Treatment of human scabies with oral ivermectin.

Thirty-eight patients with scabies (21 males and 17 females) received oral ivermectin in two doses of 200 microg/kg at 7 days interval. Excellent results were achieved in 29 cases (76.34%), improvement in 6 (15.78%) and poor responses in 3 (7.88%). Tolerance was satisfactory-excellent in 32 patients (84.2%). The effectiveness and safety of the drug described in previous studies are confirmed by the present results.

[Human ectoparasitoses: current status in Uruguay]. / Ectoparasitosis humanas: estado actual en el Uruguay.

The present status of human ectoparasitoses in Uruguay is analyzed with the main purpose of performing in the future, comparative studies in the region. After classifying ectoparasites in temporary and permanent, comments are made on particular clinical and epidemiological aspects of some of them. For remarking: the high prevalence of pediculosis capitis and scabies; the frequent observation of cutaneous myiasis by Dermatobia hominis with a very interesting modification of the geographical national distribution of the fly and the presence of an endemic area of creeping eruption by Ancylostoma braziliense and A. caninum in the north of the country.

Cutaneous botryomycosis. Report of the two first Uruguayan cases.

The first two Uruguayan cases of botryomycosis were diagnosed in white adult male patients with cutaneous lesions. Staphylococcus aureus was the etiologic agent in both cases. In one of them, however, Pseudomonas aeruginosa was also identified during relapse. General comments on diagnosis and pathogenesis of the disease are made.

Treatment of human cutaneous sporotrichosis with itraconazole.

Eighteen adult white male patients with cutaneous sporotrichosis were treated with itraconazole following different daily dose schemes. Cure was obtained in all cases after periods of 15-75 days (median 44 days) with total doses between 3.1 and 14.8 g (median 8.4 g). No serious side effects were observed and no relapses occurred in the follow-up period of between 1 and 26 months (median 14.7). These results show that itraconazole represents a safe and effective drug for the treatment of sporotrichosis. Comparison with other studies leads us to consider a daily dose of 200 mg as the most appropriate. A concomitant warming of the affected limbs should be recommended.

[Lymphatic cutaneous rickettsiosis caused by Rickettsia conorii in Uruguay]. / Rickettsiosis cutáneo ganglionar por Rickettsia conorii en el Uruguay.

Three autochthonous cases of cutaneous-ganglionar rickettsiosis transmitted by dogs ticks (Amblyomma maculatum in one of them) are reported. Two of the three cases were undoubtely produced by Rickettsia conorii according to the results of the specific indirect immunofluorescence technique IEF-IgM anti R. conorii. A third case is included due to the clinical epidemiological similarity, the positive serum reactivity with Proteus O x 19 and the rapid response to tetracycline. Autochthonous rickettsiosis by R. conorii has not been previously registered in the American area what confers special interest to this communication. The search of the disease in the other countries of the region is suggested.

Epidemiology of sporotrichosis in Latin America.

Applying the concept of 'epidemiological chain', it is successively analyzed: the etiologic agent, Sporothrix schenckii and its natural reservoirs (sources of infection); the different ways that infecting particles may reach man (mechanisms of infection); the susceptible population and the population at risk; the incidence and distribution by sex and age in countries of Latin America; the prevalence of the disease according to clinical cases in dermatological clinics and the variation of incidence rates in some countries with time; the influence of the environment mainly climatic conditions on the geographic distribution of the disease. Finally, according to Mackinnon's hypothesis, the climate could have a determining role on the predominance of a certain clinical form on another in different countries.

