Antibiotic resistance of ESKAPE group-microorganisms in health institutions from Hermosillo and Ciudad Obregón, Sonora, México.

Introduction: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. are microorganisms referred as the ESKAPE group pathogens. These microorganisms have generated great concern in health institutions around the world since most of them have resistance to multiple antibiotics and cause most infections associated with healthcare, as well as community infections. The aim of this study was the analysis of antibiotic resistance in microorganisms of the ESKAPE group, recovered from clinical samples in 11 health institutions from Hermosillo and Ciudad Obregón in the State of Sonora, México, during the period from 2019 to 2020. Methods: A cross-sectional, descriptive, observational, and temporality epidemiological study was carried out. A comparative and statistical analysis of antibiotic resistance was carried out using the chi-square test, and small values were analyzed using Fisher's exact test p ≤ 0.05. Results and discussion: All the ESKAPE group microorganisms showed significant differences in antibiotic resistance percentages between both cities. High resistance percentages for some antibiotics, like cephalosporins and ciprofloxacin were detected for Klebsiella pneumoniae and Acinetobacter baumannii.

Trauma craneoencefálico penetrante / Penetrating traumatic brain injury

El trauma craneoencefálico tiene relevancia a nivel global, con incidencia mundial estimada de 200 casos por 100 000 personas, generando una carga importante también para el sistema de salud de Latinoamérica. El objetivo del presente documento es describir la experiencia exitosa en un Centro de Trauma en la atención de un paciente con trauma craneoencefálico penetrante con objeto a "baja velocidad", un destornillador, realizándose además una sucinta revisión acerca de la literatura relacionada actual.

Trauma brain injury has relevance at the global level, with worldwide estimated incidence of 200 cases per 100 000 people, also generating a significant burden to the health system in Latin America. The aim of this document is to describe the successful experience in a Trauma Center in the management of a patient with penetrating brain trauma injury secondary to a "low speed" object, a screwdriver, in addition a concise review about the current related literature is performed.

Molecular characterization and expression analysis of the chicken-type and goose-type lysozymes from totoaba (Totoaba macdonaldi).

Lysozymes play a key role in innate immune response to bacterial pathogens, catalyzing the hydrolysis of the peptidoglycan layer of bacterial cell walls. In this study, the genes encoding the c-type (TmLyzc) and g-type (TmLyzg) lysozymes from Totoaba macdonaldi were cloned and characterized. The cDNA sequences of TmLyzg and TmLyzc were 582 and 432 bp, encoding polypeptides of 193 and 143 amino acids, respectively. Amino acid sequences of these lysozymes shared high identity (60-90%) with their counterparts of other teleosts and showed conserved functional-structural signatures of the lysozyme superfamily. Phylogenetic analysis indicated a close relationship with their vertebrate homologues but distinct evolutionary paths for each lysozyme. Expression analysis by qRT-PCR revealed that TmLyzc was expressed in stomach and pyloric caeca, while TmLyzg was highly expressed in stomach and heart. These results suggest that both lysozymes play important roles in defense of totoaba against bacterial infections or as digestive enzyme.

Genotoxic Effects of Aluminum Chloride and Their Relationship with N-Nitroso-N-Methylurea (NMU)-Induced Breast Cancer in Sprague Dawley Rats.

Recently, soluble forms of aluminum for human use or consumption have been determined to be potentially toxic due to their association with hepatic, neurological, hematological, neoplastic, and bone conditions. This study aims to assess the genotoxic effect of aluminum chloride on genomic instability associated with the onset of N-nitroso-N-methylurea (NMU)-induced breast cancer in Sprague Dawley rats. The dietary behavior of the rats was assessed, and the concentration of aluminum in the mammary glands was determined using atomic absorption spectroscopy. Genomic instability was determined in the histological sections of mammary glands stained with hematoxylin and eosin. Moreover, micronucleus in peripheral blood and comet assays were performed. The results of dietary behavior evaluation indicated no significant differences between the experimental treatments. However, aluminum concentration in breast tissues was high in the +2000Al/-NMU treatment. This experimental treatment caused moderate intraductal cell proliferation, lymph node hyperplasia, and serous gland adenoma. Furthermore, micronucleus and comet test results revealed that +2000Al/-NMU led to a genotoxic effect after a 10-day exposure and the damage was more evident after a 15-day exposure. Therefore, in conclusion, genomic instability is present and the experimental conditions assessed are not associated with breast cancer.

