Histoplasmosis in Rio Grande do Sul, Brazil: a 21-year experience.

Of 156 cases of histoplasmosis observed in the State of Rio Grande do Sul (Brazil), during a 21-year period (1978-1999) 137 were included in this study. Sixty-seven per cent of the patients had hematogeneous disseminated histoplasmosis, 24% had a self-limited syndrome (acute pulmonary histoplasmosis, histoplasmoma or primary pulmonary lymph node complex), and 9 per cent had chronic pulmonary histoplasmosis. Clinical, mycological, and epidemiological data were reviewed and commented.

Sporotrichosis in patient with AIDS: report of a case and review.

Although sporotrichosis is not an AIDS-defining infection, reports of sporotrichosis in individuals infected with HIV are increasing. We report an unusual case of this co-infection in a man with progressive deep cutaneous ulcerations with numerous pleomorphic yeast cells of Sporothrix schenckii. In addition a review of the literature on this subject was carried out and commented upon.

Cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii.

A case of cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii in an immunocompetent host is presented. In addition a review of the literature on this subject was carried out and a brief comment made on occurrence of the variety gattii in Brazil.

Possible primary ecological niche of Cryptococcus neoformans.

To study hollows of living trees as natural habitats of Cryptococcus neoformans in an endemic area of cryptococcosis in the northeastern region of Brazil, samples of decaying wood were collected inside 32 hollows of living trees and plated on niger seed agar. Identification of C. neoformans was based upon morphological and physiological tests. Canavanine-glycine-bromothymol medium was used to screen the varieties and Crypto Check Iatron Kit to serotype the isolates. A total of 123 C. neoformans colonies were recovered from samples of six (18.5%) out of 32 hollow trees. C. neoformans var. neoformans and C. neoformans var. gattii were found occurring alone (pink shower tree, fig tree and pottery tree) or sharing the same hollow (pink shower tree). Long lasting positivity (19-36 months) and significant number of cfu of C. neoformans per gram of decaying wood (0.15-21.7 x 10(3) cfu g(-1)) inside hollows of pink shower tree, fig tree and pottery tree were observed, indicating colonization of these habitats by the fungus. For the first time, C. n. var. neoformans and C. n. var. gattii were found sharing the same natural biotope, thus establishing a possible link between them in their life cycle in nature and suggesting the primary natural niche for the species.

Paracoccidioidomycosis of the male genital tract. Report of eleven cases and a review of Brazilian literature.

Eleven cases of involvement of the genital tract in paracoccidioidomycosis were collected in a retrospective study of the clinical records of 683 patients seen in Porto Alegre, Rio Grande do Sul, Brazil. These cases are herein summarily reported. Eighteen similar cases were gathered in review of the Brazilian literature. Obtained data are discussed.

Chronic pulmonary histoplasmosis in the State of Rio de Janeiro, Brazil.

Three cases of chronic pulmonary histoplasmosis affecting aged patients with chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lung lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion test and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of Histoplasma capsulatum var. capsulatum in selective media. The treatment was carried out with amphothericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed. In addition data on the epidemiology of histoplasmosis in the state of Rio de Janeiro, Brazil, were presented.

Peritonitis by scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis.

A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection.

Widespread cutaneous lesions due to Sporothrix schenckii in a patient under a long-term steroids therapy.

A case of sporotrichosis in a woman presenting 63 cutaneous lesions distributed all over the tegument is related. The patient had both humoral (Immunoglobulins) and cellular (Lymphocytes subpopulations) immunity within normal limits, but was under treatment with steroid during a long time (Prednisone 10 mg daily for 2 years), due to a sciatic pain. In addition a review of the Brazilian literature on this type of lesions was carried out and commented.

Eumycetoma by Madurella grisea. Report of the first case observed in the southern Brazilian region.

The first case of eumycetoma by Madurella grisea occurred in Southern Brazilian Region is herein related. In addition, Brazilian literature on this subject was reviewed and, the geographic distribution of this eumycetoma is presented.

Cryptococcosis due to Cryptococcus neoformans var. gattii in Brazilian patients with AIDS. Report of three cases.

Three cases of Cryptococcus neoformans var. gattii infection in AIDS patients observed in Rio Grande do Sul (Brazil) are related. A brief comment on the epidemiology of cryptococcosis in Brazil is also made.

Mycetoma caused by Exophiala jeanselmei. Report of a case successfully treated with itraconazole and review of the literature.

