Rhinocerebral mucormycosis to the rise? The impact of the worldwide diabetes epidemic

Abstract The authors present seven cases of rhinocerebral mucormycosis associated to diabetes mellitus, which is a disease with epidemic proportions affecting individuals worldwide, particularly in developing countries, and which poses significant morbidity and mortality. Mucormycosis is an opportunistic fungal infection with high mortality and requires an invasive therapeutic approach to save the patient's life with significant morbidity and sequelae, thus prevention is crucial.

Prevalencia de condilomas ano-genitales en pacientes con infección por VIH en un centro para infecciones de transmisión sexual en León, Guanajuato, México / Prevalence of anogenital condylomas in patients with HIV infection in a center for sexually transmitted infections in Leon, Guanajuato, Mexico

INTRODUCCIÓN: Los condilomas son la infección de transmisión sexual más frecuente en el mundo y tiene estrecha relación con la infección por VIH. La topografía y la serología son variables, y algunos presentan mayor riesgo de malignización. OBJETIVO: Describir la prevalencia, características clínicas, topográficas y factores asociados a la presencia de condilomas ano-genitales en pacientes con infección por VIH/SIDA en Guanajuato. MATERIAL Y MÉTODOS: Estudio descriptivo y transversal realizado entre junio y diciembre de 2014. Se incluyeron pacientes adultos con infección por VIH/SIDA, de ambos sexos, del CAPASITS León, México. Se aplicó un cuestionario que incluyó: datos de identificación, y factores de riesgo relacionados a los condilomas ano-genitales, y se les revisó dicha región corporal en busca de condilomas. Se realizó estadística descriptiva de acuerdo al tipo y distribución de las variables y se compararon las medianas de linfocitos T CD4 (LTCD4+) de los pacientes, con y sin condilomas, con la prueba U- Mann-Whitney. RESULTADOS: Se incluyeron 213 pacientes con infección por VIH/SIDA, 181 (85%) hombres. La prevalencia de condilomas ano-genitales fue de 30% (IC95%:23-36%), con mayor frecuencia en la región anal, con 21% de los casos. Encontramos una diferencia significativa entre las medianas en el recuento de linfocitos LTCD4+ en los pacientes, con y sin condilomas, (425 vs 510 LTCD4+/mL, p = 0,034). CONCLUSIONES: Se obtuvo una prevalencia alta de pacientes con condilomas ano-genitales. La presencia de condilomas fue mayor en pacientes con menor recuento de linfocitos LTCD4+. Considerando la elevada prevalencia, se recomienda la aplicación de la vacuna en este grupo de pacientes.

BACKGROUND: Condylomas are the most frequent sexually transmitted infection worldwide, and thus, have a close relation to HIV infection. The site and serology vary, and some pose higher risk of malignancy. AIM: To describe the prevalence, characteristics and associated factors to the presence of anogenital condylomas in patients with HIV/AIDS. METHODS: Descriptive cross-sectional study conducted in the period from June to December 2014. Adult HIV/AIDS positive patients from "CAPASITS" in Leon, Mexico, from both sexes were included. A questionnaire was performed that included: identification data, and risk factors related to anogenital condylomas. Anogenital area was examined for condylomas. Descriptive statistics were carried out according to the type and distribution of the variables, and the CD4 lymphocyte medians of patients with and without condylomas were compared using U- Mann-Whitney test. RESULTS: A total of 213 HIV/AIDS patients were included; 181 (85%) were male. The prevalence of anogenital condylomas was 30% (IC95%: 23-36%), predominating in the anal region, observed in 21% of the cases. A significant difference was found between median CD4 cell count of patients with and without condylomas (425 vs 510 CD4/mL, p= 0.034). CONCLUSION: A high prevalence of patients with anogenital condylomas was obtained. The presence of condylomas was higher in patients with lower CD4 count. Considering the high prevalence, the application of the vaccine is recommended in this patient group.

Isolation of Malassezia spp. in HIV-positive patients with and without seborrheic dermatitis

Abstract Background Malassezia, a skin saprophyte, is frequently isolated from patients with seborrheic dermatitis, which is one of the most common dermatoses in HIV-infected patients. Its role in pathophysiology has not been defined. Objective To determine whether patients living with HIV and seborrheic dermatitis have more Malassezia than those without seborrheic dermatitis. Method This is an descriptive, observational, prospective cross-sectional study to which all adult patients living with HIV that attend the infectious disease outpatient clinic at the Dr. Manuel Gea González General Hospital were invited. Patients presenting with scale and erythema were included in Group 1, while patients without erythema were included in Group 2. Samples were taken from all patients for smear and culture. Results Thirty patients were included in each group. All patients with seborrheic dermatitis had a positive smear, with varying amounts of yeasts. In the control group, 36.7% of patients had a negative smear. The results are statistically significant, as well as the number of colonies in the cultures.Study limitations The study used a small sample size and the subspecies were not identified. Conclusions Patients with clinical manifestations of seborrheic dermatitis have larger amounts of Malassezia. Further studies need to be performed to analyze if the greater amount is related to imbalances in the microbiota of the skin.

Tiña incógnita y granuloma de Majocchi adquirido de un erizo. Un caso mexicano / Mexican case of tinea incognito and granuloma de Majocchi acquired from a hedgehog

Resumen Las mascotas exóticas, como el erizo de tierra, son capaces de transmitir al ser humano diferentes infecciones, como salmonelosis, micobacterias, protozoos como Cryptosporidium parvum, y dermatofitosis. Presentamos el caso de un paciente adulto masculino, que recientemente había adquirido un erizo de tierra, que presentó en la mano una lesión de tiña incógnita y un granuloma de Majocchi. Se identificó el agente etiológico como Trichophyton erinacei, por cultivo micológico y biología molecular. El paciente se trató con terbinafina por vía oral, por seis meses, con excelente respuesta.

Exotic pets, such as the ground hedgehog, are capable of transmitting to the human being different zoonoses, such as salmonellosis, mycobacteria, protozoa such as Cryptosporidium parvum, and dermatophytosis. We present the case report of a male adult patient, who had recently acquired a ground hedgehog, who presented in his hand a ringworm lesion incognito and a Majocchi granuloma. The etiological agent was identified as Trichophyton erinacei by mycological culture and molecular biology. The patient was treated with terbinafine oral, with excellent response.

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.