Berberine as Source of Antiproliferative Hybrid Compounds: In Vitro Antiproliferative Activity and Quantitative Structure-activity Relationship.

BACKGROUND: Despite advances for cancer treatment, it still remains a major worldwide public health problem. Compounds derived from natural sources are important alternatives to combat this mortal disease. Berberine is an isoquinoline alkaloid with a wide variety of pharmacological properties, including antiproliferative activity. Previously, we have found that fatty acids also show antiproliferative activity against cancer cell lines.. OBJECTIVE: To combine berberine and fatty acids, or carboxylic acids, in order to improve their antiproliferative properties. METHODS: We synthetized six new hybrid derivatives through a simple methylenedioxy group-cleavage method followed by the reaction with fatty acids, or carboxylic acids. The structure of the compounds was elucidated by IR, NMR and HRMS. The in vitro antiproliferative activity against four human cancer cell lines (HeLa, A-549, PC-3 and LS-180) and one normal cell line (ARPE-19), was evaluated by the MTT method. Chemical structures were drawn using SPARTAN '08 software and the conformational analysis was carried out with a molecular mechanic level of theory and the SYBIL force field. All molecular structures were subjected to geometrical optimization at the semi-empirical method PM3. Molecular descriptors were calculated using DRAGON 5.4 and SPARTAN ´08 programs. RESULTS: The geranic acid and berberine hybrid compound (6) improved the antiproliferative activity shown by natural berberine, even more than the 16- to 18-carbon atoms fatty acids. Compound 6 showed IC50 values of 2.40 ± 0.60, 1.5 ± 0.24, 5.85 ± 1.07 and 5.44 ± 0.24 µM, against HeLa, A-549, PC-3 and LS-180 human cancer cell lines, respectively. Using this information, we performed a quantitative structure-activity relationship (QSAR) of the hybrid molecules and found that the molecular descriptors associated with the antiproliferative activity are: hydrophobic constant associated with substituents (π(A) = 6.5), molecular volume descriptor (CPKvolume≈ 700 Å3), EHOMO, number of rotatable bonds (RBN) and number of 6-membered rings (nR06). CONCLUSION: The methylendioxy and methoxyl groups in berberine are important for the antiproliferative activity shown by its derivatives. Better results in antiproliferative activity were obtained in compound 6 with the prenyl moiety. The QSAR indicates that the molecular descriptors which associated positively with the antiproliferative activity are: hydrophobic constant associated with substituents (π(A) = 6.5), molecular volume descriptor (CPKvolume≈ 700 Å3) and EHOMO. This research gave the basis for the design and preparation of new, easily afforded molecules derived from berberine and carboxylic acids, with improved antiproliferative activity.

Antiproliferative and Apoptotic Activities of the Medicinal Plant Ziziphus obtusifolia.

