Trichosporon isolation from human ungueal infections: is there a pathogenic role?

Abstract BACKGROUND: Although dermatophytes are considered the major cause of onychomycosis, many reports have incriminated non-dermatophyte moulds and yeasts in the disease’s etiology. Successive Trichosporon isolation from onychomycosis has led to the genus being suspected as a nail primary pathogen. OBJECTIVE: To determine the prevalence of Trichosporon isolation in onychomycosis patients who attended a mycology diagnostic service in Rio de Janeiro, Brazil, between January 2003 and December 2006. The study also includes a worldwide review on Trichosporon isolation prevalence in ungueal disease, emphasizing T. ovoides. METHODS: This retrospective study was conducted with the support of staff from the Mycology Laboratory at the Dermatological Service of Rio de Janeiro’s Santa Casa da Misericórdia (MLDS). RESULTS: Mycological analysis provided positive results equaling 47/5036 (0.93%) for Trichosporon spp.; obtained mainly as a single agent (72.35%), and from mixed cultures (27.65%; X2= 6.397; p= 0.018). The great majority belongs to the T. ovoides species (91.5%; n=43), obtained as a single isolate (74.41%; n= 32/43; X2 = 7.023; p= 0.014). CONCLUSIONS: Although T. ovoides is classically associated as an etiologic agent of white piedra, this study highlights its potential as a human nail disease pathogen. Our study opens doors for future epidemiologic and virulence factors aimed at determining whether T. ovoides is an important causative agent of onychomycosis in Brazil.

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.

An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycosis in dermatology offices in Brazil / Estudo obervacional descritivo da epidemiologia e abordagem terapêutica da onicomicose nos consultórios dermatológicos no Brasil

Onychomycosis is a type of fungal infection that accounts for over 50% of all onycopathies. Some authors consider superficial mycosis the most difficult to be treated. Very few studies have been carried out in order to assess the epidemiology of onychomycosis in Brazil. To describe the epidemiological profile of onychomycosis in Brazilian dermatology offices and to assess the etiology of the disease, how often mycosis exams are requested, and the treatment adopted. A descriptive, observational study was carried out between May and July, 2010. Thirty-eight dermatologists from different Brazilian regions participated in the study, and 7,852 patients with any skin diseases who had all of their nails examined were included in the study. Of the 7,852 patients, 28.3% were clinically diagnosed as having onychomycosis. Women over 45 years old who practiced exercises or with a personal history of the disease showed greater likelihood of having onychomycosis. The disease was most seen in the feet, and the majority of cases involved the hallux. On the hands, the index finger was the most affected. Mycosis exams were not requested for all clinically suspected cases. When exams were done, results showed that the most common fungus was Trichophyton rubrum. The most common clinical lesion was distal-lateral. The most prescribed topical treatments were amorolfine and ciclopirox olamine, while systemic treatments included fluconazole and terbinafine. This study was important to describe the epidemiological behavior of onychomycosis in Brazilian ...

Fundamentos: As onicomicoses são infecções fúngicas que representam mais de 50% de todas onicopatias e são consideradas por alguns autores a micose superficial de mais difícil tratamento. Poucos estudos foram feitos para investigar a epidemiologia da onicomicose no Brasil. Descrever perfil epidemiológico da onicomicose nos consultórios brasileiros de dermatologia. Também observar a etiologia, a freqüência da solicitação do exame micológico e a terapia empregada. Foi realizado um estudo descritivo e observacional no período de Maio a Julho de 2010. Participaram 38 dermatologistas de diferentes regiões do Brasil e foram incluídos 7852 pacientes. Dos 7852 pacientes, 28.3% apresentaram diagnóstico de onicomicose. Mulheres, maiores de 45 anos, praticantes de esportes, ou com histórico pessoal da doença, apresentaram chance maior de adquirir onicomicose. A doença foi mais frequente nos pés, sendo o hálux, o dedo mais acometido. Nas mãos, o primeiro dedo foi o mais atingido. Exame micológico não foi solicitado para todos os casos. Quando realizado, o fungo mais freqüente foi o Trichophyton rubrum. A lesão clinica mais comum foi a distal-lateral. Os tratamentos tópicos mais prescritos foram amorolfina e ciclopirox olamina, enquanto os sistêmicos foram o fluconazol e a terbinafina. Este estudo foi de fundamental importância para descrever o comportamento epidemiológico ...

