Tiña incógnita y granuloma de Majocchi adquirido de un erizo. Un caso mexicano / Mexican case of tinea incognito and granuloma de Majocchi acquired from a hedgehog

Resumen Las mascotas exóticas, como el erizo de tierra, son capaces de transmitir al ser humano diferentes infecciones, como salmonelosis, micobacterias, protozoos como Cryptosporidium parvum, y dermatofitosis. Presentamos el caso de un paciente adulto masculino, que recientemente había adquirido un erizo de tierra, que presentó en la mano una lesión de tiña incógnita y un granuloma de Majocchi. Se identificó el agente etiológico como Trichophyton erinacei, por cultivo micológico y biología molecular. El paciente se trató con terbinafina por vía oral, por seis meses, con excelente respuesta.

Exotic pets, such as the ground hedgehog, are capable of transmitting to the human being different zoonoses, such as salmonellosis, mycobacteria, protozoa such as Cryptosporidium parvum, and dermatophytosis. We present the case report of a male adult patient, who had recently acquired a ground hedgehog, who presented in his hand a ringworm lesion incognito and a Majocchi granuloma. The etiological agent was identified as Trichophyton erinacei by mycological culture and molecular biology. The patient was treated with terbinafine oral, with excellent response.

Analysis on curative effects and safety of 2% liranaftate ointment in treating tinea pedis and tinea corporis and cruris

The paper is intended to analyze and evaluate the specific curative effect and safety of 2% liranaftate ointment in treating patients with tinea pedis and tinea cruris. 1,100 cases of patients with tinea pedis and tinea corporis and cruris were selected as research objects and were divided into two groups according to the random number table method. They were treated with different methods: 550 cases of patients were treated with 2% liranaftate ointment for external use in the observation group and the rest 550 cases of patients were treated with 1% bifonazole cream in the control group. The treatment time was two weeks for patients with tinea corporis and cruris and four weeks for those with tinea pedis respectively. Meanwhile, the one-month follow-up visit was conducted among the patients to compare the curative effects of two groups. After the medication, the curative effectiveness rate was 87.65% [482/550] in the observation group, while that was 84.91% [467/550] in the control group. After the average follow-up visits of [15.5 +/- 2.4], the curative effectiveness rate 96.55% [531/550] in the observation group, while that was 91.45% [503/550] in the control group. Two groups of patients recovered well with a low incidence of adverse reactions in the treatment, and the overall curative effect was good with the inter-group difference at P>0.05, so it was without statistical significance. The curative effect of 2% liranaftate ointment is safe and obvious in treating tinea pedis and tinea corporis and cruris, so it is valuable for clinical popularization and application

Tinea faciei on the right eyebrow caused by Trichophyton interdigitale

Abstract Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks.

Paracoccidioidomycosis treatment / Tratamento da paracoccidioidomicose

SUMMARYConsidered to be an emerging endemic mycosis in Latin America, paracoccidioidomycosis is characterized by a chronic course and involvement of multiple organs in immunocompromised hosts. Infection sequelae are mainly related to pulmonary and adrenal insufficiency. The host-parasite interaction results in different expressions of the immune response depending on parasite pathogenicity, fungal load and genetic characteristics of the host. A few controlled and case series reports have shown that azoles and fast-acting sulfa derivatives are useful treatment alternatives in milder forms of the disease. For moderate/severe cases, more prolonged treatments or even parenteral routes are required especially when there is involvement of the digestive tract mucosa, resulting in poor drug absorption. Although comparative studies have reported that shorter treatment regimens with itraconazole are able to induce cure in chronically-infected patients, there are still treatment challenges such as the need for more controlled studies involving acute cases, the search for new drugs and combinations, and the search for compounds capable of modulating the immune response in severe cases as well as the paradoxical reactions.

