Diagnóstico micológico de histoplasmosis en Uruguay, reporte de una serie de casos de la última década

Introducción: La histoplasmosis es una micosis sistémica que afecta a humanos, su agente Histoplasma capsulatum, hongo dimorfo, es ubicuo en la naturaleza. Frecuentemente se presenta como reactivación en personas con infección por VIH/SIDA, con manifestaciones polimórficas y diseminadas. Las lesiones mucocutáneas son una importante llave diagnóstica. Objetivo: Contribuir al conocimiento de esta patología a través del reporte de los diagnósticos de laboratorio de histoplasmosis realizados en Uruguay en los últimos 10 años. Materiales y Métodos: Se realizó un estudio observacional, retrospectivo de las histoplasmosis diagnosticadas en el laboratorio de referencia de Micología de Facultad de Medicina y dos laboratorios clínicos. Se enrolaron los registros clínicos y analíticos asociados. Resultados: Fueron 69 los diagnósticos de histoplasmosis. Más de 80% correspondió a personas con infección por VIH/SIDA. El 62,3% del total presentó lesiones de piel y/o mucosas y en 58% el diagnóstico se realizó mediante el estudio de estas. El 62,3% de los diagnósticos se realizaron mediante la visualización al microscopio óptico de frotis coloreados. Conclusiones: La mayoría de las histoplasmosis se vinculan a la infección por VIH/SIDA. El estudio micológico de las lesiones de piel y/o de mucosas, es accesible, mínimamente invasivo, rápido y presenta una excelente performance diagnóstica.

Background: Histoplasmosis is a systemic mycosis that affects humans, its agent Histoplasma capsulatum, a dimorphic fungus, is ubiquitous in nature. It frequently presents as reactivation in people with HIV/AIDS infection, with polymorphic and disseminated manifestations. Mucocutaneous lesions are characteristic and an important diagnostic key. Aim: To contribute to the knowledge of this pathology through the report of histoplasmosis laboratory diagnosis made in Uruguay in the last 10 years. Methods: We conducted an observational, retrospective study of diagnosed histoplasmosis in the Mycology reference laboratory of the Faculty of Medicine and two clinical laboratories. Associated clinical and analytical records were obtained. Results: There were 69 histoplasmosis diagnoses. More than 80% corresponded to people with HIV/AIDS infection. 62.3% of the total presented skin and/or mucosal lesions and in 58% the diagnosis was made by studying them. 62.3% of the diagnoses were initially made by viewing colored smears under an optical microscope. Conclusions: Most histoplasmosis is linked to HIV/AIDS infection. Exposure to a high fungal load is a constant in cases of immunocompetent individuals. The mycological study of skin and/or mucosal lesions is accessible, minimally invasive, fast and has excellent diagnostic performance.

Epidemiología y factores predisponentes de los hallazgos dermatológicos en neonatos de Uruguay / Neonatal Dermatologic Findings in Uruguay: Epidemiology and Predisposing Factors

Introducción: La piel es fundamental en la transición de la vida intrauterina a la extrauterina. El recién nacido presenta cambios fisiológicos, siendo frecuente observar hallazgos cutáneos benignos y transitorios que varían según las características maternas, neonatales y de la gestación. Objetivos: Estimar la frecuencia de distintos hallazgos dermatológicos en neonatos en las primeras 72h de vida e identificar la existencia de diferencias de proporciones estadísticamente significativas con factores neonatales, maternos y de la gestación. Métodos Se realizó un estudio descriptivo, observacional de corte transversal entre abril-julio 2015 y julio-noviembre de 2017 en la maternidad del Centro Hospitalario Pereira Rossell. Se incluyeron neonatos de hasta 72h de vida, a los que se les practicó un examen dermatológico completo. Se presenta la proporción de cada uno de los hallazgos con el intervalo de confianza (IC) correspondiente. Se analiza la relación entre los hallazgos y determinados factores asociados. Resultado Se incluyeron 2811 neonatos. El 100% presentó al menos un hallazgo a nivel de la piel. La mediana fue de 8 lesiones por paciente (rango intercuartílico: 6-9/mínimo-máximo: 1-16). De los 46 hallazgos explorados clínicamente se encontraron 42. Las lesiones benignas y transitorias correspondieron al 99,9%. Entre ellas se observó: lanugo 98% (IC: 97,7-98,7), descamación fisiológica 79,7% (IC: 78,2-81,1) e hiperplasia sebácea 73,3% (IC: 71,6-74,9). El lanugo (p=0,001), la descamación fisiológica (p<0,001) y el eritema tóxico neonatal (p=0,001) se observaron con más frecuencia en los neonatos de término y postérmino. La hiperplasia sebácea (p=0,001) y la hiperpigmentación transitoria neonatal (p<0,001) se encontraron con mayor frecuencia en varones (AU)

