The epidemiological follow-up process for suspected and confirmed cases of COVID-19 in migrant shelters on the northern border of Mexico from July to December 2020: Between contagion underestimation and containment.

Background: Elements associated with an increased risk factor for the contagion of COVID-19 in shelters include the turnover and overcrowding of people, time spent in communal areas, daily supply needs, water availability, and sanitation levels. The "Report on the Effects of the COVID-19 Pandemic on Migrants and Refugees," shows that factors such as the shortage of food, supplies, water, sanitizing materials, spaces for healthy distancing, financial resources for rent and essential services, and the lack of medical or psychological care complicated providing care for migrants and applicants seeking international protection. Objective: We describe shelter operations regarding the detection and follow-up of suspected and confirmed COVID-19 cases showing mild symptoms among the migrant population housed in the border cities under study. Methods: We conducted semi-structured, in-depth interviews with study subjects (people in charge, managers, coordinators, shelter directors) from 22 migrant shelters, and 30 with key informants. We studied the cities of Tijuana (Baja California), Nogales (Sonora), Ciudad Juárez (Chihuahua), Piedras Negras (Coahuila), and Heroica Matamoros (Tamaulipas). The research was based on a qualitative methodological design with an ethnographic approach. The information collected was transcribed and systematized into two tables or analytical templates, one for interviews with study subjects, and another for interviews with key actors. Findings: Overall, seventy-eight registered shelters provided accommodation services for migrants in the five cities the study focused on: thirty-seven in Tijuana, five in Nogales, twenty-two in Ciudad Juárez, eight in Piedras Negras, and five plus a camp (six in total) in Matamoros. The major concentration of shelters was in Tijuana (47.4%) and Ciudad Juárez (28.2%). At the beginning of the pandemic, only a few shelter facilities met quarantine and isolation guidelines, such as having separate bathrooms and sufficient space to isolate the "asymptomatic" and "confirmed" from close "contacts". The lack of isolation space and the inability to support the monitoring of patients with COVID-19 posed a challenge for those housed in shelters, forcing many shelters to close or continue operating behind closed doors to avoid becoming a source of infection during the pandemic. Discussion and outlook: Contrary to speculation, during the onset of the pandemic northern border migrant shelters did not become sources of COVID-19 infection. According to the data analyzed from 78 shelters only seven had confirmed cases, and the classification of "outbreak" was applied only in two facilities. Contagion control or containment was successful as the result of following a preventive containment logic, including the isolation of all suspected but unconfirmed cases, without a clear understanding of the human and financial resources required to maintain isolation areas. However, shelters in the study implemented protocols for epidemiological surveillance, control, and prevention with elements that interfered with monitoring spaces, and processes that caused oversights that resulted in underestimating the number of cases. Limitations: Due to travel restrictions imposed to prevent and contain coronavirus infections it was impossible to stay on-site in the cities studied, except for Tijuana, or carry-out recordings of migrants' views in shelters.

Superficial mycoses in immunodepressed patients (AIDS).

HIV infection has the capacity to distort the epidemiology and clinical course of infectious diseases, producing atypical manifestations and changing diagnoses. Superficial fungal infections are frequent in HIV-positive/AIDS patients and are no exception. These infections are frequently different in immunodepressed patients (AIDS), with a modified course or exacerbations. This chapter discusses the diagnosis and treatment of superficial mycoses in HIV patients, including cutaneous alterations caused by Candida, dematiaceous fungi agents of phaeohyphomycosis, Malassezia spp, dermatophyte, and filamentous nondermatophyte fungi.

An outbreak of scalp white piedra in a Brazilian children day care.

White piedra is a superficial mycosis caused by Trichosporon spp. that affects the hair shaft of any part of the body. It is presented an outbreak of scalp white piedra seen in 5.8% of the children frequenting a day care in Northeastern of São Paulo State, Brazil. Mycological exam and culture identified T. cutaneum in all five cases, and scanning electron microscopy of nodules around hair shaft infected by Trichosporon spp. is demonstrated comparing them with those of black piedra and with nits of Pediculous capitis.

An outbreak of scalp white piedra in a Brazilian children day care / Surto de piedra branca afetando os cabelos do couro cabeludo de crianças em creche brasileira

White piedra is a superficial mycosis caused by Trichosporon spp. that affects the hair shaft of any part of the body. It is presented an outbreak of scalp white piedra seen in 5.8 percent of the children frequenting a day care in Northeastern of São Paulo State, Brazil. Mycological exam and culture identified T. cutaneum in all five cases, and scanning electron microscopy of nodules around hair shaft infected by Trichosporon spp. is demonstrated comparing them with those of black piedra and with nits of Pediculous capitis.

