International registry of dermatological manifestations secondary to COVID-19 infection in 347 Hispanic patients from 25 countries.

BACKGROUND: The infection by coronavirus disease 2019 (COVID-19) has been associated with multiple cutaneous manifestations, although characterization of them in Hispanic patients with darker skin phototypes is lacking. The objective of this study is to characterize the clinical dermatological manifestations associated with COVID-19 infection in cases with few or without general symptoms in patients from Latin America. METHODS: Cross-sectional study using a questionnaire that was made for health professionals (physicians with a specialty in dermatology) to investigate dermatological lesions associated with COVID-19 infection in patients from 25 countries of Latin America. The survey was active from June 9 to July 30, 2020. RESULTS: In this study, information was collected from a total of 347 patients. We found a female gender predominance: 179/347 (51.6%). The mean age at presentation was 40.87 years. The most frequent dermatological manifestations were maculopapular rash and urticarial lesions, followed by papulovesicular lesions, vesicular lesions, chilblain-like lesions, papular lesions, ecchymosis, petechial purpura, pityriasis rosea-like lesions, pruritus, palmoplantar dysesthesias, transient livedo, acral necrosis, palpable purpura, livedo racemosa, and retiform purpura. As far as we know, there are no previous reports of pruritus and palmoplantar dysesthesias. CONCLUSIONS: This registry emphasizes skin manifestations as an important criterion for establishing the diagnosis of COVID-19 infection in Latin American countries. This information will be useful for the early identification of suspected cases by health professionals (dermatologists and nondermatologists) and will allow contact tracing to mitigate the impact on health systems at different levels.

Significativo aumento de onicomicosis por hongos filamentosos no dermatofitos en red de salud privada en Santiago de Chile entre los períodos 2008-2009 y 2016-2017 / Significant increase in onychomycosis due to Filamentous Fungi Non Dermatophytes in Network of Private Health in Santiago de Chile among the periods 2008-2009 and 2016-2017

INTRODUCCION: La onicomicosis corresponde a una patología prevalente causada por hongos dermatofitos, levaduras y en menor proporción, hongos filamentosos no dermatofitos (HFND). Se ha reportado un aumento a nivel mundial en la incidencia de onicomicosis por HFND1 , sin embargo, en Chile no hay registros de ello. OBJETIVO: Comparar la epidemiología local de onicomicosis por HFND en una red privada de Santiago de Chile entre dos períodos de tiempo. Material y métodos: Se realizó un estudio transversal de análisis de los registros de laboratorio de la Red de Salud UC-Christus entre los períodos 2008- 2009 y 2016-2017. RESULTADOS: Se obtuvieron un total de 9.579 muestras en ambos períodos, 4.985 entre 2008-2009 y 4.594 entre 2016-2017, con 3.442 (36%) cultivos positivos para hongos, 1.831 (36,7%) en el primer período y 1.611 (35%) en el segundo. Del total 40 muestras (1,2%) fueron de HFND, destacando que la prevalencia aumentó significativamente entre ambos períodos: 8 (0,4%) y 32 (2,0%) cultivos, respectivamente (p<0,0001). Del total, las especies de HFND más prevalentes fueron: 23 Fusarium sp (57,5%), 8 Scopulariopsis sp (20%) y 7 Acremonium sp (17,5%). En pacientes con cultivo positivo para HFND, se buscaron asociaciones probables en los antecedentes a través de la ficha clínica, sin encontrar resultados significativos. CONCLUCION: Los HFND son la tercera causa de onicomicosis y su prevalencia fue 1,2%. Las especies más frecuentes fueron Fusarium sp, Scopulariopsis sp, Acremonium sp. La prevalencia de HFND aumentó significativamente en un período de 6 años.

