Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 1: micosis subcutáneas / Cutaneous involvement in the deep mycoses: a literature review. Part I-subcutaneous mycoses

Las micosis profundas son infecciones poco frecuentes en nuestro medio. Se presentan principalmente en pacientes inmunodeprimidos o en regiones de climas tropicales, que abarcan las micosis subcutáneas y las micosis sistémicas. Las micosis subcutáneas o por implantación siempre producen signos de afectación cutánea. En la primera parte de esta revisión se realizará una revisión de las principales micosis subcutáneas: esporotricosis, cromoblastomicosis, micetomas, feohifomicosis, hialohifomicosis y lacaziosis. Reconocer y tratar estas micosis subcutáneas de forma precoz es importante, ya que a menudo están asociadas a una alta morbilidad

The deep mycoses are uncommon in our setting. These fungal infections occur mainly in immunosuppressed patients or in tropical climates, and include subcutaneous infections and systemic infections. The skin is always involved in the former. In the first part of this review, we describe the main subcutaneous mycoses: sporotrichosis, chromoblastomycosis, mycetoma, phaeohyphomycosis, hyalohyphomycosis, and lacaziosis. Early recognition and treatment is important, as these infections are frequently associated with high morbidity

Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 2. Micosis sistémicas / Cutaneous involvement in the deep mycoses: a review. Part II -Systemic mycoses

En la segunda parte de este artículo se revisan las principales micosis sistémicas y sus manifestaciones cutáneas: paracoccidioidomicosis, coccidioidomicosis, histoplasmosis, mucormicosis y criptococosis. Las micosis sistémicas presentan lesiones en la piel solo en algunas ocasiones, ya sea por afectación directa de ella como puerta de entrada o tras la diseminación de la infección a partir de un foco profundo. Muchas veces estos signos cutáneos serán la única pista para el diagnóstico certero de patologías potencialmente fatales. Por lo mismo, y con mucho mayor énfasis que las micosis tratadas en la primera parte, es importante saber reconocer y tratar las micosis sistémicas

In the second part of this review on the deep mycoses, we describe the main systemic mycoses-paracoccidioidomycosis, coccidioidomycosis, histoplasmosis, mucormycosis, and cryptococcosis-and their cutaneous manifestations. Skin lesions are only occasionally seen in deep systemic mycoses either directly, when the skin is the route of entry for the fungus, or indirectly, when the infection has spread from a deeper focus. These cutaneous signs are often the only clue to the presence of a potentially fatal infection. As with the subcutaneous mycoses, early diagnosis and treatment is important, but in this case, even more so

Cutaneous involvement in the deep mycoses: A review. Part II -Systemic mycoses. / Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 2. Micosis sistémicas.

In the second part of this review on the deep mycoses, we describe the main systemic mycoses-paracoccidioidomycosis, coccidioidomycosis, histoplasmosis, mucormycosis, and cryptococcosis-and their cutaneous manifestations. Skin lesions are only occasionally seen in deep systemic mycoses either directly, when the skin is the route of entry for the fungus, or indirectly, when the infection has spread from a deeper focus. These cutaneous signs are often the only clue to the presence of a potentially fatal infection. As with the subcutaneous mycoses, early diagnosis and treatment is important, but in this case, even more so.

Cutaneous Involvement in the Deep Mycoses: A Literature Review. Part I-Subcutaneous Mycoses. / Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 1: micosis subcutáneas.

The deep mycoses are uncommon in our setting. These fungal infections occur mainly in immunosuppressed patients or in tropical climates, and include subcutaneous infections and systemic infections. The skin is always involved in the former. In the first part of this review, we describe the main subcutaneous mycoses: sporotrichosis, chromoblastomycosis, mycetoma, phaeohyphomycosis, hyalohyphomycosis, and lacaziosis. Early recognition and treatment is important, as these infections are frequently associated with high morbidity.

Dermatofitosis: etiología y suceptibilidad antifúngica "In Vitro" en tres centros hospitalarios de Santiago (Chile) / Dermatophytoses: etiology and antifungal suceptibility in vitro in three hospital centers of Santiago (Chile)

Con el objetivo de determinar la frecuencia de dermatofitos en lesiones sospechosas de micosis y evaluar su suceptiblidad in vitro frente a Clotrimazol (CLZ), Itraconazol (ITZ), Griseofulvina (GRI), Fluconazol (FCZ) y Terbinafina (TBF), se recolectaron 175 muestras (piel, pelo y uñas) y datos epidemiológicos de cada paciente. El diagnóstico micológico se realizó mediante: un examen directo con KOH al 20 porciento y cultivo en agar Sabouraud y Lactrimel, incubados a 25° y 37° por 21 días. La suceptibilidad in vitro se realizó por el método de microdilución en caldo según recomendaciones NCCLS (documento M38-P), determinándose CIM50 y CIM90. El examen directo fue positivo en el 73,7 porciento (n=129) de las muestras y el cultivo en 66,3 porciento (n=116), aumentando a un 80,6 porciento(n=141) al usar ambas técnicas. Los agentes aislados correspondieron a Trichophyton rubrum (81 porciento), T.mentagrophytes (14,7 porciento) y Microsporum canis (4,3 porciento). En 110 cepas, la CIM50 para FCZ fue 0,25mg/mL y 0,03mg/mL para GRI, ITZ, CLZ y TBF. La CIM90 de FCZ fue 2,0mg/mL, 0,12mg/mL para ITZ y 0,06mg/mL para CLZ, GRI y TBF. En general, los antifúngicos probados fueron activos frente a las cepas aisladas, excepto 2 cepas que mostraron CIM elevadas para ITZ.

