RESUMEN
Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.
Asunto(s)
Micetoma/epidemiología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Adulto JovenRESUMEN
A 57-year-old male presented with dermatosis of the dorsum of the foot consisting of tumefaction, deformity and sinus tract formation. The direct examination of exudates as well as the biopsy tissue, demonstrated the presence of black granules. A dematiaceous fungus was isolated from the lesions and was identified by ribosomal DNA sequencing as Cladophialophora bantiana. This is the second report of this fungus as an etiologic agent of eumycetoma in humans. Clinical and mycologic cure was achieved after 20 months of treatment with itraconazole at a starting dose of 300 mg/day that was tapered during the course of therapy. The patient's isolate had an itraconazole MIC of 0.012 microg/ml.
Asunto(s)
Antifúngicos/uso terapéutico , Ascomicetos/aislamiento & purificación , Dermatosis del Pie , Itraconazol/uso terapéutico , Micetoma , Ascomicetos/clasificación , Ascomicetos/efectos de los fármacos , Ascomicetos/genética , Dermatosis del Pie/tratamiento farmacológico , Dermatosis del Pie/microbiología , Dermatosis del Pie/patología , Humanos , Masculino , Persona de Mediana Edad , Micetoma/tratamiento farmacológico , Micetoma/microbiología , Micetoma/patología , Resultado del TratamientoRESUMEN
Sporotrichosis is a subcutaneous and exceptionally deep mycosis caused by a dimorphic fungus, Sporothrix schenckii. Itraconazole is a triazole derivative leading to good results in the treatment of sporotrichosis. Patients with cutaneous sporotrichosis proven with mycological tests (direct examination and culture) were enrolled. All patients underwent laboratory tests (at baseline and on a monthly basis) and received oral itraconazole 400 mg/day for one week with a 3-week break (pulses); thereafter the drug was administered as pulses until clinical and mycological cure was achieved. Five patients with sporotrichosis were enrolled, 4 with cutaneous lymphangitic form and one with fixed cutaneous form. Clinical and mycological cure was achieved in 4/5 cases (80%), with a mean number of pulses of 3.5. No patient had side effects and no laboratory test abnormalities occurred. Intermittent or pulsed itraconazole was effective in treating cutaneous sporotrichosis. It may be considered as a new treatment choice that entails an important reduction in total medication use.
Asunto(s)
Antifúngicos/administración & dosificación , Itraconazol/administración & dosificación , Esporotricosis/tratamiento farmacológico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Quimioterapia por Pulso , Esporotricosis/patologíaRESUMEN
Sporotrichosis in an uncommon mycoses in childhood and is generally associated with injuries received as a consequence of farm work. We undertook a retrospective study of sporotrichosis in children and adolescents seen over a 10-year period, focusing on their clinical, epidemiologic, and mycologic features as well as treatment. We included 25 children with a mean age of 9.3 years. Most of those affected were schoolchildren (84%) from rural areas. The main clinical variety of sporotrichosis seen was the lymphocutaneous form (64%), followed by the fixed cutaneous form (36%), and one instance of the disseminated cutaneous form. Most lesions were located on the upper limbs (40%) and the face (36%). Sporothrix schenckii was isolated in all patients and 24 of 25 had a positive sporotrichin skin test. Nineteen patients were treated and cured clinically and mycologically with potassium iodide, three were cured with itraconazole and one with heat therapy.
