Keratitis secondary to Fusarium spp. in Spain 2012-2014. / Queratitis secundaria a Fusarium spp. en España 2012-2014.

OBJECTIVE: To describe the clinical-epidemiological characteristics of a case series of fungal keratitis associated with Fusarium spp.., in Spain during the years 2012 to 2014. METHODS: A retrospective study of a case series was conducted on a systematic random sample of 10% of patients identified in Health Centres of provincial capitals (n=250). The centres were asked whether they had been presented with cases of Fusarium spp. keratitis characterised by microbiological methods. Of the 23 centres that responded, 14 had detected cases, with 13 of them accepting to participate, and 11 of them completing the study. The latter being sent a previously validated questionnaire. The variables analysed were: age, gender, habitual residence, profession, disease and medical history (previous systemic and ocular diseases, previous eye surgeries), and their outcomes. RESULTS: The response rate was 92%, identifying 23 cases of Fusarium spp.. of which 21 (91.3%) of them lived in urban areas. The professions most affected by the disease included chefs, administrative, and technical, with 13 cases (56.5%). The treatment guidelines established to confirm the infection showed the combined use of topical antibiotics associated with antiviral and/or antifungal agents. The use of contact lenses (86.9%) was the main risk factor. DISCUSSION: This study showed that this is a rare disease in Spain, but that a large percentage of people who present with the disease are resident in urban areas, and they work in closed environments, focusing attention on microtraumas caused by use of contact lenses.

[Conjunctival keratoacanthoma: diagnosis, treatment and monitoring by conjunctival impression cytology]. / Queratoacantoma conjuntival. Diagnóstico, tratamiento y control mediante citología de impresión conjuntival.

CASE REPORT: We present a case report of a 28-year-old patient with a lesion that is compatible both clinically and histopathologically with conjunctival keratoacanthoma. The treatment given was complete excision and 0.04% mitomycin C eye drops in the postoperative period. The outcome was a complete clinical remission during the follow-up period (6 months). DISCUSSION: It is important to make a correct differential diagnosis between keratoacanthoma and squamous cell carcinoma, as well as carrying out close monitoring after surgery due to the possibility of relapse and conversion to squamous cell carcinoma. For this reason, we propose the use of conjunctival impression cytology as a non-invasive method for monitoring such patients.

Queratoacantoma conjuntival. Diagnóstico, tratamiento y control mediante citología de impresión conjuntival / Conjunctival keratoacanthoma. Diagnosis, treatment and monitoring by conjunctival impression cytology

Caso clínico: Se presenta el caso de un paciente de 28 años con una lesión compatible clínica e histopatológicamente con queratoacantoma conjuntival. Fue tratado mediante excisión completa, y colirio de mitomicina C al 0,04% en el posoperatorio. El resultado ha sido la remisión clínica completa durante el tiempo de seguimiento (6 meses). Discusión: Es importante hacer un correcto diagnóstico diferencial entre queratoacantoma y carcinoma de células escamosas, así como un estrecho seguimiento postoperatorio por la posibilidad de recidiva o conversión a carcinoma de células escamosas. Para ello proponemos la citología de impresión conjuntival como un método no invasivo para el seguimiento de estos pacientes(AU)

Case report: We present a case report of a 28-year-old patient with a lesion that is compatible both clinically and histopathologically with conjunctival keratoacanthoma. The treatment given was complete excision and 0.04% mitomycin C eye drops in the postoperative period. The outcome was a complete clinical remission during the follow-up period (6 months). Discussion: It is important to make a correct differential diagnosis between keratoacanthoma and squamous cell carcinoma, as well as carrying out close monitoring after surgery due to the possibility of relapse and conversion to squamous cell carcinoma. For this reason, we propose the use of conjunctival impression cytology as a non-invasive method for monitoring such patients(AU)

