Micosis pulmonares en niños: un enfoque diagnóstico / Pulmonary mycosis in children: a diagnostic approach

Pulmonary mycoses are invasive fungal infections that occur more and more frequently. The rising number of patients with immunodeficiencies, HIV infection, hematopoietic stem cell and solid organ transplant recipients, as well as the use of immunosuppressive therapies have increased the incidence of this disease. Diagnosis remains a challenge because the most accurate procedure is the isolation of the germ through culture of body fluids which have low sensitivity and a long development time (4-6 weeks). The diagnosis of pulmonary mycoses is based on the presence of risk factors, clinical and/or radiological symptoms suggestive of fungal infection and a positive microbiological test. Due to the fact that pulmonary mycoses are not usually considered in the differential diagnosis in the initial clinical evaluation of diseases and that the studies to establish the diagnosis are complex, they are diagnosed late when they have already become chronic with a high risk of morbidity and mortality

Las micosis pulmonares son infecciones invasivas que se presentan cada vez con mayor frecuencia en la población. El aumento del número de pacientes con inmunodeficiencias, infección por VIH, receptores de trasplante de células hematopoyéticas y órgano sólido, así como el uso de terapias inmunosupresoras ha incrementado la incidencia de esta enfermedad. El diagnóstico continúa siendo un reto debido a que el estándar de oro es el aislamiento del germen mediante cultivo de líquidos corporales los cuales tienen baja sensibilidad y un tiempo de desarrollo prolongado (4-6 semanas). El diagnóstico de las micosis pulmonares se basa en la presencia de factores de riesgo, cuadro clínico y/o radiológico sugestivo de infección fúngica y el estudio microbiológico positivo. Debido a que las micosis pulmonares habitualmente no se consideran dentro del diagnóstico diferencial en la evaluación clínica inicial de las enfermedades, asociado a la complejidad de estudios para establecer el diagnostico, las micosis pulmonares se diagnostican en forma tardía cuando ya existe enfermedad crónica, con alto riesgo de morbimortalidad

Epidemiologia das infecções pulmonares diagnosticadas em ambiente hospitalar: um estudo retrospectivo / Epidemiology of pulmonary infections diagnosed in hospital environment: a retrospective study

O trato respiratório é o segundo sítio mais comum de infecção no ambiente hospitalar. Aspneumonias hospitalares se caracterizam por grande dificuldade de respirar, tosseprodutiva e febre elevada Os principais fatores de risco são idade, tabagismo, hospitalizaçãoe procedimentos invasivos. Este estudo objetivou verificar o número desecreções traqueais positivas e determinar os agentes etiológicos predominantes, alémde fazer uma análise epidemiológica, identificando a prevalência de gênero, faixa etáriae idade média dos pacientes acometidos. Foram analisadas ainda as taxas de resistênciaaos antimicrobianos. Os pacientes mais acometidos por infecção no sítio respiratórioforam os pacientes do gênero masculino, na faixa etária de 61 a 80 anos. Dentre osmicrorganismos isolados, Pseudomonas aeruginosa e o Acinetobacter baumannii forampreponderantes. P. aeruginosa apresentou-se mais sensível aos antimicrobianos testados(cefepime, ceftazidina, ceftriaxona, imipenem e meropenem) enquanto que A. baumannii,em sua maioria, mostrou alto grau de resistência...

Determinantes de micosis pulmonares prevalentes en pacientes con sintomatología de enfermedad respiratoria crónica baja. Alto Huallaga, 2004 - 2005 / Determinants of pulmonary Mycosis prevalent in patients with symptoms of chronic lower respiratory disease. Alto Huallaga, 2004-2005

