Derrame pleural por micosis endémica en un paciente de 8 años: reporte de un caso / Pleural effusion due to endemic mycosis in an 8-year-old patient: a case report

Coccidioides is a fungus that is frequently found in dry places of sparse storms, with warm temperatures during most of the year. Two species are known to infect the human being: C. immitis and C. posadasii.It is endemic in northern Mexico, southern United States, as well as in some regions of Central America and South America. It is a highly contagious organism, but mostly it generates self-limited and asymptomatic diseases. Only 10 percent of cases with pulmonary symptoms are severe and may manifest as lobar pneumonia. Some cases of multiple foci and pleural effusion are diagnosed through biopsy with molecular methods. The treatment in many cases includes the use of azole antifungals for 3-6 months and follow-up with antibody titres

El Coccidioides es un hongo que se encuentra de manera frecuente en lugares secos, con temperaturas cálidas durante la mayoría del año. Son dos especies las que se conoce que infectan al ser humano la C. Immitis y C. Posadasii. Es endémico del norte de México, sur de Estados Unidos, así como algunas pequeñas regiones de centro y Sudamérica. Es un organismo altamente contagioso, pero en su mayoría genera enfermedades autolimitadas y de tipo asintomático, los pacientes con manifestaciones pulmonares solamenteen 10 por ciento son de presentación grave. Esta puede ser como una neumonía lobar, pero en algunos casos de focos múltiples y con derrame pleural, el diagnóstico es mediante biopsia en a fechas recientes con métodos moleculares. Los tratamientos en muchos casos requieren únicamente vigilancia. De requerir tratamiento se usa antimicótico 3-6 meses con azoles y seguimientos con títulos de anticuerpos

Manual de diagnóstico de las micosis sistemáticas / Manual of diagnosis of systematic fungal diseases

manual es brindar un material de apoyo para el diagnóstico micológico a los laboratorios del Ministerio de Salud Pública y Bienestar Social y servir de material complementario para los cursos de capacitación realizados por la sección Micología del Departamento de Bacteriología y Micología del Laboratorio Central de Salud Pública, y de esta manera fortalecer la capacidad diagnóstica de las micosis sistémicas, especialmente la Paracoccidioidomicosis, la principal micosis sistémica del Paraguay

Coccidioidomicosis: estado actual de la endemia en Venezuela / Coccidioidomycosis: current status of the endemic in Venezuela

La coccidioidomicosis es una micosis sistémica endémica del continente americano, causada por un hongo dimórfico. La inhalación de artroconidios transportados por el viento permite la colonización del tejido pulmonar produciendo la micosis. El diagnóstico se realiza a través del estudio epidemiológico y micológico, complementándose con el histopatológico, inmunitario y molecular. En Venezuela ha sido reportada desde 1948 cuando el Dr. Humberto Campins describió el primer caso en Barquisimeto, estado Lara. Las micosis en Venezuela no son enfermedades de denuncia obligatoria por lo que existe un grave subregistro en las estadísticas anuales del país, sin embargo, los Grupos de Trabajo en Micología logran mantener la data de los casos. Los datos aportados acerca de las variables bioclimáticas y ambientales de las zonas endémicas pueden contribuir a la búsqueda del nicho ecológico del hongo, para así apoyar la vigilancia eco-epidemiológica de los casos clínicos y la pesquisa de casos subclínicos, fortaleciendo el sistema preventivo de salud y el manejo médico oportuno de la micosis.

Coccidioidomycosis is a systemic fungal infection endemic in the Americas, caused by a dimorphic fungus. Inhalation of arthroconidia transported by wind colonize lung tissue causing mycosis. Diagnosis is made through epidemiological and mycological study, complemented by histopathological, molecular and immune response. In Venezuela it has been reported since 1948 when Dr. Humberto Campins described the first case in Barquisimeto, Lara state. The fungal diseases in Venezuela are not mandatory notification, so that t6here is a serious underreporting in the annual statistics of the country; however, the working groups in Mycology manage to keep the data of the cases. The information provided by bioclimatic and environmental variables in endemic areas can contribute to the pursuit of ecological niches of the fungus in order to strengthen eco-epidemiological surveillance of clinical cases and research subclinical cases, strengthening the preventive health system and appropriate medical management of mycosis.

