الملخص
La conidiobolomicosis es una micosis subcutánea causada por un hongo saprofito, Conidiobulus spp. perteneciente a la clase Zigomicetos, orden Entomoftorales, que habita en regiones tropicales. La manifestación clínica clásica es la deformidad progresiva de estructuras faciales y su diagnóstico se basa en cultivos de la zona afectada y el estudio histopatológico, siendo el "fenómeno de Splendore-Hoeppli" el hallazgo más característico. Dada su baja frecuencia de presentación, no existe consenso sobre la mejor opción y tiempo de tratamiento. Aquí presentamos un caso de entomoftoromicosis rinofacial causada por Conidiobolus coronatus en un paciente inmunocompetente de la región sur de Colombia.
Conidiobolomycosis is a subcutaneous mycosis caused by a saprophytic fungus, Conidiobulus, belonging to the class of Zygomycetes, an order of Entomophtorales that inhabits tropical regions. Its most frequent clinical manifestation is the progressive deformity of facial midline structures, and the diagnosis is based on cultures taken from the affected area and the histopathological study, being the "Splendore-Hoeppli phenomenon" the most characteristic finding. Due to its low frequency of presentation, there is no consensus about the best option and treatment time. We present a case of rhinofacial entomophthoromycosis caused by Conidiobolus coronatus in an immunocompetent patient from the southern region of Colombia.
الموضوعات
Humans , Male , Young Adult , Zygomycosis/microbiology , Zygomycosis/diagnostic imaging , Magnetic Resonance Imaging , Conidiobolus/isolation & purification , Zygomycosis/pathology , Zygomycosis/drug therapy , Antifungal Agents/therapeutic useالملخص
Abstract Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence.
الموضوعات
Humans , Male , Child, Preschool , Colonic Diseases/microbiology , Zygomycosis/pathology , Zygomycosis/drug therapy , Zygomycosis/diagnostic imaging , Gastrointestinal Neoplasms/diagnosis , Liver Diseases/microbiology , Lymphoma/diagnosis , Triazoles/therapeutic use , Tomography, X-Ray Computed , Amphotericin B/therapeutic use , Treatment Outcome , Colonic Diseases/pathology , Colonic Diseases/diagnostic imaging , Deoxycholic Acid/therapeutic use , Diagnosis, Differential , Drug Combinations , Gastrointestinal Neoplasms/pathology , Liver Diseases/pathology , Liver Diseases/diagnostic imaging , Lymphoma/pathology , Antifungal Agents/therapeutic useالملخص
A case of intestinal obstruction caused by extensive soft tissue fungal infection of the perineum due to Basidiobolus ranarum is presented here. There was excellent response to antifungal treatment. A literature search revealed the case report of intestinal obstruction due to intrinsic mucosal involvement by the fungus, but extensive soft tissue involvement of the perineum resulting in extraneous obstruction to the rectum, has not been reported so far.
الموضوعات
Adult , Antifungal Agents/administration & dosage , Entomophthorales/isolation & purification , Female , Histocytochemistry , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/pathology , Microscopy , Perineum/microbiology , Perineum/pathology , Radiography, Abdominal , Treatment Outcome , Zygomycosis/complications , Zygomycosis/diagnosis , Zygomycosis/drug therapy , Zygomycosis/microbiologyالملخص
Zygomycosis is an infection caused by opportunistic fungi of the Zygomycetes class, specifically those from the Mucorales and Entomophthorales orders. It is an uncommon disease, mainly restricted to immunocompromised patients. We report a case of a 73-year-old male patient with a history of fever (39°C) lasting for 1 day, accompanied by shivering, trembling, and intense asthenia. The patient was admitted to the intensive care unit with complex partial seizures, and submitted to orotracheal intubation and mechanical ventilation under sedation with midazolam. The electroencephalogram showed evidence of non-convulsive status epilepticus. There is no fast specific laboratory test that permits confirmation of invasive fungal disease. Unless the physician suspects this condition, the disease may progress rapidly while the patient is treated with broad-spectrum antibiotics. Differential diagnosis between fungal and bacterial infection is often difficult. The clinical presentation is sometimes atypical, and etiological investigation is not always successful. In the present case, the histopathological examination of the biopsy obtained from the right temporal lobe indicated the presence of irregular, round, thick-walled fungi forming papillae and elongated structures of irregular diameter, with no septa, indicative of zygomycete (Basidiobolus). Treatment with liposomal amphotericin B and fluconazole was initiated after diagnosis of meningoencephalitis by zygomycete, with a successful outcome.