Objetivo: Establecer los determinantes de las micosis pulmonares prevalentes, en pacientes con sintomatología de enfermedad respiratoria crónica baja del Alto Huallaga, (Zona de Selva de los departamentos de Huánuco y San Martín), Perú. Materiales y Métodos: Estudio de casos y controles. Los casos fueron la totalidad de pacientes con enfermedades respiratorias crónicas bajas con prueba de inmunodifusión positiva para Histoplasma Capsulatum y/o Paraccocidiodes brasiliensis y/o Aspergilussp. y/o Aspergillus Fumigatus; de seis distritos (Rupa Rupa, Tocache, Uchiza, Santa Lucia, Aucayacu y Puerto Inca-Sungaro, que corresponden a las provincias de Leoncio Prado, Puerto Inca y Tocache, consideradas zonas tropicales y endémicas a micosis profundas y oportunistas), atendidos en los establecimientos de salud del MINSA y ESSALUD de los mencionados distritos, siendo 52 casos y el grupo de controles conformado por pacientes con enfermedades respiratorias crónicas bajas con prueba de inmunodifusión negativa para Histoplasma Capsulatum y/o Paraccocidiodes brasiliensis y/o Aspergilussp. y/o Aspergillus Fumigatus, siendo 116 controles incluidos en el estudio, a cada persona se le realizó el llenado de una ficha clínica-epidemiológica. Resultados: De 168 casos, 92 (54,76 por ciento) fueron de sexo femenino, edad promedio 47,62±2,9 años y tiempo de enfermedad de 7,4±14,8 meses. Los casos serológicamente positivos de micosis pulmonar fueron 15 Histoplasma capsulatum y 37 Aspergilosis spp. No se obtuvieron casos positivos de Paracoccidioides brasiliensis. En el análisis bivariado, sólo se encontró asociación con los factores procedencia zona rural (p=0,000), ingreso económico menor de 500 soles (p=0,002), visita a cueva (p=0,000) y agricultura básica (p=0,000). En el análisis multivariado de regresión logística se encontró asociación con los factores procedencia zona rural (p=0,000) y visita a cueva (p=0,000). Conclusiones: Se encontró asociación estadísticamente significativa...

Objective: To establish the determinants of pulmonary mycosis prevalent in patients with symptoms of chronic lower respiratory disease Alto Huallaga (Forest Area departments Huanuco and San Martin), Peru. Materials and Methods: A case-control study. The cases were all patients with chronic lower respiratory diseases with positive immunodiffusion test for Histoplasma capsulatum and/or Paraccocidiodes brasiliensis and/or Aspergillus sp. and/or Aspergillus fumigatus, six districts (Rupa Rupa, Tocache Uchiza, Santa Lucia, Aucuyacu and Puerto Inca-Sungaro, corresponding to the provinces of Leoncio Prado, Puerto Inca and Tocache considered endemic to tropical and deep mycosis opportunistic) treated in MOH health facilities and ESSALUD of said districts, with 52 cases and the control group consisted of patients with chronic lower respiratory disease with negative immunodiffusion test for Histoplasma capsulatum and/or Paraccocidiodes brasiliensis and/or Aspergillus sp. and/or Aspergillus fumigatus, with 116 controls included in the study, each person underwent filling a clinical-epidemiological profile. Results: Of 168 cases, 92 (54.76 per cent) were female, mean age 47.62±2.9 years and disease duration of 7.4±14.8 months. Serologically positive cases of pulmonary mycosis were 15 and 37 Histoplasma capsulatum Aspergillosis spp. There were no positive cases of Paracoccidioides brasiliensis. In the bivariate analysis, only found association with rural origin factors (p=0.000), income less than 500 soles (p=0.002), cave visit (p=0.000) and basic agriculture (p=0.000). In multivariate logistic regression analysis found the factors associated with rural origin (p=0.000) and cave visit (p=0.000). Conclusions: We found a statistically significant association, through multivariate analysis, with a history of pulmonary mycosis and chronic lower respiratory symptoms to factors origin (rural area), OR 25.2, Cl 95 per cent (9.7; 65.0), visit the cave owls, OR 6.1, Cl 95 per cent...

Coccidioidomycosis in armadillo hunters from the state of Ceará, Brazil

Coccidioidomycosis is a systemic mycosis with a variable clinical presentation. Misdiagnosis of coccidioidomycosis as bacterial pneumopathy leads to inappropriate prescription of antibiotics and delayed diagnosis. This report describes an outbreak among armadillo hunters in northeastern Brazil in which an initial diagnosis of bacterial pneumonia was later confirmed as coccidioidomycosis caused by Coccidioides posadasii. Thus, this mycosis should be considered as an alternative diagnosis in patients reporting symptoms of pneumonia, even if these symptoms are only presented for a short period, who are from areas considered endemic for this disease.

