Successful medical drainage and surgical treatment for vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by klebsiella pneumoniae in a diabetic patient

SUMMARY OBJECTIVE: We describe the case of a diabetic patient who developed vertebral osteomyelitis and bilateral psoas abscess with gas formation due to klebsiella pneumoniae. METHODS: A 64-year-old woman with a 4-year history of type-2 diabetes mellitus was admitted to the Emergency Department. The subject had a 2-day history of high-grade fever associated with chills and a 5-hour history of consciousness. She received empirical treatment with febrifuge, after which her fever decreased. RESULTS: Her fever recurred after an interval of three hours. A computed tomography scan of the abdomen revealed vertebral osteomyelitis and bilateral psoas muscle abscess with gas formation. Blood culture and purulent fluid described the growth of the Klebsiella pneumoniae. The patient received antibiotic therapy and bilateral drainage therapy after the drainage catheter was placed into the abscess cavity by CT-guidance. Due to the serious damage to the vertebral column and permanent pain, the patient underwent minimally invasive internal spinal fixation and recovered successfully. CONCLUSION: A case of vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Antibiotic therapy, drainage, and minimally invasive internal spinal fixation were performed, which enabled a good outcome.

RESUMO OBJETIVO: Descrever o caso de uma paciente diabética que desenvolveu osteomielite vertebral e abcesso bilateral do psoas com formação de gás causada por klebsiella pneumoniae. MÉTODOS: Uma mulher de 64 anos de idade, com 4 anos de histórico de diabetes mellitus tipo 2, foi admitida no Serviço de Emergência. A paciente apresentava um quadro de dias de febre alta acompanhada de calafrios e um histórico de 5 horas de consciência. Ela recebeu tratamento empírico com antitérmico, após o qual a febre diminuiu. RESULTADOS: A febre retornou após um intervalo de três horas. Uma tomografia computadorizada do abdome revelou osteomielite vertebral e abcesso bilateral do músculo psoas com formação de gás. A cultura do sangue e o fluido purulento revelaram o crescimento de Klebsiella pneumoniae. A paciente recebeu antibióticos e terapia de drenagem bilateral após o cateter de drenagem ser posicionado na cavidade do abscesso com auxílio de TC. Devido a sérios danos à coluna vertebral e a dor permanente, a paciente foi submetida à fixação vertebral interna minimamente invasiva e recuperou-se com sucesso. CONCLUSÃO: Um caso de osteomielite vertebral e abscesso do psoas bilateral com a formação de gás causada por Klebsiella pneumoniae em uma paciente diabética. Antibioticoterapia, drenagem e fixação vertebral interna minimamente invasiva foram realizadas, o que permitiu um bom resultado.

Tropical pyomyositis: diabetes facilitating the onset of an uncommon disease / Piomiosite tropical: diabetes facilitando o aparecimento de uma doença incomum

INTRODUCTION: Tropical pyomyositis is an infectious disease that affects skeletal muscle and may appear as a diffuse inflammation or a rapidly progressive myonecrotic process. The predisposition of this disease in diabetics is already mentioned in several studies. The pathogenesis is possibly related to changes in neutrophils and the reversal of the immune response pattern that occurs in situations such as parasitic diseases. Staphylococcus aureus is the most common microorganism, accounting for 90% of cases of tropical pyomyositis. The diagnosis is sometimes late because patients usually do not seek care by the first symptoms, and because it is a rare disease and physicians are not very familiar with it. CASE REPORT: A 42-year-old male patient with diabetes mellitus, hypothyroidism, anemia, thrombocytopenia, and hypoalbuminemia developed tropical pyomyositis with multiple muscle abscesses in quadriceps, soleus and anterior tibial, triceps and biceps brachialis and pronator round, requiring prolonged antibiotic therapy and surgical drainage. CONCLUSION: Pyomyositis is a little known disease and if not diagnosed early can be fatal.