Asunto(s)
Esporotricosis/diagnóstico , Esporotricosis/terapia , Adolescente , Antifúngicos/uso terapéutico , Niño , Preescolar , Estudios de Cohortes , Humanos , Hipertermia Inducida , Lactante , Itraconazol/uso terapéutico , Yoduro de Potasio/uso terapéutico , Estudios Retrospectivos , Sporothrix , Esporotricosis/microbiología , Resultado del TratamientoRESUMEN
BACKGROUND: Mycetoma is a chronic infection caused by aerobic actinomycetes and filamentous fungi. It is an occupational disease frequent in tropical countries and is uncommon in children. METHODS: A retrospective (25 years) report of mycetomas was conducted in children less than 15 years of age. Each of the cases was studied clinically and proven with microbiologic tests: direct examinations (to identify and classify the grains), cultures and identification based on morphology and biochemical tests. The therapeutic experience of the cases was also reviewed. RESULTS: In a 25-year period, a total of 334 mycetomas were seen at our institution, 15 of which (4.5%) were in patients 15 years of age and younger (mean age: 11.2 years, age range: 6-15 years). Twelve cases were males and 3 females. The main clinical location was the foot in 10 of 15 (66.6%). Etiologies included 13 actinomycetomas and 2 eumycetomas. Etiologic agents were Nocardia brasiliensis in 12 cases, Nocardia asteroides in one and Madurella mycetomatis in 2. Eleven of the13 cases of actinomycetomas treated with trimethoprim-sulfamethoxazole plus diaminodiphenylsulfone were cured. The 2 failures were successfully treated with amoxicillin/clavulanate. One of the eumycetomas was cured with itraconazole therapy, whereas the other failed various treatments eventuating in surgical amputation. CONCLUSIONS: Mycetomas are exceptional in children; in our setting, actinomycetomas are more frequent than eumycetomas. The clinical and microbiologic diagnosis is simple. Overall, treatment response is better for actinomycetomas than for eumycetomas.
Asunto(s)
Madurella/aislamiento & purificación , Micetoma/microbiología , Nocardia/aislamiento & purificación , Adolescente , Niño , Femenino , Enfermedades del Pie/diagnóstico , Enfermedades del Pie/tratamiento farmacológico , Enfermedades del Pie/microbiología , Humanos , Masculino , Micetoma/diagnóstico , Micetoma/tratamiento farmacológico , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Nocardia asteroides/aislamiento & purificación , Estudios RetrospectivosRESUMEN
Tinea imbricata (TI) or Tokelau is a superficial mycosis caused by Trichophyton concentricum, an anthropophilic dermatophyte. It is endemic in some islands of the South Pacific (Polynesia), South-East Asia, Central and South America, and Mexico, and is most often seen in individuals living in primitive and isolated conditions. The skin lesions are characteristically concentric and lamellar (imbricata: in Latin, tiled) plaques of scale. Predisposing conditions include humidity, inheritance, and immunologic factors. The diagnosis is usually made on clinical grounds, supported by skin scrapings and culture. Tokelau is a chronic and highly relapsing disease and, although no first-line treatment exists, best results are obtained with oral griseofulvin and terbinafine and a topical combination of keratolytic ointments, such as Whitfield's. TI is a disease model that allows the correlation of a series of environmental, genetic, immunologic, and therapeutic conditions.
Asunto(s)
Tiña/epidemiología , Tiña/microbiología , Trichophyton , Humanos , México/epidemiología , Tiña/diagnóstico , Tiña/terapiaRESUMEN
Chromoblastomycosis is a subcutaneous mycosis for which there is no treatment of choice but rather, several treatment options, with low cure rates and many relapses. The choice of treatment should consider several conditions, such as the causal agent (the most common one being Fonsecaea pedrosoi ), extension of the lesions, clinical topography and health status of the patient. Most oral and systemic antifungals have been used; the best results have been obtained with itraconazole and terbinafine at high doses, for a mean of 6 - 12 months. In extensive and refractory cases, chemotherapy with oral antifungals may be associated with thermotherapy (local heat and/or cryosurgery). Limited or early cases may be managed with surgical methods, always associated with oral antifungal agents. It is important to determine the in vitro sensitivity of the major causal agents to the various drugs, by estimating the minimum inhibitory concentration, as well as drug tolerability and drug interactions.