Background: The skin is a fundamental organ in the transition from intrauterine to extrauterine life. The newborn infant experiences physiological changes and often presents benign, transient skin characteristics that vary according to maternal, gestational, and neonatal factors. Objectives: To estimate the frequency of various dermatologic findings during the first 72hours of life and to identify their association with maternal, gestational, or neonatal factors. Methods Descriptive, observational, cross-sectional study from April to July 2015 and July to November 2017 in the maternity ward of Centro Hospitalario Pereira Rossell. We examined the skin of neonates within 72hours of birth. Proportions and 95% CI were calculated for all findings. Associations between findings and factors were analyzed. Results A total of 2811 neonates were included. We observed at least one neonatal skin finding in all of the neonates and found a median (interquartile range) of 8 (6-9) findings (minimum–maximum, 1-16). We observed 42 of the 46 possible characteristics we looked for; 99.9% of the findings were benign and transient. Among the findings were lanugo (98%; 95% CI, 97.7%-98.7%), physiological scaling (79.7%; 95% CI: 78.2%-81.1%), and sebaceous hyperplasia (73.3%; 95% CI: 71.6%-74.9%). Lanugo (P=.001), physiological scaling (P<.001), and erythema toxicum (P=.001) were observed significantly more often in full- and late-term neonates. Sebaceous hyperplasia (P=.001) and transient hyperpigmentation (P<.001) were found more often in newborn males. Erythema toxicum was more common after vaginal births (P=.008). Transient hyperpigmentation (P<.001) and dermal melanocytosis (P<.001) were seen more often in neonates of African descent (AU)

Neonatal Dermatologic Findings in Uruguay: Epidemiology and Predisposing Factors. / Epidemiología y factores predisponentes de los hallazgos dermatológicos en neonatos de Uruguay.

BACKGROUND: The skin is a fundamental organ in the transition from intrauterine to extrauterine life. The newborn infant experiences physiological changes and often presents benign, transient skin characteristics that vary according to maternal, gestational, and neonatal factors. OBJECTIVES: To estimate the frequency of various dermatologic findings during the first 72hours of life and to identify their association with maternal, gestational, or neonatal factors. METHODS: Descriptive, observational, cross-sectional study from April to July 2015 and July to November 2017 in the maternity ward of Centro Hospitalario Pereira Rossell. We examined the skin of neonates within 72hours of birth. Proportions and 95% CI were calculated for all findings. Associations between findings and factors were analyzed. RESULTS: A total of 2811 neonates were included. We observed at least one neonatal skin finding in all of the neonates and found a median (interquartile range) of 8 (6-9) findings (minimum-maximum, 1-16). We observed 42 of the 46 possible characteristics we looked for; 99.9% of the findings were benign and transient. Among the findings were lanugo (98%; 95% CI, 97.7%-98.7%), physiological scaling (79.7%; 95% CI: 78.2%-81.1%), and sebaceous hyperplasia (73.3%; 95% CI: 71.6%-74.9%). Lanugo (P=.001), physiological scaling (P<.001), and erythema toxicum (P=.001) were observed significantly more often in full- and late-term neonates. Sebaceous hyperplasia (P=.001) and transient hyperpigmentation (P<.001) were found more often in newborn males. Erythema toxicum was more common after vaginal births (P=.008). Transient hyperpigmentation (P<.001) and dermal melanocytosis (P<.001) were seen more often in neonates of African descent. CONCLUSIONS: All neonates have skin characteristics that are part of their adaptation to extrauterine life. Most are benign and transient. Maternal age, type of delivery, and certain neonatal factors such as gestational age, birth weight, sex, and ethnicity are associated with specific findings.

Uso de adhesivos médicos y lesiones de piel: prevalencia en Colombia / Use of medical adhesives and skin lesions: Prevalence in Colombia