INTRODUCTION: Onychomycosis is a frequent nail disease caused mainly by dermatophytes, in less proportion yeast and last non-dermatophyte molds (NDM). NDM onychomycosis is an increasing problem worldwide, though in Chile there is no epidemiological registry about it. OBJETIVE: The aim of the study was to determine the local epidemiology of NDM onychomycosis. MATERIAL Y METHODS: We did a transversal cohort study in the Red de Salud UC-Christus between 2008-2009 and 2016-2017. RESULTS: Of the 9,579 clinically suspected cases of onychomycosis, 4,985 in 2008-2009 and 4,594 in 2016-2017, 3,448 (36%) cultures were positive in total, 1,831 (36.7%) in the first period and 1,611 (35%) in the second. Only 40 cultures (1.2%) were NDM in total, but the prevalence significantly increased between both periods with 8 (0.45%) and 32 (2.0%) cultures, respectively (p y (p<0.0001). Among the total of NDM, the most prevalent species were: 23 Fusarium sp (57.5%), 8 Scopulariopsis sp (20%) and 7 Acremonium sp (17.5%). We searched for possible associations of patients with NDM onychomycosis and morbid history, but found no significant result. COMCLUSION: NDM are the third cause of onychomycosis and its prevalence of 1.2% was predominantly from toe nails. The most frequent species were Fusarium sp, Scopulariopsis sp. and Acremonium sp. The prevalence of NDM increased significantly in a period of 6 years.

Sífilis en el siglo XXI: novedades en el enfrentamiento diagnóstico y terapéutico / Syphilis in the XXI century: novelties in the diagnostic and therapeutic confrontation

La sífilis es una enfermedad de transmisión sexual altamente contagiosa con importantes complicaciones, pero con tratamiento efectivo en etapas tempranas. Actualmente, representa un problema de salud pública. La prevalencia reportada en EEUU desde el año 2008 es de 4,5 casos/100.000 habitantes, con una incidencia 10.6 millones de casos cada año, especialmente en hombres que mantienen relaciones sexuales con hombres (HSH) y pacientes portadores de VIH (PVIH). Los métodos diagnósticos basados en test moleculares aún no han sido validados para el diagnóstico de sífilis, lo que ha permitido establecer tres esquemas serológicos con diferentes rendimientos, según prevalencia poblacional. Desde este punto de vista, el screening reverso pareciera ser útil en población de alto riesgo, y el screening tradicional para la población general.

Syphilis is a sexual transmitted disease highly contagious with important complications that can be prevented with an adequate treatment in early stages. Syphilis has become a public health issue, in the USA its incidence has increased from the 2001, with a rate in the 2008 of 4,5 cases/100000 people, with a greater prevalence in men who have sex with men (HSH) and people infected by HIV (PVIH). Despite molecular detection test are used for the diagnostic of many diseases, in syphilis we still using serologist test. There are three different schemes with different per-formance depending in the prevalence of syphilis in the population. In this setting reverse screening is the most adequate method for high prevalence versus traditional method that is better in general population.

[Acute generalized exanthematous pustulosis associated with Mycoplasma pneumoniae infection: a case report]. / Pustulosis exantemática generalizada aguda asociada a Mycoplasma pneumoniae: reporte de un caso.

Acute generalized exanthematous pustulosis is an uncommon skin eruption, characterized by fever and the rapid onset of disseminated, non-follicular, sterile pustules, over an erythematous skin background. It is usually classified as a severe cutaneous adverse drug reaction, whose most relevant triggers are antibiotics and anticonvulsants. However, viral and bacterial infections have also rarely been associated with this dermatosis. We report the case of a patient, who developed lesions of acute generalized exanthematous pustulosis as an extrapulmonary manifestation of Mycoplasma pneumoniae infection.

Pustulosis exantemática generalizada aguda asociada a Mycoplasma pneumoniae: reporte de un caso / Acute generalized exanthematous pustulosis associated with Mycoplasma pneumoniae infection: a case report

Acute generalized exanthematous pustulosis is an uncommon skin eruption, characterized by fever and the rapid onset of disseminated, non-follicular, sterile pustules, over an erythematous skin background. It is usually classified as a severe cutaneous adverse drug reaction, whose most relevant triggers are antibiotics and anticonvulsants. However, viral and bacterial infections have also rarely been associated with this dermatosis. We report the case of a patient, who developed lesions of acute generalized exanthematous pustulosis as an extrapulmonary manifestation of Mycoplasma pneumoniae infection.