الموضوعات
Aged , Humans , Male , Entomophthorales/isolation & purification , Meningoencephalitis/microbiology , Shock, Septic/microbiology , Zygomycosis/diagnosis , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Follow-Up Studies , Fluconazole/therapeutic use , Immunocompromised Host , Meningoencephalitis/diagnosis , Meningoencephalitis/drug therapy , Shock, Septic/diagnosis , Shock, Septic/drug therapy , Treatment Outcome , Zygomycosis/drug therapyالملخص
La zigomicosis es una infección infrecuente causada por hongos oportunistas que pertenecen al orden Mucorales, cuya característica es la invasión vascular por hifas, lo que determina trombosis, infarto y necrosis tisular. En General afecta a pacientes con efermedades subyacentes, causando infecciones invasoras severas y a menudo fulminantes. Algunas condiciones de riesgo son: leucemias y linfomas con neutropenia prolongada, cetoacidosis diabética, malnutrición severa, ruptura de la integridad de la barrera cutánea y terapia inmunosupresora. Se presenta un caso de zigomicosis cutánea primaria en el antebrazo, en una paciente pedíatrica con leucemia linfobástica aguda de tipo B, con grave neutropenia y tratamiento con corticoides, y describimos los aspectos histológicos y clínicos de la lesión necrótica en la zona de punción venosa.
الموضوعات
Humans , Female , Child, Preschool , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Zygomycosis/diagnosis , Zygomycosis/immunology , Zygomycosis/drug therapy , Immunocompromised Host , Skin/pathology , Skin Ulcer/microbiologyالملخص
Los onicomatricomas son tumores benignos inusuales, que se originan a partir de la matriz ungueal y del estroma que la rodea. La proporción entre epitelio y estroma varía. Aquellas lesiones donde el componente epitelial predomina son consideradas como unguioblastomas. En contraste, aquellas donde el componente estromal predomina son consideradas como fibromas unguioblásticos. En raros casos donde el componente estromal es atípico, es aplicable la denominación de fibromas unguioblasticos atípicos. Esta clasificación es análoga a la utilizada para neoplasias fibroepiteliales tricoblásticas. La presencia de pigmentación asociada a este tumor como melanoquia longitudinal es extremadamente rara. Este fenómeno probablemente es causado por activación de los melanocitos matricales.
الموضوعات
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Zygomycosis/pathology , Retrospective Studies , Zygomycosis/diagnosis , Zygomycosis/drug therapyالملخص
Os autores descrevem um caso de entomoftoromicose em paciente previamente saudável, que apresentou abscesso em nádega direita, evoluindo, após drenagem cirúrgica, para tumoração retroperitoneal. Após ressecção da massa, o paciente obteve melhora clínica, em uso de cetoconazol. A análise histopatológica evidenciou fenômeno de Splendore-Hoeppli, sugerindo infecção por Basidiobolus ranarum, uma zigomicose geralmente restrita ao tecido subcutâneo, com raro comprometimento gastrintestinal.
الموضوعات
Adult , Humans , Male , Entomophthorales/isolation & purification , Retroperitoneal Space/microbiology , Zygomycosis/microbiology , Antifungal Agents/therapeutic use , Ketoconazole/therapeutic use , Retroperitoneal Space/pathology , Zygomycosis/diagnosis , Zygomycosis/drug therapyالملخص
Zigomicoses são micoses subcutâneas causadas por fungos do solo, que geralmente manifestam-se como uma infiltração granulomatosa crônica da submucosa nasal, estendendo-se para o tecido subcutâneo e pele da face. Descreve-se aqui o primeiro caso de zigomicose nasofacial causada pelo Conidiobolus coronatus, ocorrendo em Mato Grosso, Brasil.
الموضوعات
Humans , Male , Adult , Antifungal Agents/therapeutic use , Conidiobolus/isolation & purification , Ketoconazole/therapeutic use , Nose Deformities, Acquired/microbiology , Zygomycosis/pathology , Brazil , Nose Deformities, Acquired/drug therapy , Nose Deformities, Acquired/pathology , Zygomycosis/drug therapyالملخص
Rhinoentomophthoramycosis caused by Conidiobolus coronatus in a 61-year old woman was unsuccessfully treated during 8 years with all the antifungals available in the Brazilian market, including potassium iodide for 1 month, sulfamethoxazole plus trimethoprim for 2 months, amphotericin B, total dose of 1130 mg, cetoconazole, 400 mg/day for 6 months, fluconazole, 200 mg/day, for at least 2 months and, itraconazole, 400 mg/day for 2 months, followed by 200 mg/day for 4 more months. Complete clinical and mycological cure was achieved using itraconazol 400 mg/day in association with fluconazol 200 mg/day during 24 months. After cure she was submitted to plastic surgery to repair her facial deformation. Today she remains clinically and mycologically cured after 59/60 months (5 years!) without any specific antifungal. We thus suggest the use of the combination of itraconazole and fluconazole as an additional option for the treatment of this mycosis