INTRODUÇÃO: A piomiosite tropical é uma doença infecciosa que afeta o músculo esquelético, aparecendo como uma inflamação difusa ou um processo mionecrótico rapidamente progressivo. A predisposição desta enfermidade em diabéticos já é referida em vários estudos. A patogênese possivelmente está relacionada a alterações nos neutrófilos e na inversão do padrão de resposta imune que acontece em situações como parasitoses. Staphylococcus aureus é o microorganismo mais comum, representando 90% dos casos de piomiosite tropical. O diagnóstico pode ser tardio porque os pacientes geralmente não buscam cuidados com os primeiros sintomas e, por ser uma doença rara, pode surpreender um médico ainda não familiarizado com esta entidade clínica. RELATO DE CASO: Paciente do sexo masculino com 42 anos de idade com diabetes mellitus, hipotireoidismo, anemia, trombocitopenia e hipoalbuminemia que desenvolveu piomiosite tropical com múltiplos abscessos musculares em quadríceps, sóleo e tibial anterior, tríceps e bíceps braquial e pronador redondo, necessitando de antibioticoterapia prolongada e drenagem cirúrgica. CONCLUSÃO: A piomiosite não é uma doença bem conhecida e pode ser fatal se não for diagnosticada precocemente.

Estudio clínico y micológico de otomicosis en diabéticos: una serie de 17 casos / Clinical and mycological study of otomycosis in diabetics: series of 17 cases

RESUMEN Introducción: La otomicosis en pacientes inmunosuprimidos esta caracterizada por ser bilateral y ser causada por candida. Pocos estudios comparan las características micológicas encontradas en la microscopía directa y el cultivo. Objetivo: Identificar las características clínicas y micológicas de la otomicosis en pacientes diabéticos. Material y método: Estudio transversal en centro hospitalario de segundo nivel. Criterios de inclusión: pacientes diabéticos con diagnóstico clínico de otomicosis. Intervención: la muestra se examinó directamente bajo el microscopio y se cultivó. Resultados: Se incluyeron 17 pacientes, 10 mujeres y 7 hombres con una edad media de 47,5 años. Los síntomas predominantes fueron hipoacusia en 91,4% (n =16), prurito en 82,4% (n =14), otorrea en 76,5% (n=13)y otalgia en 70,6% (n =12). Afección bilateral se encontró en 47,1% (n =8). Estudio directo al microscopio mostró levaduras en 94,1% (n =16) y 5,9% mostró aspergillus (n =1). Cándida fue el género más comúnmente encontrado en los cultivos y en el examen directo microscópico con 94,1% (n =16) y Candida albicans la especie más común con 88,2% (n =15). Conclusión: Candida albicans es el agente etiológico más común en pacientes diabéticos con otomicosis. Su presentación clínica más frecuente es hipoacusia, prurito y otorrea. El examen directo identificó adecuadamente a los géneros fúngicos.

ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.

Antibacterial activity of 3, 3', 4'-Trihydroxyflavone from Justicia wynaadensis against diabetic wound and urinary tract infection

ABSTRACT The present investigation was designed to study the effect of an active compound isolated from Justicia wynaadensis against multi drug resistant organisms (MDRO's) associated with diabetic patients. The drug resistant pathogens implicated in wound and urinary tract infection of diabetic patients were isolated and identified by molecular sequencing. Solvent-solvent fractionation of crude methanol extract produced hexane, chloroform, ethyl acetate and methanol-water fraction, among which chloroform fraction was found to be potent when compared with other three fractions. Further, chloroform fraction was subjected to preparatory HPLC (High-Performance Liquid Chromatography), that produced four sub-fractions; chloroform HPLC fraction 1 (CHF1) through CHF4. Among the sub-fractions, CHF1 inhibited the pathogens effectively in comparison to other three sub-fractions. The purity of CHF1 was found to be >95%. Therefore, CHF1 was further characterized by NMR and FTIR analysis and based on the structure elucidated, the compound was found to be 3,3',4'-Trihydroxyflavone. The effective dose of this bioactive compound ranged from 32 µg/mL to 1.2 mg/mL. Thus, the present study shows that 3,3',4'-Trihydroxyflavone isolated from J. wynaadensis is an interesting biopharmaceutical agent and could be considered as a source of antimicrobial agent for the treatment of various infections and used as a template molecule for future drug development.

