RESUMEN
OBJECTIVE: Aspergillus section Nigri comprises a group of related species that include Aspergillus niger, A. welwitschiae, A. carbonarius, A. brasiliensis and A. tubingensis. Some of these species are morphologically very similar to A. niger but exhibit different patterns of susceptibility to antifungal agents; such is the case for A. tubingensis. Therefore, when diagnosing aspergillosis, it is important to identify the pathogen at the species level. This study aimed to identify the species of an Aspergillus spp. isolate (MM-82) obtained from a patient with a dermatosis localized to the right leg. MATERIALS AND METHODS: The MM-82 isolate was examined for macro- and microscopic morphology, conidia size and thermotolerance, and a phylogenetic analysis of a benA gene segment was performed for molecular identification. Susceptibility to antifungals was determined using antifungal microdilution according to the methodology of European Society of Clinical Microbiology and Infectious Diseases (EUCAST). RESULTS: Based on its phenotypic characteristics and the phylogenetic analysis of the sequence of a benA gene segment, the MM-82 isolate was identified as A. tubingensis. This fungus did not show resistance to antifungal agents commonly used for treatment. CONCLUSION: This study demonstrated that A. tubingensis can cause skin infection; this constitutes the first report of a case of aspergillosis caused by A. tubingensis in Mexico.
Asunto(s)
Antifúngicos/uso terapéutico , Aspergilosis/diagnóstico , Aspergillus/aislamiento & purificación , Enfermedades de la Piel/diagnóstico , Aspergilosis/tratamiento farmacológico , Aspergillus/clasificación , Aspergillus/efectos de los fármacos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/microbiología , Femenino , Genes Fúngicos , Humanos , Pierna/microbiología , México , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Filogenia , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/microbiología , Esporas Fúngicas/efectos de los fármacos , Esporas Fúngicas/aislamiento & purificaciónRESUMEN
A 79-year-old Caucasian man presented with multiple leg abscesses due to Nocardia pseudobrasiliensis. He was on chronic steroid therapy for myasthenia gravis. We present the difficulties in diagnosis and treatment of this rare organism. N. pseudobrasiliensis is a new emerging species that was previously thought to belong to the N. brasiliensis species. The distinction between the two species is extremely important given the different antibiotic susceptibility pattern and association of N. pseudobrasiliensis with more invasive and disseminated disease.
Asunto(s)
Absceso/microbiología , Antibacterianos/uso terapéutico , Pierna/microbiología , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Nocardia/efectos de los fármacos , Absceso/tratamiento farmacológico , Anciano , Farmacorresistencia Bacteriana , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Nocardia/clasificación , Nocardia/patogenicidad , Nocardiosis/complicacionesRESUMEN
INTRODUCTION: Necrotising fasciitis is a disease associated with high morbidity and mortality, and multi-focal necrotising fasciitis is uncommon. We present 2 cases of concurrent necrotising fasciitis of contralateral upper and lower limbs. CLINICAL PICTURE: Both presented with pain, swelling, bruising or necrosis of the affected extremities. Traditional medical therapy was sought prior to their presentation. TREATMENT: After initial debridement, one patient subsequently underwent amputation of the contralateral forearm and leg. The other underwent a forearm amputation, but refused a below-knee amputation. OUTCOME: The first patient survived, while the second died. CONCLUSION: Traditional medical therapy can cause bacterial inoculation, leading to necrotising fasciitis, and also leads to delay in appropriate treatment. Radical surgery is needed to optimise patient survival.