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.

Dos interesantes contaminantes fúngicos filamentosos en muestras clínicas positivas a Trychophyton rubrum: una situación de curiosidad morfológica / Two interesting filamentous fungal contaminants in clinical samples positive to Trychophyton rubrum: a situation of morphological curiosity

Las dermatofitosis corresponden a un grupo de enfermedades micóticas comunes en piel y fanéreas, donde Trichophyton rubrum es el agente causante más frecuente a nivel mundial y presente en nuestros 2 casos de pacientes masculinos con estas micosis, una en uñas y la otra en piel. Sin embargo, el enfoque de esta publicación se basa principalmente en la presencia de 2 interesantes contaminantes (uno en cada caso clínico) presentes solo en los cultivos de las primeras siembras como saprófitos y por ende como propágulos de dispersión, asociados al ambiente y sin intervención clínica demostrada en ambas micosis. La descripción morfofisiológica de estos 2 contaminantes Metarhizium purpureo-genum(similis) y Monascus ruber fue más bien una curiosidad esencial que el micólogo clínico adquiere en su contínua formación y ante la posibilidad de infecciones mixtas, pudiendo conjugar sus hallazgos junto al análisis taxonómico y los factores geográficos y edáficos asociados a su distribución. (AU)

Dermatophytoses belongs to a group of common mycotic diseases in skin and pharynals, where Trichophyton rubrum is the most frequent causative agent worldwide and present in our 2 cases of male patients with these mycoses, one in nails and the other in skin. However, the focus of this publication is mainly about the presence of 2 interesting contaminants (one in each clinical case) present only in the crops of the first sowings as saprophytes and therefore as dispersal propagules, associated with the environment and without clinical intervention demonstrated in both mycoses. The morphophysiological description of these 2 contaminants, Metarhizium purpureogenum (similis) and Monascus ruber was rather an essential curiosity that the clinical mycologist acquires in his continuous training and in the face of the possibility of mixed infections, being able to combine his findings together with the taxonomic analysis and the geographic and edaphic factors associated with its distribution. (AU)

Evaluation of susceptibility and response in the surface of agents of surface mycoses (Trichophyton mentagrophytes; T. tonsurans) to antifungal drugs of interest in a medical clinic / Avaliação da susceptibilidade e resposta in vitro de agentes de micoses superficiais (Trichophyton mentagrophytes; T. tonsurans) à drogas antifúngicas de interesse em clínica médica

INTRODUCTION: The resistance of fungal species to drugs usually used in clinics is of great interest in the medical field. OBJECTIVE: To evaluate susceptibility and in vitro response of species of Trichophyton spp. to antifungal drugs of interest in clinical medicine. METHODS: 12 samples of clinical isolates from humans were used, nine of T. mentagrophytes and three of T. tonsurans. Susceptibility tests were performed according to the agar diffusion (AD) and broth microdilution (BM) methods. RESULTS: In the AD method, the species T. tonsurans presented a percentage of sensitivity of 33% in relation to amphotericin B and 66% to itraconazole, with 100% resistance to ketoconazole and fluconazole. T. mentagrophytes also showed 100% resistance to ketoconazole in this technique, with 11% sensitivity to ketoconazole, 22% to itraconazole and 22% of samples classified as sensitive dose dependent. In the MC method, the species T. tonsurans presented a sensitivity percentage of 66%, 55% and 33% in relation to ketoconazole, fluconazole and itraconazole, respectively. The T. mentagrophytes species presented sensitivity percentages of 11%, 11%, 33% and 55% for amphotericin B, itraconazole, ketoconazole and fluconazole, respectively. CONCLUSION: There was resistance in vitro of the species of T. mentagrophytes and T. tonsurans against the antifungal fluconazole and relative resistance against ketoconazole in the AD method. In BM, however, important percentages of sensitivity were observed for the two species analyzed in relation to the antifungals fluconazole and ketoconazole when compared to itraconazole and amphotericin B.