Linfadenitis cervical por Salmonella no Typhi en una paciente diabética / Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient

Resumen La infección por Salmonella no Typhi es una de las enfermedades transmitidas por alimentos más común y ampliamente extendida en el mundo. Aunque la mayoría de los casos se limitan al tracto gastrointestinal, el compromiso extraintestinal no es infrecuente. Sin embargo, la adenitis como manifestación aislada, es una forma inusual de presentación de la enfermedad. Comunicamos el caso clínico de una mujer de 67 años de edad con diagnóstico de diabetes mellitus y una linfadenitis cervical por Salmonella no Typhi tratada con ciprofloxacina y y que requirió resección quirúrgica.

No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.

Perfil de sensibilidad antimicrobiana de microorganismos causantes de infecciones urinarias adquiridas en la comunidad en pacientes con diabetes mellitus en Colombia / Antimicrobial susceptibility profile in urinary pathogens causing community-acquired infections in diabetic patients in Colombia

Resumen Introducción. La infección de las vías urinarias es la más frecuente en pacientes diabéticos, y es un factor determinante de la morbilidad y la mortalidad en este grupo de pacientes. El aumento de la resistencia de los microorganismos adquiridos en la comunidad a los antibióticos comúnmente utilizados para combatirla es alarmante. Objetivo. Determinar el perfil de sensibilidad a los antibióticos de los microorganismos responsables de infecciones urinarias adquiridas en la comunidad en pacientes diabéticos atendidos en algunos hospitales de Colombia. Materiales y métodos. Se hizo un estudio descriptivo de un subgrupo de pacientes diabéticos en el marco de una investigación en adultos con infección de origen comunitario de las vías urinarias. Durante un año, se recolectaron aislamientos de Escherichia coli, Klebsiella spp. y Proteus mirabilis en nueve hospitales de Colombia y se determinó su perfil de sensibilidad mediante métodos microbiológicos y moleculares, para establecer la presencia de betalactamasas de espectro extendido del tipo AmpC y de carbapenemasas del tipo KPC. Resultados. Se recolectaron 68 aislamientos (58 de E. coli, nueve de Klebsiella spp. y uno de P. mirabilis). Cuatro (6,9 %) de los aislamientos de E. coli expresaron dichas betalactamasas, en dos (3,4 %) de ellos, pertenecientes al grupo filogenético B2 y al clon ST131, se detectaron las betalactamasas TEM-1 y CTM-X-15. En otros cuatro (6,9 %) aislamientos de E. coli se encontró el fenotipo AmpC, y en tres de ellos se produjeron las betalactamasas TEM-1 y CMY-2. Un aislamiento de K. pneumoniae expresó la carbapenemasa KPC-3. Conclusión. Se confirmó la presencia de cepas productoras de betalactamasas de espectro extendido y carbapenemasas en microorganismos responsables de infección urinaria adquirida en la comunidad en pacientes diabéticos.

Abstract Introduction: Urinary tract infection is the most common pathology in diabetic patients, and an important determinant of morbidity and mortality among them. The increasing resistance of uropathogens acquired in the community to commonly used antibiotics is alarming. Objective: To identify the profile of antibiotic susceptibility of uropathogens responsible for community-acquired infections among diabetic patients in hospitals in Colombia. Materials and methods: We conducted a descriptive study in a subgroup of diabetic patients in the framework of a larger study in adults with urinary tract infection acquired in the community. Over one year, we collected Escherichia coli, Klebsiella spp. and Proteus mirabilis isolates from nine hospitals in Colombia. Their susceptibility profile was determined using microbiological and molecular methods to establish the presence of extended-spectrum AmpC betalactamases and KPC carbapenemases. Results: We collected 68 isolates (58 E. coli, nineKlebsiella spp. and oneProteus mirabilis). Four (6.9%) of the E. coli isolates expressed extended spectrum betalactamases,two (3.4%) of thembelonged to the phylogenetic group B2 andto ST131 clone and expressed the TEM-1 and CTM-X-15 betalactamases. The AmpC phenotype was found in four(6.9%) of the E. coli isolates, three of which producedTEM-1 and CMY-2 betalactamases. One K. pneumoniaeisolate expressed the KPC-3 carbapenemase. Conclusion: The presence of extended spectrum betalactamases and carbapenemases in uropathogens responsible for community-acquired infection was confirmed in diabetic patients.