Uso de cantaridina en verrugas comunes y moluscos contagiosos: un estudio abierto / Use of cantaridine in common warts and contagious mollusca: an open study

Se realiza un estudio abierto, no randomizado, para evaluar la respuesta de cataridina en pacientes con verrugas comunes y pacientes con muluscos contagiosos. Se concluye que la cantaridina es eficaz y segura en el tratamiento de moluscos contagiosos, no así en el caso de verrugas comunes, en que logramos una respuesta pobre

[Antiretroviral therapy. Announcement of the Advisory Committee of the Chilean Society of Infectology on AIDS]. / Terapia anti retroviral. Pronunciamiento del Comité Consultivo de SIDA de la Sociedad Chilena de Infectología.

There are treatments to induce the long term suppression of viral replication and that delays the progression of HIV disease. To be effective, these treatments require the uninterrupted use of a combination of drugs (ideally three), patients must be highly compliant, must be instituted in early stages of the disease and drugs must be used for prolonged periods and given by specialists. These treatments are indicated in all symptomatic patients and in those with early immunologic deterioration or high viral load. Recent infection and acute primary retroviral infections should also be considered for treatment. The treatment sponsored and financed by the ministry of health for its beneficiaries is insufficient at this time, since it is received by a minority of eligible patients due to budgetary reasons, and only two drugs are given which is considered such optimal by most experts. The committee considers that the responsibility for financing, providing and delivering these treatments in proper combination and dosages exceeds the duty of the Ministry of Health and should include all the involved parties. However, the state and its official institutions have a special responsibility to provide with adequate treatments to the poorer segments of our population. They also should promote, supervise and control the proper access of the rest of the population to efficient treatments. The committee also considers that the efforts to prevent new infections must not be neglected and that individuals under successful treatment should not consider themselves as non infectious.

Eficacia de fluconazol 150 mg 2 veces por semana por 3 meses en pacientes con onicomicosis / Efficacy of fluconazole 150 mg given twice a week for three months in patients with onychomycosis

Fluconozol (Diflucan) es un trizólico de amplio espectro que ha demostrado ser útil en el tratamiento de micosis superficiales. Nuestro objetivo fue evaluar la eficacia clínica y micológica de esta droga en el tratamiento de omicomicosis. Ingresaron 14 pacientes (5 mujeres y 9 hombres), edades 21-68 años, todos con diagnóstico clínico de onicomicosis de ortejo mayor; completaron 3 meses de seguimiento sólo 9 pacientes. Se realizó evaluación clínica y micológica (ex. directo y cultivo) al inicio, 1,5 y 3 meses, luego 1,5 y 3 meses post tratamiento. Se administró Fluconazol 150 mg 2 veces por semana durante 3 meses y se realizaron controles hematológicos y bioquímicos. Los aislados fueron Trichophyton rubrum 10, Candida albicans 2, ambos agentes en un paciente y Trichophyton mentagrophytes en otro paciente. De 9 pacientes que completaron el estudio, uno tenía sus uñas completamente sanas a los 3 meses de tratamiento, un paciente al 1,5 mes post tratamiento y en 3 a los 3 meses post tratamiento, y sólo un paciente con un 30 por ciento de uña sana que se consideró fracaso. A los 6 meses se obtuvo cura micológica en 4 de 9 pacientes y en otros 2 pacientes se obtuvo cultivo (-) con ex. directo (-). No hubo alteraciones de pruebas funcionales ni efectos adversos. Se concluye que Fluconazol es una buena alternativa en el tratamiento de las onicomicosis

Identification of penicillinase producing Neisseria gonorrhoeae in Chile during clinical and microbiological study of gonococcal susceptibility to antimicrobial agents.

The first penicillinase producing isolates of Neisseria gonorrhoeae (PPNG) identified in Chile were discovered during a clinical and microbiological study to compare the efficacy of penicillin (4.8 MIU aqueous procaine penicillin G plus 1 g oral probenecid) and tetracycline (1.5 g followed by 500 mg four times daily for four days) treatment regimens for acute uncomplicated gonorrhoea. Penicillin treatment was effective in 93.1% (282) of 303 patients, whereas tetracycline was effective in 98.3% (233) of 237 patients. Six of the penicillin treatment failures were attributable to PPNG strains. In all, 21 PPNG strains were identified during the study. They were genetically identical, having a wild type auxotype, a WII/III serotype (serovar Bajk), and carrying cryptic and transfer plasmids and an Asian type penicillinase producing plasmid. In addition, 674 non-PPNG isolates were tested for their susceptibility to eight antimicrobials. Over 95% were sensitivie to 1 mg/l of penicillin, ampicillin, cefotaxime, cefuroxime, and erythromycin, over 90% were sensitive to 1 mg/l of tetracycline and 2 mg/l of thiamphenicol, and all were sensitive to spectinomycin. Of 226 non-PPNG isolates characterised for plasmid content and auxotype, 90% (205) were either wild type or proline requiring, 67% (153) carried only the cryptic plasmid, and a further 31% (71) carried both cryptic and transfer plasmids. Unusually, three of four isolates lacking the cryptic plasmid carried only the transfer plasmid.