RESUMOConsiderada micose endêmica emergente na América Latina, a paracoccidioidomicose é caracterizada por uma evolução crônica e envolvimento de múltiplos órgãos em pacientes com comprometimento imunológico. Sequelas da infecção estão relacionadas principalmente à insuficiência pulmonar e adrenal. A interação hospedeiro-parasito resulta em diferentes expressões da resposta imune dependendo da patogenicidade do parasito, carga fúngica e características genéticas do hospedeiro. Alguns estudos controlados e séries de casos têm demonstrado que azóis de ação rápida e derivados de sulfa constituem alternativas terapêuticas úteis nas formas mais leves da doença. Para casos moderados/graves, tratamentos mais prolongados ou mesmo por via parenteral são necessários especialmente quando há envolvimento de mucosa do trato digestivo, resultando em absorção deficiente de drogas. Embora estudos comparativos tenham relatado que esquemas terapêuticos mais curtos com itraconazol sejam capazes de induzir cura em pacientes cronicamente infectados, ainda existem desafios no tratamento, tais como a necessidade de maior número de estudos controlados envolvendo casos agudos, busca por novas drogas e combinações, compostos capazes de modular a resposta imune nos casos graves, e reações paradoxais.

Neumomediastino y necrosis cutánea en asociación a dermatomiositis: presentación de un caso clínico y revisión de la literatura / Pneumomediastinum and cutaneous necrosis in dermatomyositis: Report of one case

We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis.

Microsporum spp. onychomycosis: disease presentation, risk factors and treatment responses in an urban population

BACKGROUND: Dermatophytes are the main causative agent of all onychomycosis, but genus Microsporum is infrequent and the risk of acquiring the infection is often associated with exposure to risk factors. OBJECTIVES: To describe clinical characteristics of onychomycosis due to Microsporum onychomycosis in an urban population. METHODS: This was a retrospective analysis of the epidemiological and clinical features of 18Microsporum onychomycosis cases of a total of 4220 of onychomycosis cases diagnosed between May 2008 and September 2011 at the tertiary referral center for mycology in Guatemala. RESULTS: Eighteen cases of Microsporum onychomycosis (M. canis, n=10; M. gypseum, n=7; M. nanum, n=1) were identified (prevalence=0.43%). Infection was limited to nails only and disease duration ranged from 1 month to 20 years (mean=6.55 years). The toenails were affected in all cases except for a single M. gypseum case of fingernail. The most common clinical presentation was distal lateral subungual onychomycosis (12/18) followed by total dystrophic onychomycosis (5/18), and superficial white onychomycosis (1/18). M. gypseumpresented in 6 cases as distal lateral subungual onychomycosis and in 1 case like total dystrophic onychomycosis. Five cases (27.78%) were associated with hypertension, diabetes, and psoriasis. Treatment with terbinafine or itraconazole was effective. Two cases of M. canisdistal lateral subungual onychomycosis responded to photodynamic therapy. CONCLUSION: This is the largest reported series of Microsporum onychomycosis and demonstrates such a disease in an urban population. In 27.78% of the cases risk factors for infection were associated to comorbid states. We also report the first 2 cases of successfully treated M. canis onychomycosis with photodynamic therapy and a rare case of M. canis associated dermatophytoma. .

A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus, Leporidae): the role of dermoscopy in diagnosis

We report a case of Tinea nigra in an adolescent living in Itapema, Santa Catarina, Brazil, who presented a hyperchromic macule on the palm of the left hand, close to another erythematous macule caused by a rabbit bite. The patient received guidance on accidents and animal bites and evolved well treated with topical butenafine for the dermatomycosis. The authors also highlight the efficacy of the dermoscopic exam in diagnosing Tinea nigra with animal bite lesions and other traumas.

General aspects of drug interactions with systemic antifungals in a retrospective study sample / Aspectos gerais de interações medicamentosas com antifúngicos sistêmicos em um estudo amostral retrospectivo

A retrospective study evaluating hepatic laboratory alterations and potential drug interactions in patients treated for onychomycosis. We evaluated 202 patients, 82% female. In 273 liver enzyme tests, there were changes in only 6%. Potential drug interactions were identified in 28% of patients for imidazole and 14% for terbinafine. The risk of potential interactions increased with the patient's age and use of multiple drugs.

Estudo retrospectivo avaliando alterações laboratoriais hepáticas e potenciais interações medicamentosas em pacientes tratados para onicomicose. Foram avaliados 202 pacientes, sendo 82% do sexo feminino. Em 273 exames de enzimas hepáticas, houve alterações em apenas 6%. Potenciais interações medicamentosas foram identificadas em 28% dos pacientes para imidazólicos e 14% para terbinafina. O risco de interações potenciais aumentou com a idade do paciente e o uso de múltiplas medicações.