O b j e t i v o: e s t a bl e c e r l a pr e v a l e n c i a d e l e s i o ne s d e p i e l t i p o M a r s i e n C o l o mb i a e n e l a ñ o 2 0 1 8. M a t e r i a l e s y métodos: se llevó a cabo un estudio descriptivo transversal de prevalencia con la participación de enfermeras que laboran en 46 instituciones de diferentes niveles de atención de 11 departamentos de C o l o mb i a . S e r e m i t i e r o n 1 000 co rr e o s e l e c t r ó n i co s y s e o b t u v i e r o n 3 1 0 e n c u e s t a s L a i n f o r m a c i ón f u e r e co l e c t a d a m e d i a n t e e n c u e s t a e n l í ne a co n l a h e rr a m i e n t a S u r v e y M o n k e y ® . S e u t i l i z ó m u e s t r e o n o pr o b a b i l í s t i co d e c a s o s co n s e c u t i v o s . R e su l t a d os : e l 1 3 , 3 % d e l o s p a c i e nt es d oc u m e nta d o s p res e nta r o n e s t e t i p o d e l e s i o ne s , l o q u e co rr e s p o n d e a l 0 , 7 2 d e pr e v a l e n c i a d e l t o t a l d e un i d a d e s h o s p i t a l a r i a s a n a l i z a d a s . L o s r e s u l t a d o s s e e n c u e n t r a n d e s c r i t o s p o r s e x o , e d a d , s e r v i c i o h o s p i t a l a r i o , localización a n a t ó m i c a , m e d i d a s d e p r e v e n c i ó n y a s p e c t o s j u r í d i c o s . C o n c l u s i o n e s : l a s l e s i o n e s d e p i e l t i p o M a r s i se han convertido en un nuevo probl em a para la salud pública con sus cons ecuenci as derivadas y por t a n t o d e b e n s e r u n m o t i v o d e a t e n c i ó n . L a p r e v e n c i ó n d e e s t e t i p o d e l e s i o n e s d e b e i n c l u i r e s c a l a s d e valoración del r iesgo y se deben reforzar los c onoc imientos frente al tema debi do a que el subregistro e n m a s c a r a l a m a g n i t u d d e l p r o b l e m a y a f e c t a l o s c u i d a d o s s e g u r o s .

O bjective: This study propos ed establi shing the prevalence of MARSI skin lesions in Col om bi a. M a t e r i al s a n d m e t h o d s : a c r o s s - s e c t i o n a l , d e s c r i p t i v e s t u d y o f p r e v a l e n c e w a s c a r r i e d o u t w i t h t h e partic ipati on of Col om bi an nurses work ing in forty - six different institutions of varying levels of care i n e l e v e n d i f f e r e n t C o l o m b i a n d e p a r t m e n t s . T h e i n f o r m a t i o n w a s c o ll e c t e d t h r o u g h a n o n l i n e s u r v e y u s i n g t h e S u r v e y M o n k e y ® t o o l . N o n - p r o b a b i l i s t i c s a m p l i n g o f c o n s e c u t i v e c a s e s w a s u s e d . R e s u l t s : 1 3 . 3 % o f t h e d o c u m e n t e d p a t i e n t s p r e s e n t e d t h i s t y p e o f l e s i o n s , w h i c h c o r r e s p o n d s t o 0 . 7 2 p r e v a l e n c e o f t h e t o t a l h o s p i t a l u n i t s a n a l y z e d , t h e r e s u l t s a r e d e s c r i b e d b y s e x , a g e , h o s p i t a l s e r v i c e , a n a t o m i c a l l o c a t i o n , p r e v e n t i o n m e a s u r e s a n d l e g a l a s p e c t s . C o n c l u s i o n s : M A R S I l e s i o n s a l o n g w i t h t h e i r d e r i v e d c onsequences have bec om e a new problem for public health and therefore should be a reason for a t t e n t i o n , t h e p r e v e n t i o n o f t h i s t y p e o f i n j u r y s h o u l d i n c l u d e r i s k a s s e s s m e n t s c a l e s a n d r e i n f o r c e m e n t of knowledge on the subject because the under - registration m as ks the magnitude of the problem and a f f e c t s s a f e c a r e .

Pitiriasis rosada: a propósito de un caso / Pityriasis rosea: Report of a case

Comunicamos el caso de una paciente femenina de 23 años de edad, natural y procedente de la localidad, quien consulta el 30 de Noviembre de 2016 al Centro Integral de Especialidades "Los Grillitos", CORPOSALUD, Municipio Mario Briceño Iragorry, por presentar lesiones puntiformes no pruriginosas en tronco, cuya aparición fue posterior al cuadro viral leve, motivo por el que acude al médico quien le indica antihistamínicos orales y glucocorticoides tópicos no fluorados. Con posterioridad a la primera consulta médica, se evidencian lesiones ovales rosadas con relieve no pruriginoso, diseminado en tronco. Se continúa tratamiento y se indica administrar una ampolla de betametasona intramuscular. Acude nuevamente a evaluación médica y se evidencian lesiones ovales menos eritematosas, descamativas en el límite del borde libre; en general se encuentran involucionadas, observándose actualmente mejoría clínica del cuadro.

We communicate a 23-year-old female patient, natural and from the locality, who on November 30, 2016, visits the Integral Center of Specialties "Los Grillitos", CORPOSALUD, Municipality Mario Briceño Iragorry, for presenting non-pruriginous punctate lesions on the trunk, which appeared after a mild viral picture, reason why she goes to the doctor who indicates oral antihistamines and non-fluorinated topical glucocorticoids. Subsequent medical evolution shows pink oval lesions with non-pruriginous relief, disseminated in the trunk. Treatment is continued and an intramuscular betamethasone ampoule is indicated. The patient returns to medical evaluation and there is evidence of oval lesions less erythematous, desquamative at the border of the free border; in general they are involuted, observing at the moment clinical improvement of the picture.