Asunto(s)
Antifúngicos/uso terapéutico , Cromoblastomicosis/terapia , Administración Oral , Antifúngicos/administración & dosificación , Cromoblastomicosis/etiología , Cromoblastomicosis/cirugía , Criocirugía , Humanos , Hipertermia Inducida , MéxicoRESUMEN
Tinea barbae is a rare dermatophytosis that affects the hair and hair follicles of the beard and mustache. This paper presents 9 cases of tinea barbae observed over an 18-year period of time and classified as follows: 1 was superficial and 8 were deep (6 folliculitis-like and 2 kerion-like). Most of the cases (4) were associated with topical steroid therapy, others with pet contact (3 cases) and one with diabetes. The causal agents isolated were: Trichophyton rubrum in 3; Microsporum canis in 3; Trichophyton mentagrophytes in 2; and Trichophyton tonsurans in one. The involvement of the hair was observed and classified in all cases. The trichophytin skin reaction was positive in all 9 patients. All the patients were treated with systemic antimycotics, 3 cases with griseofulvin, 1 with ketoconazole, 3 with itraconazole, and 2 with terbinafine. Clinical and mycologic cures were achieved at 6 to 8 weeks of treatment at the usual doses.
Asunto(s)
Dermatosis Facial/epidemiología , Foliculitis/epidemiología , Tiña/epidemiología , Adulto , Antifúngicos/uso terapéutico , Diagnóstico Diferencial , Dermatosis Facial/tratamiento farmacológico , Dermatosis Facial/etiología , Dermatosis Facial/microbiología , Dermatosis Facial/patología , Foliculitis/tratamiento farmacológico , Foliculitis/etiología , Foliculitis/microbiología , Foliculitis/patología , Humanos , Masculino , México/epidemiología , Microsporum/aislamiento & purificación , Persona de Mediana Edad , Tiña/tratamiento farmacológico , Tiña/etiología , Tiña/microbiología , Tiña/patología , Trichophyton/aislamiento & purificaciónRESUMEN
An open-design, prospective, non-comparative study was conducted to evaluate the efficacy and safety of itraconazole in the treatment of tinea pedis (interdigital-type, hyperkeratotic-type and the combination of both). Treatment consisted of one pulse of itraconazole, meaning that each patient received 400 mg/day for one week. Clinical and mycologic control examinations were performed at baseline and at the end of treatment; follow-up visits took place at 30 and 60 days after the last medication administration. A total of 44 patients were evaluated. The major causal agent isolated was Trichophyton rubrum (93%). At the final follow-up visit (60 days), 37 cases (84.4%) achieved clinical and mycologic cure; 5 (11.3%) had improvement and 2 cases (4.5%) failed. Three cases reported side effects attributable to itraconazole (6.6%); one patient had a moderate headache and two reported moderate dyspepsia. None of the 3 cases required discontinuation of the medication. We concluded that the administration of one pulse of itraconazole is an effective, safe and short regimen to treat tinea pedis.
Asunto(s)
Antifúngicos/administración & dosificación , Itraconazol/administración & dosificación , Tiña del Pie/tratamiento farmacológico , Adolescente , Adulto , Antifúngicos/efectos adversos , Antifúngicos/uso terapéutico , Esquema de Medicación , Dispepsia/inducido químicamente , Femenino , Cefalea/inducido químicamente , Humanos , Itraconazol/efectos adversos , Itraconazol/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Background. Guttate psoriasis is associated with infections by Streptococcus pyogenes and cross-reaction between skin and streptococcal antigens have been reported, suggesting an autoimmune component in the disease. Methods. In this work, the authors looked for antibodies against S. pyogenes M-5 antigens by immunoblot in 52 sera of psoriasis patients and in 52 sera of normal individuals. Histological and immunohistochemical analysis in skin biopsies from lesions of another group of 16 clinically diagnosed guttate psoriasis patients and four healthy controls were also carried out. Results. All guttate psoariasis patients studied (11) had IgG antibodies that intensively recognized three different proteins of 70,60 and 14 kDa, as compared to sera from patients with other forms of psoriasis or from healthy controls. The diagnosis of psoariasis was confirmed in 14 of the patients by hematoxylin-eosin staining. Of the other two patients, one was diagnosed as parapsoriasis and the other as liquen. By indirect immunofluorescence (IFI), all 14 psoriatic patients had autoantibodies against