Lamisil versus clotrimazole in the treatment of vulvovaginal candidiasis

Vaginal candidiasis is a common disease in women during their lifetime and occurs in diabetes patients, during pregnancy and oral contraceptives users. Although several antifungals are routinely used for treatment; however, vaginal candidiasis is a challenge for patients and gynecologists. The aim of the present study was to evaluate terbinafme [Lamisil] on Candida vaginitis versus clotrimazole. In the present study women suspected to have vulvovaginal candidiasis were sampled and disease confirmed using direct smear and culture examination from vaginal discharge. Then, patients were randomly divided into two groups, the first group [32 cases] was treated with clotrimazole and the next [25 cases] with Lamisil. All patients were followed-up to three weeks of treatment and therapeutic effects of both antifungal were compared. Our results shows that 12 [37.5%] patients were completely treated with clotrimazole during two weeks and, 6[18.8%] patients did not respond to drugs and were refereed for fluconazole therapy. Fourteen [43.8%] patients showed moderate response and clotrimazole therapy was extended for one more week. When Lamisil was administrated, 19 [76.0%] patients were completely treated with Lamisil in two weeks, and 1 [4.0%] of the patients did not respond to the drug and was refereed for fluconazole therapy. Five [20.0%] of our patients showed moderate response and Lamisil therapy was extended for one more week. Our results show that vaginal cream, 1% Lamisil, could be suggested as a first-line treatment in vulvovaginal candidiasis

Efecto de esfingolípidos y Agelosina B en la movilización de Ca2+ y la señalización celular en células de cáncer de mama (MCF-7) y su relación con la apoptosis / Effect of sphingolipids and Agelosin B on Ca2 + mobilization and cell signaling in breast cancer cells (MCF-7) and its relationship with apoptosis

Los esfingolípidos, como la ceramida (Cer), la ceramida-1-fosfato (C-1-P), la esfingosina (Sph) y la esfingosina-1-fosfato (S-1P) estan relacionados con la señalización intracelular en procesos como crecimiento celular, movilización intracelular de Ca+2 y apoptósis. En este trabajo se evaluó el efecto de estos esfingolípidos en la homeostasis de Ca+2 intracelular y en la apoptósis en células de cáncer de mama MCF-7. Se utilizaron fluoróforos específicos para el Ca+2 y microscopía confocal. Se demostró que en estas células, la Sph (20 uM), la Cer (10uM), la S-P (2uM) y la C--P (uM) aumentaron la concentración intracelular ce Ca+2, induciendo su liberación desde el retículo endoplasmático (RE). Además, se observo que la esfingosina abrioun canal de Ca2+ en la membrana plasmática. También se demostró que la Cer inhibe parcialmente la actividad de la Ca2+-ATPasa del RE (SERCA), de forma dosis dependiente, mientras que la ceramina, su análogo no hidrolisable la inhibe totalmente. La Sph también inhibe completamente la actividad de la SERCA, a la misma concentración que induce la liberación del Ca+2 del RE. Asimismo, se evaluó el efecto de estos esfingolípidos sobre la inducción de la apotósis en células MCF-7 evidenciando que el tratamiento con la Cer, la ceramida, la Sph inducen toxicidad. También se observo que mientras la ceramida activo la caspasa 7 y la caspasa 8, el esfingolipido natural, la Cer no tuvo ningún efecto. Por su parte, la Sph activa la caspasa 8 sin modificar la activdad de la caspasa 7. Tanto la Cer, como la ceramida y la Sph, disminuyeron la expresión de la proteína Bcl-2 amti-apoptótica, y también indujeron la fragmentación de ADN, visualizada mediante la técnica de TUNEL, demostrando que estos esfingolípidos inducen apoptósis en MCF-7. La agelasina B, toxina purificada a partir de la esponja marina Agelas clathrodes tiene un efecto citotóxico un orden de magnitud mayor en MCF-7, en comparación con fibroplastos humanos. La agelasina B induce la liberación del Ca+2 almacenado en el RE en celulas MCF-7, ademas de inhibir la actividad de la SERCA en un 100%. También se demostró que esta toxina induce apoptosis, ya que disminuye el potencial de membrana mitocondrial, activa la caspasa 8, disminuye la expresion de la proteina Bcl-2 e induce fragmentación del ADN de las células MCF-7. Este mecanismo es similar al efecto de la tapsigargina.

