[Furuncular myiasis]. / Miasis furunculosa.

Prior knowledge of foruncular myiasis in Africa and American specially México, is reviewed, leading to current criteria for definitive on of this disease. The Dermatobia genus, species hominis, are parasitic for man. Our cases belong to the latter. Epidemiological studies show the States of Tabasco, Chiapas and Campeche as most heavily affected, specially during the rainy season in which insects proliferate including vectors. Clinical studies confirmed five evolutionary stages of larvae. In the first stage larvae show a wide anterior and a narrow distal ends. The latter curls in. They show noticeable rings and reach up to 1 cm. in length. In the second stage, at 15 days, larvae resemble a segmented dagger. In the third stage, at 30 days, become ovate, showing rings and cyliae, the worms being white and soft. In the fourth stage, at 45 days, the worms are two cms. long and one cm. thick, the cyliae becoming more abundant and black. At 50 days structures suggesting wings appear. Adult Dermatobia are large flies, two cms. in length, with long extremities, a brown thorax, and a purplish blue abdomen, with a metallic sheen. Man becomes infested through arthropod bites or bathing in a pool larvae reach inside follicles, giving rise to erythema, papules and severe pruritus, Papules increase in size, infiltrate subcutaneous tissue, forming bluish red hard nodules, 1-2 cms. in length, which contain one or several larvae. From 10 to 60 days, their tops show an ecchymotic plaque which breaks down. The parasites come out usually dead. Besides pruritus symptoms include pain, a burning sensation, perception of larval motion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Toxic epidermal necrosis. Review of the theme and presentation of 20 cases]. / Necrólisis epidérmica tóxica. Revisión del tema y presentación de 20 casos.

Twenty cases of toxic epidermal necrolysis were studied. 14 male and 6 female. The peak incidence by age was in the first two decades. All of them were related to drugs. Twelve of the cases had received antibiotics and, therefore an infection existed. The remaining 8 cases did not receive antibiotics and had no concomitant infection. We emphasise the clinical observation that in 11 cases the first symptom was an increase in cutaneous sensitivity, and then a rise in temperature, malaise, and extensive cutaneous sloughing resembling extensive burns. As for complications, only in 4 patients could we demonstrate disseminated intravascular coagulation (haematological tests were carried out in only 14 patients). The commonest complication observed was glomerular nephritis. Blood counts, blood chemistry and urine tests were altered more in relation to complications than to TEN. Protein electrophoresis, conversely, showed an increase of gamma globulin in 53.3% of cases, and inverted A/G ratio in 80%. S. aureus was cultured in 12 cases (not all of them children). E.S.R. was increased in 18 cases. Pathological findings with those already described: "in toto" epidermal necrolysis, intra and subepidermal blisters, and occasional inflamatory reaction at the level of the papillae, and the non-uniform presence of melanin in basal cells and Lyell cells. Prognosis was excellent, since we only had one death and one case of blindness due to bilateral ocular perforation. This could be due to the general medical care of the patient, nursing them with D.I.C., which in certain cases substituted by heparin with excellent results. Antibiotics were used in those infected.