Melioidosis en Colombia, descripción de un caso clínico y consideraciones epidemiológicas / Melioidosis in Colombia, description of a clinical case and epidemiological considerations

Resumen La melioidosis es una enfermedad infecciosa causada por Burkholderia pseudomallei cuyo diagnóstico clínico puede ser difícil debido a su variada presentación clínica y a las dificultades del diagnóstico microbiológico, por lo cual pueden requerirse técnicas moleculares para su adecuada identificación una vez se sospecha su presencia. Son pocos los antibióticos disponibles para el tratamiento de esta enfermedad y, además, deben usarse durante un tiempo prolongado. Aunque se conoce por ser endémica en Tailandia, Malasia, Singapur, Vietnam y Australia, en Colombia se han reportado algunos pocos casos. Se presenta un caso de melioidosis en la región norte de Colombia, se hace una revisión de las características clínicas y el tratamiento, y se describe la epidemiología local de esta enfermedad.

Abstract Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

Comparative efficacy of continuous and pulse dose terbinafifine regimes in toenail dermatophytosis: A randomized double-blind trial.

Introduction: Dermatophytes are the most frequently implicated agents in toenail onychomycosis and oral terbinafi ne has shown the best cure rates in this condition. The pharmacokinetics of terbinafi ne favors its effi cacy in pulse dosing. Objectives: To compare the effi cacy of terbinafi ne in continuous and pulse dosing schedules in the treatment of toenail dermatophytosis. Methods: Seventy-six patients of potassium hydroxide (KOH) and culture positive dermatophyte toenail onychomycosis were randomly allocated to two treatment groups receiving either continuous terbinafi ne 250 mg daily for 12 weeks or 3 pulses of terbinafi ne (each of 500mg daily for a week) repeated every 4 weeks. Patients were followed up at 4, 8 and12 weeks during treatment and post-treatment at 24 weeks. At each visit, a KOH mount and culture were performed. In each patient, improvement in a target nail was assessed using a clinical score; total scores for all nails and global assessments by physician and patient were also recorded. Mycological, clinical and complete cure rates, clinical effectivity and treatment failure rates were then compared. Results: The declines in target nail and total scores from baseline were signifi cant at each follow-up visit in both the treatment groups. However, the inter-group difference was statistically insignifi cant. The same was true for global assessment indices, clinical effectivity as well as clinical, mycological, and complete cure rates. Limitations: The short follow-up in our study may have led to lower cure rates being recorded. Conclusion: Terbinafi ne in pulse dosing is as effective as continuous dosing in the treatment of dermatophyte toenail onychomycosis.

Onicomicosis: epidemiología, agentes causales y evaluación de los métodos diagnósticos de laboratorio / Onychomycoses: epidemiology, causative agents and assessment of diagnostic laboratory methods

Desde marzo de 2007 hasta marzo de 2011 se estudiaron prospectivamente 414 pacientes con onicodistrofias en un laboratorio privado de Esquel. La prevalencia de onicomicosis de pie fue del 78 %; la de mano, del 58 %. Los principales agentes etiológicos fueron Trichophyton rubrum, Candida spp. y Trichophyton mentagrophytes. El desarrollo de dermatofitos prevaleció en las onicopatías de pie y el de Candida spp. en las de uñas de mano (ambos, p < 0,05). En las onicomicosis candidiásicas predominaron especies diferentes a Candida albicans. Las onicomicosis fueron más frecuentes en los hombres que en las mujeres. A su vez, en los hombres hubo más aislamientos de T. rubrum en pies (p < 0,05) y mayor proporción de exámenes directos (ED) y cultivos positivos (ambos, p < 0,05). La correlación entre los resultados del ED y del cultivo fue del 68 %. El rédito de ambos métodos se asoció a un mayor tamaño de la lesión ungueal. El ED fue más efectivo en onicodistrofias que superaban los 5 años de evolución. La positividad del cultivo fue independiente de la cronicidad de la onicodistrofia.

Since March 2007 to March 2011, 414 patients with onychopathies were prospectively analyzed. Prevalence of the toenail and fingernail mycoses was 78 % and 58 %, respectively. The major etiological agents were Trichophyton rubrum, Candida spp. and Trichophyton mentagrophytes. Dermatophytes were more frequently cultured from toenails, whereas Candida spp. from fingernails (both, p < 0.05). In candidal onychomycosis, species different from C. albicans were prevalent. A higher prevalence of toenail and fingernail mycoses, a predominance of T. rubrum in toenails (p < 0.05), and greater positivity in the direct examination (DE) and in culture (both, p < 0.05) were more frequently observed in men than in women. The correlation between DE and culture was 68 %. DE and culture yields were associated with a greater size lesion. DE was more effective in onycodystrophies with duration of more than 5 years. Culture positivity was independent of nail affection chronicity.