INTRODUÇÃO: A resistência de espécies fúngicas às drogas usualmente empregadas no meio clínico é motivo de grande interesse na área médica. OBJETIVO: Avaliar susceptibilidade e resposta in vitro de espécies de Trichophyton spp. a drogas antifúngicas de interesse em clínica médica. MÉTODOS: Foram utilizadas 12 amostras de isolados clínicos de humanos, sendo nove de T. mentagrophytes e três de T. tonsurans. Foram realizados testes de susceptibilidade segundo os métodos de difusão em ágar (DA) e microdiluição em caldo (MC). RESULTADOS: No método de DA, a espécie T. tonsurans apresentou percentual de sensibilidade de 33% em relação à anfotericina B e de 66% ao itraconazol, com 100% de resistência frente ao cetoconazol e ao fluconazol. A espécie T. mentagrophytes também apresentou 100% de resistência frente ao cetoconazol nesta técnica, com 11% de sensibilidade ao cetoconazol, 22% ao itraconazol e 22% das amostras classificadas como sensível dose dependente. No método de MC, a espécie T. tonsurans apresentou percentual de sensibilidade de 66%, 55% e 33% em relação ao cetoconazol, fluconazol e itraconazol, respectivamente. A espécie T. mentagrophytes apresentou percentuais de sensibilidade de 11%, 11%, 33% e 55% para anfotericina B, itraconazol, cetoconazol e fluconazol, respectivamente. CONCLUSÃO: Houve resistência in vitro das espécies do T. mentagrophytes e T. tonsurans frente ao antifúngico fluconazol e resistência relativa frente ao cetoconazol no método de DA. Na MC, no entanto, foram observados importantes percentuais de sensibilidade das duas espécies analisadas frente aos antifúngicos fluconazol e cetoconazol quando comparadas ao itraconazol e à anfotericina B.

Brote de tiña por Trichophyton tonsurans en una escuela básica de Valparaíso, Chile / Ringworm of Trichophyton tonsurans outbreak in a basic school in Valparaíso, Chile

Resumen Introducción: Las tiñas son infecciones que afectan la piel y anexos. Trichophyton tonsurans es un hongo antropofílico emergente que puede provocar brotes. Objetivo: Describir un brote de tiña por T. tonsurans en una escuela de Valparaíso. Materiales y Método: Estudio descriptivo realizado entre junio-agosto de 2018. Se consideró caso a todo alumno de la escuela y a familiares directos en contacto con ellos, con diagnóstico clínico de tiña. El estudio micológico de las muestras tomadas se realizó a través de pruebas morfo-fisiológicas. Los datos se expresaron en números y porcentajes. Resultados: Hubo 18 casos, 16 niños (15 del kindergarten) y dos adultos. Tasa de ataque en kindergarten fue de 68%. Nueve casos fueron varones con promedio de edad de 6 años. Catorce de nacionalidad chilena y una haitiana. El caso índice fue un niño chileno y el primario el niño haitiano. La localización más frecuente fue en el rostro. Diez casos tuvieron cultivo con desarrollo de T. tonsurans. La mayoría requirió tratamiento con terbinafina por fracaso terapéutico con clotrimazol. Conclusiones: El brote por T. tonsurans ocurrió principalmente en varones del kindergarten. La principal localización fue en el rostro. La mayoría de los casos requirió terbinafina como tratamiento por fracaso terapéutico con clotrimazol.

Background: Ringworm are skin and its annexes infections. Trichophyton tonsurans is an emergent anthropophilic fungus that might cause outbreaks. Aim: To describe a ringworm outbreak by T tonsurans in an elementary school in Valparaíso, Chile. Methods: A descriptive study was run between June and August, 2018. Students and his closest relatives in contact with them who were clinically diagnosed with ringworm have been considered a case. Mycological studies of samples had been carried out through morphophysiology tests. Data are shown in numbers and percentages. Results: There were 18 cases, 16 kids (15 from kindergarten) and 2 adults. Attack rate was 68% in kindergarten. Nine cases were boys with average age of 6 years old. For 14 cases their nationality was Chilean and in 1 case Haitian. First case was a Chilean boy, and primary case was a Haitian boy. The most frequent location was face. Ten cases yielded positive cultures for T tonsurans. Most of the patients needed terbinafine treatment after a therapeutic failure performed with clotrimazole. Conclusion: T. tonsurans outbreak ocurred mainly in kindergarten male. The most frequent location was face. Most of the patients needed terbinafine treatment after a therapeutic failure with clotrimazole.

