RESUMEN
INTRODUCTION: Trichophyton tonsurans is an anthropophilic dermatophyte, frequent in the USA and in Asia where it is responsible for causing tinea capitis. At present, we attend an emergence of this species in certain regions where it was not or little met. Here, we report a case of onychomycosis of the hand due to T. tonsurans associated with non-albicans Candida species at an adult woman. OBSERVATION: The patient is a 62-year-old woman, with hypertension and diabetes. She reports the rather frequent use of chemical cleaners for the housework. She presented one year previously a distal onycholysis of the last four fingers of the left hand. The clinical examination objectified a presence of intertrigo in the second interdigital space. The mycological examination showed at the direct examination mycelial elements and the culture allowed the isolation of T. tonsurans associated with non-albicans Candida species. DISCUSSION-CONCLUSION: Our observation highlights especially the identification of a species, which has been described only once in Morocco about a case with onychomycosis of the feet. A possible emergence of this species in our country is not far from being possible.
Asunto(s)
Candidiasis Cutánea/complicaciones , Dermatosis de la Mano/diagnóstico , Onicomicosis/diagnóstico , Tiña/complicaciones , Candida/aislamiento & purificación , Candidiasis Cutánea/diagnóstico , Femenino , Dermatosis de la Mano/microbiología , Humanos , Intertrigo/diagnóstico , Intertrigo/microbiología , Persona de Mediana Edad , Marruecos , Onicomicosis/microbiología , Tiña/diagnóstico , Trichophyton/aislamiento & purificaciónRESUMEN
UNLABELLED: Nasal carriage of Staphylococcus aureus may be responsible for some serious infections among hemodialyzed patients. Its pathogenic potential and commensal nature allows for an easy transmission both in and out of hospital environment. PURPOSE: This study was to assess the prevalence of S. aureus nasal carriage, to determine its frequency and nature in hemodialyzed patients of the Rabat Ibn Sina University hospital, in Morocco. PATIENT AND METHOD: The study began in March 2008 according to the following protocol: screening of nasal carriage with five samplings, performed once a month three times, then once a month two times again after an interruption period of three months. Screening was performed weekly during the first month in hemodialyzed patients treated with mupirocin (Bactroban(®) 2%), and then monthly, to monitor the kinetics of S. aureus eradication. RESULTS: The study included 54 hemodialyzed patients with a mean 44.16±14 years of age, sex ratio of 0.54, and mean hemodialysis duration of 118.7±67 months. Permanent and intermittent S. aureus carriage was found in respectively 18.52% and 25.92% of patients. Eighty-one strains of S. aureus were identified, 14.81% of which were methicillin resistant. Eradication was sustained beyond 20 months in patients treated with mupirocin. CONCLUSION: This investigation allowed us to identify hemodialyzed patients at risk, so as to implement the rules of individual and collective hygiene, and to extend mupirocin antibiotic prophylaxis in our hemodialysis unit.
Asunto(s)
Portador Sano/epidemiología , Cavidad Nasal/microbiología , Diálisis Renal , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Administración Intranasal , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Portador Sano/tratamiento farmacológico , Portador Sano/prevención & control , Comorbilidad , Farmacorresistencia Bacteriana Múltiple , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/terapia , Masculino , Tamizaje Masivo , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Marruecos/epidemiología , Mupirocina/administración & dosificación , Mupirocina/uso terapéutico , Prevalencia , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureus/efectos de los fármacosRESUMEN
Atypical forms of visceral leishmaniasis associated with immunosuppressive treatment are difficult to diagnose and cause high mortality. The purpose of this report is to describe a case involving a 42-year-old patient living in a leishmaniasis-endemic area, who was undergoing immunosuppressive treatment using corticosteroids and methotrexate for pemphigus. Despite clinical and laboratory findings consistent with visceral leishmaniasis, detection of Leishmania bodies was a coincidental finding of cytological examination of bone marrow during workup for pancytopenia and associated clinical signs. This case argues in favor of systematic screening for this opportunistic parasitic disease before undertaking immunosuppressive treatment in patients presenting risk factors and consistent clinical/laboratory findings.