Coccidioidomicosis cutánea: Comunicación de seis casos mexicanos / Cutaneous coccidioidomycoses: Six mexican cases report

Coccidioidomycosis is a systemic airborne mycosis that may involve secondarily other organs through systemic dissemination. Fungi Coccidioides immitis and C. posadasii are the etiologic agents. The former is ubiquitous from the area of California in North America, and the latter is found elsewhere in the world. Primary cutaneous infection is rare. We present six Mexican male cases, residents of Tijuana B.C. Three of them with primary pulmonary infection and further cutaneous dissemination, and three cases of primary cutaneous coccicioidomycosis. In half the cases C. posadasii was isolated. The clinical suspicion is basic for reaching the diagnosis, and we must always keep in mind that the cutaneous manifestations are widely varied and that the lesions are more severe when systemic dissemination occurs.

La coccidioidomicosis es una micosis con vía de entrada inhalatoria que puede tener manifestaciones secundarias en otros órganos, y diseminación sistèmica. Se han identificado como agentes etiológicos a Coccidioides immitis y C. posadasii, El primero está presente en California de Norteamérica y el segundo en cualquier otra región del mundo. La infección cutánea primaria es una presentación poco común. Presentamos seis casos clínicos mexicanos, de sexo masculino, residentes de la ciudad de Tijuana, B.C. Tres de ellos con infección pulmonar primaria y diseminación cutánea y tres cutáneos primarios. En la mitad de los casos se logró aislar C. posadasii. La sospecha clínica es fundamental para llegar al diagnóstico ya que las manifestaciones cutáneas son muy variadas, y ante diseminación sistèmica las lesiones cutáneas son más graves.

Insights from paleomicrobiology into the indigenous peoples of pre-colonial America - A Review

This review investigates ancient infectious diseases in the Americas dated to the pre-colonial period and considers what these findings can tell us about the history of the indigenous peoples of the Americas. It gives an overview, but focuses on four microbial pathogens from this period: Helicobacter pylori, Mycobacterium tuberculosis, Trypanosoma cruzi and Coccidioides immitis, which cause stomach ulceration and gastric cancer, tuberculosis, Chagas disease and valley fever, respectively. These pathogens were selected as H. pylori can give insight into ancient human migrations into the Americas, M. tuberculosis is associated with population density and urban development, T. cruzi can elucidate human living conditions and C. immitis can indicate agricultural development. A range of methods are used to diagnose infectious disease in ancient human remains, with DNA analysis by polymerase chain reaction one of the most reliable, provided strict precautions are taken against cross contamination. The review concludes with a brief summary of the changes that took place after European exploration and colonisation.

Falla de tratamiento en neumonía adquirida en la comunidad: coccidioidomicosis en un viajero / Treatment failure in community-adquired pneumonia: coccidioidomycosis in a traveler patient

Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.

La neumonía de evolución tórpida son aquellas en que no se logra una respuesta clínica adecuada con el uso de terapia antimicrobiana. Existen múltiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atípicos. Coccidioides immitis es un hongo causante de neumonía en el hemisferio norte, especialmente en E.U.A y norte de México. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonía que no respondió al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logró establecer mediante el estudio histopatológico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clínica y radiológica favorable al tratamiento antifúngico.

Coccidioidomycosis in armadillo hunters from the state of Ceará, Brazil

Coccidioidomycosis is a systemic mycosis with a variable clinical presentation. Misdiagnosis of coccidioidomycosis as bacterial pneumopathy leads to inappropriate prescription of antibiotics and delayed diagnosis. This report describes an outbreak among armadillo hunters in northeastern Brazil in which an initial diagnosis of bacterial pneumonia was later confirmed as coccidioidomycosis caused by Coccidioides posadasii. Thus, this mycosis should be considered as an alternative diagnosis in patients reporting symptoms of pneumonia, even if these symptoms are only presented for a short period, who are from areas considered endemic for this disease.