Occurrence of dermatophytoses in patients from the Sistema Único de Saúde

Abstract: Background: Dermatophytosis is a cutaneous disease caused by filamentous keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton, which present a high prevalence in the general population, being among the most common mycoses affecting about 20% of the world's population. Objective: To carry out the epidemiological survey of cases of dermatophytosis in patients from the Sistema Único de Saúde in a regional Laboratory in the period of 5 years (2009 to 2013). Methods: A retrospective study (January 2009 to December 2013) was carried out with a qualitative and quantitative design, through the registry book of the laboratory, Mycology Sector, where cases of patients with suspected dermatomycosis were analyzed. Results: In a 5-year period, a total of 4467 cases were suspected of having a fungal infection. Of these, 68.74% (3071) cases were of dermatomycosis. In relation to cultures with fungal growth, 12.54% (385 cases) were dermatophyte fungi and 7.97% (245 cases) non-dermatophyte fungi were isolated. Among the species identified, there was a higher prevalence of T. rubrum complex (75%), T. mentagrophytes complex (11.68%) and M. canis (7.01%). Regarding the sites analyzed, nail involvement was the most frequent in 75% of the cases. Study Limitations: This work is representative in the studied region. Conclusions: Dermatomycosis samples are the most frequent among all samples of fungal infections from these patients, with the nail being the most affected area and the fungi T. rubrum complex and T. mentagrophytes complex the most frequent.

Tiña negra: reporte de tres casos pediátricos / Tinea nigra: report of three pediatrics cases

Resumen: Introducción: La tiña negra es una micosis superficial causada por Hortaea werneckii. Su caracte rística clínica es la aparición de una mácula café negruzca de rápido crecimiento, producto del pig mento sintetizado por el mismo hongo. Sus características pigmentarias y de rápido crecimiento, de localización preferentemente acral, genera preocupación en los pacientes y en sus médicos tratantes por la sospecha de una lesion névica en evolución. Objetivos: Presentar 3 casos clínicos de pacientes pediátricos con esta patología y dar a conocer las herramientas para su diagnóstico diferencial. Casos clínicos: Tres pacientes, edades 3 y 5 años, con lesión macular pigmentada en palmas o plantas, cuyos padres referían habían crecido en forma rápida en poco tiempo. Dos de los casos tenían antecedentes de viajes previos al Caribe. Ante la sospecha clínica y dermatoscópica de una tiña negra, se realizó exámen micológico que confirmó el diagnóstico. En todos los casos, el tratamiento con antimicóticos tópicos llevó a la resolución completa de las lesiones. Conclusión: Aunque la tiña negra es rara en un clima seco, los viajes cada vez más frecuentes de los pacientes a países tropicales, probablemente aumentarán el número de casos. La dermatoscopía y el examen micológico son las herramientas que permiten realizar un correcto diagnóstico, evitando biopsias y/o cirugías innecesarias.

Abstract: Introduction: Tinea nigra is a superficial mycosis caused by Hortaea werneckii. Its clinical characte ristic is the appearance of a blackish brown macula of rapid growth, caused by the pigment produced by the fungus itself. The presence of a dark, fast growing, acral pigmentary lesion causes concern among patients and their treating physician about the possibility of a malignant pigmentary lesion. Objective: To present a series of three clinical cases in pediatric patients with this pathology and to show the tools that help to make a differential diagnosis. Clinical cases: Three patients between three and five years of age, which present a macular pigmented lesion on palms or soles, whose parents reported a rapid growth over a short period of time. Two of the patients reported previous trips to the Caribbean. Clinical and dermatoscopy suspicion of tinea nigra lead to a direct mycological exa mination, which confirmed the diagnosis. In all three cases, treatment with topical antifungals led to complete healing of the lesions. Conclusions: Although tinea nigra is rare in a dry climate, increasing travel of patients to tropical countries will increase the number of cases. Dermatoscopy and direct mycological examination are the tools that allow performing a correct diagnosis and avoiding unne cessary biopsies and/or surgeries.