Dermatophytes and other skin mycoses found in featherless broiler toe webs

Feartherless broilers which are produced by a complex breeding programme from feathered parents carrying the Sc-gene, dissipates excessive body heat under hot and humid conditions. It has high body weight, and grows very rapidly when compared with standard commercial broilers. Their toe webs are bigger than standard commercial broilers, and could harbor fungi which can cause infections where there is the opportunity. To isolate and identify the presence of fungi in toe webs of featherless broilers. A total of 50 featherless broilers' toe webs samples were examined microscopically for the presence of fungi. The samples were examined microscopically and culturally using standard microbiological techniques. The fungi recovered were as follows. Microsporum gypseum 9 [22%], Trichophyton mentagrophytes var. mentagrophytes 5 [12%], Microsporum gallinae 3 [7%], Aspergilus flavus 10 [24%], Fusarium sp 6 [15%], Alternaria alternata 3 [7%] Scopulariopsis brevicaulis 2 [5%] and Candida albicans 3 [7%], The featherless broilers' toe webs habour fungi which cause mycotic skin disease and cannot be regarded as ordinary normal flora of toe webs

Ecthyma gangrenosum: a rare cutaneous manifestation caused by pseudomonas aeruginosa without bacteraemia in a leukaemic patient--a case report.

Ecthyma gangrenosum is a rare and invasive cutaneous infection caused by Pseudomonas aeruginosa in the majority of cases, typically affecting immunocompromised patients, particularly those with neutropenia. We report a rare case of ecthyma gangrenosum in the absence of bacteraemia presenting as a solitary necrotic ulcer in a female patient with acute lymphoblastic leukaemia. A culture from the ecthyma lesion revealed the presence of Pesudomonas aeruginosa, but the results of repeated blood cultures were negative. The patient responded well to amikacin to which the isolate was susceptible in vitro. Considering high rate of mortality, early diagnosis and prompt effective treatment is mandatory.

Pattern of bacteria and fungi growth in the non-insulin dependent diabetes mellitus'toe webs

To assess the growth of bacteria and fungi in the Non Insulin Dependent Diabetes Mellitus [NIDDM] toe webs and to correlate with the glycaemic control and to frequent feet washing. Sixty one NIDDM patients [28 males, 33 females] with a mean age of 51.7 years, and mean diabetes duration of 7 years [0.5-30 years]. Compared with 29 non-diabetic healthy subjects as a control group with mean age 45.5 years, were randomly selected, evaluated and examined in the Endocrine Clinic - KHMC for skin peripheral pulse status. Skin scrapings were taken from both 4th toe webs regardless of the presence or absence of any lesion. These were cultured on Saboroud's dextrose and blood agar media. Gram stain and lactophenol cotton blue stain were also obtained. Venous blood for blood sugar and HbA 1c was also extracted. HbA 1c was considered as a measure of control. Levels < 7% were considered good control, 7.1-9.5% fair control, > 9.5% poor control. In the NIDDM group, there were 21 [34.4%] patients with superficial skin lesions over the fourth toe web, 28 [45.9%] were having absent tibialis posterior and dorsalis pedis pulses bilaterally and 5 unilaterally. 55.7% were having associated diseases and 80.33% were using frequent foot washings for religious purposes. Seventeen patients were having good control of their diabetes, 29 fair control and 15 with poor control. The mean HbA1c was 8.68 +/- 1.16 [ +/- SD]. In the control group 2 were having skin lesions and 75.86% were using frequent foot washings. 7.4% of the diabetic sample were having positive cultures, gram positive cocci, candida albicans, mixed growth of gram positive and negative, gram negative cocci and dermatophytes in decrescendo manner were obtained [19.7%, 14.7%, 13.2%, 4.9%, 4.9% versus 6.9% in the control group [Candida Albicans 100%] P <0.05. All patients with poor glycaemic control were having positive cultures, versus 41.7% with fair control and 47% with good glycaemic control P<0.001. None of the patients with dermatophytes were having intact skin, while 55% of patients with candida were having superficial lesions. Positive cultures with normal skin occurred in 27.9% in NIDDM group versus 6.9% in control group, and with toe lesions in 29.5% in NIDDM group, versus none in control group P <0.05. 61.2% of feet washers in NIDDM group have positive cultures versus 4.5% in control group. Diabetic patients have a higher carriage rate of both bacteria and fungi which increases with skin breakdown. Susceptibility of infection in increased by poor glycaemic control. Diabetes does not predispose to the carriage of dermatophytes in the toe webs of normal appearance. Frequent feet washing predisposes more to infection in diabetics and needs special attention

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.

Aspectos microbiológicos dos espaços interdigitais dos pés: V. Flora microbiana aeróbica em lesöes secas e úmidas / Microbiological aspects of the toewebs: V. Aerobic microbial flora in dry and most lesions

O conhecimento da flora microbiana aeróbia das lesöes intertriginosas dos pés levou os autores a investigar eventuais diferenças entre os componentes microbianos nas lesöes secas e úmidas e também nas lesöes exulceradas com o objetivo de correlacionar a alteraçäo clínica com a composiçäo desta microflora