Piedra branca caracteriza-se por ser micose superficial, causada por Trichosporon spp., que compromete a haste dos pelos de qualquer região do corpo. Um surto de piedra branca, afetando os cabelos do couro cabeludo, foi registrado em 5,8 por cento das crianças que freqüentavam uma creche na região nordeste do estado de São Paulo. Exame micológico direto e cultura identificaram T. cutaneum nas cinco crianças afetadas. Enfatiza-se a utilização da microscopia eletrônica de varredura, que mostrou nódulos circundando a haste dos cabelos infectada por Trichosporon spp., comparando-os com nódulos de Piedra nigra e com lêndeas de Pediculus capitis.

White piedra in children.

BACKGROUND: White piedra is a fungal infection of the hair shaft caused by species of Trichosporon. Rarely has this infection been reported in the United States. Historically, infected individuals required shaving of their hair to achieve clearance of the infection. OBJECTIVE: We sought to describe 8 cases of Trichosporon scalp infections seen in the northeastern United States. METHODS: We conducted chart review and prospective evaluation of 7 girls and 1 boy seen in two dermatology practices in New Haven, Conn, and New York, NY. RESULTS: Seven girls, ages 4 to 16 years old, and one 4-year-old boy were determined to have Trichosporon scalp infection, all through culture. Of the 8 children who were available for follow-up, 7 had clearance of their infection with a combination of oral azole antifungal medication and azole antifungal shampoo, without shaving the scalp hair. LIMITATIONS: This was a sample of patients from a localized region of the United States. CONCLUSIONS: White piedra is emerging as a commonly seen hair and scalp infection in the northeastern United States. Contrary to prior publications, scalp and hair infection may be successfully treated with a combination of oral azole antifungals and shampoos without shaving the scalp.

White piedra: further evidence of a synergistic infection.

White piedra is a fungal infection of the hair shaft caused by Trichosporon beigelii. A synergistic coryneform bacterial infection is often present with T beigelii. White piedra, although not commonly reported to infect scalp hair in North America, is an important consideration in the differential diagnosis of scalp hair concretions. We report a case of white piedra of scalp hair with synergistic coryneform bacterial infection in two sisters, both US natives. Culture and light and electronmicroscopic evidence of the synergistic infection are presented.

[Cutaneous mycoses as a problem of the tropics. I. Superficial tropical mycoses]. / Grzybice skóry jako problem regionów tropikalnych. I. Grzybice tropikalne powierzchniowe.

Cutaneous mycoses are third among diseases after parasitic and infectious ones that pose problems for persons returning from the tropics. The paper presents semiotics of the following tropical superficial mycoses: tinea imbricata, infections with Scytalidium, tinea nigra, zakazenia grzybami Scytalidium, lupieZ czarny, black piedra, white piedra. Treatment, diagnostics and prophylaxis are discussed.

White piedra and Trichosporon species in equatorial Africa. I. History and clinical aspects: an analysis of 449 superficial inguinal specimens.

White piedra is a hair infection characterized by nodules composed of fungal elements which envelop the hair shaft. Classically, this infection was considered to be produced by an asexual yeast-like fungus, Trichosporon beigelii. At present, in accordance with studies carried out previously, this species is subdivided into six newly defined distinct species (T. asahii, T. ovoides, T. inkin, T. mucoides, T. asteroides and T. cutaneum), all belonging to the class Basidiomycetes. Although widespread, white piedra has not previously been described in tropical regions of Africa. The present study, carried out in Libreville (Gabon), an equatorial region of Africa, shows that the incidence of this infection is quite high (18% of 449 inguinal specimens) in the female population aged 15-60 years, with a predominance in young patients (15-44 years). The relationship between the clinical manifestations and the specific hair lesions is also detailed. Three species belonging to the genus Trichosporon were identified: T. mucoides, T. asahii and T. inkin.

White piedra and Trichosporon species in equatorial Africa. III. Identification of Trichosporon species by slide agglutination test.

Fifty-two Trichosporon strains isolated from Gabonese female patients 15-60 years, were studied. The identity of these strains was established by two different methods: the method proposed by Guého et al. (1992), based on mycological criteria, and a slide agglutination method performed with monospecific antisera prepared in our laboratory. The final results show a perfect correlation between the two methods, which allowed us to identify 25 strains of T. mucoides, 21 strains of T. inkin and seven strains of T. asahii. The results of the agglutination tests performed with 24-h-old subcultures grown on Sabouraud glucose agar are available in less than 15 mins. In the light of these results, it appears that this method, which is rapid and easy to perform and reproduce, may readily be used in hospital laboratories. In addition, this method allowed us to verify the presence of antigens common to the genera Cryptococcus and Trichosporon, which were easily shown by the use of crude sera. The fact that the anti-Trichosporon monospecific sera lose their capacity to agglutinate Cryptococcus neoformans proves their high specificity.