[Dermatologic manifestations associated with HIV/AIDS]. / Manifestaciones dermatológicas asociadas a la infección por VIH/SIDA.

The ongoing human immunodeficiency virus (HIV) infection epidemic coupled with more efficacious and available treatments has led to a larger number of patients living with HIV or AIDS. As a result, skin manifestations related to HIV/AIDS or its therapy have become increasingly more common and are reported to occur in as many as 95% of patients. Herein, we review the most common HIV/AIDS related cutaneous pathologies and classify them into inflammatory, HAART-associated, neoplastic, and infectious manifestations. Cutaneous manifestations should be promptly recognized and treated by physicians and health care personnel in order to provide optimal care.

Manifestaciones dermatológicas asociadas a la infección por VIH/SIDA / Dermatologic manifestations associated with HIV/AIDS

The ongoing human immunodeficiency virus (HIV) infection epidemic coupled with more efficacious and available treatments has led to a larger number of patients living with HIV or AIDS. As a result, skin manifestations related to HIV/AIDS or its therapy have become increasingly more common and are reported to occur in as many as 95% of patients. Herein, we review the most common HIV/AIDS related cutaneous pathologies and classify them into inflammatory, HAART-associated, neoplastic, and infectious manifestations. Cutaneous manifestations should be promptly recognized and treated by physicians and health care personnel in order to provide optimal care.

La epidemia del virus de la inmunodeficiencia humana (VIH) sumado al mayor acceso a terapias antiretrovirales (TARV) han llevado a un aumento del número y la sobrevida de pacientes que viven con esta infección crónica. Se estima que hasta 95% de los pacientes con infección por VIH/SIDA presentarán alguna manifestación cutánea, por lo cual, debemos conocerlas. En la presente revisión se estudiarán las manifestaciones cutáneas de la infección por el VIH/SIDA clasificadas como: manifestaciones inflamatorias, manifestaciones asociadas a la TARV, manifestaciones neoplásicas y manifestaciones infecciosas asociadas a infección por VIH/SIDA (bacterianas, virales, fúngicas y parasitarias). Estas manifestaciones deben ser reconocidas por los médicos y el personal de salud a cargo del tratamiento y control de los pacientes con esta patología crónica.

Lewandowsky's Rosaceiform Eruption: a Form of Cutaneous Tuberculosis Confirmed by PCR in Two Patients.

INTRODUCTION: Cutaneous tuberculosis (TBC) is a chronic disease caused by Mycobacterium tuberculosis, and is present in less than 1-2% of all TBC cases. The current problem with diagnosis is the demonstration of bacillus in the skin, especially paucibacillar forms, where sources like polymerase chain reaction (PCR) have improved diagnostic capacity. CASE PRESENTATION: Two cases of cutaneous TBC are reported. The first patient was 52-year-old woman with facial erythematous papulo-nodular lesions which had been developing for 4 months, and had previously been treated as acne rosacea, with partial response. Histopathological studies showed chronic granulomatous inflammation. TBC was suspected, so PCR was performed, which showed positive for M. tuberculosis. The second case was a 43-year-old woman with a facial rosaceiform plaque which began 6 months previously, and was treated as rosacea without any change for 5 months. Skin biopsy and PCR were positive for TBC. Both cases were treated using primary schedule for TBC, and both presented a favorable response. DISCUSSION: A clinical profile called Lewandowsky's rosacea-like eruption has been previously described. The condition has been questioned for years and was later removed from the spectrum of tuberculids and cutaneous TBC for not being able to isolate microorganisms in skin samples, a situation that might now change. In paucibacillar forms, when culture and staining are negative and TBC is still suspected, it is recommended to use DNA amplification by PCR for an accurate diagnosis. Both cases bring up the concern about once again bringing Lewandowsky's rosaceiform eruption into the spectrum of cutaneous TBC, and the discussion about the current definition of tuberculid.