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.

Frecuencia de Epidermophyton floccosum en dermatofitos aislados en un laboratorio de la Región de Valparaíso, Chile. Período 1980-2010 / Frequency of Epidermophyton floccosum in isolated dermatophytea laboratory from the Region of Valparaiso, Chile. Time frame: 1990-2010

Resumen Introducción: Las dermatofitosis son infecciones comunes en humanos, provocadas por hongos de los géneros Trichophyton, Microsporum y Epidermophyton. Objetivo: Determinar la frecuencia de E. floccosum en dermatofitos aislados en un laboratorio de la Región de Valparaíso durante las últimas tres décadas. Conocer las localizaciones más frecuentes, los grupos etarios y sexo de los pacientes afectados por este agente. Materiales y Método: Se revisaron los informes de cultivos superficiales con desarrollo de E. floccosum, Microsporum spp y Trichophyton spp de las tres últimas décadas del laboratorio de Micología de la Universidad de Valparaíso. Se registró en una planilla Excel el resultado del cultivo, edad, sexo y ubicación de la lesión de los pacientes. Resultados: El total de dermatofitosis con agente identificado fue de 6.780. En 26 casos hubo desarrollo de E. floccosum, de éstos, 73% (19/26) fueron en hombres y con una edad promedio de 37 años. La frecuencia disminuyó progresivamente desde la década de los ochenta hasta la del 2000. El grupo etario más afectados fue el de 36-60 años. Las localizaciones más frecuentemente afectadas fueron la planta y uñas de los pies. Conclusiones: Existe una disminución progresiva de la frecuencia de aislamiento de E. floccosum en el período estudiado. El sexo masculino y el grupo etario de 36-60 años fueron los más afectados. Las localizaciones más frecuentes fueron la planta y uñas de los pies.

Background: Dermatophytoses are frequent infections in human, which are produced by fungus genera Trichophyton, Microsporum and Epidermophyton. Aim: To determine frequency of E. floccosum in isolated dermatophyte in a laboratory from Valparaíso during the last three decades, in addition to knowing the most frequent localization, age and gender of patients affected by this agent. Method: All superficial culture reports, issued by the Universidad de Valparaíso's mycology laboratory in the last three decades, with E. floccosum, Microsporum spp and Trichophyton spp development, has been reviewed. Patients age, gender, location of the injury and culture report has been registered in an excel spreadsheet. Results: The total number of reports with dermatophyte development in the culture was 6,780. Only 26 cases show E. floccosum development, 73% of this (19/26) were present on men with and average age of 37 years. Frequency did progressively fall since eighty's until 2000 decade. The age group most affected by this etiological agent was 30-36 years. The most frequently localization in both man and woman were foot plant and nails. Conclusions: Frequency of isolation did decrease progressively in dermatophytose by E. floccosum for the study period. Masculine gender and 36-60 age group were the most affected. The most frequently localization were foot plant and nails.

Reflectance confocal microscopy of tinea nigra: comparing images with dermoscopy and mycological examination results

Abstract: Tinea nigra is a superficial mycosis whose diagnosis is confirmed by isolating the infectious agent Hortae werneckii through mycological examinations. In vivo reflectance confocal microscopy, initially used in melanocytic dermatosis, has been used with skin infectious diseases to identify the parasite at the cellular level. We report, for the first time in the scientific literature, the use of reflectance confocal microscopy in a case of tinea nigra and compare its findings to dermoscopy and mycological examination results.