White piedra and Trichosporon species in equatorial Africa. II. Clinical and mycological associations: an analysis of 449 superficial inguinal specimens.

Eighty-one of 449 Gabonese female patients examined were found to be positive for genitopubic white piedra. The association with trichobacteriosis is frequent (53 cases), and mostly seen with inguinal intertrigo. Fifty-two strains belonging to the genus Trichosporon were isolated from genital hairs as well as from inguinal intertrigo lesions. These strains were identified in accordance with previously defined morphological and biochemical criteria. Three species were recognized: T. mucoides (25 strains), T. inkin (20 strains) and T. asahii (seven strains). Their macroscopic and microscopic morphological properties, as well as their ability to reduce tetrazolium, were determined. In addition, the study of the clinical and pathogenic associations in which each of these strains was involved revealed some of their particular properties.

Prevalence of Trichosporon beigelii. Colonization of normal perigenital skin.

Although the natural habitat of Trichosporon species is considered to be the soil, the role of normal skin in the carriage of Trichosporon beigelii is unknown. The purpose of this study was to determine the prevalence of T. beigelii colonization on normal perigenital skin. Inguinal skin scrapings were obtained from 322 asymptomatic volunteers. There were 261 males and 61 females ranging in age from 18 to 89; 136 were white, 134 were black, and 52 were Hispanic. Specimens were cultured on Sabouraud's glucose agar containing 500 micrograms ml-1 chloramphenicol, and incubated at 23-26 degrees C for up to 4 weeks. The overall incidence of T. beigelii colonization was 12.4%. However, this varied with patient's age, sex, race and socioeconomic background. The highest prevalence (27.1%) was found in black males who attended a Veterans Affairs hospital. The prevalence was lowest in females (1.6%), and no patients who attended a private clinic were colonized. It was concluded that T. beigelii colonizes normal skin with some regularity.

White piedra and Trichosporon beigelii: the incidence in patients attending a clinic in genitourinary medicine.

To assess the occurrence of white piedra and the asymptomatic carriage rate of T beigelii, 100 heterosexual and 49 homosexual/bisexual men were entered into the study. White piedra of the scrotal hair was discovered in a total of four (2.7%) patients (two heterosexual, one homosexual and one bisexual), while in addition a positive scrotal culture for T beigelii was noted in a further seven (4.8%) patients (four heterosexual and three homosexual). Rectal carriage rates were 1% in the heterosexual and 4% in the homosexual/bisexual groups, while there was no pharyngeal carriage in either group.

Black piedra among the Zoró Indians from Amazônia (Brazil).

A total of 130 Zoró Indians from the Brazilian Amazon were observed as part of an epidemiological survey. Black piedra was found in 74 (56.9%) individuals. Infection rates between the sexes were not significantly different. The age group least infected comprised the children, 0-10 years of age. The authors comment on the epidemiology of the infection among the Zoró.

White piedra and Trichosporon beigelii carriage in homosexual men.

Trichosporon beigelii was isolated from the anal region in 45 (13%) of 343 Danish homosexual men. T. beigelii was also present on the scrotal skin of six anal carriers who were accessible for re-examination, and white piedra of the genital hair was observed in two cases. Because T. beigelii may cause systemic infections in compromised hosts it may pose a threat to homosexuals infected by HTLVIII/LAV virus.

Genital white piedra: epidemiology, microbiology, and therapy.

The epidemiology of genital white piedra was investigated in 166 young men with a variety of genital complaints. Trichosporon beigelii was isolated from sixty-six (40%) of the cultured scrotal hairs. Infection was more common among black patients--54% of those examined, compared to 16% of white patients and 30% of "others" (p less than 0.001). There was no relationship between infection and foreign travel. White piedra was also found in young women, but less frequently than in young men (14% vs 40%, respectively). Transmission rarely occurred from person to person. Occasionally multiple body sites were simultaneously infected. A relationship may exist between T. beigelii and Corynebacterium concurrently infecting genital hair shafts. Eradication of infection was extremely difficult, despite in vitro sensitivity to antifungal agents. Spontaneous remissions occurred, however, in some patients.

Mycoses in India--study in Madras.

The incidence of mycoses is high in Madras accounting for over 13% of dermatoses diagnosed in a three-year period. Dermatophytoses (tinea corporis and tinea cruris) and pityriasis versicolor were most common in May and October. A correlation was observed between these infections and environmental temperature, humidity and rainfall. Most cases of all dermatophytoses except tinea capitis were recorded between 10 and 30 years of age but the latter was most common between one and 10 years. Males were predominantly affected with all except tinea axillaris, candidiasis and piedra. The incidence of piedra and deep mycoses was low.