Mucormicosis: Una micosis emergente / Mucormycosis: An emergent mycosis

El objetivo de este trabajo es presentar la incidencia, frecuencia, características clínicas y evolución de los pacientes con mucormicosis atendidos en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, entre los años 1982 y 2010. Durante ese período se diagnosticaron 10 casos de mucormicosis. Los tres primeros entre 1982 y 2004 y los últimos 7 entre 2005 y 2010. La incidencia y frecuencia de esta enfermedad, para el período 1980-2004 fue 0.13 pacientes/año y 0.1 casos/10 000 egresos (IC 95%: 0.00 a 0.3) respectivamente. En el período 2005-2010 la incidencia fue 0.86 pacientes/año y la frecuencia de 1.1 casos/10 000 egresos (IC 95%: 0.5 a 2.4). Hubo nueve casos de mucormicosis rinosinuso-orbitaria, siete en pacientes con diabetes mellitus, uno en una paciente con una hemopatía maligna y neutropenia, y el restante en un paciente con HIV/sida que además estaba neutropénico y con un síndrome hemofagocítico. En una paciente se realizó el diagnóstico post mortem de mucormicosis pulmonar. El diagnóstico se efectuó por la observación de filamentos cenocíticos en los diez casos. Hubo desarrollo de mucorales en los cultivos de 8/9 pacientes; cinco Rhizopus spp y tres Mucor spp. Todos los pacientes recibieron un tratamiento inicial con anfotericina B deoxicolato, que en tres de ellos fue continuado con anfotericina B liposomal, y cirugía. Tres enfermos recibieron además un tratamiento adyuvante con oxigeno hiperbárico. La mortalidad fue 30%.

Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales. It is characterized by rapid progression and high morbidity and mortality in the absence of early diagnosis and prompt treatment. It was an infrequent disease, but in recent years, its incidence appears to have increased. The aim of this paper is to report the cases of mucormycosis diagnosed from 1982 to 2010 at the Hospital de Clinicas José de San Martín, University of Buenos Aires. We diagnosed 10 cases of mucormycosis; the first three between 1982 and 2004 and the last 7 between 2005 and 2010. The incidence from 1980 to 2004 was 0.13 patient-years and the frequency 0.1/10 000 discharges (95% CI 0.00- 0.3). In the period 2005 to 2010, the incidence was 0.86 patients per year with 1.1/10 000 discharges (95% CI 0.5-2.4). There was a pulmonary mucormycosis case (in a patient treated with corticosteroids) and nine rhinocerebral cases, two in neutropenic and seven in diabetic patients. The diagnosis was made by observation of cenocytic hyphae in 10/10 patients. Mucorales were recovered in 8/9 cultures (5 Rhizopus spp and 3 Mucor spp.). In one case diagnosis of pulmonary mucormycosis was made post-mortem. Nine patients were treated with amphotericin B deoxycholate (in 3 patients supplemented with liposomal amphotericin B) and surgery. Three patients underwent hyperbaric chamber. Seven patients had favorable outcome. In conclusion, mucormycosis is a rare disease, but its incidence has increased over the past five years. A good evolution of the patients is linked to early diagnosis and treatment.

Infección diseminada por Penicillium marneffei en un paciente HIV-positivo: Primera observación en la República Argentina / Disseminated infection due to Penicillium marneffei related to HIV infection: First observation in Argentina

Se presenta el primer caso humano de peniciliosis por Penicillium marneffei observado en la República Argentina. El paciente era un joven de 16 años, HIV-positivo, procedente de un área rural del sur de China. El paciente fue internado en el Hospital "F. J. Muñiz" por padecer una neumonía grave con insufciencia respiratoria aguda. El agente causal fue aislado de un lavado broncoalveolar y se lo observó en un citodiagnóstico de piel. La identifcación de P. marneffei fue confrmada por las características fenotípicas del aislamiento y la amplifcación del ADNr. El enfermo padecía una infección muy avanzada por HIV que condujo a la aparición simultánea de infecciones por citomegalovirus, Pneumocystis jirovecii y procesos bacterianos nosocomiales. Este complejo cuadro derivó en una evolución fatal.

The frst case observed in Argentina of AIDS-related human penicillosis is herein presented. The patient was a six- teen year-old young man coming from a rural area of southern China. He was admitted at the F. J. Muñiz Hospital of Buenos Aires city with severe pneumonia and adult respiratory distress. Penicillium marneffei was isolated from bronchoalveolar lavage fuid and was microscopically observed in a skin cytodiagnosis. P. marneffei identifcation was confrmed by rRNA amplifcation and its phenotypic characteristics. The patient suffered an advanced HIV infection and also presented several AIDS-related diseases due to CMV, nosocomial bacterial infections and Pneumocystis jirovecii which led to a fatal outcome.