their own lesional skin that did not recognized normal skin from control subjects or from the two non-psoriatic patients. The parapsoriatic and the liquen patients did not have autoantibodies. A rabbit immune serum against S. pyogenes antigens reacted with lesional skin from the 14 guttate psoriatic patients, but not with normal skin from controls or with lesional skin from the 2 non-psoriatic patients. Conclusions. The recognition by immunoblot of streptococcal antigens by serum of guttate psoriasis patients, the presence of autoantibodies against their own skin, and recognition of the same skin antigens by anti-streptococcal rabbit antibodies confirm the participation of the immune system and of streptococcal infection in guttate psoriasis
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Autoantígenos/análisis , Estudios de Casos y Controles , Infecciones Estreptocócicas/inmunología , Psoriasis/inmunología , Psoriasis/microbiología , Piel/inmunologíaRESUMEN
Objetivo: Evaluar la efectividad y seguridad de la nistatina en solución como tratamiento profiláctico contra la flora de Candida sp en pacientes seropósitivos al virus de la inmunodeficiencia humana (VIH). Metodología: Se incluyeron 33 pacientes seropositivos al VIH con flora comprobada de Candida sp y con cifras de linfocitos CD4 mayores a 200 células, a los cuales se les administró nistatina en solución por 15 días en dosis de 4 mL tres veces al día (1'200,ooo U/día) y se realizó seguimiento a los 15 y 30 días de la última administración. Resultados: Las especies más frecuentes fueron C. albicans registrada en 27 casos (82 por ciento) y C. tropicalis en tres (9 por ciento). Al final del tratamiento, se obtuvo negativización micológica en el 91 por ciento y después del seguimiento la cifra fue de 78.7 por ciento. Se observó un solo efecto colateral, dispepsia y náuseas, que no ameritó la suspensión del fármaco. Conclusión: Se considera que la nistatina es útil y segura para el tratamiento profiláctico inicial y que reduce el número de episodios de candidosis
Asunto(s)
Humanos , Masculino , Candidiasis/diagnóstico , Candidiasis/terapia , Nistatina/administración & dosificación , Nistatina/uso terapéutico , Seropositividad para VIH/diagnóstico , Seropositividad para VIH/tratamiento farmacológico , Terapia de Inmunosupresión , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/terapiaRESUMEN
La amplitud de las indicaciones dermatológicas hacen a las tetraciclinas un grupo básico en esta especialidad. Comparte propiedades antimicrobianas, antiinflamatorias e inmunosupresoras entre otras, por lo que han sido usadas en el tratamiento de varios estados patológicos no infecciosos. Se hace una revisión de las enfermedades cutáneas que han sido tratadas con tetraciclinas y algunas propiedades que justifican su uso
Asunto(s)
Humanos , Enfermedades de la Piel/uso terapéutico , Tetraciclinas/uso terapéutico , Enfermedades de la Piel/microbiología , Tetraciclinas/farmacologíaRESUMEN
En forma prospectiva se estudiaron los aspectos clínicos de 53 pacientes con alopecia areata. Las asociaciones más frecuentes fueron el estrés emocional agudo, los antecedentes familiares y los antecedentes personales de la enfermedad. Se realizó un estudio terapéutico comparativo entre antralina y betametasona tópica, resultando superior la antralina en forma estadísticamente significativa
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Alopecia Areata/tratamiento farmacológico , Antralina/uso terapéutico , Betametasona/uso terapéutico , Alopecia Areata/fisiopatología , Antralina/farmacología , Betametasona/farmacologíaRESUMEN
Se reporta en caso de una paciente de 43 años con diagnóstico de Enfermedad Humana por adyuvantes con manifestaciones que semejaban enfermedad mixta del tejido conectivo. Este caso representa una iatrogenia terapéutica, ya que la inyección de substancia extraña se realizó con fines "curativos". Se incluye una breve revisión.
Asunto(s)
Humanos , Femenino , Adulto , Cirugía General , Adyuvantes Farmacéuticos/efectos adversos , Enfermedades del Tejido Conjuntivo/diagnóstico , Cosméticos/efectos adversos , Hipersensibilidad , Aceite Mineral/efectos adversos , Siliconas/efectos adversos , Manifestaciones CutáneasRESUMEN
Se reporta el caso de una niña de 18 meses de edad con diagnóstico de hipomelanosis de Ito, con lesiones cutáneas características que aparecieron desde los 3 meses de edad. Se hace una breve revisión sobre los conceptos actuales de esta genodermatosis.
