Mucormycosis in children: a study of 22 cases in a Mexican hospital.

We present a single-centre, retrospective study (1985-2012) of 22 cases of mucormycosis in children. A total of 158 mucormycosis cases were identified, of which 22 (13.96%) were children. The mean age of the children was 10.3 years (range: 6 months-18 years), and 59% of the infections occurred in males. The rhinocerebral form was the main clinical presentation (77.27%), followed by the primary cutaneous and pulmonary patterns. The major underlying predisposing factors were diabetes mellitus in 68.18% of the patients and haematologic diseases in 27.7% of the patients. The cases were diagnosed by mycological tests, with positive cultures in 95.4% of the patients. Rhizopus arrhizus was the foremost aetiologic agent in 13/22 cases (59.1%). In 21 cultures, the aetiologic agents were identified morphologically and by molecular identification. In 10 cultures, the internal transcribed spacer region of the ribosomal DNA was sequenced. Clinical cure and mycological cure were achieved in 27.3% cases, which were managed with amphotericin B deoxycholate and by treatment of the underlying conditions.

Mycetoma: experience of 482 cases in a single center in Mexico.

Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

Trichomycosis (trichobacteriosis): clinical and microbiological experience with 56 cases.

BACKGROUND: Trichomycosis is asymptomatic bacterial infection of the axillary hairs caused by Corynebacterium sp. OBJECTIVE: to bring a series of cases of trichomycosis, its clinical and microbiological experience. MATERIALS AND METHODS: This report consists in a linear and observational retrospective study of 15 years of cases of trichomycosis confirmed clinically and microbiologically. RESULTS: Fifty six confirmed cases of trichomycosis were included in this report. The majority were men 53/56 (94.6%), mean age was 32.5 years. The most commonly affected area was the axilla (92%), trichomycosis flava was the principal variant 55/56 (98.2%) and signs and symptoms associated were hyperhidrosis (87.5%), hairs' texture change (57.1%) and odor (35.7%). Bacterial concretions were observed in all cases, and the predominant causative agent in 89.3% of all cases was Corynebacterium sp. Thirty patients were included in therapeutic portion of the study, and 28 (93.3%) of them experienced a clinical and microbiological cure. CONCLUSION: Trichomycosis is asymptomatic, superficial infection, which primarily affects axillary hairs.

Tinea versicolor, tinea nigra, white piedra, and black piedra.

Superficial mycoses are fungal infections limited to the stratum corneum and its adnexal structures. The most frequent types are dermatophytoses or tineas. Tinea versicolor involves the skin in the form of hypochromic or hyperchromic plaques, and tinea nigra affects the skin of the palms with dark plaques. White piedra and black piedra are parasitic infections of scalp hairs in the form of concretions caused by fungal growth. Diagnosis of these mycoses is made from mycologic studies, direct examination, stains, and isolation, and identification of the fungi. Treatment includes systemic antifungals, topical antifungals, and keratolytics.

[Majocchi's granuloma]. / Granuloma de Majocchi.

Majocchi's granuloma or dermatophytic granuloma is a mycosis observed among immunocompetent and immunocompromised patients caused by dermatophytes, particularly Trichophyton rubrum, which may be responsible for 50% of cases. The mechanism by which it occurs is yet unknown although reports suggest it may occur after localized trauma that alters the hair follicle and enables the entrance of the microorganism. Diabetes and the use of topical steroids are among some of the predispEl cuadro 1 no está acotado. Favor de hacerloEl cuadro 1 no está acotado. Favor de hacerloosing factors. Majocchi's granuloma has two clinical presentations, among immunocompetent patients it displays follicular papules and among immunocom-promised patients a subcutaneous nodular type is observed. Diagnosis is confirmed through histopathology, where granulomas and dermatophytes in the form of filaments or spores are observed in the mid and deep dermis. Treatment includes systemic antimycotics. We reviewed the etiopathogenic, clinical, histopathological and therapeutic aspects of Majocchi's granuloma.

Granuloma de Majocchi / Majocchi's granuloma

El granuloma de Majocchi o granuloma dermatofítico es una micosis causada por dermatofitos, regularmente del género Trichophyton, predominando T. rubrum en 50%. Se presenta en pacientes inmunocompetentes o inmunodeprimidos. No se sabe cómo se produce la infección, al parecer inicia con trauma físico que guía a alteraciones del folículo piloso y a la introducción pasiva del hongo. Para el desarrollo de la infección se requieren factores predisponentes y desencadenantes, los más importantes son la diabetes y el uso de esteroides. Clínicamente se clasifica en papular perifolicular o superficial en pacientes inmunocompetentes, y en nodular subcutánea o profunda en pacientes con inmunosupresión. Se confirma el diagnóstico por histopatología, encontrando granulomas en dermis media y profunda, con estructuras dermatofíticas en forma de filamentos o esporas. El tratamiento es con antimicóticos sistémicos. Se hace una revisión del tema resaltando los aspectos etiopatogénicos, clínico-patológicos y terapéuticos de la enfermedad.