Paracoccidioidomicosis asociada a otras patologías respiratorias en un hospital de Corrientes, Argentina / Association of paracoccidioidomycosis with different pulmonary pathologies in a hospital in Corrientes province, Argentina

Se realizó la búsqueda sistemática de paracoccidioidomicosis (PCM) en un conjunto de pacientes que fueron atendidos en un hospital de la ciudad de Corrientes dentro de un período de dos años. El criterio de inclusión fue: pacientes con tuberculosis (TBC), pacientes con diagnóstico presuntivo o confirmado de cáncer de pulmón (CA), pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y pacientes con imagen radiológica compatible con micosis pulmonar (IRXC). Se estudiaron 84 pacientes: 57 con TBC, 1 con CA, 5 con EPOC, 3 con TBC+CA, 4 con TBC+EPOC, 4 con EPOC+CA y 10 con IRXC. A todos se les realizó serología por inmunodifusión en gel de agar (IDGA) y, en los casos en que se pudo obtener una muestra clínica, también se efectuaron estudios microbiológicos. Por IDGA se diagnosticaron 10 casos de PCM: 4 asociados a TBC, 1 a TBC+CA, 3 a EPOC y 2 a IRXC; 9 de ellos se corroboraron por el hallazgo del hongo. La búsqueda sistemática de PCM en habitantes del área endémica que presentan patología pulmonar favorecería el diagnóstico precoz y, por lo tanto, las posibilidades de un tratamiento eficaz.

For 2 years, a systematic research of paracoccidioidomycosis (PCM) had been conducted in a hospital in the city of Corrientes. The inclusion criterium used was: tuberculosis patients (TBC), presumptive or confirmed diagnosis of pulmonary cancer (CA), chronic obstructive pulmonary disease (COPD) and/or X-ray images compatible with pulmonary mycosis (XRC). Eighty four patients were studied: 57 (TBC), 1 (CA), 5 (COPD), 3 (TBC+CA), 4 (TBC+COPD), 4 (COPD+CA) and 10 (XRC). Serology tests by agar gel immunodiffusion (IDGA) were performed on all patients, whereas microbiological studies were performed on those cases in which clinical samples could be obtained. Ten PCM were diagnosed by IDGA; 4 associated to TBC, 1 to TBC+CA, 3 to COPD and only 2 to XRC. PCM was mycologically proven in 9 of these cases. Systematic research of PCM would lead to an early diagnosis and therefore, to better chances for a successful treatment.

Microepidemia de histoplasmose em Blumenau, Santa Catarina / An outbreak of histoplasmosis in the city of Blumenau, Santa Catarina

A histoplasmose pulmonar aguda é pouco diagnosticada e muitas vezes confundida com tuberculose. A maior parte do conhecimento sobre a doença veio de relatos de epidemias resultantes da exposição de certo número de indivíduos a uma mesma fonte de infecção. O isolamento do H. capsulatum var. capsulatum a partir de amostras de solo comprova o foco epidêmico. Pela primeira vez é descrita uma microepidemia, com o relato de dois casos e o isolamento do fungo do foco de infecção, em Santa Catarina. Recomendam-se novos estudos epidemiológicos para se determinar a prevalência da infecção nesse estado.

Acute pulmonary histoplasmosis is rarely diagnosed and is often confused with tuberculosis. Most knowledge of the disease has been derived from descriptions of epidemics in which a number of individuals were exposed to the same source of infection. Isolation of Histoplasma capsulatum var. capsulatum from soil samples is conclusive evidence of an epidemic focus. This is the first report of an outbreak of histoplasmosis, in which two cases were reported and the fungus was isolated at the focus of the epidemic, in the state of Santa Catarina. Further epidemiological studies are needed in order to determine the prevalence of the infection statewide.

Characterization of Candida species isolated from cases of lower respiratory tract infection.