Onicomicose por Scytalidium spp.: estudo clínico-epidemiológico em um hospital universitário do Rio de Janeiro, Brasil / Onycomychosis due to Scytalidium spp.: a clinical and epidemiologic study at a University Hospital in Rio de Janeiro, Brazil

FUNDAMENTOS: O Scytalidium spp. é fungo filamentoso, saprobio do solo e plantas, considerado, atualmente, patógeno primário das unhas. A prevalência das infecções ungueais causadas por este fungo vem aumentando nas últimas décadas, embora ainda sejam poucos os trabalhos publicados sobre sua epidemiologia. OBJETIVO: Estudo clínico-epidemiológico dos pacientes portadores de onicomicose por Scytalidium spp. em um hospital universitário do Rio de Janeiro. MÉTODOS: Foram avaliados os dados clínico-epidemiológicos de 30 pacientes com onicomicose por Scytalidium spp. por meio do estudo observacional de 1.295 pacientes que se submeteram a exame micológico ungueal no período de 16 meses. RESULTADOS: A maioria dos pacientes era do sexo feminino (66,6 por cento), a média de idade foi de 56,7 anos e 63,3 por cento eram não-brancos. O nível de escolaridade em 53,3 por cento dos pacientes era o ensino fundamental e a renda familiar predominante foi de 3 a 5 salários mínimos em 36,6 por cento dos entrevistados. Em 90 por cento dos casos, as unhas dos pododáctilos foram acometidas, sendo a alteração clínica mais comum a onicólise (18 pacientes) e em 66,6 por cento dos casos observou-se melanoníquia. O tempo de evolução da doença foi maior do que cinco anos em 43,3 por cento dos casos. Dezenove pacientes (63,3 por cento) já haviam realizado tratamento medicamentoso para o quadro atual. CONCLUSÕES: Os dados mostram que a infecção ungueal pelo Scytalidium spp. é crônica, mais comum no sexo feminino (2:1) e atinge indivíduos adultos. Clinicamente, é semelhante às dermatofitoses. A prevalência na amostra estudada foi de 4,86 por cento e correspondeu a 26,92 por cento dos exames positivos.

BACKGROUND: Scytalidium sp. is a filamentous (thread-like), saprobic fungus which affects soil and plants. It is currently considered a primary pathogen of the nail. The prevalence of nail infections caused by this fungus has been increasing in recent decades, although few published studies have been done on its epidemiology. OBJECTIVE: To study clinico-epidemiological data referring to patients with onychomycosis caused by Scytalidium spp. at a University Hospital in Rio de Janeiro. METHODS: We evaluated the clinical and epidemiological data of 30 patients with onychomycosis by Scytalidium sp. through an observational study of 1295 patients who underwent mycological nail tests over a period of 16 months. RESULTS: The majority of the patients were female (66.6 percent), with an average age of 56.7 years. 63.3 percent of them were nonwhite. 53.3 percent of the patients had attended elementary school and 36.6 percent referred a family income of 3 to 5 minimum wages. In 90 percent of cases, the toenails were affected, primarily with onycholysis (18 patients), and in 66 percent of the cases melanonychia was observed. In 43.3 percent of cases the disease had progressed for more than 5 years. 19 patients (63.3 percent) had undergone some medical treatment for their current condition. CONCLUSIONS: Our data show that nail infection by Scytalidium sp. is chronic, affecting adults, particularly females (2:1). Clinically the disease resembles dermatophytosis. Prevalence of the disease in our sample was 4.86 percent, accounting for 26.92 percent of the positive tests.

Avaliação clínica e micológica de onicomicose em pacientes brasileiros com HIV/AIDS / Clinical and mycological evaluation of onychomycosis among Brazilian HIV/AIDS patients

INTRODUÇÃO: Onicomicoses são comuns em pacientes imunocomprometidos embora espécies emergentes tenham sido verificadas, modificado o perfil epidemiológico desta micose. Assim, o objetivo desta pesquisa é avaliar o perfil clínico e micológico da onicomicose em pacientes com infecção pelo HIV/AIDS. MÉTODOS: Amostras clínicas foram coletadas, processados para exame direto e a cultura mantida a temperatura de 30°C e 37ºC durante 15 dias. RESULTADOS: Dos 100 pacientes, 32 apresentavam onicomicose. Os agentes isolados foram Candida albicans, C. parapsilosis, C. tropicalis, C. guilliermondii, Trichophyton rubrum, T. mentagrophytes, Fusarium solani, Scytalidium hialinum, S. japonicum, Aspergillus niger, Cylindrocarpon destructans e Phialophora reptans. CONCLUSÕES: Onicomicoses em HIV/AIDS apresentam variadas manifestações clínicas e podem ser causadas por fungos emergentes. As peculiaridades apresentadas pelos diferentes agentes de origem fúngica justificam a necessidade de identificação ao nível da espécie, com a finalidade de orientar uma melhor abordagem terapêutica e minimizar a exposição desses pacientes a condições de risco de uma infecção disseminada.