Seroprevalencia de anticuerpos contra trypanosoma cruzi en 13 departamentos del Uruguay / Seroprevalence of trypanosoma cruzi in 13 deparments of Uruguay

In 1985 a study was undertaken of the prevalence of Trypanosoma cruzi antibodies in 13 departments of Uruguay where transmission of the parasite by the vector Triatoma infestans persists. A total of 5 924 serum samples were selected using a probabilistic method- 3 840 from individuals over the age of 12 (sample I) and 2 084 from subjects who where 12 years old (sample II). The population was classified acording to place of residence (capital city, non-capital city, suburban área, and rural área). The percentage of positive sera detected by indirect immunofluorescence in the different departments ranged from 1 to 11 percent, and overall seroprevalence for the área was 3.4 percent. Based on the results obtained, it was possible to distinguish three áreas: A, which seroprevalence from 6 to 11 percent; B, 2 to 3.2 percent, and C, 1 to 4 percent. In sample II from the Departments of Paysandu, Soriano, Flores, Florida, and Durazno, no cases of Chagas' disease were detected which suggests that there is no active transmission of T. cruzi in this age group in the área studied. The number of persons estimated to have the disease was 36 952, or 1.3 percent of the total population of Uruguay and 4 percent of the population in the área surveyed. These seroprevalence figures are similar to those recorded in the povince of Entre Rios, Argentina, and in the neighboring municipalities of Rio Grande do Sul, Brazil

[Cutaneous lymphangitic-nodular sporotrichosis with multiple portals of entry]. / Esporotricosis cutánea, linfangítico-nodular, con puerta de entrada múltiple.

A human case of cutaneous sporotrichosis with three chancriform primary lesions and regional lymphangitis is presented in a male patient infected during the hunting of armadillos. The clinical picture shows very well the usual mechanism of infection for the disease in Uruguay, which is a direct contact of man with armadillos and their burrows.

[Pitted keratolysis of hyperkeratotic form and isolation of the etiologic agent: Corynebacterium sp]. / Queratólisis en hoyuelos (pitted keratolysis) a forma hiperqueratósica y aislamiento del agente etiológico: Corynebacterium sp.

Two cases of "pitted keratolysis" with a very accentuated plantar hyperkeratosis, and the isolation on chocolate thelurite agar of the presumptive etiologic agent, Corynebacterium sp., is presented. In order to keep permanently in mind, for a proper diagnosis, the original description of the disease as "keratoma plantare sulcatum" (Castellani, 1910), we are proposing to distinguish two different clinical forms: The hyperkeratotic one and the common or usual form of "pitted keratolysis" with keratolysis as the main sign. The prosecution of our biochemical studies with a significant number of strains isolated from both "pitted keratolysis" and from classical erythrasma cases, will surely permit us to definitively determine if all of them should or not be assimilated to Corynebacterium minutissimum.

[Tinea nigra. 1st clinical case in Uruguay]. / Tiña negra. Primera observación en el Uruguay.

The first case in Uruguay of 'tinea nigra' is described in a 44-year-old male patient with a maculous pigmented lesion on the right foot. It represents the most meridional case of the disease yet recorded in South America. Exophiala werneckii was isolated in cultures (strain 1905 IHM).

[Experimental pathogenicity of isolates of Nocardia asteroides, Nocardia brasiliensis and Nocardia caviae from different sources]. / Patogenicidad experimental de cepas de Nocardia asteroides, Nocardia brasiliensis y Nocardia caviae de diferentes procedencias.

The experimental pathogenicity of 14 isolates of Nocardia brasiliensis, 15 of N. asteroides, and 5 of N. caviae was investigated for the white Swiss mice inoculated intraperitoneally and in the foot pad, and for the guinea-pig and the hamster (Mesocricetus auratus) both inoculated intratesticularly. The guinea-pig was remarkably sensitive to N. asteroides, with an apparent relationship between pathogenicity and thermotolerance, confirming previous observations. Mice were in general less susceptible to this species. In both guinea-pigs and hamsters it was possible to observe typical granules with or without clubs. N. caviae was highly pathogenic for the guinea-pig and the hamster but no mycetomas were produced in the mice inoculated in the foot pad. Isolates of N. brasiliensis from natural sources were scarcely virulent for the different animals. Those of human origin produced significant lesions in the mice inoculated intraperitoneally with granules. Foot pad inoculation of mice with N. brasiliensis caused mycetomas in several animals.

[Paracoccidioidomycosis: apropos of 3 new Uruguayan cases]. / Paracoccidioidomicosis: a proposito de 3 nuevos casos nacionales.