BACKGROUND: Ziziphus obtusifolia is a spiny shrub found in Northwest Mexico desert, with traditional medicinal use to treat several diseases including cancer. OBJECTIVE: The aims of the present study were to evaluate the antiproliferative and apoptotic activities of the aerial parts of this plant. MATERIALS AND METHODS: The methanol extract and its fractions were prepared using several solvents. The antiproliferative activity was evaluated by the (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium) (MTT) assay on HeLa, A549, RAW 264.7, M12.C3.F6, and L-929 cell lines, and the apoptotic activity using Annexin V and (5,50,6,60-tetra-chloro-1,10,3,30-tetra-ethylbenzimidazol-carbocyanine iodide) staining. The most active fraction was further separated by column chromatography. RESULTS: The most active fraction was hexane with an IC50 of 90.4 µg/mL against RAW 264.7, 94 µg/mL against M12.C3.F6, 165.5 µg/mL against HeLa and 187.7 µg/mL against A549 cell lines. In apoptotic activity assays the methanol extract and its n-hexane fraction were found to induce mitochondrial depolarization in HeLa cells (83 and 87% respectively), and both induced the externalization of the phosphatidylserine increasing the percentage of cells in early apoptosis from 1.4% in untreated control cells, to 1.9% and 3.5% for methanol extract and n-hexane fraction-treated cells, respectively, statistically different for the total percentage of apoptotic cells (P < 0.05). CONCLUSIONS: These results show that Z. obtusifolia has antiproliferative and apoptotic activities in vitro and confirms its use in traditional medicine. SUMMARY: The methanol extract and its fractions using several solvents were evaluated in the antiproliferative activity by the MTT assay on HeLa, A549, RAW 264.7, M12.C3.F6, and L-929 cell lines, and the apoptotic activity using Annexin V and (5,50,6,60-tetra-chloro-1,10,3,30-tetra-ethylbenzimidazol-carbocyanine iodide) staining. The most active fraction against cell lines was hexane. In apoptotic activity assays, the methanol extract and its n-hexane fraction were found to induce mitochondrial depolarization. This results we showed that Ziziphus obtusifolia has antiproliferative and apoptotic activities in vitro.Abbreviations Used: DMEM: Dulbecco's modified eagle's medium, DMSO: Dimethyl sulfoxide, MTT: (3-4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium), JC-1: (5,50,6,60-tetra-chloro-1,10,3,30-tetra-ethylbenzimidazol-carbocyanine iodide), FBS: Fetal bovine serum, CAPE: Caffeic acid phenethyl ester, PBS: Phosphate-buffered saline.

Antiproliferative activity of spinasterol isolated of Stegnosperma halimifolium (Benth, 1844).

Cancer is the major cause of death in the world, representing a significant public health problem. Plants have been shown as a great source of secondary metabolites with anticancer activity. The aim of this work was evaluated the antiproliferative activity of the methanolic extracts, chemical fractions and the compound spinasterol isolated of medicinal plant Stegnosperma halimifolium. The methanolic extracts of stem, leaf and stem/leaf was obtained by maceration. The methanolic extract of stem was purified by successive extractions with solvents as n-hexane, ethyl acetate and ethanol. The n-hexane fraction was separated by column chromatographic and monitored by thin layer chromatographic. The compound spinasterol was characterized by 1H NMR, 13C NMR and Mass Spectrometry. Methanolic extracts, chemical, chromatographic fractions and spinasterol was evaluated against RAW 264.7, M12.C3.F6, PC-3, LS-180, A549 and HeLa cancer cell lines by the standardized method MTT for determinate the antiproliferative activity. Methanolic extract of stem shown the better antiproliferative activity against the murine macrophage cancer cell line RAW 264.7. n-Hexane chemical fraction shown antiproliferative activity against human alveolar cancer cell line A549 and RAW 264.7. Was isolated and characterized a compound by NMR 1H and 13C, revealing the presence of sterol spinasterol. Spinasterol shown to have antiproliferative activity against cervical cancer cell line HeLa and RAW 264.7, indicating that spinasterol can be a responsible compound of antiproliferative activity found in the methanolic extract of Stegnosperma halimifolium.

[Detection of Helicobacter pylori in children and adolescents using the monoclonal coproantigen immunoassay and its association with gastrointestinal diseases]. / Detección de Helicobacter pylori en niños y adolescentes mediante coproantígeno monoclonal y su asociación con gastropatías.

