RESUMO
Pulmonary coccidioidomycosis shares characteristics with other pulmonary pathologies. In tissue, spherules containing endospores are markers of Coccidioides immitis and C. posadasii infection. Mycelial forms presenting without classical parasitic structures are often misdiagnosed. The study was performed at the National Institute of Respiratory Diseases (INER) of Mexico between September 1991 and June 2005 and analyzed the association between cases, controls, and risk factors, including co-morbidity. A case was defined as any patient who presented mycelial forms and a control as any patient who presented only spherules or no parasitic forms. All patients (n = 44) with pulmonary coccidioidomycosis were diagnosed by culture, histopathology, cytology, and immunology. Type 2 diabetic patients with pulmonary coccidioidomycosis were four times more likely than non-diabetics to develop parasitic mycelial forms (95% confidence interval [CI], 0.85-20.10; P < 0.01). We formulated a comprehensive definition based on the results as follows: patients with pulmonary coccidioidomycosis with an evolution longer than 8 months, cough, hemoptysis, radiological evidence of a cavitary lesion, and type 2 diabetes mellitus, develop parasitic mycelial forms of Coccidioides spp. Based on microscopic images of patient specimens, we propose incorporating mycelial forms into the parasitic phase of Coccidioides spp. in patients with type 2 diabetes mellitus and chronic and cavitary pulmonary coccidioidomycosis.
Assuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/complicações , Diabetes Mellitus Tipo 2/complicações , Pneumopatias Fúngicas/complicações , Micélio/isolamento & purificação , Adulto , Idoso , Distribuição de Qui-Quadrado , Coccidioidomicose/diagnóstico , Coccidioidomicose/microbiologia , Coccidioidomicose/patologia , Feminino , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Masculino , México , Pessoa de Meia-Idade , Adulto JovemRESUMO
In this article, we report the results of a survey taken in towns with less than 2,500 inhabitants in the rural tetanigenic zone of the State of Jalisco. The purpose was to know the Infant Mortality Rate (IMR), the Neonatal Tetanus Mortality Rate (NTMR), the incidence of neonatal tetanus, and a partial register of these indicators, as well as the identification of the risk factors associated with fatalities from this disease. The sampling was multistaged with random selection of the conglomerates. The results were as follows: 75 deaths in children of less than one year of age with an IMR of 34.7 per 1,000 Live Births Registered (LBR), 40 deaths in those of less than 29 days old (Neonatal Mortality Rate of 18.5 per 1,000 LBR), eight deaths by neonatal tetanus (NTMR of 3.7 per 1,000 LBR), the estimated annual incidence rate of neonatal tetanus was 4.6 per 1,000 LBR, and the proportion of neonatal deaths due to tetanus was 20 per cent. The main factors studied which were statistically found to be significantly associated with the mortality rate from neonatal tetanus were: a maternal history of two or more prior child deaths having an Odds Ratio (OR) of seven; the existence of cramped living conditions greater than 3.5 persons per room (OR = 7.93); maternal illiteracy (OR = 7.22); and birth at the home (OR = 17.89). When the logistics model was used to control some of the misleading factors and obtain adjusted OR estimates, place of birth and the maternal history or two or more prior child deaths were found to be significant.