Prevalence of urinary tract infections among diabetes mellitus and non-diabetic patients attending a teaching hospital in Ajman, United Arab Emirtaes

To explore the prevalence and determinants of UTI among diabetic and non-diabetic patients attending the Gulf Medical College Hospital and Research Center, Ajman, UAE. Across sectional comparative study was conducted during February and March 2012. 400 adults [aged >20 years] attending the Internal Medicine Department outpatient in GMCHRC [200 diabetes mellitus patients and 200 non-diabetic patients] were included in the study. A validated pilot-tested questionnaire was used as a tool for data collection. A positive association was found between diabetes mellitus and the development of urinary tract infections. Contributing factors that showed a significant association were age >40 years, female gender, lower education level, employment status, poor diabetic control, and age at diagnosis of diabetes [>60 years]. Factors such as diagnosis at older age, poor diabetes control, and socio-demographic factors like age, gender, education, and occupation were significantly associated with UTI

Rhinocerebral zygomycosis in a diabetic patient / Zigomicose rinocerebral em paciente diabética

Rhinocerebral zygomycosis is the most frequent form of fungal infection caused by members of the Zygomycetes class. A fatal case of rhinocerebral zygomycosis caused by Rhizopus (oryzae) arrhizus with histopathological and mycological diagnosis is reported in a diabetic patient.

Zigomicose rinocerebral é a forma mais frequente das infecções fúngicas causadas por membros da classe Zygomicetes. É relatado um caso fatal de zigomicose rinocerebral por Rhizopus (oryzae) arrhizus com diagnóstico histopatológico e micológico, em paciente diabética.

Klebsiella pneumonia as a rare cause of parapharyngeal abscess

The incidence of parapharyngeal abscess has reduced dramatically, with the evolution of antibiotics. In a high risk patient for example diabetics, the condition do occur and the abscess is usually well formed and frank abscess will be drained. We report a case of diabetic lady who presented with left neck mass. Imaging showed collection of pus with trapped air under the fascia. Culture from drainage obtained revealed Klebsiella pneumonia, which is a rare organism in the region

Determinants of periodontopathogens in microbiological monitoring of diabetic patients with periodontitis

To determine and analyze the frequency of periodontopathogens in microbiological monitoring of diabetic patients with periodontitis. This cross-sectional study included 352 diabetic patients with periodontitis who were registered at Riyadh Armed Forces Hospital, King Faisal Specialist Hospital and Research Centre, King Abdul Aziz Medical City, Naval Base Hospital, and Sultan Bin Adulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia from July 2004 to August 2008. Microbiological analysis comprised the detection of Bacteroides forsythus [Bf], Aggregatibacter actinomycetemcomitans [Aa], Porphyromonas gingivalis [Pg], and Prevotella intermedia [Pi] by polymerase chain reaction method. The mean age of patients was 54.4 +/- 0.67 [range: 21-80 years]. There were 214 [61%] males and 138 [39%] females. Among the study population, 36 [10%] had type 1, and 316 [90%] patients had type 2 diabetes. The results showed that 55.6% of patients had Bf, 51.7% had Az, 63.7% had Pg, and 6.1% had Pi. The frequencies of periodontopathogens were higher in males than females in all age groups. The risk of periodontopathogens Bf were found higher level in 41-50 age group, Aa in 51-60, Pg in 51-60, and Pi in 31-40 age groups. This study found that the frequencies of periodontal pathogens Bf, Aa, and Pg were higher than Pi in diabetic patients with periodontitis

