RESUMEN
Opportunistic onychomycosis is defined, when a non-dermatophyte mould is cultured from an abnormal nail unit in the absence of a dermatophyte. The presumption is that the mould has caused the abnormal clinical appearance of the nail unit, yet there are no data available to substantiate this claim. Reports have only identified the mould being recovered from the nail unit niche. A review of the published dermatologic literature describing toenail opportunistic onychomycosis by non-dermatophyte fungi has shown toenails with onycholysis, nail bed (NB) keratosis and nail plate surface abnormalities. The appearance of these clinical changes is indistinguishable from the diagnosis of the Asymmetric Gait Nail Unit Signs (AGNUS). AGNUS is produced by the friction of the closed shoe in patients with an asymmetric gait, resulting primarily from the ubiquitous uneven flat feet. Most commonly, species of Acremonium (Cephalosporium), Aspergillus, Fusarium, Scopulariopsis and rarely species of many different fungi genera are capable of surviving and reproducing in a keratinous environment and change the clinical appearance of the involved nail unit. AGNUS toenails predispose to the colonization by the non-dermatophyte opportunistic fungi but not by dermatophyte fungi.
Asunto(s)
Dermatosis del Pie/etiología , Marcha , Onicomicosis/etiología , Dermatosis del Pie/fisiopatología , Humanos , Onicomicosis/fisiopatologíaRESUMEN
Causative isolates, clinical features, and laboratory studies are reported for sixty-one cases of culture-proved mycotic keratitis. Isolates are categorized into four groups, including 36 Fusarium solani, 11 other Moniliaceae species, seven Dematiaceae, and seven yeasts. Of the 61 patients, 42 were men. Mild outdoor trauma was sustained in 14 of 24 cases. Patients were often referred with a clinical diagnosis of presumed fungal keratitis, within one week of symptom development, and usually had not received topically applied steroids prior to referral. Laboratory diagnosis necessitates prompt corneal scrapings, preferably stained with Giemsa or Gram, and culture on Sabouraud and blood agar maintained at room temperature, with growth usually evident by 48 hours.
Asunto(s)
Queratitis/diagnóstico , Micosis/diagnóstico , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Fusarium/aislamiento & purificación , Humanos , Queratitis/tratamiento farmacológico , Queratitis/microbiología , Masculino , Persona de Mediana Edad , Hongos Mitospóricos/aislamiento & purificación , Micosis/tratamiento farmacológico , Micosis/microbiología , Levaduras/aislamiento & purificaciónRESUMEN
Medical management of 61 cases of mycotic keratitis, including the use of natamycin (pimaricine) in 53 cases, resulted in successful healing in 46 cases. A final visual acuity of 20/40 or better was achieved in 25 cases by medical therapy alone. Thirteen cases were considered medical treatment failures, and 11 necessitated therapeutic surgery. A final visual acuity of 20/70 or better was achieved in six of these cases, including five of nine therapeutic penetrating keratoplasties. In four cases, ulceration had progressed despite natamycin treatment, but fungal cultures were negative at the time of therapeutic surgery.
Asunto(s)
Úlcera de la Córnea/tratamiento farmacológico , Fusarium , Micosis/tratamiento farmacológico , Antibacterianos/farmacología , Candida albicans/efectos de los fármacos , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/cirugía , Fusarium/efectos de los fármacos , Humanos , Hongos Mitospóricos/efectos de los fármacos , Micosis/diagnóstico , Micosis/cirugía , Natamicina/uso terapéuticoRESUMEN
The limulus lysate assay is an inexpensive, reliable, and rapid means of detecting and presence of Gram-negative endotoxin. In all ten cases of experimentally induced Proteus endophthalmitis in rabbits, the assay was positive, and the assay was appropriately negative in all ten cases of Staphylococcal endophthalmitis, ten cases of Candida endophthalmitis, and ten cases of sterile endophthalmitis in rabbits. In a clinical assessment of keratitis, the assay of corneal scrapings was positive in 11 of 13 Gram-negative corneal ulcers. In a similar study of clinical endophthalmitis, both Gram-negative cases had a negative limulus assay, but two cases are insufficient to be conclusive. The assay may prove to be a useful adjunct both to standard diagnostic evaluations and in the rapid direction of appropriate therapy for these conditions.
Asunto(s)
Úlcera de la Córnea/diagnóstico , Endoftalmitis/diagnóstico , Queratitis/diagnóstico , Prueba de Limulus , Animales , Candidiasis/diagnóstico , Endotoxinas/análisis , Reacciones Falso Negativas , Humanos , Infecciones por Proteus/diagnóstico , Infecciones Estafilocócicas/diagnósticoRESUMEN
One of two cases of endogenous Aspergillus endophthalmitis in abusers of intravenously administered drugs was treated successfully by subtotal pars plana vitrectomy; amphotericin B administered by intravitreal, periocular, and systemic routes; and flucytosine administered systemically. Aspergillus sp should be considered a possible pathogenic organism in drug abusers with endogenous endophthalmitis. An aggressive diagnostic and therapeutic approach may result in preservation of useful vision.