La coccidioidomicosis en Argentina, 1892-2009 / Coccidioidomycosis in Argentina, 1892-2009

Los casos clínicos de coccidioidomicosis en Argentina son pocos y han tenido lugar fundamentalmente en la extensa región árida precordillerana. Este trabajo tiene como objetivos realizar una revisión retrospectiva del total de casos de coccidioidomicosis documentados en Argentina desde el año 1892 hasta 2009 y describir una serie de casos ocurridos en los últimos 4 años. En 117 años se documentaron 128 casos. Desde la primera descripción de la enfermedad en 1892 hasta 1939 se registraron 6 casos; desde 1940 hasta 1999, 59 casos (6-14 casos cada 10 años); y los 63 casos restantes (49% del total histórico) se produjeron en el último decenio. La mediana de edad de los 34 pacientes registrados en el período 2006-2009 fue de 31 años (rango: 7-89), la relación hombre:mujer fue 1,3:1; 12 de estos individuos eran inmunocomprometidos. Veintiséis casos se confirmaron por examen microscópico, por cultivo o por ambos procedimientos; los casos restantes se confirmaron por serología. Todos los aislamientos recuperados fueron identificados como Coccidioides posadasii. Treinta pacientes residían en una amplia área geográfica con epicentro en el valle de Catamarca. Entre 2006 y 2009, la tasa de incidencia en la provincia de Catamarca se incrementó desde valores históricos inferiores a 0,5 casos cada 100 000 habitantes hasta 2,0 casos cada 100 000 habitantes. Este aumento sugiere una emergencia de la coccidioidomicosis en el área.

Clinical cases of coccidioidomycosis are rare in Argentina and are generally found in the large arid precordilleran area of the country. This study aims to perform a retrospective review of all coccidioidomycosis cases documented in the country from 1892 to 2009, and to describe those occurring in the last 4 years. One hundred and twenty eight cases were documented in the 117 year-period. Since the original description of the disease in 1892 until 1939, only 6 cases were registered; between 1940 and 1999, 59 (6-14/10 yrs) and the remaining 63 (49% of total cases) occurred in the last decade. The median age of 34 patients registered in 2006-2009 was 31 years (range: 7-89), male/female ratio was 1.3:1 and 12 patients were immunocompromised. Twenty-six cases were confirmed by direct microscopy and/or culture whereas the remaining ones by serology. All isolates were identified as Coccidioides posadasii. Thirty patients lived in a vast geographic region with epicenter in Catamarca Valley. Between 2006 and 2009, annual disease incidence rates in Catamarca Province increased from historical values below 0.5/100,000 to 2/100,000 inhabitants. Such increase suggests an emergency of coccidioidomycosis in that region.

Manifestações cutâneo-mucosas da coccidioidomicose: estudo de trinta casos procedentes dos estados do Piauí e Maranhão / Skin and mucous membrane manifestations of coccidioidomycosis: a study of thirty cases in the Brazilian states of Piauí and Maranhão

FUNDAMENTOS: A coccidioidomicose é micose sistêmica usualmente manifesta como infecção benigna de resolução espontânea; porém, uma pequena proporção dos infectados desenvolve quadros progressivos potencialmente fatais, podendo atingir a pele com lesões pleomórficas disseminadas. OBJETIVOS: Identificar e descrever as manifestações cutâneo-mucosas da coccidioidomicose, as ocupações de risco relacionadas à doença e o quadro clínico associado. MÉTODOS: Estudo realizado entre os anos 2003 e 2006 em 30 pacientes portadores de coccidioidomicose provenientes dos estados do Piauí e Maranhão e diagnosticados por exame microscópico direto, cultivo do escarro ou sorologia de triagem de imunodifusão dupla em gel de ágar, aliados à anamnese e exame físico. RESULTADOS: Identificaram-se lesões extrapulmonares em 13 casos (43,3 por cento), com predomínio de manifestações dermatológicas de hipersensibilidade: eritema nodoso (26,6 por cento), exantema com lesões eritemato-escamosas (26,6 por cento) e eritema multiforme (23,3 por cento), além de úlceras de língua (13,3 por cento) e lábio (6,6 por cento) e abscesso subcutâneo (3,3 por cento). Tais manifestações foram observadas na fase aguda da doença. CONCLUSÕES: As manifestações cutâneas associadas à infecção respiratória aguda fortalecem a hipótese diagnóstica desta doença, especialmente, em caçadores de tatus ou pessoas expostas à escavação do solo.