Cutaneous, pulmonary and sinusal aspergillosis in a diabetic patient

Cutaneous aspergillosis is rarely reported in diabetic patients. The objective of our study is to report a case of lethal disseminated aspergillosis revealed by multiples skin necroses with pulmonary and sinusal involvement in a diabetic patient. A 60-year-old diabetic woman. presented wins one month-rapidly-extensive, 1 to 10 cm skin necroses of the trunk limbs and eyelids. Few days after her admission. she developed dyspnoea. Chest X-ray showed an interstitial and alveolar syndrome with multiple excavated anfractuous-edged-opacities. Facial CT scan showed a right orbital cellulitis with Pansinusitis. The methamine-silver stains on a cutaneous biopsy showed filamentous septate fungal hyphae with branches at right angles. The immunofluorescence with an anti-aspergillus serum was positive. The diagnosis of secondary disseminated aspergillosis to a pulmonary focus with cutaneous, sinusal, and upper airway's dissemination was made. The patient died despite an intravenous amphotericin B therapy. This report emphasizes the importance of evoking and seeking for a mycosis in every skin necrotic and ulcerative lesions occurring in an immunocompromised patient. The prognosis den on the diagnosis and treatment institution delay

Necrotizing fasciitis and its association with Diabetes Mellitus

To analyze the different presentation, types of infection, predisposing factors [particularly diabetes mellitus] of necrotizing fasciitis; a rare potentially fatal rapidly progressing necrotizing infection of subcutaneous tissue and superficial fascia with secondary necrosis of overlying skin, the medical records were reviewed retrospectively of 94 patients [71 male; 23 female,] admitted to the surgical intensive care unit of Hamad General Hospital, Qatar, between January 1995 and February 2005. Fifty-three patients [56.4%] were diabetic with a mean age of 55 years compared with 40.2 years in non-diabetic patients. Type 1 necrotizing fasciitis, especially of the perineal and genital regions, was more common in diabetic patients whereas type 2 necrotizing fasciitis, especially of torso and upper limbs, was more common in non-diabetic patients. Overall 63.4% of cases were type 2 necrotizing fasciitis. E.coli was the most common bacterium isolated from necrotic tissue of diabetic patients and streptococci were the most common cause of necrotizing fasciitis in non-diabetic patients. Fifteen [16%] patients died but there was no significant difference in mortality between the groups, eight [15.1%] diabetic, seven [17.1%] non-diabetic, although diabetic patients were significantly older

Incidence of metallo-beta-lactamase-producing Pseudomonas aeruginosa in diabetes and cancer patients.

Metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa strains have been reported to be an important cause of nosocomial infections. There is not enough information from India regarding their prevalence in diabetic and cancer patients. The present study was undertaken over a period of one year from January to December 2006 to study the incidence of MBL P. aeruginosa and the clinical outcome in diabetes and cancer patients admitted to S.L. Raheja Hospital, Mumbai. Two hundred and thirty isolates of P. aeruginosa were obtained from different samples of patients. These isolates were subjected to susceptibility testing to anti-pseudomonal drugs as per CLSI guidelines. They were further screened for the production of MBL by disc potentiation testing using EDTA-impregnated imipenem and meropenem discs. Of the 230 isolates of P. aeruginosa, 60 (26%) isolates were found resistant to carbapenems (both imipenem and meropenem) and 33 (14.3%) were found to be MBL producers. Of the 33 MBL-producing isolates, 24 (72.7%) were diabetic patients, six (18.1%) were cancer patients and three (9%) patients had both diabetes and cancer. Five (15.1%) patients responded to the combination therapy of colistin, piperacillin with tazobactam and amikacin, while 28 (84.8%) patients responded to the combination therapy of amikacin, piperacillin with tazobactam and gatifloxacin. Thus, the rapid dissemination of MBL producers is worrisome and necessitates the implementation of not just surveillance studies but also proper and judicious selection of antibiotics, especially carbapenems.

Infección profunda del cuello por Streptococcus grupo B en un paciente diabético: Caso clínico / Retropharyngeal phlegmon caused by a group B Streptococcus in a diabetic patient: Report of one case

We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam.

Nocardia brain abscess in a diabetic patient.

Brain abscess due to disseminated nocardia infection is an acute medical emergency among immunocompromised patients. We report a case of rapidly progressive nocardia brain abscess in an apparently healthy diabetic individual. The close similarity of the radiological features with those of malignancy and tuberculosis may delay the diagnosis of central nervous system (CNS) nocardiosis. A high index of suspicion and early intervention like stereotactic brain biopsy remain the cornerstone to increase the chance of positive clinical outcome.