BACKGROUND: Infection by Helicobacter pylori (H. pilory) affects 50% of the world population. Simple methods for its detection are now available. OBJECTIVES: To identify H. pylori by using a monoclonal coproantigen technique in paediatric patients, and to determine its association with gastrointestinal diseases. MATERIALS AND METHODS: The study included a total of 110 subjects aged 1 to 18 years. The study variables included: Family history of gastrointestinal disease, age, gender, gastrointestinal symptoms, as well as apparently healthy (asymptomatic) subjects. The monoclonal coproantigen test was performed on stool samples. Two groups, I symptomatic (n=29), and II asymptomatic (n=81) were compared using parametric and non-parametric statistics. RESULTS: Of the 110 patients, 59 (54%) were male. The relationship between a family history of gastritis and a positive for H. pylori, was significant for mothers (p<0.0005), fathers (p<0.0001), and paternal grandfathers (p<0.0001). It was significant for gastric cancer in maternal grandparents (p<0.0178) and paternal grandparents (p<0.0092). The monoclonal coproantigen test was positive in 31 (28.2%) of the subjects. All were positive in group I, and only 2 in group II. A significant positive association was observed between H. pylori and various signs and symptoms, such as epigastric pain (p<0.001), recurrent peri-umbilical pain (p<0.001), bloating (p=0.016), heartburn (p=0.0007), nausea (P=0.0061), diarrhoea (p=0.0389), and constipation (p=0.0019). CONCLUSIONS: H. pylori detection, was positive in 28% of both groups, and showed significant relationships with family gastrointestinal diseases and gastrointestinal symptoms.

In vitro anti-proliferative activity of Argemone gracilenta and identification of some active components.

BACKGROUND: Cancer is one of the leading causes of death worldwide. Natural products have been regarded as important sources of potential chemotherapeutic agents. In this study, we evaluated the anti-proliferative activity of Argemone gracilenta's methanol extract and its fractions. We identified those compounds of the most active fractions that displayed anti-proliferative activity. METHODS: The anti-proliferative activity on different cancerous cell lines (M12.C3F6, RAW 264.7, HeLa) was evaluated in vitro using the MTT colorimetric method. Identification of the active compounds present in the fractions with the highest activity was achieved by nuclear magnetic resonance (NMR) and gas chromatography-mass spectrometry (GC-MS) analyses. RESULTS: Both argemonine and berberine alkaloids, isolated from the ethyl acetate fraction, displayed high anti-proliferative activity with IC50 values of 2.8, 2.5, 12.1, and 2.7, 2.4, 79.5 µg/mL on M12.C3F6, RAW 264.7, and HeLa cancerous cell lines, respectively. No activity was shown on the normal L-929 cell line. From the hexane fraction, a mixture of fatty acids and fatty acid esters of 16 or more carbon atoms with anti-proliferative activity was identified, showing a range of IC50 values of 16.8-24.9, 34.1-35.4, and 67.6-91.8 µg/mL on M12.C3F6, RAW 264.7, and HeLa cancerous cell lines, respectively. On the normal L-929 cell line, this mixture showed a range of IC50 values of 85.1 to 100 µg/mL. CONCLUSION: This is the first study that relates argemonine, berberine, and a mixture of fatty acids and fatty acid esters with the anti-proliferative activity displayed by Argemone gracilenta.

In vitro anti-mycobacterial activity of nine medicinal plants used by ethnic groups in Sonora, Mexico.

BACKGROUND: Sonoran ethnic groups (Yaquis, Mayos, Seris, Guarijíos, Pimas, Kikapúes and Pápagos) use mainly herbal based preparations as their first line of medicinal treatment. Among the plants used are those with anti-tuberculosis properties; however, no formal research is available. METHODS: Organic extracts were obtained from nine medicinal plants traditionally used by Sonoran ethnic groups to treat different kinds of diseases; three of them are mainly used to treat tuberculosis. All of the extracts were tested against Mycobacterium tuberculosis H37Rv using the Alamar Blue redox bioassay. RESULTS: Methanolic extracts from Ambrosia confertiflora, Ambrosia ambrosioides and Guaiacum coulteri showed minimal inhibitory concentration (MIC) values of 200, 790 and 1000 µg/mL, respectively, whereas no effect was observed with the rest of the methanolic extracts at the concentrations tested. Chloroform, dichloromethane, and ethyl acetate extracts from Ambrosia confertiflora showed a MIC of 90, 120 and 160 µg/mL, respectively. CONCLUSIONS: A. confertiflora and A. ambrosioides showed the best anti-mycobacterial activity in vitro. The activity of Guaiacum coulteri is consistent with the traditional use by Sonoran ethnic groups as anti-tuberculosis agent.For these reasons, it is important to investigate a broader spectrum of medicinal plants in order to find compounds active against Mycobacterium tuberculosis.

