Mycobacterial disease in patients with chronic granulomatous disease: A retrospective analysis of 71 cases.

BACKGROUND: Chronic granulomatous disease (CGD) is a rare primary immunodeficiency caused by inborn errors of the phagocyte nicotinamide adenine dinucleotide phosphate oxidase complex. From the first year of life onward, most affected patients display multiple, severe, and recurrent infections caused by bacteria and fungi. Mycobacterial infections have also been reported in some patients. OBJECTIVE: Our objective was to assess the effect of mycobacterial disease in patients with CGD. METHODS: We analyzed retrospectively the clinical features of mycobacterial disease in 71 patients with CGD. Tuberculosis and BCG disease were diagnosed on the basis of microbiological, pathological, and/or clinical criteria. RESULTS: Thirty-one (44%) patients had tuberculosis, and 53 (75%) presented with adverse effects of BCG vaccination; 13 (18%) had both tuberculosis and BCG infections. None of these patients displayed clinical disease caused by environmental mycobacteria, Mycobacterium leprae, or Mycobacterium ulcerans. Most patients (76%) also had other pyogenic and fungal infections, but 24% presented solely with mycobacterial disease. Most patients presented a single localized episode of mycobacterial disease (37%), but recurrence (18%), disseminated disease (27%), and even death (18%) were also observed. One common feature in these patients was an early age at presentation for BCG disease. Mycobacterial disease was the first clinical manifestation of CGD in 60% of these patients. CONCLUSION: Mycobacterial disease is relatively common in patients with CGD living in countries in which tuberculosis is endemic, BCG vaccine is mandatory, or both. Adverse reactions to BCG and severe forms of tuberculosis should lead to a suspicion of CGD. BCG vaccine is contraindicated in patients with CGD.

The prevalence of common skin infections in four districts in Timor-Leste: a cross sectional survey.

BACKGROUND: Skin infections are a common public health problem in developing countries; however, they are rarely managed using a population based approach. Recent data on the burden of skin infections in Timor-Leste are limited. Our survey appears to be the only widespread survey conducted in more than 30 years and was designed to determine the baseline prevalence of some common skin infections in Timor-Leste. METHODS: We conducted a cross sectional survey in 14 sites including community health clinics, schools and hospitals within four different geographical regions. Participants were examined for five conditions (scabies, pyoderma, fungal infections, leprosy and yaws) by a multidisciplinary team. Analyses were conducted using EpiInfo version 6.04d. RESULTS: We examined the skin of 1535 participants aged between four months and 97 years. The majority of participants were male, aged between 11 and 20 years and had at least one condition of interest (56.0%, 56.0%, and 63.1%, respectively). Fungal infections were the most common presentation (39.0%) and males were more commonly affected than females (42.3% vs 34.0%, respectively, pvalue < 0.0001).Among those people with more than one condition the two most common co-infections were scabies with either pyoderma or a fungal infection (38.0% and 32.0%, respectively). The survey identified 29 previously undiagnosed cases of leprosy and six cases of yaws. CONCLUSIONS: Our findings indicate the need for a comprehensive programme to address these conditions. There are successful disease control programmes in place within the country and it is hoped a healthy skin programme could be integrated into an established disease control programme in order to maximise health benefits and resources.

Informe sobre micosis profundas / Report of deep mycosis profundas

A partir de 1980, se estudiaron 73 enfermos con micosis profundas en un Servicio de Dermatología de la ciudad de Santa Fe conjuntamente con la sección Micología de la Cátedra de Prácticas Finales de La Facultad de Bioquimica de la Universidad Nacional del Litoral. Hubo 44 pacientes con paracoccidioidomicosis, de los cuales uno presentó la forma clínica juvenil, los restantes tuvieron la forma crónica tipo adulto. Se observaron 12 enfermos con aspergilosis cavitaria, todos tuberculosos inactivos, menos uno en que persistía actividad bacilar. De los 5 casos histoplasmosis, 4 fueron formas clínicas pulmonares crónicas y el restante diseminada crónica. Atendimos 9 pacientes con esporotricosis; de ellos 8 acusaron formas cutáneo-linfáticas y 1 cutáneo fija. Diagnosticamos un caso de micetoma maduromicótico, otro caso de actinomicosis geniana y una candidiasis invasiva en una paciente diabética. Hemos observado que un porcentaje elevado de enfermos no concluyó el tratamiento y faltó al control prefijado. Esto demuestra la necesidad de implementar programas de detección y control de micosis profundas en áreas endémicas en Argentina, como los desarrollados en tuberculosis y lepra

Informe sobre micosis profundas / Report of deep mycosis profundas

A partir de 1980, se estudiaron 73 enfermos con micosis profundas en un Servicio de Dermatología de la ciudad de Santa Fe conjuntamente con la sección Micología de la Cátedra de Prácticas Finales de La Facultad de Bioquimica de la Universidad Nacional del Litoral. Hubo 44 pacientes con paracoccidioidomicosis, de los cuales uno presentó la forma clínica juvenil, los restantes tuvieron la forma crónica tipo adulto. Se observaron 12 enfermos con aspergilosis cavitaria, todos tuberculosos inactivos, menos uno en que persistía actividad bacilar. De los 5 casos histoplasmosis, 4 fueron formas clínicas pulmonares crónicas y el restante diseminada crónica. Atendimos 9 pacientes con esporotricosis; de ellos 8 acusaron formas cutáneo-linfáticas y 1 cutáneo fija. Diagnosticamos un caso de micetoma maduromicótico, otro caso de actinomicosis geniana y una candidiasis invasiva en una paciente diabética. Hemos observado que un porcentaje elevado de enfermos no concluyó el tratamiento y faltó al control prefijado. Esto demuestra la necesidad de implementar programas de detección y control de micosis profundas en áreas endémicas en Argentina, como los desarrollados en tuberculosis y lepra (AU)