Pseudomicetoma dermatofítico disseminado em um gato persa - Relato de caso / Dermatophytic pseudomycetoma disseminated in a persian cat - Case report / Pseudomicetoma dermatofitos diseminada en un gato persa - Relato de caso

O pseudomicetoma dermatofítico (PMD) é uma profunda infecção dérmica, causada por fungos, sendo o Microsporum canis o agente etiológico mais frequentemente envolvido. O objetivo do presente trabalho é relatar um caso de pseudomicetoma em um gato persa e alertar os médicos veterinários para incluir a doença como diagnóstico diferencial em dermatopatias em gatos, principalmente os da raça persa. Um felino macho, da raça Persa, de três anos, veio para atendimento apresentando 22 nódulos subcutâneos, distribuídos em todo corpo, com diâmetros que variavam de 2 a 8 centímetros, inclusive dentro do pavilhão auricular direito. Realizou-se raspado cutâneo e citologia aspirativa por agulha fina, obtendo resultados pouco conclusivos. Após a realização de exérese cirúrgica de grande parte dos nódulos e encaminhamento para exame histopatológico, obteve-se o diagnóstico de PMD. Após tratamento com itraconazol 10mg/kg SID por 5 meses houve completa remissão do quadro. A excisão cirúrgica foi essencial para a resolução do quadro, que juntamente com o itraconazol sistêmico tornou o tratamento efetivo para o PMD.(AU)

Dermatophytic pseudomycetoma (DPM) is a deep skin infection. Microsporum canis is the etiologic agent most frequently involved in DPM. The purpose of this study is to report a case of DPM in a Persian cat and suggest the veterinarians to include the disease as a differential diagnosis in skin diseases in Persian cats. A male Persian cat, 3 years old, came to be attended at the Veterinary Hospital. The patient was presenting 22 subcutaneous nodules measuring 2-8 cm in diameter, in different parts of the body, including inside the right ear. Skin scraping and fine needle aspiration cytology were performed, yielding inconclusive results. After performing the surgical removal of most of the nodules and a skin biopsy, the diagnosis of DPM was obtained. The cat had a complete remission of the disease after the treatment with itraconazole 10mg/kg SID for 5 months. It is important to emphasize that, as a therapeutic point of view, surgical excision is considered essential, but not enough to establish a permanent cure. Since there can be recurrence, the systemic use of itraconazole is indicated to efficiently cure animals presenting DPM.(AU)

El pseudomicetoma dermatofitos (PMD) es una infección profunda de la piel causada por hongos, siendo el Microsporum canis el agente etiológico implicado con mayor frecuencia. El objetivo de este trabajo es presentar un caso de pseudomicetoma en un gato persa y alertar los médicos veterinarios para incluir la enfermedad como un diagnóstico diferencial de enfermedades de la piel en gatos, especialmente la raza persa. Un gato macho, de la raza persa, de tres años, llegó a la asistencia presentando 22 nódulos subcutáneos, distribuidos por todo el cuerpo, con diámetros que variaban de 2 a 8 cm, inclusive dentro de la oreja derecha. Se afeitó la piel y con citología por aspiración, con aguja fina, se obtuvo resultados poco conclusivos. Después de realizar la extirpación quirúrgica de la mayor parte de los nódulos y enrutamiento para el examen histopatológico, se ha obtenido el diagnóstico de PMD. Tras el tratamiento con itraconazol l0mg/kg SID, por cinco meses, hubo remisión completa. La escisión quirúrgica fue esencial para la resolución del cuadro, que junto con itraconazol sistémico se convirtió en un tratamiento eficaz para el PMD.(AU)

Dermatophytosis caused by Microsporum gypseum in infants: report of four cases and review of the literature

Abstract Dermatophytosis caused by Microsporum gypseum is rare, especially in infants, with few published cases. Diagnosis in this age group is frequently delayed. We review the literature and report 4 new cases of tinea of glabrous skin caused by M. gypseum mimicking eczema in infants. Considering new and previously reported cases, half of patients were exposed to sand, emphasizing the importance of this transmission vehicle in this age group. In conclusion, although rare, dermatophytosis by M. gypseum should be part of the differential diagnosis of inflammatory dermatosis in infants. A clinical suspicion and the availability of culture are keys to the diagnosis.

