RESUMO
Coccidioidomycosis is accepted as being noncontagious because the infectious arthroconidial form of Coccidioides immitis is not produced in humans and other mammalian hosts. However, disseminated coccidioidomycosis developed in a veterinarian who autopsied a horse with disseminated disease but without draining lesions or productive cough. We postulate transmission occurred by inhalation of tissue-phase endospores aerosolized in the course of dissection.
Assuntos
Autopsia/veterinária , Coccidioidomicose/transmissão , Doenças Profissionais/etiologia , Medicina Veterinária , Adulto , Anfotericina B/uso terapêutico , Animais , Coccidioides/isolamento & purificação , Coccidioidomicose/tratamento farmacológico , Coccidioidomicose/veterinária , Doenças dos Cavalos/transmissão , Cavalos , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/etiologia , Masculino , Meningite Fúngica/tratamento farmacológico , Doenças Profissionais/tratamento farmacológico , Esporos FúngicosRESUMO
Miconazole at dosages up to 30 mg/kg/day was given intravenously to seven patients with complicated courses of disseminated coccidioidomycosis. Six had received treatment with amphotericin B previously and five of these patients could be evaluated for the efficacy of the treatment. In three patients the condition failed to respond to therapy, another patient required intratracheal administration of amphotericin B later, and the fifth patient had an equivocal response to treatment. Severe phlebitis, pruritus, nausea, vomiting, hyperlipidemia, and thrombocytosis were frequent side effects. These limited unfavorable results indicate that until controlled studies demonstrate its safety and efficacy, therapy with miconazole should be reserved for highly selected patients with disseminated coccidioidomycosis who cannot receive amphotericin B.
Assuntos
Coccidioidomicose/tratamento farmacológico , Imidazóis/uso terapêutico , Miconazol/uso terapêutico , Adulto , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Avaliação de Medicamentos , Humanos , Infusões Parenterais , Injeções Intraventriculares , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Meningite/tratamento farmacológico , Miconazol/administração & dosagem , Miconazol/efeitos adversos , Pessoa de Meia-IdadeRESUMO
Trichosporon is a frequent cause of superficial mycotic infections but has rarely been associated with invasive disease. A patient undergoing bone marrow transplantation who died from disseminated Trichosporon capitatum infection with endocarditis is reported, and the clinical spectrum of human infection caused by fungi of this genus is reviewed. To our knowledge, this is the first reported case of clearly invasive disease caused by this specific organism and emphasizes the expanding spectrum of unusual infections in the severely immunosuppressed patient.