OBJECTIVES: (1) To identify and characterize the Candida species isolates from lower respiratory tract infection. (2) to determine the rate of isolation of Candida species from sputum samples. METHODS: This study was carried out in the Department of Microbiology, Manipal Teaching Hospital, Pokhara, Nepal from June 2002 to January 2003. A total of 462 sputum samples were collected from patients suspected lower respiratory tract infection. The samples were processed as Gram staining to find out the suitability of the specimen, cultured on Sabouraud's Dextrose Agar (SDA) and also on blood agar and chocolate agar to identify the potential lower respiratory tract pathogens. For the identification of Candida, sputum samples were processed for Gram stain, culture, germ tube test, production of chlamydospore, sugar fermentation and assimilation test. For the identification of bacteria, Gram stain, culture, and biochemical tests were performed by standardized procedure. RESULT: Out of 462 samples, 246 (53.24%) samples grew potential pathogens of lower respiratory tract. Among them Haemophilus influenzae 61(24.79%) and Streptococcus pneumoniae 57 (23.17%) were the predominant bacterial pathogens. Candida species were isolated from 30 samples (12.2%). The majority of Candida species amongst the Candida isolates were Candida albicans 21(70%) followed by Candida tropicalis 4(13.33%). Candida krusei 3(10%), Candida parapsilosis 1(3.33%) and Candida stellatoidea 1(3.33%). The highest rate of isolation of Candida was between the age of 71 and 80. CONCLUSION: Candida isolation from sputum samples is important as found in the present study in which Candida species were the third most common pathogen isolated from patients with lower respiratory tract infection.

Coccidioidomicosis osteoarticular: estudio clinicopatológico de una serie de 36 pacientes mexicanos / Osteoarticular coccidioidomicosis clinical and pathological: study of 36 Mexican patients

Coccidioidomycosis (CM) is primarily a lung disease. Systemic spread occurs in 1% of cases and one of its manifestation is osteoarthritis. Aim. To describe the clinical and pathological characteristics of 36 patients with osteoarthritis by Coccidioides immitis (COA). Material and methods. The surgical pathology records of two medical institutions were reviewed; patients with clinical diagnosis of osteoarthritis and definitive histopathological diagnosis of COA were included in the study. Results were analyzed by contingence tables (RXC) and test. Results. Twenty six adults (19 men, seven women) and 10 children (seven males, three females) were studied. The analysis demonstrated a predominance of disease in men (72.2%, p - 0.008). There was no difference between males and females in relation to history of mycotic disease or diagnosis of lung disease after the diagnosis of COA. Bone involvement (76% of cases) was more frequent that pure joint lesions and the predominant radiological lesion was of lytic type. 30.5% of patients (11 cases) had multiple bone lesions and eight of them were men with multiple vertebral bone lesions. Discussion. The COA was the only manifestation of disease in 83% of the patients. Therefore is important to consider this etiology in patients of endemic area. The clinical and radiological spectrum of COA is wide and may include a dentigerous and synovial cyst or simulates metastatic disease. The recognition of the clinical manifestations of COA may contribute to an opportune diagnosis and treatment.

La coccidioidomicosis (CM) es una enfermedad primariamente pulmonar. La diseminación sistémica ocurre en 1% de los casos y una de sus manifestaciones es la osteoartritis. Objetivo. Conocer las características clínicas y patológicas de 36 pacientes con osteoartritis por Coccidioides immitis (OAC). Material y métodos. Se revisaron los archivos de patología quirúrgica de dos instituciones y se incluyeron aquellos pacientes que consultaron por enfermedad osteoarticular y cuyo diagnóstico final histopatológico fue de CM. Los resultados se analizaron con tablas de contingencia (programa RXC) y prueba de . Resultados. Se estudiaron 26 adultos (19 hombres, siete mujeres) y 10 niños (siete hombres y tres mujeres). La prueba de mostró un predominio de casos en hombres (72.2%, p = 0.008). No hubo diferencia entre hombres y mujeres en relación con antecedentes de enfermedad micótica ni en el diagnóstico de enfermedad pulmonar posterior al diagnóstico de OAM. El compromiso óseo (76% de los casos) fue más frecuente que las lesiones articulares puras y la imagen radiológica predominante fue la osteolítica. De los casos estudiados, 30.5% (11 casos) presentaban lesiones óseas múltiples. De estos 11 casos, ocho eran hombres que en su mayoría presentaban lesiones vertebrales dorsales bajas y lumbares. Discusión. En 83% de los pacientes que se presentaron por OAC, esta fue la única manifestación de la enfermedad. El espectro clínico y radiológico de OAC es muy amplio y puede presentarse como un quiste dentígero, un quiste sinovial o simular enfermedad metastásica. El reconocimiento de esta variedad de presentaciones clínicas en individuos de zonas endémicas puede contribuir a un diagnóstico oportuno y tratamiento específico.