We report a case of black grain mycetoma in a 74-years-old man who presented with a 50-yr. history of sinus-tract formation in the right foot. This is the first case of an Exophiala jeanselmeimycetoma successfully treated with itraconazole. In addition a review of the literature on this subject was done.

Paracoccidioidomycosis in children in the state of Rio de Janeiro (Brazil). Geographic distribution and the study of a "reservarea".

Thirty six cases of acute disseminated paracoccidioidomycosis in 3 to 12 year-old children, natives of the state of Rio de Janeiro, were seen in the period 1981-1996. All patients were residents in the rural region of 15 counties, scattered on the Southwestern part of this state. The rural region of two neighboring counties, where 16 cases (44.4%) occurred, was visited. It exhibited the environmental conditions that are considered favorable to the survival of P. brasiliensis. The most important of these conditions, abundant watercourses and autochthonous forest, are distributed on well defined and limited areas, in which the dwellings are also localized. Probably, a careful epidemiological study of forthcoming cases of the disease in children may facilitate the search for the micro-niche of the fungus.

Paracoccidioidomycosis in children in the state of Rio de Janeiro (Brazil): geographic distribution and the study of a "reservarea"

No periodo 1981-1996 foram observados 36 casos de paracoccidioidomicose aguda disseminada em criancas, entre 3 e 12 anos de idade, nativas do estado do Rio de Janeiro. Todos os pacientes residiam em regiäo rural, distribuida por 15 municipios localizados na parte sudoeste do estado. Dois municipios vizinhos, onde haviam ocorrido 16 (44,4 por cento) dos casos, foram visitados. Na regiäo rural de ambos, existem as condicöes climáticas e ambientais favoraveis a sobrevivência do P. brasiliensis. Dentre essas condicöes, as mais importantes, abundantes cursos de agua e vegetacao nativa, distribuem-se em areas limitadas e bem definidas. Nessas areas localizam-se, também, as casas dos ruriculas. Provavelmente, um cuidadoso estudo epidemiologico de novos casos, que venham a ocorrer na regiäo, facilitara a busca do nicho do fungom

Pulmonary scedosporiosis.

A case of a solitary pulmonary nodule due to Scedosporium apiospermum (Pseudallescheria boydii) is related. A review of the pertinent literature was done and, in addition, similar lesions caused by other opportunistic fungi are commented.

An unusual presentation of paracoccidioidomycosis in an AIDS patient: a case report.

A case of paracoccidioidomycosis presenting as a solitary pulmonary nodular lesion in a patient with acquired immunodeficiency syndrome (AIDS) is presented. This case illustrates that restricted lung lesions can also be found and diagnosed in immunodeficient patients.

Paracoccidioidomycosis in women.

A retrospective review of paracoccidioidomycosis cases seen between January 1966 to January 1997 revealled 27 of the 627 cases occurred in women (male to female ratio 27.3:1). Data for 23 of these 27 cases demonstrated the protective effect of female hormones.

Subcutaneous scedosporiosis. Report of two cases and review of the literature.

Two cases of subcutaneous scedosporiosis, caused by Scedosporium apiospermum, are reported. Both patients had lesions localized in the forearm: a solitary ulceration in one and a sporotrichoid-like lesion in the other. The literature is reviewed.

Paracoccidioidoma: case record and review.

A case of solitary pulmonary paracoccidioidal lesion-paracoccidioidoma-is related. It is the first reported case in Brazil. The literature on spontaneously regressive lesion of paracoccidioidomycosis is commented upon.

Cerebral phaeohyphomycosis caused by Cladophialophora bantiana in a Brazilian drug abuser.

We present a case of cerebral phaeohyphomycosis caused by Cladophialophora bantiana in an apparently immunocompetent patient with a history of intravenous drug use. The diagnosis was achieved in specimens obtained at necropsy by histological and mycological examination, with subsequent identification of the isolate in culture.

Pulmonary Aspergillus niger intracavitary colonization. Report of 23 cases and a review of the literature.

In this study we have compared clinical data obtained from 40 reported cases of pulmonary Aspergillus niger intracavitary colonization in the literature and those of our series 23 cases. Additionaly six of our cases have been summarized. Our findings revealed a similar occurrence of male sex, active tuberculosis, diabetes mellitus, systemic oxalosis, and lethal outcome in both groups. In conclusion, A. niger is not the most frequent causative agent of saprophytic aspergillosis neither is the most pathogenic species of Aspergillus. Despite that, when pulmonary A. niger intracavitary colonization is associated with diabetes the prognosis is generaly poor, probably due to acute oxalosis.