacientes son Staphylococcus aureus, Haemophilus spp., y Pseudomonas aeruginosa. Entre noviembre de 2001 y agosto de 2004 se estudiaron 222 muestras respiratorias de pacientes con FQ de entre 4 meses y 11 años de edad. Se aislaron S. aureus (38,7%), P. aeruginosa (37,4%) y Haemophilus spp., (15,3%). En S. aureus la meticilina-resistencia fue del 25,9% y se asoció con altas resistencias a eritromicina (35,0%) y clindamicina (29,4%). El mayor porcentaje de resistencia observado en las cepas de P. aeruginosa fue frente a gentamicina (31,0%). Los aislamientos de Haemophilus spp. fueron resistentes a ampicilina (23,0%) debido a la presencia de beta-lactamasas, y a trimetoprima/sulfametoxazol (59,0%).

Cystic Fibrosis (CF) is characterized by a dysfunction of the exocrine secretion glands. The first symptoms often appear in the respiratory system which constitutes one of the most important morbimortality causes in these patients. Chronic respiratory tract colonization is caused mainly by bacteria such as Staphylococcus aureus, Haemophilus spp. and Pseudomonas aeruginosa. Respiratory samples from patients with CF (age group: 4 months to 11 years) were analyzed from November 2001 to August 2004. The most frequently isolated microorganisms were S. aureus (38.7%), P. aeruginosa (37.4%) and Haemophilus spp (15.3%). A high resistance to erithromycine (35.0%) and clindamicine (29.4%) was observed in S. aureus strains and 25.9% of them were methicillin-resistant. P. aeruginosa strains were mainly gentamicin-resistant (31.0%). The rate of ampicillin-resistant Haemophilus spp. was 23.0% and it was due to the presence of beta-lactamases, but a high trimethoprim-sulfamethoxazole resistance was observed in this microorganism (59.0%).

Infecciones en pacientes sometidos a trasplante de órgano sólido / Infections in solid organ transplant recipients

The main problems in solid organ transplant recipients are rejection and infections. The new immunosuppressive regimens have lowered the risk of rejection, however, infections continue to be one of the most important determinants for morbidity and mortality in these patients. The survival of the transplanted organ is also impacted by the different infectious diseases that occur in the post-transplant period. These infections are of viral, bacterial, fungal and parasitic origin, and their presentation occurs characteristically within well defined risk periods after the transplant. The clinical presentation is commonly atypical; therefore for optimal management, it is necessary to have a through knowledge of the epidemiology and clinical manifestations of these problems, but most importantly, the experience of the clinician in the clinical approach and early detection will result in better outcomes. We review recent information regarding the infectious diseases that affect solid organ recipients according to the type of transplant, the post-transplant, risk factors before the transplant and the type of immunosuppressive therapy used, which are the main determinants for these complications and their prognosis.

Los problemas principales en el paciente sometido a trasplante de órgano sólido (TOS) son el rechazo del órgano y las infecciones. Los nuevos esquemas inmunosupresores han disminuido el riesgo de rechazo, sin embargo, las infecciones siguen siendo uno de los determinantes más importantes de morbilidad y mortalidad en estos pacientes. La sobrevida del órgano trasplantado es impactada también por los diversos procesos infecciosos que ocurren en el periodo postrasplante. Las infecciones que afectan a estos pacientes son de origen viral, bacteriano, fúngico y parasitario y su presentación ocurre característicamente dentro de periodos bien definidos de riesgo posterior al trasplante. La presentación clínica frecuentemente es atípica, por lo que para el manejo óptimo es necesario conocer la epidemiología y las manifestaciones clínicas de estos problemas, pero sobre todo la experiencia del clínico en el abordaje y en la detección temprana resulta en un mejor desenlace. En este artículo se revisa la información reciente sobre las enfermedades infecciosas que afectan a pacientes sometidos a TOS de acuerdo con el tipo de trasplante, al periodo postrasplante, a los factores de riesgo previo al trasplante y al tipo de terapia inmunosupresora utilizada, los cuales son los principales determinantes de estas complicaciones y de su pronóstico.

Conidiobolomicosis: hallazgos histopatológicos / Conidiobolomycosis: a case report with histophathologic findings

La conidiobolomicosis es una micosis subcutánea que se localiza generalmente en la línea media facial; es causada por un hongo saprófito de suelos y vegetales secos, propio de regiones intertropicales, que afecta principalmente a hombres adultos. El agente etiológico C onidiobolus coronatus pertenece a la clase de los Zigomicetos, orden Entomoftorales; se caracteriza por hifas cortas y gruesas, generalmente aseptadas, que crece entre 30°C y 37°C y produce granulomas nasales. Se informan a continuación los hallazgos histológicos de un caso de conidiobolomicosis en un paciente de 31 años de raza negra, natural y procedente de la región de Urabá, quien presentaba deformidad mediofacial con edema de nariz, labio superior e imágenes polipoides en senos maxilares con destrucción del tabique nasal. La biopsia demostró inflamación granulomatosa necrosante difusa en la dermis profunda e hipodermis asociada con eosinófilos y fenómeno de Splendore-Hoeppli, en cuya zona central se ubicaban espacios aparentemente vacíos que contenían el hongo que no se tiñó con HE, pero que sí lo hizo con las coloraciones de PAS y Grocott lo cual permitió la observación de hifas de paredes gruesas y rígidas, con torsión central y extremos cónicos