Sucesso terapêutico da terbinafina em um caso de esporotricose / Successful treatment of terbinafine in a case of sporotrichosis

A esporotricose é uma infecção subaguda ou crônica, causada por fungos pertencentes ao Complexo Sporothrix. Relato do caso: esporotricose de localização nasal foi tratada com iodeto de potássio e como não se obteve sucesso, reiniciou-se o tratamento com associação de iodeto de potássio e itraconazol. Porém, ocorreu nova recidiva. As culturas dos exames micológicos foram submetidas a ensaios de atividade antifúngica in vitro para auxiliar no tratamento. A terbinafina foi o antifúngico que apresentou melhores resultados, por isso, o tratamento foi reiniciado com este antifúngico e, após dois anos do término do mesmo, não recidivou. Adicionalmente, ambas as culturas foram comparadas por RAPD, obtendo padrões de fragmentos distintos, indicando que os isolados são diferentes ou demonstrando um processo microevolutivo do microrganismo.

Sporotrichosis is a chronic subacute infection caused by fungi belonging to the Sporothrix Complex. In the present clinical case, nasal sporotrichosis was treated with potassium iodide. This was unsuccessful, and the treatment was restarted with a combination of potassium iodide and itraconazole. This however resulted in a further recurrence of the infection. The mycological cultures were tested in vitro for antifungal activity to assist in treatment. Terbinafine, an antifungal drug, produced the best results and was therefore used for the rest of the treatment course, with no recurrence after two years of its completion. In addition, both cultures were compared using RAPD and different fragment patterns were observed. This indicated that the isolates were either different or indicated a microevolutionary process of this microorganism.

Tinea granulomatosa de Majocchi / Majocchi's granuloma

Relata-se o caso de um homem de 45 anos com dermatofitose superficial de longa data, tratado, inadvertidamente, com corticoide e antibiótico, com progressão subsequente para a forma profunda, conhecida como granuloma de Majocchi. O tratamento com terbinafina VO foi curativo.

We report the case of a man of 45 with superficial dermatophytosis longtime inadvertently treated with antibiotics and corticosteroids with subsequent progression to the deep form, known as granuloma Majocchi. Treatment with orally terbinafine was successful.

Sporothrix schenckii associated with armadillo hunting in Southern Brazil: epidemiological and antifungal susceptibility profiles / Sporothrix schenckii relacionado à caça ao tatu no Sul do Brasil: aspectos epidemiológicos e suscetibilidade dos isolados aos antifúngicos

INTRODUCTION: Sporotrichosis is the most common subcutaneous mycosis observed in Brazil and it is generally consequent to a little trauma caused by vegetal particles or spines which inoculate the fungi in the subcutaneous area. Although sporotrichosis had been frequently mentioned with armadillo hunting this form has not been widely reported in Brazil until now. In this study we report ten cases of sporotrichosis evolving the armadillo's hunting diagnosed in some towns located in the central and west regions of Rio Grande do Sul State. METHODS: The cases were established based on clinical and classic mycological laboratorial techniques. The susceptibility tests were conducted by microdilution technique according to M38-A2 CLSI documents. RESULTS: Ten cases of sporotrichosis associated with armadillo hunting detected in the State of Rio Grande do Sul were diagnosed by mycological methods. The susceptibility tests of Sporothrix schenckii isolates to antifungal agents itraconazole, ketoconazole and terbinafine showed that all the isolates were susceptible. CONCLUSIONS: The paper discusses some cultural aspects related to hunting of this wild animal as well as possible causes of this unexpected occurrence in southern Brazil.

INTRODUÇÃO: A esporotricose constitui-se na micose subcutânea mais frequentemente observada e, na maioria dos casos, a infecção é decorrente de pequenos traumas envolvendo fragmentos vegetais ou espinhos que inoculam o fungo no tecido subcutâneo. Embora frequentemente relacionada a caça a tatus, esta ocorrência tem sido raramente relatada no Brasil. Neste estudo relatamos dez casos envolvendo esta prática, observados em várias cidades das regiões centro e oeste do Estado do Rio Grande do Sul. MÉTODOS: o diagnóstico clínico foi confirmado pelos métodos clássicos de cultura em ágar Mycobiotic, identificação micromorfológica seguida de reversão a fase leveduriforme em ágar BHI. Os testes de suscetibilidade foram realizados pela técnica de microdiluição em caldo, de acordo com as normas estabelecidas pelo documento CLSI M38-A2 (2008). RESULTADOS: A esporotricose, decorrente de lesões causadas pela caça ao tatu foi confirmada pelo métodos microbiológicos. Os testes de suscetibilidade indicaram que todos os isolados eram sensíveis ao itraconazol, cetoconazol e terbinafina. CONCLUSÕES: O artigo discute aspectos ambientais e culturais relacionados a caça a este animal silvestre bem como àqueles relacionados a esta inesperada ocorrência.