Three new Uruguayan paracoccidioidomycosis human cases are presented. Two of them correspond to the disseminated form with metastatic lesions at the oral mucosa; the remaining one, with important pulmonary bilateral lesions corresponds to the pure chronic pulmonary form of the disease which is recognized by the first time in the country. No doubt, these clinical forms will be found much more frequently in the endemic areas of Latin America if serological surveys are developed in the near future.

[Apropos of the 2nd case of cutaneous granuloma caused by Mycobacterium marinum in Uruguay]. / A propósito del segundo caso nacional de granuloma cutáneo por "Mycobacterium marinum".

A new, second uruguayan case of cutaneous granuloma by Mycobacterium marinum is presented. The patient a 31 years old white man from Montevideo city had two granulomatous and ulcerated lesions on the right knee, secondary to wounds suffered with mussels' shells 5 years before while cleaning his boat in saline waters close to our Rio de la Plata river. Diagnosis was made by finding the typical acid fast organisms in the lesions, the isolation of the agent in cultures and through experimental inoculation of laboratory animals. Metastatic nodular lesions were observed in hamsters (Mesocricetus auratus) after intratesticular inoculation. A clear improvement was obtained by local heat confirming previous observations.

Electrophoretic migration of Paracoccidioides brasiliensis specific antigenic fraction.

Using the technique of immunoelectroosmophoresis-immunodiffusion (IEOP-ID), two antigenic fractions of Paracoccidioides brasiliensis one of them species-specific, produced precipitin bands in both the cathodic and anodic zones. Reactions of complete identity among the bands formed in these zones were demonstrated by a modification of the technique, employing additional wells around the central antigen well. Such bands would correspond to a simple diffusion of the corresponding antigenic fractions rather than to active electrophoretic migration.

[Mycetoma and premycetomatous lesions in Uruguay]. / Micetomas y procesos premicetomatosos en el Uruguay.

Five cases of mycetomas and 5 "premycetomatous' lesions have been recorded in Uruguay. Two mycetomas were produced by fungi and three by nocardias. The casual fungi were identified as Scedosporium apoispermum in one case and Rubromadurella langeroni in the other. Nocardia asteroides was isolated from 2 cases and no cultures were obtained from the remaining one. Three mycetomas were diagnosed in an early stage of development and easy cures were obtained through medical or surgical procedures. In the other two cases the diagnosis was made in a late stage and the final result was amputation. A new clinical form of mycetoma called "lymphangitic' is proposed after describing a patient with mycetoma of the forearm and arm by S. apiospermum. Premycetomatous lesions included 3 cases of lymphangitic nocardiasis of the arm by N. brasiliensis, an abscess of the shoulder by the same species and an arthritis of the ankle by N. asteroides. All were cured after short periods of therapy. The usual early diagnosis of mycetomas and related diseases un Uruguay is considered to be the result of a prompt medical consultation due mainly to the abscence of important geographical obstacles in the Country.

Micetomas y procesos premicetomatosos en el Uruguay / Mycetoma and premycetomatous lesions in Uruguay

Five cases of mycetomas and 5 premycetomatous' lesions have been recorded in Uruguay. Two mycetomas were produced by fungi and three by nocardias. The casual fungi were identified as Scedosporium apoispermum in one case and Rubromadurella langeroni in the other. Nocardia asteroides was isolated from 2 cases and no cultures were obtained from the remaining one. Three mycetomas were diagnosed in an early stage of development and easy cures were obtained through medical or surgical procedures. In the other two cases the diagnosis was made in a late stage and the final result was amputation. A new clinical form of mycetoma called lymphangitic' is proposed after describing a patient with mycetoma of the forearm and arm by S. apiospermum. Premycetomatous lesions included 3 cases of lymphangitic nocardiasis of the arm by N. brasiliensis, an abscess of the shoulder by the same species and an arthritis of the ankle by N. asteroides. All were cured after short periods of therapy. The usual early diagnosis of mycetomas and related diseases un Uruguay is considered to be the result of a prompt medical consultation due mainly to the abscence of important geographical obstacles in the Country.