Mycoses associated with AIDS in the Third World.

Despite advances in diagnosis and treatment, the epidemiological status of the human immunodeficiency virus (HIV) infection is far from under control in most of the developing world. Sub-Saharan Africa, Southeast Asia and India show increased rates of new infections. In Latin America and the Caribbean there were 1.6 million estimated cases of HIV-infected patients at the end of 1997. Fungal diseases have been one of the most relevant diagnoses in relation to the acquired immunodeficiency syndrome (AIDS). Infections due to Candida species and Cryptococcus neoformans var. neoformans are common worldwide. Histoplasma capsulatum, Coccidioides immitis and Penicillium marneffei are important causes of disease in endemic areas. Infection due to Sporothrix schenckii, Blastomyces dermatitidis and Paracoccidioides brasiliensis are uncommon even where they are endemic. Phaeohyphomycetes, hyalohyphomycetes and zygomycetes are still rare as a cause of disease among AIDS patients. However, agents pertaining to these groups, such as Aspergillus spp., have an increasing incidence. Superficial mycoses due to dermatophytes have special features from epidemiological, clinical and therapeutic points of view.

Treatment of tinea pedis interdigitalis with bifonazole, 1% gel.

329 adult patients with tinea pedis interdigitalis, which clinical diagnosis was confirmed by positive direct microscopic examinations and cultures of organisms from the lesions, were enrolled in this open and multicentric study. Informed consent was requested and obtained in each case. The bifonazole, 1% gel, tested was applied topically once daily for 3 weeks. Weekly clinical controls were performed during the treatment period and, at least, two clinical mycological posttreatment assessments were carried out. The evaluation criteria were based on the clinical and mycological findings at the end of the second posttreatment week. According to these criteria, the results obtained were: very good (clinical cure, negative mycology) 276 (84.0%); good (clinical improvement, negative mycology) 32 (9.5%); moderate (clinical improvement, positive mycology) 20 (6.0%), and failure (no clinical and mycological changes) 1 (0.5%). Tolerance was excellent, side effects were not observed in any case.

Prophylaxis of tinea pedis interdigitalis with bifonazole, 1% powder.

With the objectives of determining the effectiveness of bifonazole 1% powder in the prophylactic treatment of tinea pedis interdigitalis and its local tolerance, 200 patients who achieved clinical and mycological cure in another previous trial with bifonazole 1% gel, and who were also reliable in the compliance of the treatment, were included in this study. Informed consent was requested and obtained in each case. This was a multicenter, double-blind, controlled and comparative study of one group (100 patients) treated with bifonazole verum against another group (100 patients) treated with bifonazole placebo. The allocation to each group was performed by randomization. Bifonazole was applied once daily in the morning on both feet, after showering, and inside shoes; patients applied it again when changing shoes or socks during the day. Treatment lasted up to 6 months. During the treatment, patients were clinically and mycologically assessed once a month and, if it was necessary, when signs and/or symptoms of infection reappeared. The evaluation criteria were based on the reinfection, clinically and mycologically demonstrable, during the treatment. 29 patients abandoned the treatment. Reinfection was observed in 57 out of the 171 patients who finished the treatment, 47 reinfections occurred in the placebo group and the remaining 10 in the verum group. Tolerance was excellent, no side effects were observed in any patient.

Enfermedad de Gaucher, hipoplasia de glandulas sebaceas y dermatoficie diseminada (incluyendo tina "capitis" del adulto). Sus vinculaciones. / Gauchers disease, sebaceous glands hypoplasia and disseminated dermatophyte (including tinea capitis of adult). Its links

Se comunica el caso de una paciente de 29 anos con enfermedad de Gaucher diagnosticada hace 6 anos, que presenta una tina capitis, tina "corporis" y onicomicosis por Trychophyton Tonsurans. Pensamos que la tina "capitis" se debe a una asociacion de las alteraciones del estado general (desnutricion, falta de higiene, alteraciones del ciclo menstrual) sumada a la aplasia de glandulas sebaceas encontrada en la biopsia del cuero cabelludo; y la diseminacion del dermatofito la enfermedad de Gaucher con todas sus implicancias. Se analizan los factores condicionantes de las tinas en adultos y se resalta el hallazgo de la aplasia de las glandulas sebaceas del cuero cabelludo. Se propone el estudio histopatologico del cuero cabelludo en todo paciente adulto con tina "capitis"

Enfermedad de Gaucher, hipoplasia de glandulas sebaceas y dermatoficie diseminada (incluyendo tina "capitis" del adulto). Sus vinculaciones. / Gaucher's disease, sebaceous glands hypoplasia and disseminated dermatophyte (including tinea capitis of adult). Its links

Se comunica el caso de una paciente de 29 anos con enfermedad de Gaucher diagnosticada hace 6 anos, que presenta una tina capitis, tina "corporis" y onicomicosis por Trychophyton Tonsurans. Pensamos que la tina "capitis" se debe a una asociacion de las alteraciones del estado general (desnutricion, falta de higiene, alteraciones del ciclo menstrual) sumada a la aplasia de glandulas sebaceas encontrada en la biopsia del cuero cabelludo; y la diseminacion del dermatofito la enfermedad de Gaucher con todas sus implicancias. Se analizan los factores condicionantes de las tinas en adultos y se resalta el hallazgo de la aplasia de las glandulas sebaceas del cuero cabelludo. Se propone el estudio histopatologico del cuero cabelludo en todo paciente adulto con tina "capitis"

Ketoconazole in the treatment of paracoccidioidomycosis and histoplasmosis.

Ketoconazole was given orally to 33 patients with paracoccidioidomycosis and 23 with histoplasmosis. There were 55 men and one woman, and ages ranged from 28 to 67 years. Each patient had either the chronic disseminated or the chronic pulmonary form of disease. The diagnosis was established in 54 patients by culture of Paracoccidioides brasiliensis or Histoplasma capsulatum from lesions and in two patients by the clinical picture and results of serologic tests for histoplasmosis. The initial dosage was 400 mg per day. The dosage was reduced to 200 mg when a cure was achieved. The duration of treatment ranged from two to 18 months. Results of treatment were classified as very good (clinical and serologic cure) in 23 (41%) of the patients; good (clinical cure only) in 28 (50%); fair (partial improvement) in one (2%); and poor (no improvement) in three (5%). The results were not assessable in one patient who did not complete therapy. The three patients who did not respond to treatment had less than or equal to 0.19 microgram of ketoconazole/ml in their blood. The drug was well tolerated, and no side effects were reported.