Seroprevalencia de micosis pulmonares en pacientes con sintomatología de enfermedad respiratoria crónica baja: Alto Huallaga, Perú 2004 / Pulmonary mycosis seroprevalence in patients with chronic low respiratory symptomatology: Alto Huallaga, Peru 2004

Objetivo: Detectar por serología la presencia de micosis de localización pulmonar (Paracoccidioides brasiliensis, Aspergillus sp. e Histoplasma capsulatum), en pacientes con síntomas de enfermedad respiratoria crónica. Diseño: Estudio transversal. Lugar: Alto Huallaga (selva de los departamentos de Huánuco y San Martín), Perú. Pacientes: Se incluyó personas procedentes de seis distritos (Rupa Rupa, Tocache, Uchiza, Santa Lucia, Aucayacu y Puerto Inca - Sungaro) con diagnóstico de enfermedad respiratoria crónica baja, tres episodios o más de bronquitis al año y/o tos con expectoración por más de tres meses y en quienes se descartó tuberculosis pulmonar mediante baciloscopia directa. Intervenciones: Por cada persona se llenó una ficha clínica-epidemiológica durante abril a septiembre de 2004, seguido de la toma de una muestra de suero (10 mL) para las pruebas de inmunodifusión para Histoplasma capsulatum, Paraccocidiodes brasiliensis, Aspergilus sp, y Aspergillus fumigatus. Principales medidas de resultados: Seroprevalencia de micosis a Histoplasma capsulatum, Aspergilosis spp. y Paracoccidioides brasiliensis. Resultados: De 640 casos, 327 (51,1 por ciento) fueron de sexo masculino, edad promedio 37,1 años y tiempo de enfermedad de 7,4 meses. La seroprevalencia de micosis fue 1,7 por ciento (11/640): 4 Histoplasma capsulatum y 7 Aspergilosis spp. No se obtuvo casos positivos de Paracoccidioides brasiliensis y, en los casos positivos, solo se encontró asociación con 'baja de peso' (p = 0,004). Conclusión: Si bien la frecuencia micoserológica obtenida fue baja, se sugiere en esta zona endémica considerar a las micosis dentro del diagnóstico diferencial de casos con enfermedades respiratorias crónicas bajas, así como la utilización de técnicas de inmunodifusión para el diagnóstico de estas etiologías.

Objective: To detect lung mycosis (Paracoccidioides brasiliensis, Aspergillus sp., and Histoplasma capsulatum) with chronic respiratory disease symptoms (Huanuco and San Martin departments forest). Design: Cross-sectional study. Setting: Peru's Alto Huallaga . Patients: Study done in six districts' (Rupa Rupa, Tocache, Uchiza, Santa Lucia, Aucayacu and Puerto Inca - Sungaro) subjects with diagnosis of chronic respiratory disease, three or more episodes of bronchitis per year and/or cough for over three months in whom pulmonary tuberculosis was screened by direct baciloscopy. Interventions: Each subject had a clinical epidemiological card filled and 10 mL of blood was collected for immunodiffusion test for Histoplasma capsulatum, Paraccocidiodes brasiliensis, and Aspergilus sp, between April and September 2004. Main outcome mesasures: Mycosis seroprevalence, including Histoplasma capsulatum, Aspergilus spp., and Paracoccidioides brasiliensis. Results: From 640 cases, 327 (51,1 per cent) were males, avegare age 37,1 years and time of disease 7,4 months. Mycosis seroprevalence was 1,7 per cent (11/640), including 4 Histoplasma capsulatum and 7 Aspergilus spp. No positive cases of Paracoccidioides brasiliensis was obtained and the positive cases were associated only to 'low weight' (p = 0,004). Conclusion: Although the mycosis serologic frequency was low, we suggest to consider mycosis in the differential diagnosis of cases with chronic respiratory diseases in endemic zones, as well as the use of immunodiffusion techniques for diagnosis.

Histoplasmose pulmonar aguda no Rio Grande do Sul / Acute pulmonary histoplasmosis in the State of Rio Grande do Sul, Brazil