Medicina y viajes II: después del viaje / Medicine and trips II: after the trip

Ante todo viajero que consulta al regreso de un viaje debe realizarse una historia detallada del viaje haciendo especial hincapié en la ruta y países visitados, las fechas, el tipo de alojamiento, la historia de vacunaciones, la realización de quimioprofilaxis frente a la malaria, etc. A continuación, y como es habitual ante cualquier problema de salud, se llevará a cabo una anamnesis pormenorizada de los síntomas y una exploración física completa. Con los datos así obtenidos, el médico de Atención Primaria puede establecer una sospecha diagnóstica y solicitar aquellas pruebas complementarias que considere necesarias para realizar un buen diagnóstico diferencial. Los motivos de consulta más frecuentes al regreso son la diarrea, la fiebre y los problemas dermatológicos. Con respecto a la fiebre, cabe destacar que en viajeros procedentes del trópico siempre se debe descartar la malaria, incluso en aquellos pacientes que hayan realizado quimioprofilaxis, sin olvidar otras causas potencialmente graves como dengue, enfermedades producidas por Rickettsias, etc. La diarrea, por su parte, es la causa más frecuente de enfermedad en viajeros, y es muy importante en el estudio de ésta diferenciar los casos agudos de los crónicos, ya que el abordaje y el tratamiento van a ser distintos en uno y otro caso

A detailed history of the trip should be done for any traveler who consults the doctor on returning from a trip, placing special emphasis on the route on countries visited, dates, type of lodging, history of vaccinations, performance of chemoprophylaxis against malaria, etc. Afterwards, and as is common in any health problem, a detailed anamnesis of the symptoms and complete physical examination should be done. With the data thus obtained, the primary health care physician can establish a diagnostic suspicion and request those complementary tests considered necessary to conduct a good differential diagnosis. The most frequent reasons for consultation on return are diarrhea, fever and skin problems. In regards to fever, malaria should be ruled out in those travelers from tropical areas, even in those patients who have had chemoprophylaxis, without overlooking other potentially serious causes such as dengue, diseases produced by rickettsias, etc. On its part, diarrhea is the most frequent cause of disease in travelers and it is very important in the study of diarrhea in travelers to differentiate acute cases from chronic ones, since the approach in treatment will be different in one case or the other

Medicina y viajes (I): antes del viaje / Medicines and Travel 1: before the trip

En las últimas décadas el desarrollo de medios de transporte cada vez más rápidos y seguros ha propiciado un aumento en el número de personas que viajan a través del mundo ya sea por razones humanitarias, laborales o de ocio. De hecho, más de 50 millones de personas de los países desarrollados visitan países en vías de desarrollo cada año. Como consecuencia de este incremento de viajes internacionales, surge la denominada "medicina del viajero". El médico de Atención Primaria, como puerta de entrada al sistema sanitario, debe ser capaz de afrontar los problemas de salud relacionados con los viajes, cada vez más frecuentes en nuestro quehacer diario; aconsejar adecuadamente a los viajeros antes de partir sobre medidas generales y específicas de prevención (vacunas, quimioprofilaxis, etc.), y realizar un correcto diagnóstico y tratamiento de problemas planteados por el viajero a su regreso

In the last decades, the development of increasingly rapid and safe transportation means have led to an increase in the number of persons who travel over the world for humanitarian, work or leisure reasons. In fact, more than 50 million persons from developed countries visit developing countries every year. As a consequence of this increase in international trials, the name "traveler's medicine" has arisen. The Primary Health Care physician, as the entry site to the health care system, should be capable of dealing with health care problems related with travel which is increasingly more frequent in our everyday tasks, adequately advising the travelers before they leave on general and specific prevention measures (vaccinations, chemoprophylaxis, etc) and making a correct diagnosis and treatment of problems posed by the traveler on his/her return

[Lupus vulgaris as initial manifestation of asymptomatic pulmonary tuberculosis]. / Lupus vulgar como manifestación inicial de tuberculosis pulmonar inadvertida.

A clinical case of a male with lupus lesion localized in scalp associated to a bilateral cavitated pulmonary tuberculosis which was non symptomatic. The cutaneous symptoms of tuberculosis is reviewed because the rareness of this presentation.