RESUMEN
The present study describes 21 Argentinian patients living in the province of Corrientes, who had developed oral manifestations due to Paracoccidioides brasiliensis infection. Of these, 20 patients were men and one a woman. Patients were of an average age of 39 years (range 25 to 72 years). Approximately, 76.2% of the patients were farmers. Gingival lesions were observed in 76%. Also, the tongue (71%) and the lips (62%) were frequently affected. Cytological smears and histopathology showed the characteristic fungal cells with the characteristic granulomatous inflammatory reaction consisting of lymphocytes, epithelioid cells and giant cells of the Langhans type. All patients except one had detectable pulmonary involvement. Therapy consists of long-term administration of itraconazole. Oral manifestations of paracoccidioidomycosis are characteristic in their clinical presentation. Early diagnosis and adequate therapy may prevent extensive tissue destructions. Long-term follow-up is mandatory.
Asunto(s)
Enfermedades de la Boca/microbiología , Paracoccidioidomicosis , Adulto , Anciano , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Argentina/epidemiología , Femenino , Humanos , Itraconazol/farmacología , Itraconazol/uso terapéutico , Cetoconazol/farmacología , Cetoconazol/uso terapéutico , Enfermedades Pulmonares Fúngicas/microbiología , Ganglios Linfáticos/microbiología , Masculino , Persona de Mediana Edad , Enfermedades Nasales/microbiología , Paracoccidioidomicosis/diagnóstico , Paracoccidioidomicosis/tratamiento farmacológico , Paracoccidioidomicosis/patologíaRESUMEN
Although Candida albicans is the most common human yeast pathogen, other Candida species such as C. krusei are now recognized as emerging agents, especially in patients with human immunodeficiency virus (HIV) disease. C. krusei is inherently resistant to the widely used triazole antifungal fluconazole and poses therapeutic problems, especially in systemic candidiasis. In a surveillance study of leprosy patients (with arrested or burnt-out disease) in a leprosarium in northern Thailand, we found a rate of oral carriage of C. krusei (36 per cent) significantly (P smaller 0.05) higher than that for a healthy control group (10 per cent). Among the Candida-positive patients, 16 of 35 (46 per cent) carried C. krusei, while C. albicans was the second most common isolate (12 of 35 patients; 34 per cent). The corresponding figures for the control group were 2 of 13 (15 per cent) and 6 of 13 (46 per cent), respectively. Studies of the antifungal resistance of the C. krusei isolates from patients indicated that all except one of the isolates were resistant to fluconazole, two isolates were resistant to ketoconazole, and all isolates were sensitive to amphotericin B. Evaluation of their genetic profiles by randomly amplified polymorphic DNA analysis with three different primers and subsequent analysis of the gel profiles by computerized cluster-derived dendrograms revealed that the C. krusei isolates from patients belonged to 10 disparate clusters, despite the origin from a single locale. These nascent findings indicate an alarmingly high prevalence of a Candida species resistant to a widely used antifungal in a part of the world where HIV disease is endemic.