Antibacterial activity of Sonoran propolis and some of its constituents against clinically significant Vibrio species.

The aim of the present study was to evaluate the anti-Vibrio activity of propolis collected from three different areas of the Sonoran Desert in northwestern, Mexico [Pueblo de Alamos (PAP), Ures (UP), and Caborca (CP)]. The anti-Vibrio spp. activity of Sonoran propolis was determined by the broth microdilution method. UP propolis showed the highest antibacterial activity [minimal inhibitory concentration (MIC(50))<50 µg mL(-1)] against Vibrio spp. (UP>CP>PAP). UP propolis significantly inhibited the growth of Vibrio cholerae O1 serotype Inaba (MIC(50)<50 µg mL(-1)), V. cholerae non-O1 (MIC(50)<50 µg mL(-1)), V. vulnificus (MIC(50)<50 µg mL(-1)), and V. cholerae O1 serotype Ogawa (MIC(50) 100 µg mL(-1)), in a concentration-dependent manner. The UP propolis constituents, galangin and caffeic acid phenethyl ester (CAPE), exhibited a potent growth inhibitory activity (MIC(50) 0.05-0.1 mmol l(-1)) against V. cholerae strains (non-O1 and serotype Ogawa). The strong anti-Vibrio activity of Sonoran propolis and some of its chemical constituents (galangin and CAPE) support further studies on the clinical applications of this natural bee product against different Vibrio spp., mainly V. cholerae.

[Hospital and community-acquired ß-lactamases-producing Escherichia coli and Klebsiella pneumoniae at hospitals in Hermosillo, Sonora]. / Escherichia coli y Klebsiella pneumoniae comunitarias y hospitalarias productoras de ß-lactamasas en hospitales de Hermosillo, Sonora.

OBJECTIVE: To determine the prevalence of extended-spectrum ß-lactamases (ESBL)-producing Esherichia coli and Klebsiella pneumoniae in hospitals of Hermosillo, Sonora, Mexico. MATERIAL AND METHODS: To detect ESBL-production, 1 412 bacterial isolates obtained over a one year period (2008-2009) were analyzed using the double-disk synergy test, with and without clavulanic acid. RESULTS: Hospitalaryacquired ESBL-producing E.coli and K.pneumoniae (31.8% and 35.3%) were isolated with higher prevalence that community-acquired isolates (14.4% and 0.0%) (p<0.005). CONCLUSIONS: Our study shows the presence of ESBL-producing bacteria in the three hospitals.

Escherichia coli y Klebsiella pneumoniae comunitarias y hospitalarias productoras de β-lactamasas en hospitales de Hermosillo, Sonora / Hospital and community-acquired β-lactamases-producing Escherichia coli and Klebsiella pneumoniae at hospitals in Hermosillo, Sonora

OBJETIVO: Determinar la prevalencia de Escherichia coli y Klebsiella pneumoniae productoras de β-lactamasas de espectro extendido (BLEE) en hospitales de Hermosillo, Sonora, México. MATERIAL Y MÉTODOS: Se analizaron 1 412 aislamientos obtenidos durante un año (2008-2009). La detección de productores de BLEE se realizó por el método de sinergia de doble disco con y sin ácido clavulánico. RESULTADOS: Se aislaron E.coli y K.pneumoniae productores de BLEE hospitalarios (31.8 y 35.3 por ciento) con mayor prevalencia que los comunitarios (14.4 y 0.0 por ciento) (p<0.005). CONCLUSIONES: Nuestro estudio demuestra la presencia de microorganismos productores de BLEE en los tres hospitales.