Candida parapsilosis and Candida guillermondii: emerging pathogens in nail candidiasis.

BACKGROUND: Onychomycosis of the fingernails and toenails is generally caused by dermatophytes and yeasts. Toenail mycoses involve mainly dermatophytes but when Candida is also involved, the strain most commonly isolated worldwide is C. albicans. AIMS: To determine Candida strains prevailing in onychomycosis. MATERIALS AND METHODS: A retrospective, observational and descriptive study of fungal cultures retrieved from the registry of the microbiology laboratory of the Pontificia Universidad Católica was performed. Specimens obtained from patients attending the healthcare network between December 2007 and December 2010 was analyzed. STATISTICAL ANALYSIS: A descriptive statistical analysis was performed. RESULTS: Candida was retrieved from 467 of 8443 specimens (52% fingernails and 48% toenails). Cultures were negative in 5320 specimens (63.6%). Among Candida-positive cultures, parapsilosis was the most commonly isolated strain with 202 cases (43.3%). While isolates of Candida guillermondii were 113 (24.2%), those of Candida albicans were 110 (23.6%), those of spp. were 20 (4.3%) and there were 22 cases of other isolates (4.71%). Among the 467 patients with positive cultures for Candida, 136 (29,1%) were men and 331 (70,9%) were women. All patients were older than 18 years old. Clinical files were available for only 169 of the 467 patients with positive cultures for Candida. For those, age, gender, underlying illnesses and use of immunossupresive agents during the trial was reviewed. CONCLUSIONS: The present study shows that both C. parapsilosis as well as C. guillermondii appear as emerging pathogens that would be in fact taking the place of C. albicans as the most commonly isolated pathogen in patients with Candida onychomycosis. The relative percentage of C parapsilosis increases every year. Identification of Candida strains as etiological agents of nail candidiasis becomes relevant to the management both nail as well as systemic candidiasis, in view of the resistance to conventional treatments readily reported in the literature.

Alopecia rectangular transitoria post embolización de fístula carótido-cavernosa: reporte de caso y revisión de la literatura / Transient alopecia after embolization: case report and literature review

En la actualidad, los procedimientos de radiología intervencional intracraneanos son cada vez más frecuentes. Sin embargo, la exposición a altas dosis de radiación durante la fluoroscopía puede inducir a complicaciones cutáneas como la alopecia transitoria post embolización, forma peculiar de radiodermatitis que afecta a las regiones del cuero cabelludo que reciben dosis más altas de radiación durante el proceso de embolización. El cuadro clínico se caracteriza por alopecia completa, no cicatricial, en parches con bordes bien delimitados y formas peculiares(rectángulos, círculos superpuestos), generalmente de localización occipital o en región temporo-parietal. Ocurre en promedio 2 a 4 semanas después del procedimiento endovascular, con repoblación del área alopécica a partir de las 4 a 5 semanas. Es de buen pronóstico y no requiere tratamiento específico. Es importante conocer este cuadro para poder orientar adecuadamente a los pacientes y alertar respecto a la incidencia de efectos adversos de la radiación terapéutica.

In the present, the neuroradiological procedures are more frequent. However, exposure to radiation can conduce to dermatological complication as transient alopecia after embolization, rare form of radiodermatitis that affect the areas of the scalp that receive highest doses of radiation. The clinical presentation is characterized by a complete alopecia, without any signs of inflammation of the scalp, with sharply defined patches in rare forms (rectangular, overlapped circles), generally located on occipital or temporo-parietal region. This phenomenon starts after 2 or 4 weeks since endovascular procedure, with hair re-growth after 4 or 5 weeks. It has good prognosis and no specific treatment is required. It is important to recognize this condition, in order to give adequate information to patients and warn about the incidence of adverse effects of therapeutic radiation.