Esporotricose cutânea experimental: Avaliação in vivo do itraconazol e terbinafina / Experimental cutaneous sporotrichosis: in vivo evaluation of itraconazole and terbinafine

O estudo objetivou avaliar a atividade in vivo do itraconazol e terbinafina no tratamento da esporotricose cutânea experimental. Foram utilizados 80 ratos Wistar divididos em quatro grupos (TERB20, TERB30, ITRA e CONT) inoculados no coxim plantar esquerdo com 0,2ml de solução contendo 2x103 células de Sporothrix schenckii/ml e tratados com terbinafina (20 e 30mg/kg), itraconazol (10mg/kg) e placebo durante 13 semanas. As lesões do sítio de inoculação foram avaliadas e mensuradas semanalmente, assim como a disseminação das mesmas. Após foi realizada análise micológica e histopatológica. Os resultados demonstraram que os animais do grupo ITRA diferiram estatisticamente em todos os parâmetros avaliados em relação ao CONT. Em relação à terbinafina, não houve diferenças estatísticas entre os grupos tratados e controle. Pode-se confirmar a boa atividade do itraconazol no tratamento da esporotricose e a pouca eficácia da terbinafina nas doses utilizadas, sendo necessários mais estudos com este antifúngico.

The aim of this study was to evaluate the in vivo activity of itraconazole and terbinafine for treating experimental cutaneous sporotrichosis. Eighty Wistar rats were used, divided into four groups (TERB20, TERB30, ITRA and CONT). They were inoculated in the left plantar pad with 0.2 ml of solution containing 2x10³ cell/ml of Sporothrix schenckii and treated with terbinafine (20 and 30 mg/kg), itraconazole (10 mg/kg) or placebo for 13 weeks. The lesions at the inoculation site were evaluated and measured weekly, along with their dissemination. Mycological and histopathological analyses were performed subsequently. The results showed that the animals in the ITRA group differed statistically in all parameters evaluated, in relation to CONT. For terbinafine, there were no statistical differences between the treated and control groups. It could be confirmed that itraconazole presented good activity for treating sporotrichosis, while terbinafine was ineffective for this disease at the doses used. However, more studies on the latter antifungal agent are needed.

Phaeomycotic cyst--a case report.

Phaeomycotic cyst or subcutaneous phaeohyphomycosis is the most common type of phaeohyphomycosis. Fonsecaea pedrosoi as the causative agent of subcutaneous phaeohyphomycosis was earlier reported in India. Here a case of a patient of 22-year-old farmer is presented with a soft cystic swelling on the left wrist. Direct examination of the aspirate from the swelling showed dematiaceous hyphae. Culture grew Fonsecaea pedrosoi. The patient responded to antifungal therapy.

An open randomized comparative study of oral itraconazole pulse and terbinafine pulse in the treatment of onychomycosis.

BACKGROUND: Onychomycosis is a recalcitrant disease of the nails caused by dermatophytes, yeasts, and molds. AIMS: To compare the clinical efficacy of oral itraconazole pulse therapy and oral terbinafine pulse therapy in onychomycosis. METHODS: A randomized single-blind clinical comparative study was undertaken on 120 patients of onychomycosis during the period March 1999-February 2002. Sixty patients were randomly assigned to receive oral itraconazole 100 mg, two capsules twice daily for seven days a month and the other group of sixty patients received oral terbinafine 250 mg, one tablet twice daily for seven days every month. Four such monthly pulses were administered for each drug. The patients were evaluated at 4-weekly intervals till sixteen weeks and then at 24, 36 and 48 weeks. RESULTS: We observed a clinical cure rate of 82% and mycological cure rate of 90% in the group of patients treated with itraconazole while the group with terbinafine showed clinical and mycological cure rates of 79% and 87% respectively. This difference was not statistically significant. CONCLUSIONS: Both oral itraconazole and terbinafine are effective in the treatment of onychomycosis when administered in the pulse dosage form. Terbinafine is more cost effective while itraconazole has a broader spectrum of antimycotic activity.