Mycetomas: an epidemiological, etiological, clinical, laboratory and therapeutic review

Abstract: Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.

Bullous pemphigoid in a 3-month-old infant: case report and literature review of this dermatosis in childhood / Penfigoide bolhoso em lactente de 3 meses: relato de caso e revisao de literatura da dermatose na infancia

Bullous pemphigoid is an autoimmune subepidermal blistering dermatosis that is uncommon in childhood. We report a case of a female infant, 3 months old, which presented clinical and laboratory data for the confirmatory diagnosis of bullous pemphigoid. The authors used immunohistochemical staining for collagen type IV that allowed the differentiation of bullous pemphigoid from other subepidermal bullous diseases. Opportunely we review the clinical, immunological, therapeutic and prognostic features of this pathology in children.

O penfigoide bolhoso é uma dermatose bolhosa autoimune subepidérmica, incomum na infância. Relatamos um caso de lactente feminina, com 3 meses de idade, que apresentou dados clínicos e laboratoriais confirmatórios para o diagnóstico de penfigoide bolhoso. Os autores utilizaram a coloração de imuno-histoquímica para o colágeno tipo IV que permitiu a diferenciação do penfigoide bolhoso de outras buloses subepidérmicas. Oportunamente, revisamos as características clínicas, imunológicas, terapêuticas e prognósticas da patologia na criança.

Study of dermatoses in kidney transplant patients / Estudo das dermatoses em pacientes transplantados renais

BACKGROUND: The increasing in the number of kidney transplant recipients has favored, more frequently than before, the emergence of dermatoses and warranted their study through subsequent publications. OBJECTIVES: to evaluate the frequency of dermatoses in kidney transplant recipients. METHODS: kidney transplant recipients with suspected dermatoses between March 1st 2009 and June 30th 2010. RESULTS: 53 patients (28 males and 25 females), aged between 22 and 69 (mean age = 45 years) were evaluated. Most of them came from the cities of Ceilândia, Samambaia and São Sebastião/DF, and had already been transplanted for 5 to 10 years before (37.7%); 62.3% were recipients of living donors and 83% were prednisone-treated. The most prevalent dermatoses were of fungal (45.3%) and viral (39.6%) etiologies. Among the non-melanoma malignant neoplasms, the basal cell carcinoma prevailed (six cases), in spite of the low incidence. Concerning fungal dermatoses, 12 cases of onychomycosis, five of pityriasis versicolor and four of pityrosporum folliculitis were reported. For diagnosis, in most cases (64.2%), laboratory examinations (mycological and histopathological) were performed. CONCLUSION: cutaneous manifestations in kidney transplant recipients are generally secondary to immunosuppression. The infectious dermatoses, especially those of fungal origin, are frequently found in kidney transplant recipients and their occurrence increases progressively according to the time elapsed from the transplantation, which makes follow-up important. .

FUNDAMENTOS: o crescente aumento do número dos transplantados renais tem favorecido o aparecimento mais frequente das dermatoses e permitido o estudo em sucessivos trabalhos. OBJETIVOS: avaliar a frequência das dermatoses em pacientes transplantados renais. MÉTODOS: captação de pacientes transplantados renais durante o período de 1° de março de 2009 a 30 de junho de 2010 com suspeita de dermatoses. RESULTADOS : foram avaliados 53 pacientes (28 homens e 25 mulheres), entre 22 e 69 anos (com uma média de 45 anos), a maioria procedente de Ceilândia, Samambaia e São Sebastião/DF, entre 5 e 10 anos de transplante renal (37,7%), sendo 62,3% receptor de doador vivo e 83% em uso de prednisona. As dermatoses mais prevalentes foram as de etiologia fúngica (45,3%) e viral (39,6%). Das neoplasias malignas não-melanoma, apesar da baixa incidência, predominou o carcinoma basocelular (seis casos). Com relação s dermatoses de origem fúngica, ocorreram 12 casos de onicomicoses, cinco casos de pitiríase versicolor e quatro casos de foliculite pitirospórica. Para realização do diagnóstico, na maioria dos casos (64,2%), foi utilizado os exames laboratoriais ( micológicos e histopatológicos). CONCLUSÃO: as manifestações cutâneas em pacientes transplantados renais são geralmente secundárias imunossupressão. As dermatoses infecciosas, principalmente as de etiologia fúngica, são frequentes em pacientes transplantados renais, e sua ocorrência aumenta progressivamente, conforme o tempo transcorrido, a partir do transplante, sendo importante o acompanhamento. .