Tungiasis, una enfermedad tropical emergente en Chile: Comunicación de tres casos clínicos importados / Tungiasis, an emerging tropical disease in Chile: Three imported cases reports

Tungiasis is a cutaneous ectoparasitosis caused by the sand flea Tunga penetrans whose higher prevalence occurs in South America, the Caribbean and Sub-Saharan Africa. It is clinically characterized by a papular lesion, either single or multiple, with a whitish halo and a brown-black central core, most of them localized on the feet. The lesions can be painful and itchy with the most common complication being bacterial superinfection of the skin. We report three cases of Chilean patients who presented skin lesions suggestive of tungiasis on their return from areas of high prevalence of the disease. The diagnosis is made by the clinical features of lesions in a patient from an endemic zone. Standard treatment consists of surgical extraction of the flea followed by application of a topical antibiotic and a tetanus prophylaxis. Prevention of the infestation is essential and includes the use of closed footwear and repellents.

La tungiasis es una ectoparasitosis cutánea causada por la pulga Tunga penetrans, prevalente en Sudamérica, el Caribe y África Subsahariana. Clínicamente se caracteriza por la formación de pápulas, únicas o múltiples, con un halo blanquecino translúcido y una región central pardo-negruzca, frecuentemente localizadas en los pies. Las lesiones pueden cursar con prurito o dolor leve, siendo la sobreinfección bacteriana la complicación más frecuente. Se comunican tres casos clínicos de chilenos que viajaron a zonas de alta prevalencia de tungiasis y que a su regreso presentaron lesiones dérmicas sugerentes de la enfermedad. El diagnóstico se realizó en base a las características clínicas de las lesiones en un paciente proveniente de zonas endémicas. El tratamiento de elección es la extracción quirúrgica de la pulga seguido del uso de antimicrobianos tópicos y la vacunación antitetánica. La prevención es esencial con el uso de calzado cerrado y repelentes.

Antimicrobial susceptibility and genetic characteristics of Propionibacterium acnes isolated from patients with acne.

BACKGROUND: Propionibacterium acnes is an important target in acne management. Antibiotic resistance has increased, reducing its clinical efficiency. OBJECTIVE: To study the prevalence, antimicrobial susceptibility patterns, and resistance mechanisms of P. acnes isolated from patients with acne. METHODS: Skin swabs were collected from 83 patients. Agar dilution determined the minimum inhibitory concentrations of five antibiotics. Polymerase chain reaction and DNA sequencing were used to identify mutations. Results P. acnes was isolated in 80 of 83 patients (96%), and 27 patients had resistance to antibiotics (33.7%). The mean age was older in the antibiotic-resistant group (20.8 ± 5.8 vs. 18.3 ± 3.7, P = 0.02). Resistance to trimethoprim-sulfamethoxazole was 26.3%, erythromycin 12.5%, and clindamycin 7.5%. All clindamycin-resistant strains had cross-resistance to erythromycin, and 40% erythromycin-resistant strains had cross-resistance to trimethoprim-sulfamethoxazole. All strains were sensitive to tetracycline and doxycycline. The use of topical erythromycin or clindamycin was a risk factor to carry resistant strains (P = 0.02, P = 0.04, respectively). Resistance to trimethoprim-sulfamethoxazole was associated with acne severity (P = 0.02). Six of the 10 erythromycin-resistant strains had a mutation in the peptidyl transferase region of the 23S rRNA gene: one A2058G and five A2059G. No strain carrying mutation G2057A was found. CONCLUSIONS: Resistance to trimethoprim-sulfamethoxazole was the most common pattern found, and further studies are required to clarify its resistance mechanism. A certain tetracycline resistance was expected, but interestingly all strains remained sensitive. Resistance to erythromycin and clindamycin were influenced using topical formulations. Mutation A2059G was related to high resistance to erythromycin. Antibiotic resistance is increasing, and new strategies are needed.