INTRODUCTION: Onychomycosis is common in immunocompromised patients, but emerging species have been verified, thereby modifying the epidemiological profile of this mycosis. Thus, the aim of this study was to evaluate clinical and mycological profile of onychomycosis among HIV/AIDS patients. METHODS: Clinical samples were collected and processed for direct examination, and cultures were maintained at a temperature of 30°C and 37°C for 15 days. RESULTS: Out of 100 patients, 32 had onychomycosis. The etiological agents isolated were Candida albicans, C. parapsilosis, C. tropicalis, C. guilliermondii, Trichophyton rubrum, T. mentagrophytes, Fusarium solani, Scytalidium hialinum, S. japonicum, Aspergillus niger, Cylindrocarpon destructans and Phialophora reptans. CONCLUSIONS: Onychomycosis in HIV/AIDS patients presents various clinical manifestations and may be caused by emerging fungi. The peculiarities presented by different fungal agents justify the need for identification to species level, with the purpose of guiding better therapeutic approaches and minimizing these patients' exposure to conditions presenting a risk of disseminated infection.

Aspectos epidemiológicos de pacientes com lesões ungueais e cutâneas causadas por Scytalidium spp / Epidemiological aspects of patients with ungual and cutaneous lesions caused by Scytalidium spp

FUNDAMENTO: As dermatomicoses causadas por fungos filamentosos não dermatófitos são infecções raras, exceto as onicomicoses, cuja prevalência vem crescendo nos últimos anos. Dentre esses agentes etiológicos destacam-se o Scytalidium dimidiatum e o S. hyalinum, fungos emergentes responsáveis por micoses em unhas e pele. OBJETIVO: Investigar as características epidemiológicas das onicomicoses e micoses de outras localizações causadas pelos fungos do gênero Scytalidium, utilizando-se como parâmetros sexo, idade e localizações das lesões. MÉTODOS: Avaliaram-se 81 amostras com cultura positiva para o gênero em estudo, oriundas de 74 pacientes encaminhados ao Laboratório de Investigação em Dermatologia (ID) situado na cidade do Rio de Janeiro (RJ), no período de 1997 a 2006. As amostras foram submetidas a confirmação diagnóstica por exame direto e cultura. RESULTADOS: A prevalência de onicomicoses por Scytalidium spp. foi de 0,87 por cento, entre as idades de 41 e 60 anos (48,64 por cento). Em relação à localização das lesões, os pés foram mais acometidos (91,36 por cento), com predomínio do hálux esquerdo. No exame direto, as estruturas mais encontradas foram hifas hialinas; na cultura, a espécie S. dimidiatum foi a mais frequente. CONCLUSÃO: As onicomicoses por Scytalidium spp. são raras e o S. dimidiatum foi a espécie mais isolada neste laboratório no período em estudo.

BACKGROUND: Dermatomycoses caused by non-dermatophyte filamentous fungi are rare infections, except for onychomycosis, whose prevalence has increased over the past few years. Among these etiologic agents, we highlight Scytalidium dimidiatum and S. hyalinum, emergent fungi that cause mycoses that affect the nails and skin. OBJECTIVE: To investigate the characteristics of onychomycosis and other mycoses caused by the fungi Scytalidium spp, using sex, age and site of infection as parameters. METHODS: Eighty-one samples were evaluated showing positive culture for Scytalidium spp, obtained from 74 patients referred to the Laboratory of Investigation in Dermatology (ID) located in the city of Rio de Janeiro, RJ, between 1997 and 2006. The samples were submitted to diagnostic confirmation through direct exam and culture. RESULTS: The prevalence of onychomycosis caused by Scytalidium spp. was of 0,87 percent. The most prevalent age was between 41-60 years (48.64 percent). Regarding the site of infection, the feet (91.36 percent) were most affected, with predominance of the left hallux. Hyaline hyphae were the most common structures in direct examination and the species S. dimidiatum was the most frequent in culture. CONCLUSION: Onychomycosis caused by Scytalidium spp. is rare and S. dimidiatum was the most isolated species in this laboratory during the period of the study.