BACKGROUND: Coccidioidomycosis is a systemic mycosis that usually presents as a benign infection. Patients generally recover spontaneously; however, a small proportion of infected individuals develop progressive complications that may affect the skin in the form of disseminated pleomorphic lesions and may become fatal. OBJECTIVES: To identify and describe skin and mucous membrane manifestations of coccidioidomycosis, to identify occupational hazards associated with the disease and to determine its associated clinical presentation. METHODS: A study conducted between 2003 and 2006 involving 30 patients from the Brazilian states of Piauí and Maranhão with coccidioidomycosis diagnosed by direct microscopy, sputum culture or screening serology using agar gel double immunodiffusion, in association with anamnesis and physical examination. RESULTS: Extrapulmonary lesions were found in 13 cases (43.3 percent), consisting predominantly of dermatological manifestations of hypersensitivity: erythema nodosum (26.6 percent), exanthema with erythematosquamous lesions (26.6 percent) and erythema multiforme (23.3 percent), as well as ulcerations of the tongue (13.3 percent), lip ulcers (6.6 percent) and subcutaneous abscess (3.3 percent). These manifestations were seen during the acute phase of the disease. CONCLUSIONS: Skin manifestations associated with an acute respiratory infection reinforce the hypothesis of a diagnosis of coccidioidomycosis, particularly in individuals who hunt armadillos or in those exposed to soil excavation.

Capítulo 2: coccidioidomicose / Chapter 2: coccidioidomycosis

A coccidioidomicose é uma micose sistêmica causada pelos fungos dimórficos Coccidioides immitis e Coccidioides posadasii. A infecção é adquirida pela inalação de artroconídios infectantes presentes no solo. Usualmente apresenta-se como infecção benigna de resolução espontânea em 60 por cento dos casos. A micose é encontrada em regiões áridas e semiáridas do continente americano entre os paralelos 40ºN e 40ºS, principalmente no sudoeste dos Estados Unidos e no norte do México. A coccidioidomicose foi diagnosticada recentemente na região semiárida do nordeste do Brasil em quatro estados: Piauí (100 casos), Ceará (20 casos), Maranhão (6 casos) e Bahia (2 casos). A micose se manifesta sob três formas clínicas principais: forma pulmonar primária, forma pulmonar progressiva ou forma disseminada. Os sintomas de infecção respiratória manifestam-se, em média, 10 dias após a exposição. O diagnóstico faz-se pelo isolamento do Coccidioides sp. em cultivo ou pelo exame direto positivo (hidróxido de potássio a 10 por cento) de qualquer material suspeito (escarro, líquido cefalorraquidiano, exsudato de tegumento, linfonodos, etc.), ou corados por ácido periódico de Schiff ou impregnação argêntea. A imunodifusão em gel de ágar é o teste imunológico mais empregado na rotina diagnóstica. As manifestações radiológicas e tomográficas mais frequentes são nódulos pulmonares múltiplos, a maioria escavados, distribuídos difusamente. As drogas indicadas para o tratamento são fluconazol e itraconazol, com doses médias variando de 200 a 400 mg/dia, podendo chegar a 1.200 mg/dia. Nos casos graves, a anfotericina B pode ser a droga de escolha inicial. Na manifestação neurológica, o fluconazol é a droga preferida na dose mínima de 400 mg/dia.

Coccidioidomycosis is a systemic mycosis caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. Infection is acquired by inhalation of infective arthroconidia that live in the soil. In 60 percent of cases, the infection is benign and resolves spontaneously. In the northern hemisphere, coccidioidomycosis is endemic to arid and semi-arid regions at latitudes between 40ºN and 40ºS, particularly in the southwestern United States and in northern Mexico. In the semi-arid northeastern region of Brazil, cases of coccidioidomycosis have recently been reported in four states: Piauí (100 cases); Ceará (20 cases); Maranhão (6 cases); and Bahia (2 cases). The illness manifests in one of three clinical forms: the primary pulmonary form; the progressive pulmonary form; or the disseminated form. On average, the symptoms of respiratory infection appear 10 days after exposure. The diagnosis is made by the isolation of Coccidioides sp. in culture or by positive results from smear microscopy (10 percent potassium hydroxide test), periodic acid-Schiff staining or silver staining of any suspect material (sputum, cerebrospinal fluid, skin exudate, lymph node aspirate, etc.) Agar gel immunodiffusion is the diagnostic test most widely used. The most common finding on X-rays and CT scans is diffuse distribution of multiple pulmonary nodules, most of which are cavitated. The recommended treatment is fluconazole or itraconazole, the mean dose ranging from 200 to 400 mg/day, although as much as 1,200 mg/day is used in certain cases. In severe cases, amphotericin B can be the drug of choice. In cases of neurological involvement, the recommended treatment is administration of fluconazole, at a minimum dose of 400 mg/day.