[Tungiasis, an emerging tropical disease in Chile: three imported cases reports]. / Tungiasis, una enfermedad tropical emergente en Chile: Comunicación de tres casos clínicos importados.

Tungiasis is a cutaneous ectoparasitosis caused by the sand flea Tunga penetrans whose higher prevalence occurs in South America, the Caribbean and Sub-Saharan Africa. It is clinically characterized by a papular lesion, either single or multiple, with a whitish halo and a brown-black central core, most of them localized on the feet. The lesions can be painful and itchy with the most common complication being bacterial superinfection of the skin. We report three cases of Chilean patients who presented skin lesions suggestive of tungiasis on their return from areas of high prevalence of the disease. The diagnosis is made by the clinical features of lesions in a patient from an endemic zone. Standard treatment consists of surgical extraction of the flea followed by application of a topical antibiotic and a tetanus prophylaxis. Prevention of the infestation is essential and includes the use of closed footwear and repellents.

[Actinomycotic mycetoma due to Actinomadura madurae]. / Micetoma actinomicótico por Actinomadura madurae.

Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory lesion caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Mycetoma commonly affects young people between 20 and 40 years old. The most common affected site is the foot. The characteristic clinical triad is tumefaction, draining sinuses and discharging grains. We report a healthy 31-year-old male, with a 6-year history of a progressive inflammatory tumor associated with sinus tracts and granules on his left sole. Actinomycetoma was suspected. The clinical diagnosis was confirmed by microbiological and histopathological study. Polymerase chain reaction and DNA sequencing identified Actinomadura madurae. To our knowledge, this is the second case of mycetoma reported in Chile. Our report emphasizes the need to consider this diagnosis in patients with chronic granulomatous disease associated with sinus tracts, fistulas and grains.

Micetoma actinomicótico por Actinomadura madurae / Actinomycotic mycetoma due to Actinomadura madurae

Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory lesion caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Mycetoma commonly affects young people between 20 and 40 years old. The most common affected site is the foot. The characteristic clinical triad is tumefaction, draining sinuses and discharging grains. We report a healthy 31-year-old male, with a 6-year history of a progressive inflammatory tumor associated with sinus tracts and granules on his left sole. Actinomycetoma was suspected. The clinical diagnosis was confirmed by microbiological and histopathological study. Polymerase chain reaction and DNA sequencing identified Actinomadura madurae. To our knowledge, this is the second case of mycetoma reported in Chile. Our report emphasizes the need to consider this diagnosis in patients with chronic granulomatous disease associated with sinus tracts, fistulas and grains.

El micetoma es una lesión subcutánea inflamatoria granulomatosa crónica causada por hongos (eumiceto-ma) o bacterias filamentosas (actinomicetoma). Afecta a adultos entre los 20-40 años y el sitio más comúnmente afectado es el pie. La tríada característica es un aumento de volumen del tejido afectado, con trayectos sinuosos y gránulos excretados. Comunicamos el caso de un hombre de 31 años, sano, con una historia de 6 años de un tumor asociado a trayectos sinuosos y gránulos en la región plantar izquierda. El diagnóstico clínico de micetoma fue confirmado mediante estudio microbiológico e histológico. La amplificación y secuenciación del AlDN bacteriano identificó Actinomadura madurae. Es el segundo caso de actinomicetoma reportado en Chile. Consideramos importante considerar este diagnóstico en pacientes con enfermedad granulomatosa crónica asociado a trayectos sinuosos, fístulas y gránulos.

The first case of tinea faciei caused by Trichophyton mentagrophytes var. erinacei isolated in Chile.

