RESUMO
BACKGROUND: Many methods and medications had been tried for the treatment of chromoblastomycosis with unsatisfactory results. Recently, there were several reports showing a good response of chromoblastomycosis to itraconazole, but it took as long as 18-30 months for lesions to heal. METHODS: Itraconazole, 200 to 400 mg/day alone or in combination with monthly liquid nitrogen cryotherapy, was tried on 10 cases of chromoblastomycosis, caused by Fonsecaea pedrosoi in order to increase the potency of the drug and shorten the duration of treatment. RESULTS: The 10 cases included five newly diagnosed and five recalcitrant cases. Two patients were cured by 200 mg/day alone within 3 months. Seven patients required itraconazole, 400 mg/day, with combined cryotherapy to cure the lesions within 5 to 10 months. One case showed marked improvement but no cure. After the period of 1-year follow-up, only one case had a recurrent infection. CONCLUSIONS: Itraconazole was highly effective and may be useful in the treatment of chromoblastomycosis. A high dose is indicated in chronic fibrotic lesions in combination with liquid nitrogen cryotherapy, with higher efficacy and quicker healing than with medication alone.
Assuntos
Antifúngicos/uso terapêutico , Cromoblastomicose/terapia , Crioterapia , Itraconazol/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Cromoblastomicose/patologia , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Dermatomicoses/diagnóstico , Dermatomicoses/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cromoblastomicose/diagnóstico , Cromoblastomicose/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucormicose/diagnóstico , Mucormicose/terapia , Rinosporidiose/diagnóstico , Rinosporidiose/terapia , Esporotricose/diagnóstico , Esporotricose/terapiaAssuntos
Fungos/enzimologia , Fungos/patogenicidade , Aciltransferases/análise , Aciltransferases/química , Sequência de Bases , Clonagem Molecular , Endopeptidases/análise , Endopeptidases/metabolismo , Fungos/genética , Lipase/análise , Lipase/metabolismo , Lisofosfolipase/análise , Lisofosfolipase/química , Dados de Sequência Molecular , Complexos Multienzimáticos/análise , Complexos Multienzimáticos/químicaRESUMO
An extracellular proteinase from a fast-growing strain of Hendersonula toruloidea was demonstrated when it was cultivated in liquid medium containing bovine serum albumin as the sole nitrogen source. Purification to homogeneity of the proteinase was performed by carboxymethyl cellulose, CM Sephadex G-50, and Sephacryl S-200 column chromatographies. The purified enzyme was a chymotrypsinlike serine proteinase, as indicated by the strong inhibitory activities of diisopropyl fluorophosphate, phenylmethylsulfonyl fluoride, L-1-tosylamido-2-phenylethylchloromethyl ketone, and chymostatin and good kinetic constants for a synthetic substrate, Suc-Ala-Ala-Pro-Phe-MCA. The enzyme had a pI of 8.4, a pH optimum of 9.0, and a molecular weight of 34,000. Skin constituents such as stratum corneum and nail, but not hair, were easily digested by this enzyme. Thus, this extracellular proteinase may play a role in the invasion of thickly keratinized skin and nail by this organism.
Assuntos
Arthrodermataceae/enzimologia , Endopeptidases/isolamento & purificação , Sequência de Aminoácidos , Arthrodermataceae/efeitos dos fármacos , Ácido Edético/farmacologia , Eletroforese em Gel de Poliacrilamida , Etilmaleimida/farmacologia , Concentração de Íons de Hidrogênio , Cinética , Dados de Sequência Molecular , Especificidade por Substrato , alfa-Macroglobulinas/farmacologiaRESUMO
Hendersonula toruloidea infection is present in Thailand, where the clinical picture of tinea pedis is scales 61%, erythema 22%, maceration 10.8%, and hyperkeratosis 9%. The diagnosis was confirmed by repeated isolation of H. toruloidea. The slow-growing type was found more often than the fast-growing in the ratio of 2.8:1. In patients with H. toruloidea infection, skin test with Hs antigen of 1:10 was positive. Griseofulvin sensitivity test revealed that the MIC of 20 cultures was more than 100 micrograms/ml. Only 2 out of 93 cases (0.02%) were cured with half-strength Whitfield ointment for 4 months. Pathomechanism of the infection is being studied.