OBJECTIVE: To determine the prevalence of extended-spectrum β-lactamases (ESBL)-producing Esherichia coli and Klebsiella pneumoniae in hospitals of Hermosillo, Sonora, Mexico. MATERIAL AND METHODS: To detect ESBL-production, 1 412 bacterial isolates obtained over a one year period (2008-2009) were analyzed using the double-disk synergy test, with and without clavulanic acid. RESULTS: Hospitalaryacquired ESBL-producing E.coli and K.pneumoniae (31.8 percent and 35.3 percent) were isolated with higher prevalence that community-acquired isolates (14.4 percent and 0.0 percent) (p<0.005). CONCLUSIONS: Our study shows the presence of ESBL-producing bacteria in the three hospitals.

Antimicrobial activity of Northwestern Mexican plants against Helicobacter pylori.

Helicobacter pylori is the major etiologic agent of such gastric disorders as chronic active gastritis and gastric carcinoma. Over the past few years, the appearance of antibiotic-resistant bacteria has led to the development of better treatments, such as the use of natural products. This study evaluated the anti-H. pylori activity of 17 Mexican plants used mainly in the northwestern part of Mexico (Sonora) for the empirical treatment of gastrointestinal disorders. The anti-H. pylori activity of methanolic extracts of the plants was determined by using the broth microdilution method. The 50% minimum inhibitory concentrations ranged from less than 200 to 400 µg/mL for Castella tortuosa, Amphipterygium adstringens, Ibervillea sonorae, Pscalium decompositum, Krameria erecta, Selaginella lepidophylla, Pimpinella anisum, Marrubium vulgare, Ambrosia confertiflora, and Couterea latiflora and were greater than 800 µg/mL for Byophyllum pinnatum, Tecoma stans linnaeus, Kohleria deppena, Jatropha cuneata, Chenopodium ambrosoides, and Taxodium macronatum. Only Equisetum gigantum showed no activity against H. pylori. This study suggests the important role that these plants may have in the treatment of gastrointestinal disorders caused by H. pylori. The findings set the groundwork for further characterization and elucidation of the active compounds responsible for such activity.

Low number of peripheral blood B lymphocytes in patients with pulmonary tuberculosis.

The cellular immune response plays a critical role in the containment of persistent Mycobacterium tuberculosis infection; however, the immunological mechanisms that lead to its control are not completely identified. The goal of this study was to evaluate B (CD19+) and T (CD3+) peripheral blood lymphocyte profiles and T-cell subsets (CD4+ and CD8+) in patients with pulmonary tuberculosis (TB). Percentages (p = 0.02) and absolute numbers (p = 0.005) of B cells were significantly lower in patients with pulmonary TB than in healthy donors. In contrast, percentages (p = 0.12) and absolute numbers (p = 0.14) of T cells were similar in TB patients and healthy donors. No significant differences in percentages of CD4+ (p = 0.19) or CD8+ (p = 0.85) T cells between patients and healthy donors were observed. In summary, patients with pulmonary tuberculosis had a lower number of peripheral blood B lymphocytes than healthy controls.

The role of heparan sulfate on adhesion of 47 and 51 kDa outer membrane proteins of Helicobacter pylori to gastric cancer cells.

Helicobacter pylori is a common gastrointestinal pathogenic bacterium in humans and the usual preference for the stomach's outer membrane proteins (OMPs) are antigens involved in the adhesion process. Through SDS-PAGE and blotting analyses, using horseradish peroxidase-labeled heparan sulfate (HRP-HS) as a probe, we identified H. pylori OMPs with affinity for heparan sulfate (OMP-HS). Biotin-streptavidin bacterial-adhesion assay was used to evaluate participation of OMP-HS in the adhesion of H. pylori to semi-confluent HeLa S3 and Kato III cell monolayers. The results provide evidence that induction of antibodies against 2 OMP-HSs (HSBP-47 and HSBP-51) could reduce binding of H. pylori to both cell lines and induce detachment of cell-bound bacteria from infected cultured cells.