BACKGROUND: Trichophyton mentagrophytes var. erinacei is a zoophilic dermatophyte transmitted by hedgehogs which human infections manifest as highly inflammatory and pruritic eruptions. METHODS: We report a 21-year-old woman who presented with a two-week history of a pruritic scaly erythematous plaque on the nose. The patient had kept hedgehogs as pets, and one had bitten her on the tip of the nose two months prior to the appearance of the nasal lesion. RESULTS: Fungal culture from the scales on the tip of the patient's nose was compatible with T. mentagrophytes var. erinacei. The strains isolated from cultures made from samples taken from the noses and ears of the pet hedgehogs were morphologically similar to the strain isolated from the patient. Morphological identification was confirmed by sequencing the internal transcribed spacer. The lesion was diagnosed as tinea faciei, and therapy was initiated with topical and systemic terbinafine 250mg/day for eight weeks, which resulted in complete improvement. CONCLUSIONS: Trichophyton mentagrophytes var. erinacei is the most common dermatophyte isolated in hedgehogs. Usually T. mentagrophytes var. erinacei infection manifests as an extremely inflammatory and pruritic eruption that is confined to the site of contact with the hedgehog. Although the identification of T. mentagrophytes by traditional methods is possible, identification by ITS region analysis is a fast, simple, and increasingly available method. The increasing frequency of the practice of keeping exotic animals as pets has resulted in the emergence of several zoonotic diseases that can potentially be transmitted to humans.

[Laboratory diagnosis of Treponema pallidum infection in patients with early syphilis and neurosyphilis through a PCR-based test]. / Diagnóstico de la infección por Treponema pallidum en pacientes con sífilis temprana y neurosífilis mediante reacción de la polimerasa en cadena.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The diagnosis is based mainly in clinical presentation and non-specific assays. PCR-based diagnosis has been suggested as an attractive alternative method. The aim of this study was the validation of a PCR-based test for the diagnosis of early syphilis (ES) and neurosyphilis (NS). Clinical samples of mucocutaneous lesions and cerebrospinal fluid (CSF) specimens from patients previously diagnosed for ES and NS respectively using an enlarged gold standard, were tested by PCR. The reaction was done using primers targeting the tpN47 gene. Twenty out of 21 mucocutaneous samples from patients diagnosed with ES were positive by PCR, with a clinical sensitivity of 95%. Four out of 8 CSF samples from patients previously diagnosed with NS were positive by PCR, with a clinical sensitivity of 50%. The clinical specificity for both ES and NS was 100%. The PCR sensitivity and specificity for mucocutaneous samples allowed us to implement this assay in our laboratory for routine diagnosis. Although the sensitivity of the PCR in CSF was low, it may be useful to support clinical diagnosis.

Asertividad en el diagnóstico clínico de los tumores cutáneos / Assessment of clinical diagnostic accuracy for skin cancer

Background: There is an increase in the incidence rates of skin cancer in Chile. Aim: To study the clinical diagnostic accuracy (CDA) for skin cancer. Material y methods: CDA was defined as the percentage of agreement between clinical and pathological diagnosis. Approximately 600,000 pathological reports from five hospitals in Santiago were reviewed. A total of 2,593 skin tumours; 230 Malignant Melanoma (MM); 412 Squamous Cell Carcinoma (SCC) and 1,951 Basal Cell Carcinoma (BCC) were studied. These tumours were clinically diagnosed and surgically treated by dermatologists. The CDA was studied for each tumour, by the anatomical localization of the tumour, Breslow Index in MM, by age and sex of the patient. Results: The highest CDA was observed for BCC (76.2%); followed by MM (64.3%) and SCC (34.7%). By anatomical localization, for MM the highest CDA was observed in the soles (p <0.05); for BCC, the hightest CDA was in the face (p <0.05). No significant differences were observed in SCC. By age, for MM, the CDA was higher in patients aged less than 50 years. No differences in CDA by age were observed in the other two tumours. By sex, no differences were found. A higher CDA was found in MM with Breslow indexes III and IV than for MM with Breslow indexes I and II. Conclusions: CDA is affected by the clinical variables analyzed in this study. A more accurate clinical diagnosis of skin cancer could be obtained taking into account these variables (Rev Méd Chile 2003; 131: 1421-7).