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.

Levantamento epidemiológico das DST no Serviço de Dermatologia do Hospital Universitário Prof. Walter Cantidio of the Iniversidade Federal do Ceará / Epidemiological suvey of STD at the Dermatological Service of Hospital Universitário Prof Walter Cantidio of the Univeridade Federal do Ceará

Os autores fizeram um levantamento epidemiológico das DST no Serviço de Dermatologia do Hospital Universitário Prof. Walter Cantídio da Universidade Federal do Ceará, no período de 1982/1986, com o objetivo de verificar o comportamentpo dessas doenças na populaçäo assistida por esse hospital. Observou-se que a sífilis foi a doença mais freqüente, acometendo todas as faixas etárias predominando entre os 20-29 anos e no sexo masculino, enquanto que a escabiose mostrou-se mais freqüente entre as mulheres, ascendendo a curva das doenças eventualmente transmitidas por contato sexual. O estudo foi desenvolvido com base no registro dos doentes de primeira consulta no Serviço de Dermatologia e em revisöes, de prontuários, no período compreendido entre janeiro/82 e dezembro/86, tomando-se como referência a proposta de classificaçäo das DST de José Serruya e Antônio Carlos Pereira Júnior e relacionando-se essas doenças com sexo e idade

Netilmicina: uma opçäo no tratamento da erisipela / Netilmicin: an option in the treatment of erysipelas

Os autores realizaram um ensaio clínico com 10 pacientes acometidos de erisipela que foram submetidos a tratamento com netilmicina na dose de 150 mg de 12/12 horas, durante 10 dias. A análise dos resultados demonstrou um índice máximo de 100% de cura sem a constataçäo de efeitos colaterais ototóxicos ou nefrotóxicos perceptíveis. Esses resultados evidenciaram o excelente desempenho do referido antibiótico frente a esse tipo de infecçäo, o que o qualifica como excelente alternativa terapêutica