INTRODUÇAO: A histoplasmose pulmonar aguda depende da inalação de uma grande quantidade de propágulos fúngicos por um paciente hígido. O tempo de exposição determina a gravidade da doença. Uma epidemia é influenciada por fatores que afetam o crescimento e a transmissão do Histoplasma capsulatum var. capsulatum na natureza. OBJETIVO: Identificar os aspectos epidemiológicos e clínico-laboratoriais dos pacientes com histoplasmose pulmonar aguda no Rio Grande do Sul e compará-los com as microepidemias relatadas no Brasil. MÉTODO: Foram revisados 212 prontuários clínicos de pacientes com histoplasmose dos arquivos do Laboratório de Micologia do Complexo Hospitalar Santa Casa de Porto Alegre (RS) num período de 25 anos (1977-2002). Foram identificados e incluídos no estudo os casos de histoplasmose pulmonar aguda com cultivo positivo e/ou achado histopatológico compatível. As microepidemias foram diagnosticadas com a comprovação de um caso ou evidência soromicológica com história clínica compatível. Foram revisadas as microepidemias publicadas no Brasil. RESULTADOS: Dezoito de um total de 212 pacientes (8,5 por cento) foram incluídos no trabalho. A idade variou de 8 a 63 anos (média de 35,4; mediana de 34,5), e 67 por cento eram do sexo masculino. A história epidemiológica foi sugestiva em 11 pacientes (61 por cento). O tipo primário de histoplasmose pulmonar aguda foi o mais freqüente (17; 95 por cento). Houve predomínio de casos isolados. CONCLUSAO: O reconhecimento de casos isolados e a presença de microepidemias demonstram a abundância do H. capsulatum no solo, e juntamente com a ocorrência de todas as formas da doença, confirmam o Rio Grande do Sul como hiperendêmico para histoplasmose.

Isolation of fungi from patients with pulmonary system disorder

Sputum from 210 patients suffering from pulmonary system disorder were culturing on SDA, in order to isolation fungi species which may be have a role in this cases. Five species of fungi were diagnostic: Candida albicans, Aspergillus niger Aspergillus fumigatus, Geotrichum candidum and Mucor sp. C. albicans was showed a high percents No. [45.71 percent] follow by A. niger [9.52 percent] and A. fumigatus [8.57 percent], especially in males than females with 33.80 percent of negative growth. Smoking and antibiotic therapy were also recorded from all patients and C. albicans with Aspergillus species have also recorded from all patients and C. albicans with Aspergillus species have also been a high rats of isolate from these patients, whereas, Geotrichum candidum was not isolated from neither smoking patients nor patients under antibiotic therapy

Estudo do agente causal do complexo primário na cidade de Niterói (Brasil) / The study of causal agent of the primary complex in Niterói city (Brazil)

Introdução: o presente trabalho tem por objetivo estudar a prevalência de histoplasmose como o agente causal de complexo primário na cidade de Niterói (estado do Rio de Janeiro, Brasil). Métodos: no período de Janeiro de 1985 a Dezembro de 1986 foram submetidos à necropsia 100 pacientes falecidos por causas diversas e internados nas diversas nas diferentes clínicas do Hospital Antônio Pedro - Universidade Federal Fluminense, localizado em Niterói. Em 34 (34/100) dos casos (todos de Niterói) foram encol)trados nódulos e/ou gânglios intra-torácicos compatíveis com complexo primário cuja etiologia foi investigada. Em todos os casos foram utilizadas as colorações de hematoxilina-eosina, ácido periódico de Shiff (PA.S.), Crocott, mucicarmin e Ziehl-Neelsen. Resultados: em 20 (7/34) dos casos estudados foi visualizado somente o H. capsulatum. Conclusão: o elevado percentual de H. capsulatum como agente causal do complexo-primário na amostra estudada sugere que este tipo de micose seja mais freqüente no nosso meio do que se supõe. Este resultado é compatível com os resultados sugeridos através de inquéritos utilizando testes cutâneos com histoplasmina em área endêmicas de histoplasmose

Histoplasmose pulmonar aguda: relato de uma microepidemia / Acute pulmonary histoplasmosis: report of an outbreak

Os autores relatam uma microepidemia de histoplasmose pulmonar, com cinco crianças que desenvolveram a doença em um período de 7 a 14 dias após a limpeza de um forno desativado para produção de carvão vegetal. Todas apresentaram quadro de febre alta persistente, tosse seca, astenia e anorexia, com 28 dias de evolução. Quando buscaram atendimento médico, uma delas encontrava-se taquipnéica, febril, com hepatomegalia e palidez cutânea, estando as restantes em regular estado geral e já sem febre. As radiografias de tórax demonstravam, em todos os casos, infiltrados reticulonodulares grosseiros, difusos e bilaterais, além de linfonodomegalias hilares. As tomografias computadorizadas evidenciaram pequenos nódulos difusos, com distribuição aleatória, além das linfonodomegalias. Os diagnósticos foram confirmados por meio da imunodifusão em gel para Histoplasma capsulatum, que foi positiva em todas as amostras pareadas coletadas com 15 dias de intervalo. Apenas uma criança necessitou de internação, por causa de importante queda no estado geral, sendo realizado tratamento de suporte e observação. Todas as crianças evoluíram com melhora clínica, sem o uso de antifúngicos, e foram submetidas a tomografias de controle após cerca de 50 dias, que demonstraram importante regressão das lesões.

