RESUMEN
BACKGROUND: The first therapeutic choice for the treatment of cutaneous sporotrichosis is oral itraconazole; however, the increase in cases of zoonotic transmission outbreak necessitates a search for effective and safe treatment alternatives. OBJECTIVE: To evaluate a new potassium iodide (KI) posology as an alternative for the treatment of limited cutaneous forms of sporotrichosis. METHODS: One hundred and two patients with sporotrichosis diagnosed by isolation of Sporothrix sp. were included and were divided into 2 groups that received different doses of KI: group A received the conventional dose, and group B received the reduced dose. The cure criteria were based on clinical and serological data. RESULTS: Seventy-nine patients (77.4%) reached clinical cure: 70.6% and 84.3% of groups A and B respectively. Sixteen patients (15.6%) were lost during follow-up, and seven changed drug therapy: five in group A and two in group B. The incidence of adverse events was similar for both groups (64.7%): predominantly metallic taste (44%), followed by mild gastrointestinal intolerance and acneiform eruption (10.7% each). No serious adverse events occurred, and there were no recurrences. Analysis of the results showed no statistically significant difference between groups (P = 0.9255). The improvement in serologic titres was significant in both treatment groups. CONCLUSION: Through statistical analysis, the usual posology was not shown to be superior to the one proposed in this study. Serology for sporotrichosis may be used as a valuable tool in the clinical monitoring of these patients.
Asunto(s)
Antifúngicos/administración & dosificación , Yoduro de Potasio/administración & dosificación , Esporotricosis/tratamiento farmacológico , Erupciones Acneiformes/inducido químicamente , Adolescente , Adulto , Antifúngicos/efectos adversos , Niño , Preescolar , Erupciones por Medicamentos/etiología , Femenino , Humanos , Masculino , Náusea/inducido químicamente , Yoduro de Potasio/efectos adversos , Pruebas Serológicas , Sporothrix/inmunología , Trastornos del Gusto/inducido químicamente , Resultado del TratamientoRESUMEN
Sporothrix brasiliensis is the main species of the S. schenckii complex implicated in the zoonotic epidemics of sporotrichosis in Rio de Janeiro, Brazil. Epidemiological features have been already described, such as zoonotic transmission by cats and increased frequency of atypical clinical aspects. The involvement of the face by contact with cats is common in childhood; as a result, ophthalmic manifestations have increased. We report a case of acute dacryocystitis in a 9-year-old girl. A calmodulin-based molecular phylogeny was used to identify the agent as S. brasiliensis. This is a rare type of presentation, usually complicated with nasolacrimal duct occlusion. The patient was cured without sequelae after treatment with a low dose of saturated solution of potassium iodide and decompressive oculoplastic surgery. Therapeutic options and considerations of aetiological agents and serology are discussed.
Asunto(s)
Antifúngicos/administración & dosificación , Dacriocistitis/microbiología , Dermatosis Facial/tratamiento farmacológico , Yoduro de Potasio/administración & dosificación , Esporotricosis/tratamiento farmacológico , Enfermedad Aguda , Niño , Terapia Combinada , Dacriocistitis/tratamiento farmacológico , Dacriocistorrinostomía , Dermatosis Facial/cirugía , Femenino , Humanos , Obstrucción del Conducto Lagrimal/tratamiento farmacológico , Obstrucción del Conducto Lagrimal/microbiología , Conducto Nasolagrimal , Procedimientos de Cirugía Plástica , Sporothrix , Esporotricosis/cirugíaRESUMEN
Sporotrichosis is a subacute or chronic fungal infection caused by Sporothrix schenckii, which is commonly acquired by traumatic inoculation of the fungus carried in a contaminated material into the skin. Joint involvement is the most frequent extracutaneous manifestation in immunosuppressed patients. We report the case of an immunocompetent woman who acquired sporotrichosis through the scratch of a sick cat. She presented skin lesions and arthritis possibly because of a hypersensitivity reaction. Treatment resulted in complete cure up to 13 months of clinical and serological follow-up.
Asunto(s)
Artritis/inmunología , Artritis/microbiología , Hipersensibilidad/microbiología , Hipersensibilidad/patología , Sporothrix/aislamiento & purificación , Esporotricosis/complicaciones , Esporotricosis/transmisión , Zoonosis/transmisión , Adulto , Animales , Anticuerpos Antifúngicos/sangre , Antifúngicos/uso terapéutico , Artritis/patología , Enfermedades de los Gatos/microbiología , Enfermedades de los Gatos/transmisión , Gatos , Dermatomicosis/inmunología , Dermatomicosis/microbiología , Dermatomicosis/patología , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina G/sangre , Esporotricosis/inmunología , Esporotricosis/patología , Resultado del Tratamiento , Zoonosis/microbiologíaRESUMEN
BACKGROUND: Tinea capitis, a common clinical pattern of dermatophyte infection in children is becoming a public health hazard in some countries. Several studies have reported terbinafine to be a safe and well-tolerated fungicidal drug for the treatment of this infection. However, the optimal treatment duration for its use in the treatment of tinea capitis caused by Microsporum species has not yet been determined. OBJECTIVE: (i) To establish the optimal duration for terbinafine treatment to bring about complete cure of tinea capitis due to Microsporum infection in a large paediatric population, and (ii) to obtain information on the maximum therapeutic effect of the existing therapy. PATIENTS AND METHODS: This parallel-group, double-blind, multicentre study was conducted in Europe and South America. Patients were randomized to one of four oral terbinafine treatment arms (6, 8, 10 or 12 weeks treatment) or to an open label, 12-week, high-dose griseofulvin (20 mg x kg(-1) x day(-1)) arm at a 1 : 1 : 1 : 1 : 1 ratio. All patients were followed up for 4 weeks after the end of the treatment phase. RESULTS: In this group of 134 intention-to-treat patients, effective treatment was observed at the end of study in 62% of patients treated with terbinafine for 6 weeks and in 63% treated for 8 weeks. Mycological cure was obtained in 59% and 57%, respectively, and clinical cure in 76% and 80%. In the griseofulvin group, effective treatment was 88%, mycological cure was 76% and clinical cure 96%. However, these high rates were believed to be due to the high dosage of this drug and the prolonged course of treatment. Complete cure was observed at the end of study in 62% patients treated with terbinafine for 6 weeks, in 60% treated for 8 weeks and in 84% patients treated with griseofulvin for 12 weeks. CONCLUSIONS: Although there was no statistical trend between the duration of terbinafine treatment within the groups for complete cure at the end of study, there was a positive correlation between the daily dose of terbinafine (mg x kg(-1)) and complete cure. Terbinafine therapy for 6 weeks could represent an alternative to griseofulvin for the treatment of Microsporum tinea capitis. However, further clinical trials are required in order to optimize the dose regimen to allow higher cure rates to be reached.