Coccidioidomicose pulmonar e extrapulmonar: três casos em zona endêmica no interior do Ceará / Pulmonary and extrapulmonary coccidioidomycosis: three cases in an endemic area in the state of Ceará, Brazil

A coccidioidomicose, uma doença fúngica adquirida através da inalação do agente Coccidioides sp. sob a forma de artroconídio, foi pela primeira vez descrita em 1894. Restringe-se principalmente a áreas de clima árido, solo alcalino e regiões de baixo índice pluviométrico. Não por acaso, a maioria dos casos descritos no Brasil ocorreu na região Nordeste. Relatam-se três casos de coccidioidomicose pulmonar ocorridos nos anos de 2005 e 2006, em zona endêmica no interior do Ceará. Todos eram homens imunocompetentes de idade adulta, adeptos à prática de caça a tatus (Dasypus novemcinctus) com queixas de tosse, febre, dispneia e dor pleurítica. Houve evoluções com comprometimento pulmonar e lesão cutânea foi observada em apenas um paciente. Todos apresentaram radiografia e TC de tórax com lesões características da coccidioidomicose. O diagnóstico foi confirmado através de teste sorológico. Todos evoluíram para cura após tratamento com antifúngico.

Coccidioidomycosis, a fungal illness acquired by the inhalation of arthroconidia of Coccidioides sp., was first described in 1894. Coccidioidomycosis is mainly restricted to areas with arid climate, alkaline soil and low rainfall. Consequently, most of the reported cases in Brazil have occurred in the northeastern region. We report three cases of pulmonary coccidioidomycosis occurring between 2005 and 2006 in an endemic area in the state of Ceará, Brazil. The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain. All three patients presented pulmonary involvement, and only one also presented cutaneous lesions. Chest X-rays and CT scans of the patients revealed characteristic coccidioidomycosis lesions. The diagnosis was confirmed by serological testing. All of the patients evolved to cure after antifungal treatment.

Coccidioidomicose: estudo clínico / Coccidiioidomycosis: clinicar study

Coccidioidomicose - infecção endêmica com distribuição geográfica relativamente limitada - é adquirida através da inalação de fungos do gênero Coccidioides, o qual tem atração por terrenos arenosos, alcalinos e de elevada salinidade. No Brasil, a região com maior quantidade de diagnósticos é o Nordeste. O quadro clínico varia de uma infecção respiratória leve à fatalidade. A infecção afeta os pulmões, e por disseminação linfática, pode afetar outros órgãos. Quando atinge o sistema nervoso central causa quadro de meningoencefalite crônica. O diagnóstico presuntivo pode ser baseado na detecção de anticorpos específicos no soro, fixação do complemento, além de teste cutânea de hipersensibilidade retardada à coccidioidina. Deve-se tratar apenas pacientes com fator de risco para a forma disseminada - sintomatologia há mais de dois meses e alterações à telerradiografia. O tratamento deve ser feito com itraconazol ou fluconazol, com duração de três meses, podendo se estender até seis meses.

Coccidioidomycosis - an endemic infection somewhat geographically limited - is acquired by inhaling spores of coccidioides fungi, which are common in alkaline highly saline sandy soils. In Brazil, the area with prevaling coccidioidosis diagnostics is the northeast region. Clinical signs range from mild respiratory disorders to mortality. From the lungs the disease may spread to other organs through the lymphatic system; when affecting the central nervous system it causes chronic meningoencephalitis. Presumptive diagnosis may be bases on the presence of specific antibodies in the serum level, complement fixation or skin tests of delayed hypersensibility to coccidioidin. Only the patients with risk factors for the disseminated form are treated - those who have been symptomatic for more than two months or show sign or alterations on teleradiography. Treatment of choice is itraconazole or fluconazole for three to six months.