Asunto(s)
Aspergilosis/diagnóstico , Endoftalmitis/etiología , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Anfotericina B/administración & dosificación , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/microbiología , Femenino , Flucitosina/uso terapéutico , Humanos , Técnicas Microbiológicas , Agudeza Visual , Cuerpo Vítreo/cirugíaRESUMEN
Because of the frequency of fungal keratitis due to Fusarium solani, we needed a sustained, progressive infection in an animal model to determine the mechanisms of pathogenicity and to evaluate the new antifungal agents. Pigmented rabbits interlamellarly injected with actively germinating conidia from lyophilized temperature-tolerant strains of F. solani produced sustained culture-positive ulcers in high percentage of eyes at two and three weeks, pretreatment with subconjunctival corticosteroids was necessary. Histopathology, although a poor index of infectivity since some corneas with plentiful hyphal fragments had negative cultures, simulated human fungal pathology.
Asunto(s)
Córnea/microbiología , Modelos Animales de Enfermedad , Fusarium , Queratitis , Micosis , Conejos , Animales , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Aspergillus fumigatus/patogenicidad , Técnicas Bacteriológicas , Córnea/patología , Técnicas de Cultivo , Haplorrinos , Queratitis/tratamiento farmacológico , Queratitis/microbiología , Queratitis/patología , Micosis/tratamiento farmacológico , Micosis/microbiología , Micosis/patología , Pomadas , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Triamcinolona/administración & dosificación , Triamcinolona/uso terapéuticoRESUMEN
A 68-year-old woman had a marked decrease in visual acuity, increased intraocular pressure, and acute iridocyclitis. She developed a pigmented hypopyon simulating an occult intraocular melanoma. Two anterior chamber paracenteses showed growth of Listeria monocytogenes. The patient received systemic intravenous penicillin, topical fortified gentamicin sulfate drops, and intraocular injections of cephaloridine. On discharge from the hospital after a two-week stay, visual acuity had improved and intraocular pressure had decreased.
Asunto(s)
Cámara Anterior/microbiología , Endoftalmitis/microbiología , Listeriosis/complicaciones , Anciano , Cámara Anterior/citología , Cámara Anterior/patología , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Endoftalmitis/diagnóstico , Endoftalmitis/patología , Neoplasias del Ojo/diagnóstico , Femenino , Humanos , Listeria monocytogenes/aislamiento & purificación , Listeriosis/tratamiento farmacológico , Listeriosis/patología , Melanoma/diagnósticoRESUMEN
In a 15-year-old boy a culture-proved keratitis after a corneal perforation healed without antifungal agents after corneal suturing and application of tissue glue. Eight months later a posterior corneal abscess developed. Diagnostic and therapeutic penetrating keratoplasty was performed when the lesion failed to respond to pimaricin. Cultures were positive for Acremonium potronii, the same fungus isolated from the original corneal laceration eight months previously. To our acknowledge, this is the first case report of a central corneal ulcer or abscess due to this specific organism.
Asunto(s)
Lesiones de la Cornea , Queratitis/etiología , Micosis/complicaciones , Adolescente , Atropina/uso terapéutico , Bacitracina/uso terapéutico , Úlcera de la Córnea/etiología , Cianoacrilatos/uso terapéutico , Lesiones Oculares/complicaciones , Gentamicinas/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Masculino , Micosis/tratamiento farmacológico , Natamicina/uso terapéutico , Neomicina/uso terapéutico , Polimixinas/uso terapéutico , Prednisolona/uso terapéutico , Recurrencia , Tetraciclina/uso terapéutico , Cicatrización de HeridasRESUMEN
A shortened version of Grocott's methenamine-silver technique for use in staining corneal scrapings was superior to current methods for the diagnosis of mycotic keratitis.
Asunto(s)
Queratitis/diagnóstico , Metenamina , Micosis/diagnóstico , Plata , Coloración y EtiquetadoRESUMEN
Medical treatment failure necessitated surgery in nine cases of fungal keratitis. Therapeutic surgery eliminated fungal infection in seven cases, and useful vision was retained in five out of six penetrating keratoplasties. In three cases Natamycin (Pimaricin) therapy rendered fungi non-viable, but two were demonstrable by histopathology. These results suggest that antifungal treatment should be applied for as long as possible before therapeutic surgery in order to improve the final visual outcome.