Alternariosis de senos paranasales / Alternariosis of paranasal sinus

Paciente, de sexo femenino , de 47 años de edad, sin antecedentes clínicos de importancia, que presenta una neoformación que ocupa el seno paranasal izquierdo con obstrucción nasal, rinorrea y protrusión del globo ocular del mismo lado. No hay manifestaciones cutáneas. La TC (tomografía computada) muestra una masa ocupante del seno maxilar, etmoides y frontal izquierdo con destrucción de la pared orbitaria, apófisis pterigoides, lámina cribosa del etmoides y desviación del tabique nasal a la derecha. Se efectúa una sinusotomía frontal y del material obtenido se aísla Alternaria alternata. Se realiza tratamiento con anfotericina B, 820 mg dosis total durante un mes. Continúa en forma ambulatoria con grisepfulvina 2 g por día. Finaliza a los dos meses con involución total de las lesiones y controlada por la TC. hasta la fecha no se ha demostrado en nuestra paciente signos de inmunodeficiencia

Alternariosis de senos paranasales / Alternariosis of paranasal sinus

Paciente, de sexo femenino , de 47 años de edad, sin antecedentes clínicos de importancia, que presenta una neoformación que ocupa el seno paranasal izquierdo con obstrucción nasal, rinorrea y protrusión del globo ocular del mismo lado. No hay manifestaciones cutáneas. La TC (tomografía computada) muestra una masa ocupante del seno maxilar, etmoides y frontal izquierdo con destrucción de la pared orbitaria, apófisis pterigoides, lámina cribosa del etmoides y desviación del tabique nasal a la derecha. Se efectúa una sinusotomía frontal y del material obtenido se aísla Alternaria alternata. Se realiza tratamiento con anfotericina B, 820 mg dosis total durante un mes. Continúa en forma ambulatoria con grisepfulvina 2 g por día. Finaliza a los dos meses con involución total de las lesiones y controlada por la TC. hasta la fecha no se ha demostrado en nuestra paciente signos de inmunodeficiencia (AU)

Zigomicosis rinocerebral: manifestaciones cutáneo-mucosas / Rhinocerebral zygomycosis: mucocutaneous manifestations

Paciente, sexo masculino, 49 años de edad, con antecedentes de tabaquismo, alcoholismo crónico, hepatopatía y diabetes metacorticoidea. Previo episodio de cetoacidosis diabética es internado, presentando rinorrea acuosa de fosa nasal izquierda, parestesia fronto-orbitaria, ptosis palpebral con exoftalmía y ceguera unilaterales izquierdas. En paladar duro del mismo lado, se observa una úlcera de gran tamaño cubierta por tejido necrótico secretante y de olor fétido. La tomografía computada evidencia una masa ocupante en cavidad sinusal y maxilar iszquierda. En el examen micológico de tejido de paladar se observan abundantes filamentos, gruesos, no tabicados con características de un Mucoral. Los cultivos en Sabouraud permiten identificar el agente causal como Rhizopus sp. Inicia tratamiento con Anfotericina B, completando 225 mg dosis total hasta su fallecimiento

Zigomicosis rinocerebral: manifestaciones cutáneo-mucosas / Rhinocerebral zygomycosis: mucocutaneous manifestations

Paciente, sexo masculino, 49 años de edad, con antecedentes de tabaquismo, alcoholismo crónico, hepatopatía y diabetes metacorticoidea. Previo episodio de cetoacidosis diabética es internado, presentando rinorrea acuosa de fosa nasal izquierda, parestesia fronto-orbitaria, ptosis palpebral con exoftalmía y ceguera unilaterales izquierdas. En paladar duro del mismo lado, se observa una úlcera de gran tamaño cubierta por tejido necrótico secretante y de olor fétido. La tomografía computada evidencia una masa ocupante en cavidad sinusal y maxilar iszquierda. En el examen micológico de tejido de paladar se observan abundantes filamentos, gruesos, no tabicados con características de un Mucoral. Los cultivos en Sabouraud permiten identificar el agente causal como Rhizopus sp. Inicia tratamiento con Anfotericina B, completando 225 mg dosis total hasta su fallecimiento (AU)