Detección de infección por Coccidioides immitis en zonas del estado de Coahuila, México / Detection of Coccidioides immitis infection in Coahuila, Mexico

La coccidioidomicosis es una micosis inicialmente pulmonar causada por Coccidioides immitis; puede diseminarse principalmente a sistema nervioso central, huesos y piel. En México se desconoce la frecuencia exacta de esta enfermedad. Nuestro objetivo fue determinar, por intradermorreacción y por serología, los casos de infección por C. immitis en 12 comunidades (10 rurales y dos urbanas) atendidas en el Hospital Rural Nº 79 del Instituto Mexicano del Seguro Social (IMSS) del estado de Coahuila, México. Se estudiaron 668 individuos adultos de ambos sexos; se les aplicó 0,1 ml de coccidioidina por vía intradérmica; después de 72 hs. se midió el diámetro de induración. Fueron seleccionados 180 individuos y a partir del suero se determinaron los niveles de inmunoglobulinas anti-C. immitis por ELISA. Fueron positivos a la coccidioidina 621 sujetos (93%), frecuencia mucho mayor a la reportada previamente en Coahuila. De los 180 sueros estudiados los promedios de densidad óptica (DO) fueron: IgG1, 1,55; IgG2, 0,94; IgG total, 0,33; IgG3, 0,29; IgG4, 0,27; IgM, 0,08. Los valores de IgG1, IgG2 e IgM comparados con las otras inmunoglobulinas fueron estadísticamente significativos. Los valores de IgG1 e IgG2 sugieren contacto frecuente con los antígenos e incluso probables casos de enfermedad no diagnosticada.

Coccidioidomycosis is a mycosis firstly pulmonar caused by Coccidioides immitis; it can be disseminated to central nervous system, bones and skin, principaly. In Mexico, the real frequency of the disease is unknown. The aim of this work was to determine, by skin test and by serology, the infection cases by C. immitis in twelve communities (10 rural and two urban), attended in the Hospital Rural Nº 79 at the Instituto Mexicano del Seguro Social (IMSS) from the Coahuila State, Mexico. Six hundred and sixty eight adult individuals of both sexes were studied, to whom 0.1 ml of coccidioidin by intradermal route was applied; 72 h after, the induration diameter was measured. One hundred eighty individuals were selected and seric anti-C. immitis immunoglobulins levels were determined by ELISA. Six hundred twenty one individuals (93%) were positive to coccidioidin, the frequency was much higher than that previously reported in Coahuila. From 180 sera studied, the means of optical density (OD) were: IgG1, 1.55; IgG2, 0.94; total IgG, 0.33; IgG3, 0.29; IgG4, 0.27; IgM, 0.08. The values of IgG1, IgG2 and IgM compared with the other immunoglobulins were statistically significant. The high values of IgG1 and IgG2 suggest frequent contact with the antigen, and probable cases of undiagnosed disease.

Inmunodiagnóstico de micosis endémicas y aspergilosis broncopulmonar: Estudio multicéntrico en la República Argentina / Immunodiagnosis of endemic mycoses and bronchopulmonary aspergilosis: A multicenter study in Argentina

Se realizó entre 01-04-2000 y 30-03-2001, un estudio de corte transversal, para conocer la frecuencia relativa de las enfermedades por hongos dimorfos y Aspergillus spp. en la República Argentina y evaluar la certeza en el diagnóstico de los laboratorios de diferentes áreas geográficas. Participaron 25 centros de salud provenientes de 12 provincias y de la Ciudad Autónoma de Buenos Aires. Fueron analizados en el laboratorio de origen 965 sueros de pacientes con sospecha clínica de histoplasmosis (HP), paracoccidioidomicosis (PCM), coccidioidomicosis (CM) y aspergilosis. Todos los sueros positivos y el 35% de los negativos fueron reevaluados en el laboratorio de referencia por inmunodifusión doble en agar. La concordancia entre los resultados obtenidos en los centros de origen y el de referencia fue de 98,8%. Se detectaron anticuerpos específicos en 120 sueros correspondientes a 98 pacientes. El 71,4% (70 casos) de los diagnósticos correspondió a micosis endémicas (HP, PCM y CM) y el resto a aspergilosis. PCM fue diagnosticada en 47,9% (47 casos), aspergilosis en 28,6% (28 casos), HP en13,3% (13 casos) y CM en 10,2% (10 casos). La participación en este estudio fue voluntaria y no todos los centros del país estaban representados, sin embargo, las frecuencias de enfermedades fúngicas fueron las esperadas y coincidentes con estudios previos realizados a nivel nacional.