Asunto(s)
Queratitis/cirugía , Micosis/cirugía , Conjuntiva/cirugía , Trasplante de Córnea , Fusarium , Humanos , Queratitis/tratamiento farmacológico , Queratitis/patología , Micosis/tratamiento farmacológico , Micosis/patología , Natamicina/uso terapéutico , Factores de Tiempo , Trasplante , Agudeza VisualRESUMEN
Clinical and laboratory features of 16 cases of keratitis that were caused by dematiaceous pigmented fungi are reported. Management, including the treatment of nine cases with Natamycin (Pimaricin), resulted in corneal healing in 14 cases, and therapeutic surgery in two cases.
Asunto(s)
Queratitis/terapia , Micosis/terapia , Administración Tópica , Adolescente , Adulto , Anfotericina B/uso terapéutico , Niño , Cromoblastomicosis/diagnóstico , Úlcera de la Córnea/terapia , Femenino , Gentamicinas/uso terapéutico , Humanos , Queratitis/tratamiento farmacológico , Queratitis/microbiología , Persona de Mediana Edad , Micosis/tratamiento farmacológico , Micosis/microbiología , Natamicina/uso terapéutico , Agudeza VisualRESUMEN
Nine successive groups of green sea turtles (Chelonia mydas) were observed in aquaculture during the posthatchling period. During the first 6 months of growth, each group underwent an epizootic of skin lesions, named gray-patch disease. Two types of skin lesions are associated with gray-patch disease: papules and, more characteristically, spreading gray patches which appear 7 to 8 weeks after hatching. In both types of lesions, intranuclear inclusions are found in keratinocytes in the malpighian layer of the epidermis. Electron microscopic examination of scrapings from lesions and biopsies revealed many viral particles, with features characteristic of the herpesvirus group. Transmission of gray-patch disease is possible with bacteria-free preparations of viral particles.
Asunto(s)
Infecciones por Herpesviridae/veterinaria , Enfermedades Cutáneas Infecciosas/veterinaria , Tortugas , Animales , Herpesviridae/ultraestructura , Infecciones por Herpesviridae/microbiología , Infecciones por Herpesviridae/patología , Agua de Mar , Piel/microbiología , Piel/patología , Piel/ultraestructura , Enfermedades Cutáneas Infecciosas/microbiología , Enfermedades Cutáneas Infecciosas/patologíaRESUMEN
Caryospora cheloniae sp. n. is described from mariculture-reared green sea turtles (Chelonia m. mydas). The sporulated oocyst has a thin, transparent, single-layered wall which often ruptures, leaving a naked sporulated sporocyst. Oocysts measured 33.8 to 40.1 micrometer by 11.0 to 14.6 micrometer (mean 37.4 by 12.8 micrometer). Greatest concentrations of developmental stages of C. cheloniae were found in the hindgut. Transverse binary fission was observed in dividing tissue stages. Pathologic alterations were most pronounced in the posterior third of the intestines (hindgut). The hindgut lumen was greatly dilated and filled with blood, oocysts and tissue debris. The hindgut wall was thinner than normal and the mucosal folds had sloughed into the intestinal lumen. Free blood escaped from the blood vessels of the tunica propria into the intestinal lumen. Epithelial hyperplasia was pronounced at the margins of denuded mucosal areas. Numerous inflammatory cells infiltrated the infected mucosal surface.
Asunto(s)
Apicomplexa/clasificación , Coccidios/clasificación , Coccidiosis/veterinaria , Tortugas , Animales , Coccidios/crecimiento & desarrollo , Coccidiosis/parasitología , Coccidiosis/patología , Intestinos/parasitología , Intestinos/patologíaRESUMEN
Onychomycosis is a persistent fungal infection of the toenails or fingernails that is usually not painful but is unsightly and can affect a patient's quality of life by interfering with footwear. It may affect up to 30% of the population by age 60. In more that 99% of cases, it is caused by dermatophytes, the most common of which are Trichophyton rubrum and Trichophyton mentagrophytes. Each of the four clinical types of onychomycosis, as defined by the route of fungal invasion, has a characteristic appearance, but other diseases, particularly psoriasis, may have a similar appearance. Proper management, therefore, includes confirmation of fungal infection by potassium hydroxide slide preparation and culture. Traditionally, pharmacologic treatment has been less than optimal. In many cases, griseofulvin, the first oral agent approved for onychomycosis in the United States, must be given for 1 year or more to be effective. Low cure rates are related to poor bioavailability and the fungistatic rather than fungicidal effect of the drug. Newer agents, such as oral itraconazole and oral terbinafine, promise to substantially increase cure rates while shortening treatment duration. Oral terbinafine is potently fungicidal against dermatophytes and has proven efficacious with regimens as brief as 12 weeks when the nail is not 100% involved.