Como o clipping pode auxiliar o dermatologista / How the Nail clipping helps the dermatologist

Alterações ungueais são queixas muito frequentes nos consultórios dermatológicos. Onicomicoses representam cerca de 50% das onicopatias, daí a importância de se estabelecer o diagnóstico correto antes de se iniciar o tratamento. Neste artigo, relataremos a utilidade de um exame que é de fácil execução pelo clínico, de baixo custo e sensível: esse exame consiste na análise histopatológica da queratina ungueal distal, atualmente já consagrado com o termo clipping.

Onycodystrophies are common problems in dermatologic practice. About 50% of dystrophic nails have a fungal cause, so it is very important to establish a correct diagnosis before treatment. In this article we relate the usefulness of an easydoing exam, free from pain, cheap and sensible. This exam is the histopathology of the nail keratin or nail clipping.

Histoplasmose cutânea primária: relato de caso em paciente imunocompetente e revisão de literatura / Primary cutaneous histoplasmosis: case report on an immunocompetent patient and review of the literature

É relatado um caso de histoplasmose cutânea primária em um homem de 45 anos, com apresentação de um nódulo eritematoso no dorso da mão direita acompanhado de linfadenomegalia regional indolor, que se desenvolveu após trauma local ocorrido durante treinamento militar em túnel habitado por morcegos. O exame histológico de biópsia da lesão cutânea mostrou um infiltrado granulomatoso, porém não evidenciou elementos fúngicos. O cultivo deste material incubado em Ágar Sabouraud mostrou crescimento de Histoplasma capsulatum. Não foi encontrada evidência de envolvimento sistêmico ou imunossupressão. O tratamento com 400mg diários de itraconazol oral durante 6 meses resultou na remissão completa da lesão, mantida um ano após o término do tratamento.

This report describes a case of primary cutaneous histoplasmosis in a 45-year-old male. The presentation consisted of an erythematous nodule on the back of the right hand, accompanied by nontender regional lymphadenomegaly that developed following local trauma that occurred during military training in a tunnel inhabited by bats. Histological examination of a biopsy specimen from the skin lesion showed granulomatous infiltrate, but did not show fungal elements. Culturing of this material, incubated in Sabouraud agar, showed growth of Histoplasma capsulatum. No evidence of systemic involvement or immunosuppression was found. Treatment with 400 mg/day of itraconazole orally for six months resulted in complete remission of the lesion, which was maintained one year after the end of the treatment.

Successive mycological nail tests for onychomycosis: a strategy to improve diagnosis efficiency

Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts and moulds, accounting for about 50 percent of onychopathies. A high frequency of onychomycosis caused by Candida species has been reported during the last few years in northeast Brazil, as well as in other regions of the world. A clinical diagnosis of onychomycosis needs to be confirmed through laboratory exams. We evaluated the importance of serial repetition of direct microscopic exams and fungal culture for the diagnosis of onychomycosis in the city of Fortaleza, Ceará, in northeast Brazil. We first made a retrospective study of 127 patients with onychomycosis, identifying the fungi that had been isolated from fingernails and toenails. We then made a prospective study of 120 patients, who were submitted to three successive mycological examinations. Ungual residues were scraped off and directly examined with a microscope and fungal cultures were made. In the retrospective study, in which only one sample was analyzed, the incidence of onychomycosis was 25.0 percent. In our prospective study, in which we had data from successive mycological examinations, 37.8 percent had onychomycosis. The most commonly isolated fungi in both studies were yeasts from the genera Candida, especially C albicans, C. parapsilosis and C. tropicalis. We found a high proportion of onychomycosis caused by Candida species. We also concluded that serial repetition of direct microscopic examination and fungal culture, with intervals of 2-5 days improved the diagnosis of onychomycosis. We suggest that this laboratorial strategy is necessary for accurate diagnosis of this type of mycosis, especially when the standard procedures fail to diagnose fungal infection, despite strong clinical suspicion.