In order to contribute to the knowledge of the relative frequency of chronic fungal diseases and assess the performance of diagnostic laboratories in Argentina, a multicenter study was performed with the participation of 25 medical centers located in 12 different provinces and Buenos Aires City. Between 04-01-2000 and 03-30-2001, 965 serum specimens from patients clinically suspected of having histoplasmosis (HP), paracoccidioidomycosis (PCM), coccidioidomycosis (CM) or aspergilosis were analyzed. Agar immunodiffusion tests (IDD) were done locally. All positive and 35% of negative sera were retested in the reference center. Results of laboratories of origin showed 98.8% concordance with those of reference center. Antibodies against any of the etiological agents were detected in 120 specimens from 98 patients. Endemic mycoses (HP, PCM and CM) were diagnosed in 70 patients (71.4%) and aspergilosis in 28 (28.6%). The frequencies of the different mycoses in decreasing order were PCM 47 patients (47.9%), aspergilosis 28 patients (28.6%), HP 13 patients (13.3%) and CM 10 patients (10.2%). The study was carried out on a voluntary basis and some areas of the country were not represented. However, the frequencies were in range with the expected rates in the population under study.

Coccidioidomicose pulmonar em caçador de tatus / Pulmonary coccidioidomycosis in a armadillo hunter

A coccidioidomicose, uma doença fúngica adquirida através da inalação do agente Coccidioides immitis sob forma de artroconídio, vem sendo descrita desde 1892. Restringe-se principalmente a áreas de clima árido, solo alcalino e regiões de baixo índice pluviométrico. Não por acaso, a maioria dos casos descritos no Brasil ocorreu na região Nordeste. Relata-se o caso de um homem de 19 anos, imunocompetente, com queixa de dor pleural bilateral, febre, adinamia e tosse seca havia dois meses. A radiografia de tórax evidenciou múltiplos nódulos bilaterais. O paciente participava de caçadas a tatus (Dasypus novemcinctus) e a pesquisa direta para fungos no escarro evidenciou Coccidioides sp. Tratado com anfotericina B, apresentou pneumotórax e insuficiência respiratória, indo a óbito. A biópsia pulmonar post mortem evidenciou Coccidioides immitis sob a forma de endósporos

Prevalance of skin reactivity to coccidioidin and associated risks factors in subjects living in a Northern City of Mexico

Background. Coccidioidomycosis is a reemerging fungal disease seen mainly in the states located at the Mexican-U.S: border. The finding of advanced cases of the disease are now more frequent. Methods. A cross-sectional study was conducted to determine the prevalence of skin reactivity to coccidioidin in the city of Torreón, Coahuila, Mexico, located in the northern region of the country. A multifactorial association of environmental, social, and health conditions was analyzed. A total of 1,653 coccidioidin skin tests was applied in male and female subjects older than 8 years of age. Results. The overall rate of positive reactivity in this city was 40.2 percent, with a 95 percent confidence interval of 37.8-42.5. This was related to time/life exposure risk and to the habitat of unpaved streets. No statistically significant difference regarding gender, socioeconomic level, and working activities was found. the highest reactivity was observed in subjects between 30 and 65 years of age. Conslusions. Positive results were related to exposure risk and habitat, principally in the sputheast region of the city. These results were applied both to residents and outsiders with no differences between the groups. Of the total, 87.5 percent were considered high-risk subjects. It is recommended that future surveys be carried out in other northern cities of Mexico to obtain more useful data concerning the extent of the infection and mainly to establish preventive measures, such as appropriate reforestation and urbanization procedures