Detection of seasonal asymptomatic dermatophytes in Van cats

Abstract The Van cat is a domestic landrace found in the Van province of eastern Turkey. In this study, we aimed to determine the seasonal carriage of dermatophytes in Van cats without clinical lesions. A total of 264 hair specimens were collected from clinically healthy cats in and around the Van Province. Of these samples, 30.3% were obtained in spring, 30.6% in summer, 16.6% in autumn, and 22.3% in winter; 45.1% of samples were from male cats and the rest from female ones. Of the studied cats, 118 were younger than 1 year, 78 were 1–3 years old, and 68 were older than 3 years. The specimens were subjected to direct microscopic examination with 15% potassium hydroxide and cultured on Sabouraud dextrose agar and dermatophyte test medium supplemented with cycloheximide and chloramphenicol. Dermatophyte identification was carried out based on macroscopic and microscopic colony morphology, urease activities, in vitro hair perforation test, growth at 37 °C, and pigmentation on corn meal agar. Dermatophytes were isolated from 19 (7.1%) of the 264 specimens examined. The most frequently isolated fungi were Trichophyton terrestre (4.1%), followed by Microsporum gypseum (1.1%), M. nanum (1.1%), and T. mentagrophytes (0.7%), and these fungi may represent a health risk for humans in contact with clinically healthy Van cats. M. canis was not isolated from any of the specimens. Our results show no significant (p > 0.05) association between carriage of dermatophytes and the gender of cats. The carriage rate of dermatophytes was high in spring and winter, and the only possible risk factor for infection was age of the animal.

Dermatofitoses: agentes etiológicos, formas clínicas, terapêutica e novas perspectivas de tratamento / Dermatophytoses: etiologic agents, clinical forms, therapy and new perspectives of treatment

As dermatofitoses têm ocorrência mundial, sendo mais prevalentes em países de clima tropical e subtropical. Dados epidemiológicos indicam que essas micoses estão entre as infecções fúngicas de maior ocorrência. O quadro clínico mais comum de dermatofitose inclui despigmentação, placas anulares, prurido e perda de cabelo, com lesões tipicamente conhecidas como tineas, ocasionadas por fungos filamentosos dermatofíticos de três gêneros anamórficos: Microsporum, Trichophyton e Epidermophyton. O tratamento das dermatofitoses, em geral, está relacionado ao uso de antifúngicos tópicos e/ou sistêmicos, apresentando como problemática o surgimento de espécies multirresistentes. Esta revisão aborda as dermatofitoses e seus agentes etiológicos de forma aprofundada em aspectos epidemiológicos, apresentando a importância clínica do tema, com ênfase na causa, prevenção, tratamento e prognóstico dessa micose cutânea (AU)

Dermatophytoses have worldwide occurrence with higher prevalence in tropical and subtropical countries. Epidemiological data show that these mycoses are among the most frequent fungal infections. The most common symptoms of dermatophytoses include depigmentation, annular plaques, itching and hair loss, with lesions such as tinea, caused by dermatophytic filamentous fungi of three anamorphic genera: Microsporum, Trichophyton and Epidermophyton. Topical and/or systemic antifungalmedications are used in the treatment of dermatophytoses in general, resulting in problems such as the emergence of multidrug-resistant species. This review discusses dermatophytoses and their etiological agents with a focus on epidemiological aspects, presenting the clinical importance of the issue, with emphasis on cause, prevention, treatment and prognosis of this skin mycosis (AU)

Scanning electron microscopy of superficial white onychomycosis

AbstractSuperficial white onychomycosis is characterized by opaque, friable, whitish superficial spots on the nail plate. We examined an affected halux nail of a 20-year-old male patient with scanning electron microscopy. The mycological examination isolated Trichophyton mentagrophytes. Abundant hyphae with the formation of arthrospores were found on the nail's surface, forming small fungal colonies. These findings showed the great capacity for dissemination of this form of onychomycosis.