Tinea nigra palmaris: presentación de un caso clínico en la República Argentina

Se presenta el caso clínico de una paciente que consultó por una mancha oscura en la palma izquierda. El examen micológico permitió determinar que la infección había sido producida por un hongo pigmentado, Hortaea werneckii, agente etiológico de la tinea nigra palmaris. Esta es una infección benigna que puede ser rápidamente diagnosticada y tiene tratamiento eficaz. La paciente fue tratada con econazol durante un mes, con remisión completa de las lesiones. Frente a la sospecha de una infección fúngica por la presencia de manchas de color pardo es muy importante practicar el estudio micológico, ya que mediante una técnica no invasora es posible establecer un diagnóstico diferencial y descartar fácilmente otras patologías más graves con las que puede confundirse en el examen clínico.

A clinical case of a female patient with a black spot on the palm of her left hand is presented. The infection was due to a black fungus identified as Hortaea werneckii, the aetiological agent of tinea nigra palmaris. This infection can be easily diagnosed and it is important to establish the differential diagnosis from other skin pathologies. Normally, the treatment has a successful outcome. In this case, the patient was treated with econazole locally applied during one month, with complete remission of the lesions. In conclusion, the early diagnosis of this disease is very important since the mycology procedures are fast and non-invasive and cure is obtained with local treatment.

Subcutaneous phaeohyphomycosis caused by Cladophialophora sp: a case report

A case of subcutaneous phaeohyphomycosis caused by Cladophialophora sp. is reported. The patient, an immunosuppressed host presented a nodule on the dorsum of the right hand which relapsed four months after excision. Dematiaceous septate hyphal and yeast like elements were seen in mycological and histological examination. The isolated fungus was identified on the basis of micro-macromorphological and physiologic characteristics.

É descrito caso de feohifomicose subcutânea causada por Cladophialophora sp. O paciente, imunossuprimido, apresentou nódulo no dorso da mão direita que recidivou quatro meses após excisão. Os exames micológico e histopatológico evidenciaram hifas septadas demácias e células leveduriformes. O fungo foi identificado com base no estudo micro-macromorfológico e fisiológico.

Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit linked to onychomycosis in a healthcare worker

OBJETIVO: Descrever surto por Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido em berçário de risco intermediário. MÉTODOS: Após identificação dos primeiros casos, a situação foi conduzida como surto, sendo intensificadas as medidas básicas de prevenção de infecções hospitalares e investigadas possíveis fontes de disseminação da bactéria. RESULTADOS: O surto durou 6 meses e atingiu 36 recém-nascidos, causando sete infecções e 29 colonizações. Na primeira fase do surto, os portadores evoluíram com infecção, porém, na segunda fase, os portadores eram assintomáticos e só foram identificados por culturas de vigilância. O surto foi resolvido após identificação e tratamento de profissional de saúde que apresentava onicomicose e era portadora de Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido nas mãos. CONCLUSÃO: Detecção e controle da disseminação oculta da bactéria multirresistente entre os recém-nascidos de menor risco evitou sua instalação endêmica no berçário, bem como a conseqüente exposição dos pacientes mais graves e suscetíveis à infecção.

OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS: After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS: The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSION: The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection.

Itraconazole pulse therapy in the treatment of disto-lateral subungual onychomycosis

To assess the efficacy of itraconazole pulse therapy in disto-lateral subungual onychomycosis. Design: Quasi interventional study. Place and Duration of Study: The study was conducted at the Department of Dermatology, KEMC/Mayo Hospital, Lahore, during the period from 1996-1998. Subjects and Sixty-seven patients, ages ranging from 19 to 55 years, with disto-lateral subungual onychomycosis were enrolled in the study period. Therapy was started with short pulse doses of itraconazole 200 mg twice daily for one week followed by a medicine-free interval of three weeks. Pulses were administered for two consecutive months in fingernail and three months for toenail onychomycosis. Patients were followed upto six months for fingernail onychomycosis and nine months for toenail onychomycosis. Out of 67 cases, there were 62 evaluable patients. Trichophyton rubrum was the most common pathogen, isolated in 42 [67.8%] followed by Candida in 11 [17.8%], T. violaceum in 5 [8%], T. interdigitale in 3 [4.8%] and Epidermophyton floccosum in one [1.6%]. Fingernails were affected in 46 cases whereas 16 had toenail infection. Clinical cure in finger and toenail onychomycosis was seen in 41 [89%] and 13 [81.2%] patients, respectively while mycological cure in 43 [93.5%] and 14 [87.5%] patients, respectively with itraconazole pulse therapy. Itraconazole was found to be effective, well-tolerated and safe therapy for disto-lateral subungual onychomycosis

