Ischaemic colitis (necrotizing colitis, pseudomembranous colitis) in acute schistosomiasis mansoni: report of two cases.

Two cases of ischaemic necrosis of the sigmoid colon (necrotizing colitis) are reported in 2 brothers aged 7 and 4 years, diagnosed within a 10 d interval. The children had bathed in streams suspected to be contaminated by Schistosoma mansoni about 50-60 d before the onset of acute disease. Both patients had been previously exposed to schistosome-infected streams without showing signs or symptoms of infection. Before admission, S. mansoni eggs had not been found in the stool. Both patients presented with an apparently identical, relatively symptomatic clinical course with rapid evolution to an acute abdomen. Laparotomy disclosed, in both patients, extensive necrosis (ischaemic necrotizing colitis of schistosomal aetiology) of about 20 cm in the first child and 8 cm in the second, extending from part of the descending colon to the sigmoid. The patients were successfully operated upon (hemicolectomy plus colostomy). The histopathological findings were similar in both patients. Ischaemic necrosis with complete destruction of the mucosa and part of the submucosa was detected in the first case; in the necrotic areas a few eggs of S. mansoni were seen, with no granulomatous reaction, but surrounded by cell shadows, pycnotic nuclei and amorphous material. Necrosis extended to the muscular layer and serosa, in which schistosome granulomas in the necrotic-exudative phase were seen, as well as diffuse granulocytic exudate and fibrin. Sections of tissue from both patients contained numerous eggs and granulomas all in the same exudative phase in regional lymph nodes and near the thrombotic vessels. After surgery, the 2 patients progressed similarly. About 10 d after hospital discharge, the patients received anti-schistosomal treatment with oxamniquine. No further sign of infection was detected at subsequent recall visits.

[Combination of 5-fluorocytosine and amphotericin B in the treatment of chromomycosis]. / Associação de 5-fluorocitosina e anfotericina B no tratamento da cromomicose.

The authors discuss the problem of resistance of chromomycosis to 5-fluorocytosine (5-FC), observed in a previous study in 7 patients initially treated with the drug and subsequently treated with 5-FC associated with other medicaments. All the associations, including that with amphotericin B, failed to overcome resistance. Experiments in mice and "in vitro" show a synergism between 5-FC and amphotericin B against "C. albicans", "C. neoformans" and "Fonsecaeae pedrosoi" already confirmed in human subjects infected with the above mentioned fungi. Resistance to 5-FC seems to be irreversible, as shown in previous experiments. The mechanism of action of the drugs on the fungi is discussed, as well as the fact that amphothericin B prevents the development of resistance to 5-FC. Results obtained with the use of the above association in 5 cases of chromomycosis are presented; all the patients had old and well established lesions, and in three cases these lesions were large and disseminated, conditions probably associated with the development of resistance to 5-FC used alone. The drugs were given in small doses, inferior to those usually recommended. The good therapeutic results seem to confirm the synergism observed in laboratory trials. Four cases were discharged as cured and one abandoned treatment for personal reasons. The association seems to act more rapidly than 5-FC alone. Tolerance was excellent in all cases.

Six years' experience in treatment of chromomycosis with 5-fluorocytosine,.

Twenty-three patients with chromomycosis were treated with oral 5-fluorocytosine for periods ranging from 2 to 67 months. Sixteen were considered cured, after 3 consecutive monthly controls showing healing of the lesions and absence of fungi in mycologic and histopathologic examinations of biopsy specimens. Seven, in spite of initial clinical improvement, showed resistance to treatment. Associated treatment with amphotericin B, calciferol or thiabendazole failed to help patients resistant to 5-fluorocytosine. Resistance seems to occur especially in those with long-standing lesions or widespread involvement.