Micosis superficiales en pacientes del estado Anzoátegui, Venezuela, periodo 2002-2012 / Superficial mycoses in patients from Anzoátegui state, Venezuela, period 2002-2012

Las enfermedades fúngicas superficiales que afectan la piel y sus faneras son motivo de consultas en los servicios básicos de triaje y en dermatología. Se encuentran distribuidas en Venezuela con una incidencia de 92,9%. El objetivo del presente estudio fue conocer los géneros y especies que causan dermatomicosis en pacientes residentes del estado Anzoátegui, Venezuela, en el período 2002-2012. Se estudiaron 4257 pacientes con edades entre 7 meses y 79 años. La prevalencia general fue de 30,9%. Las más frecuentes fueron las dermatofitosis (44,7%). M. canis produjo 148 casos de tiña de la cabeza. Tres agentes dermatofiticos representaron el 95% de todos los casos, con predominio significativo de T. mentagrophytes representado por un 50%. La candidosis se presentó en 28,4%. C. albicans, y el complejo C. parapsilosis, fueron responsables del 80% de los casos. Otras especies identificadas fueron C. tropicalis (n = 41; 11,0%), C. glabrata (n = 10; 2,7%), C. guilliermondii (n = 6; 1,6%), C. krusei (n = 4; 1,1%). Pitiriasis versicolor se presentó en (22,4%), y en menor frecuencia la onicomicosis por mohos no dermatofitos, dominando Fusarium oxysporum (n = 34; 65,4%), Aspergillus terreus (n = 16; 30,8%) y Scytalidium dimidiatum (2; 3,8%). Raros casos de onicomicosis por Trichosporon (0,5%) y un caso de tinea negra. Estos resultados revelan una alta frecuencia de las micosis superficiales con predominio de las dermatofitosis indicando la existencia de un problema de salud pública.

Superficial fungal diseases that affect the skin and its appendages are frequently seen in basic triage and in dermatology services. These diseases are distributed in Venezuela with an incidence of 92.9%. The aim of this study was to determine the genera and species that cause dermatomycoses in residents of Anzoátegui state, Venezuela, during the period 2002-2012. A total of 4257 patients with a presumptive diagnosis of superficial mycoses were studied, with ages from 7 months to 79 years. The overall prevalence was 30.9%. The most frequent were dermatophytosis (44.7%). M. canis produced 148 cases of tinea capitis. Three dermatophytic agents represented 95% of all cases, with a significant predominance of T. mentagrophytes with 50%. Candidosis occurred in 28.4%. C. albicans, and the C. parapsilosis complex, were responsible for 80% of the cases. The other species identified were C. tropicalis (n = 41, 11.0%), C. glabrata (n = 10, 2.7%), C. guilliermondii (n = 6, 1.6%), C. krusei (n = 4, 1.1%). Pityriasis versicolor occurred in 22.4% of the cases studied, and less frequently were present onychomycosis produced by a non dermatophytic mold: Fusarium oxysporum (n = 34, 65.4%), Aspergillus terreus (n=16, 30.8%) and Scytalidium dimidiatum (n=2; 3.8%). Rare cases of Trichosporon onychomycosis (0.5%) and one case of black tinea were also found. Health education in the population is recommended to promote measures to prevent transmission of these fungi and prevent the spread of this silent public health problem.

Scanning electron microscopy of tinea nigra

Tinea nigra is a rare superficial mycosis caused by Hortaea werneckii. This infection presents as asymptomatic brown to black maculae mostly in palmo-plantar regions. We performed scanning electron microscopy of a superficial shaving of a tinea nigra lesion. The examination of the outer surface of the sample showed the epidermis with corneocytes and hyphae and elimination of fungal filaments. The inner surface of the sample showed important aggregation of hyphae among keratinocytes, which formed small fungal colonies. The ultrastructural findings correlated with those of dermoscopic examination - the small fungal aggregations may be the dark spicules seen on dermoscopy - and also allowed to document the mode of dissemination of tinea nigra, showing how hyphae are eliminated on the surface of the lesion.