The authors report a pulmonary histoplasmosis outbreak occurring in five children after the cleaning of a deactivated coal furnace. The symptoms were high fever, dry cough, asthenia and anorexia. By the time parents seeked for medical care, only one child remained symptomatic with fever, tachypnea and hepatomegaly. All the patients had similar radiological findings. Chest films showed diffuse, bilateral, reticulonodular infiltrates and lymph node enlargement. Computed tomography showed small nodules with a random distribution and hilar and mediastinal lymph nodes. Diagnosis was confirmed by positive gel immunodiffusion for Histoplasma capsulatum. Only one patient needed to be hospitalized to receive supportive treatment. The use of antifungal agents was not necessary in any of the patients. After 50 days all patients were submitted to computed tomography studies that revealed significant remission of the lesions.

Surto de Histoplasmose em Pedro Leopoldo, Minas Gerais, Brasil / Outbreak of histoplasmosis in Pedro Leopoldo, Minas Gerais, Brazil

Um surto de histoplasmose foi identificado em Pedro Leopoldo, cidade do Estado de Minas Gerais, Brasil em 1997, na qual quatro indivíduos tiveram contato com uma caverna habitada por morcegos. O diagnóstico de histoplasmose pulmonar aguda foi feito com o uso de critérios clínicos, sorológicos, radiológicos e epidemiológícos. lnstituiu-se uma terapia antifúngica com cetoconazol (400mg/dia durante 30 dias) havendo remissão dos sintomas em poucos dias

Bronchopulmonary candidiasis in a tertiary referral hospital of Assam, India.

One hundred patients with chronic chest infection suffering for more than three months admitted into a tertiary referral Hospital, northeast India were examined for pulmonary mycoses. The morning sputum samples in 3 consecutive days with a throat swab of each patient were examined for detection, isolation and identification of the fungus. Study showed Pulmonary candidiasis in 50% of the patients where Candida albicans were having highest incidence of association followed by 5 other species of Candida. Pre-existing conditions like pulmonary tuberculosis, bronchogenic carcinoma, lung abscess, bronchial asthma make the lungs prone to be invaded by the candida species. Long term antibiotics and steroids therapy was found to be associated with pulmonary candidiasis. Other conditions like irradiation treatment, malignancy, diabetes mellitus and malnutrition were also found to be the predisposing factors which influence bronchopulmonary candidiasis.

The spectrum of respiratory mycoses in a referral hospital in north-western India.

There has been an increasing recognition of respiratory mycoses in this country in the recent past. Candidiasis, aspergillosis and cryptococcosis have been reported from different centres. Occasional cases of histoplasmosis and sporotrichosis have also been reported. Infections with Pneumocystis carinii, which is now classified as a fungus, are being frequently diagnosed, especially in the immuno-compromised patients such as those on prolonged immunosuppressive therapy or with HIV infection. Although the clinical picture of respiratory mycoses resembles that of any other infection, the presentation in several cases is atypical and the diagnosis is delayed. In a review of our patients of respiratory fungal infections seen in the last few years, we found several interesting examples. We report here the general clinical spectrum of respiratory mycoses and some interesting cases seen at our Centre.

Paracoccidioidomicose em índios brasileiros da tribo Suruí: estudo clínico-laboratorial de 2 casos / Paracoccidioidomycosis in Amerindiam populations of the Brazilian Suruí tribe: a clinical and laboratory study of two cases

Paracoccidioidomicose é considerada a micose sistêmica endêmica mais prevalente na América Latina. Apesar da maior parte da casuística de paracoccidioidomicose ocorrer entre trabalhadores rurais, há poucos casos documentados de ocorrência dessa micose entre índios brasileiros. Säo apresentados 2 casos de paracoccidioidomicose em índios Suruí, família linguística Tupi-Mondé, procedentes de Cacoal, Rondônia. Ambos apresentaram sorologia positiva a imunodifusäo apenas com antígenos da fase miceliana do P. brasiliensis. Os autores apresentam revisäo de literatura sobre a ocorrência dessa micose entre índios brasileiros e discutem a necessidade de futuras investigaçöes buscando caracterizar as diferenças regionais de cepas de P. brasiliensis e seu impacto no diagnóstico sorológico dessa micose