Majocchi's granuloma or dermatophytic granuloma is a mycosis observed among immunocompetent and immunocompromised patients caused by dermatophytes, particularly Trichophyton rubrum, which may be responsible for 50% of cases. The mechanism by which it occurs is yet unknown although reports suggest it may occur after localized trauma that alters the hair follicle and enables the entrance of the microorganism. Diabetes and the use of topical steroids are among some of the predispEl cuadro 1 no está acotado. Favor de hacerloEl cuadro 1 no está acotado. Favor de hacerloosing factors. Majocchi's granuloma has two clinical presentations, among immunocompetent patients it displays follicular papules and among immunocom-promised patients a subcutaneous nodular type is observed. Diagnosis is confirmed through histopathology, where granulomas and dermatophytes in the form of filaments or spores are observed in the mid and deep dermis. Treatment includes systemic antimycotics. We reviewed the etiopathogenic, clinical, histopathological and therapeutic aspects of Majocchi's granuloma.

Cutaneous sporotrichosis. Intermittent treatment (pulses) with itraconazole.

Sporotrichosis is a subcutaneous and exceptionally deep mycosis caused by a dimorphic fungus, Sporothrix schenckii. Itraconazole is a triazole derivative leading to good results in the treatment of sporotrichosis. Patients with cutaneous sporotrichosis proven with mycological tests (direct examination and culture) were enrolled. All patients underwent laboratory tests (at baseline and on a monthly basis) and received oral itraconazole 400 mg/day for one week with a 3-week break (pulses); thereafter the drug was administered as pulses until clinical and mycological cure was achieved. Five patients with sporotrichosis were enrolled, 4 with cutaneous lymphangitic form and one with fixed cutaneous form. Clinical and mycological cure was achieved in 4/5 cases (80%), with a mean number of pulses of 3.5. No patient had side effects and no laboratory test abnormalities occurred. Intermittent or pulsed itraconazole was effective in treating cutaneous sporotrichosis. It may be considered as a new treatment choice that entails an important reduction in total medication use.

Cytobrush-culture method to diagnose tinea capitis.

This is a comparative study to isolate the dermatophytes of tinea capitis using the cytobrush and comparing it versus the standard method. A prospective, observational, comparative trial of 178 probable cases of tinea capitis was conducted in two dermatological centers. Each patient underwent mycological tests that included direct exam with KOH and cultures with either of two methods: scraping the scalp to remove hair and cell debris, and the cytobrush. A total of 135 clinically and mycologically proven cases of tinea capitis were included; 119 were non-inflammatory and 16 inflammatory tinea. A total of 131 had a positive direct exam and subsequent primary isolation cultures were obtained in 135 cases. The main dermatophytes isolated were Microsporum canis (68%) and Trichophyton tonsurans (20%). A total of 115/135 (85.1%), were detected with the traditional method, with an average of 11.2 days until positive, while the number detected with the cytobrush was 132/135 (97.7%) with an average of 8.5 days until positive. The chi-square statistical method showed that the cytobrush culture was superior to the standard one with a chi-square of 5.078 (P = 0.025), with a statistically significant difference versus the standard method.

Onychomycosis by molds. Report of 78 cases.

A retrospective study of onychomycohosis by molds was carried out during a 14-year period (1992-2005). All cases were clinically and mycologically proven (repetitive KOH and culture) and then each of the molds was identified. A total of 5,221 cases of onychomycosis were evaluated, 78 of which were molds (1.49%). Mean patient age was 44.1 years. 75/78 cases occurred in toenails. Associated factors were detected in 39/78 (50.0%) cases, with the major ones being: peripheral vascular disease, contact with soil, and trauma. The most frequent clinical presentation was distal and lateral subungual onychomycosis (DLSO), in 54/78 cases (69%). The most frequent causative agents were: Scopulariopsis brevicaulis in 34/78 cases and Aspergillus niger in 13/78 cases. Onychomycoses by molds are infrequent; in this study they accounted for 1.49% of cases. The clinical features are virtually similar to those caused by dermatophytes, which makes the clinicomycological tests necessary.