Dermatophytosis diagnosed at the Evandro Chagas Institute, Pará, Brazil

Dermatophytosis is caused by a dermatophyte fungus that affects the stratum corneum and keratinized tissue. Dermatophyte fungus has been reported worldwide as the causative agent of dermatophytosis, but the etio-epidemiological aspects of these mycoses in the state of Pará remain unknown. The purpose of this study was to describe the etio-epidemiological profile of dermatophytosis diagnosed in patients at the Evandro Chagas Institute from May 2005 to June 2006. A total of 494 patients were admitted, and their samples were collected, submitted for direct microscopic examination using 20% KOH and cultured in Sabouraud and Mycosel medium. The identification was based in macro and microscopic characteristics. Direct examinations were positive in 13% (66/494) of the patients, and agent isolation by cultivation of the biological sample was successful in 4% (20/494), with a high prevalence of T. mentagrophytes (40%; 8/20). Dermatophytosis was more frequent in women (58%; 38/66). Fifty-two percent (21/38) of the cases were children with an average age of 8 years. The most frequent clinical presentation was Tinea corporis (55%, 36/66). For the cases in which the dermatophyte agent was not isolated, we discuss the factors that may be interfering with isolation. Tinea corporis occurred more frequently observed when T. mentagrophytes and T. rubrum were the major etiologic agents.

Actividad antifúngica y perfil de seguridad del producto natural derivado del aceite de maravilla ozonizado (AMO3) en dermatofitos / In vitro antifungal susceptibility, in vivo antifungal activity and security from a natural product obtained from sunrise oil (AMO3) against dermatophytes

This work studied safety and antifungal activity of ozonized sunflower oil (AMO3) against dermatophytes. AMO3 was prepared through a new original process that modifies the oil before ozonation by alcoholic catalytic esterification. Susceptibility was studied in 41 dermatophytes by agar diffusion and broth microdilution tests. The experimental model to assess the topical safety of the oil included 60 CF1 mice divided in three groups that were treated with vaseline (control), 1 percent AMO3 and 50 percent AMO3 (overdose), respectively. Then, experimental dermatophytosis was induced in CF1 mice. Seventy-five individuals were selected and divided in 5 groups that were treated once a day with placebo, cream with 1 percent, 2 percent and 3 percent AMO3 plus an untreated control group. This new natural product showed antifungal activity against all strains studied. The MIC ranged between was 0,125 and 1 percent, while minimum fungicidal concentration (MFC) was 2 percent. The application of vaseline and AMO3 1 percent and 50 percent did not produce clinical or histopathological lesions. The mice with dermatophytosis that were treated with 1 percent, 2 percent and 3 percent AMO3 showed 100 percent clinical cure and 94 percent average mycological cure, exceeding placebo and control groups (p < 0,05). This product exhibits high antifungal activity and could be a safe alternative for ringworm topical treatment.

Se evaluó la seguridad y actividad antifúngica del aceite de maravilla ozonizado (AMO3) frente a dermatofitos. AMO3 se generó a través de un proceso original que implica modificación del aceite previa ozonización por esterificación catalítica con alcohol. La sensibilidad fue estudiada en 41 dermatofitos por difusión en agar y microdilución en caldo. El modelo experimental para evaluar tópicamente la seguridad del aceite, incluyó 60 ratones CF1, formando tres grupos a los cuales se les aplicó respectivamente vaselina (control), AMO3 1 por ciento y AMO3 50 por ciento (sobredosis). Luego, se indujo derma-tofitosis experimental en ratones CF1, seleccionando 75 individuos divididos en cinco grupos tratados una vez al día con placebo, crema con AMO3 al 1 por ciento, 2 por ciento y 3 por ciento, más un grupo control sin tratamiento. Este nuevo producto natural presentó actividad antifúngica frente a todas las cepas estudiadas. La CIM fluctuó entre 0,125 y 1 por ciento mientras la concentración fungicida mínima (CFM) fue de 2 por ciento. La aplicación de AMO3 no generó lesiones clínicas ni histopatológicas. Los ratones con dermatofitosis tratados con AMO3 presentaron 100 por ciento de cura clínica y 94 por ciento de promedio en cura micológica, siendo superior al grupo control y placebo (P < 0,05). Este producto muestra elevada actividad antimicótica y podría ser una alternativa segura para tratamiento tópico de dermatofitosis.