Freqüência e atividade enzimática de Candida spp. na cavidade oral de pacientes diabéticos do serviço de endocrinologia de um hospital de Fortaleza-CE / Frequency and enzymatic activity of Candida spp. oral cavity of diabetic patients of the service of endocrinology of a hospital of Fortaleza-CE

O diabetes mellitus (DM), uma doença endócrino-metabólica de alta e crescente prevalência, é citada como responsável pela ocorrência das candidíases orais. A candidíase constitui um espectro de infecções causadas por fungos do gênero Candida, sendo o seu agente mais comum a Candida albicans, embora outras espécies tenham sido identificadas (Candida tropicalis, Candida guillermondii, Candida glabrata, Candida krusei). O objetivo deste trabalho foi avaliar a freqüência e a atividade enzimática de Candida spp. na cavidade oral de pacientes diabéticos atendidos no Serviço de Endocrinologia do Hospital Universitário Walter Cantídio da Universidade Federal do Ceará (HUWC/UFC). Foram coletadas amostras de 48 pacientes diabéticos, de ambos os sexos, com situações variáveis de controle glicêmico. Os materiais clínicos foram colhidos com ajuda de swabs e semeados em placas de Petri contendo ágar-Sabouraud dextrose com cloranfenicol e incubado a 37ºC. Os crescimentos foram identificados pelas provas clássicas usadas em micologia. Depois, essas cepas de Candida foram submetidas a provas de detecção de enzimas fosfolipase e proteinase. Destas, 15 amostras (31,25 por cento) apresentaram cultura positiva para o gênero Candida. A espécie mais freqüente foi a C. albicans, com 80 por cento, seguida de C. tropicalis (13,3 por cento) e C. guillermondii (6,7 por cento). Quanto à pesquisa da atividade enzimática de Candida spp., foi observado que 86,6 por cento delas apresentaram atividade de proteinase e 80 por cento, de fosfolipase. Conclui-se com tais resultados que a C. albicans é a mais freqüente e que as espécies de Candida isoladas possuem fortes atividades enzimáticas.

Diabetes mellitus, a endocrine-metabolic disease, of high and increasing prevalence, is cited as responsible by the occurrence of oral candidiasis. Candidiasis constitutes a specter of infections caused by fungi of genera Candida; the most common agent is Candida albicans, but other species have also been identified (Candida tropicalis, Candida guillermondii, Candida glabrata, Candida krusei). The objective of this work was to evaluate frequency and enzymatic activity of Candida spp. in the oral cavity of diabetic patients taken care in the service of endocrinology of the University Hospital Walter Cantídio of the Federal University of the Ceará. Samples had been collected of 48 diabetic patients, men and women, with various situations of glicemic control. Clinical materials had been collected with aid of swab and harvested in plates of Petri contend Sabouraud agar dextrose with cloranfenicol and incubated to 37ºC. The grown were identified by the used classic tests in mycology. In the following, these Candida strains were submitted to tests to detect phospholipase and proteinase enzymes. Of these, 15 samples (31,35 percent) presented positive culture for the genera Candida. The species more frequent was C. albicans with 80 percent, followed by C. tropicalis (13.3 percent) and C. guilliermondii (6.7 percent). Asfor the research on the enzymatic activity of Candida sp. it was observed that 86.6 percent presented activity of proteinase and 80 percent of phospholipase. It was concluded with these results that C. albicans is more frequent and that Candida spp. isolated species have strong enzymatic activity.

Mucormycosis presenting as palatal perforation.

Mucormycosis is an opportunistic fungal infection that is caused by normally saprobic organism of the class Zygomycetes. The main form of mucormycosis are pulmonary and rhinocerebral. Rhinocerebral mycormycosis typically starts in the maxillary antrum, particularly in poorly controlled diabetics. Invasion of surrounding tissue can cause necrotizing ulceration of palate with a blackish slough and exposure of bone. A case of mucormycosis presenting as palatal performation is discussed in this article.