Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 1: micosis subcutáneas / Cutaneous involvement in the deep mycoses: a literature review. Part I-subcutaneous mycoses

Las micosis profundas son infecciones poco frecuentes en nuestro medio. Se presentan principalmente en pacientes inmunodeprimidos o en regiones de climas tropicales, que abarcan las micosis subcutáneas y las micosis sistémicas. Las micosis subcutáneas o por implantación siempre producen signos de afectación cutánea. En la primera parte de esta revisión se realizará una revisión de las principales micosis subcutáneas: esporotricosis, cromoblastomicosis, micetomas, feohifomicosis, hialohifomicosis y lacaziosis. Reconocer y tratar estas micosis subcutáneas de forma precoz es importante, ya que a menudo están asociadas a una alta morbilidad

The deep mycoses are uncommon in our setting. These fungal infections occur mainly in immunosuppressed patients or in tropical climates, and include subcutaneous infections and systemic infections. The skin is always involved in the former. In the first part of this review, we describe the main subcutaneous mycoses: sporotrichosis, chromoblastomycosis, mycetoma, phaeohyphomycosis, hyalohyphomycosis, and lacaziosis. Early recognition and treatment is important, as these infections are frequently associated with high morbidity

Disseminated Penicilium marneffei infection.

This is a case report of disseminated Penicillium marneffei infection in a patient with leprosy, responding to antifungal therapy. Radiologically there were nodules in the left lung, right pleural effusion, lymphadenopathy in neck, mediastinum and upper abdomen and abscesses in the liver and right parietal lobe. This case highlights a rare infection in a non-HIV related immunocompromised patient, and its nonspecific radiologic manifestations.

Breakthrough invasive infection due to Debaryomyces hansenii (teleomorph Candida famata) and Scopulariopsis brevicaulis in a stem cell transplant patient receiving liposomal amphotericin B and caspofungin for suspected aspergillosis.

An allogeneic stem cell transplant recipient developed pulmonary infiltrates and Aspergillus antigenemia during prophylactic low-dose liposomal amphotericin B. No response to therapy was observed after increasing the dose of liposomal amphotericin B and addition of caspofungin, and breakthrough candidemia developed. Therapy switch to voriconazole did not prevent the development of lethal septic shock. Shortly before death, Scopulariopsis brevicaulis was cultured from bronchial secretions, and positive blood cultures demonstrated persistent candidemia due to Debaryomyces hansenii, teleomorph of Candida famata.

Corneal ulcer caused by Bipolaris hawaiiensis.

Following an injury to the right eye, a corneal ulcer with hypopyon developed in a leprosy patient. Direct examination of the corneal scrapings on three occasions showed septate, branched, dematiaceous hyphal elements. When scrapings were cultured on Sabouraud's glucose and brain heart infusion agars. Bipolaris hawaiiensis was isolated repeatedly. The patient responded successfully to treatment with nystatin ointment, although the central opacity of the cornea remained and visual acuity did not improve.

[Basic trends and the prospects for creating new synthetic chemotherapeutic preparations]. / Osnovnye napravleniia i perspektivy sozdaniia novykh sinteticheskikh khimioterapevticheskikh preparatov.

Chemotherapy and chemoprophylaxis play a significant role in control of various infectious diseases. The use of chemotherapeutic drugs is associated with a number of difficulties, such as development of drug resistance in pathogenic microorganism during the treatment, possible toxic effects of drugs on their prolonged use, inefficiency of chemotherapy in bacteria carriers, etc. In spite of the achievements in chemotherapy of acute bacterial infections, tuberculosis, lepra, mycoses, protozoal infections, it is necessary to have available new drugs for the treatment of these diseases. The achievements in chemotherapy of viral infections are relatively modest. However, therapy of such infections is of great importance for medicine. Highly effective broad-spectrum antiviral agents may play a significant role in the control of widely spread viral diseases of man and cattle. Such drugs will be of great significance in prevention of complications in persons with viral infections and studying the diseases of supposed viral etiology. For the successful solution of the problems of chemotherapy, a proper strategy in the development of the research work in this field is of importance.

Progress in antimycotic chemotherapy 1945-1980

Before 1950 no reliable or safe therapy existed for systemic and invasive mycoses, and only traditional and empirical topical preparations were available for dermatomycoses. Two distinct eras of rapid progress in antifungal therapy followed: first, in the 1950's came the introduction of the polyenes, nystatin and pimaricin for cutaneous, vaginal and intestinal candidiasis, and amphotericin B for the treatment of severe systemic mycoses. The second phase saw the successful introduction and clinical use of 5-fluorocytosine and several imidazole derivatives some twenty years later, at a time when the vast increase in iatrogenic systemic mycoses caused by opportunistic fungi had created an urgent and pressing need for new agents in addition to those still effective.