Asunto(s)
Humanos , Femenino , Lactante , Trastornos de la Pigmentación/diagnósticoRESUMEN
Se presenta y comenta el caso de un hombre de 52 años con lepra lepromatosa con reacción leprosa tipo 2 que en último brote presentó, además de los síntomas conocidos, disfagia y disfonía no explicadas por otra patología, que cedieron con el tratamiento con talidomida como todo el brote reaccional. Se supone que estas manifestaciones desusadas de la reacción leprosa hayan sido debidas a una afectación de lso pares craneales 9, y 10, lo cual no es frecuente en lepra.
Asunto(s)
Lepra/complicaciones , Lepra/diagnósticoRESUMEN
Se realizó un estudio sencillo, abierto, prospectivo con terbinafine en el tratamiento de micosis superficiales, encontrando una excelente eficacia contra dermatofitos, no siendo así para candida. Se observaron escasos efectos adversos y no se registraron alteraciones significativas en los exámenes de laboratorio rutinarios
Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Masculino , Femenino , Antifúngicos/administración & dosificación , Alilamina/administración & dosificación , Dermatomicosis/tratamiento farmacológico , Estudios ProspectivosRESUMEN
Se presenta y comenta el caso de un paciente masculino de 44 años con lepra lepromatosa nodular con reacción leprosa tipo II que mostraba eritema nudoso necrótico y una anemia hemolítica importante. El paciente mostró talidomidorresistencia. Con este motivo se discuten los mecanismos que se han involucrado en la patogenia de la anemia en los enfermos de lepra, sobre todo la de tipo hemolítico y se concluye indicando que tal vez intervinieron varios factores en este paciente para causar la anemia hemolítica.
Asunto(s)
Humanos , Adulto , Masculino , Anemia Hemolítica/inducido químicamente , Lepra/complicaciones , Anemia Hemolítica/complicaciones , Dapsona/efectos adversos , Resistencia a Medicamentos , Lepra/inmunología , Lepra/patología , Talidomida/uso terapéuticoRESUMEN
Se presenta y comenta el caso de un paciente masculino de 44 años con lepra lepromatosa nodular con reacción leprosa tipo II que mostraba eritema nudoso necrótico y una anemia hemolítica importante. El paciente mostró talidomidorresistencia. Con este motivo se discuten los mecanismos que se han involucrado en la patogenia de la anemia en los enfermos de lepra, sobre todo la de tipo hemolítico y se concluye indicando que tal vez intervinieron varios factores en este paciente para causar la anemia hemolítica. (AU)
Asunto(s)
Humanos , Adulto , Masculino , Lepra/complicaciones , Anemia Hemolítica/inducido químicamente , Lepra/inmunología , Lepra/patología , Anemia Hemolítica/complicaciones , Dapsona/efectos adversos , Talidomida/uso terapéutico , Resistencia a MedicamentosRESUMEN
La lepra, enfermedad esencialmente crónica, tiene episodios agudos de diferente tipo: excaberación de lesiones preexistentes lepromatosas y tuberculoides y aparición de nuevas lesiones que constituyen las llamadas leprorreacciones; éstas son de dos tipos: las de tipo I en que se involucra la inmunidad celular, si aumenta se habla de reacción de reserva, si disminuye se menciona la reacción de degrado. Este tipo de manifestaciones se presentan en casos interpolares y subpolares. Las reacciones tipo dos constituyen la clásica reacción leprosa, exclusiva de los lepromatosos polares y subpolares y mediada por complejos inmunes. Se presenta con síntomas generales, viscerales y cutáneos: eritema nudoso, polimorfo y necrosante. Se tratan también las neuritis reaccionales y la llamada mano reaccional. Del oportuno reconocimiento de estos estados agudos depende su tratamiento adecuado y la prevención de graves consecuencias para el paciente, inclusive su muerte