Onychomycosis caused by Scytalidium dimidiatum. Report of two cases. Review of the taxonomy of the synanamorph and anamorph forms of this coelomycete

The authors report two cases of onychomycosis in the dystrophic form, one of them involving an HIV-positive patient, provoked by Scytalidium dimidiatum, previously called Scytalidium lignicola. The subject is reviewed from the taxonomic viewpoint, considering the anamorph Hendersonula toruloidea as a synonym of Nattrassia mangiferae, and having Scytalidium dimidiatum as the major synanamorph. According to many mycologists, Scytalidium hyalinum may be a separate species or a hyaline mutant of Scytalidium dimidiatum. Scytalidium lignicola Pesante 1957 was considered to be the type-species of the genus by ELLIS (1971)13 and later to be a "conidial state" of Hendersonula toruloidea by the same author, today known as Nattrassia mangiferae. The microorganism lives only on the roots of certain plants (mainly Platanus and Pinus). It produces pycnidia and is not considered to be a pathogen, although it is considered as a possible emerging agent capable of provoking opportunistic fungal lesions. The importance of this topic as one of the most outstanding in fungal taxonomy, so likely to be modified over time, as well as its interest in the field of dermatologic mycology, are emphasized

Subcutaneous and osteolytic rhinosporidiosis.

A young man presented with multiple Subcutaneous nodules over scalp, hand, feet and osteolytic lesions of small bones of hand. Clinically and radiologically he was diagnosed as a case of Giant Cell Tumour. Aspiration cytology and biopsy proved it to be rhinosporidiosis. Epidemiological study revealed that he perhaps contracted this infection as an occupational hazard. This is the third reported case of osteolytic lesions due to rhinosporidiosis. Diagnostic dilemmas of subcutaneous and osteolytic rhinosporidiosis are discussed.

Feo-hifomicose subcutânea no estado do Pará: relato de três casos / Subcutaneous phaeohyphomycosis in the state of Pará: report of 3 cases

Sao descritos três casos de feo-hifomicose subcutânea, os primeiros encontrados no Estado do Pará, todos oriundos de localidades situadas a leste de Belém, nas microrregioes do Salgado e Bragantina. O diagnóstico teve por base o reconhecimento dos parasitos em cortes histológicos, sem identificaçao de espécie, uma vez que todo o material disponível para exame - compreendendo as lesoes completamente excisadas -, ao ser recebido, já estava fixado em formol e imprestável, portanto, para qualquer tentativa de estudo micológico. A abundância de elementos fúngicos verificada nos tecidos, após impregnaçao pela prata (métodos de Grocott e de Fontana-Masson), contrastava com a dificuldade para visualizá-los em cortes nao-corados ou corados por hematoxilina-eosina, fato devido certamente ao aspecto das hifas neles existentes: delgadas, de paredes finas e cor quase imperceptível.

Estudio clínico micológico de onicomicosis en ancianos / Clinico-mycological study of onychomycosis in elderly patients

Physical examination of nails was carried out in 210 elderly patients and nail scrapings were obtained from onychomycosis suggested lesions in order to determine their causative agents, incidence and clinical characteristics. Diagnostic was confirmed by the isolation of the agents from 74 patients, mainly from toe-nails (incidence 35.2). Tinea pedis occurred in 25 of the cases and Diabetes mellitus was the most prevalent associated disease and the most frequent clinical characteristics were the thickening, the opacity and the presence of longitudinal strias in the surface of the nails. It was compared the results obtained by microscopic examination and by culture. Trichophyton rubrum was the most common dermatophyte isolated; Candida parapsilosis was dominant among Candida species.

Localizaçäo das lesöes únicas em pacientes hansenianos / Localization of simple lesions in leprosy

Neste trabalho, os autores estudam a localizaçäo de lesöes únicas de hanseníase, em 317 pacientes paucibacilares, registrados no ambulatório do CMS Jorge Saldanha e no Hospital Estadual de Curupaiti, ambos localizados em Jacarepaguá, Rio de Janeiro. A localizaçäo preferencial das lesöes, sua relaçäo com sexo e idade e os possíveis fatores de interferência nesta distribuiçäo na populaçäo estudada säo discutidos. Estes achados säo comparados com os resultados obtidos em pesquisas similares, realizadas por outros autores no contimente asiático e africano