RESUMO
Sex steroid hormones have an important physiological role in humans. They can also affect the gene expression of many organisms, including bacteria. In Mexico, Nocardia brasiliensis is the main causative agent of actinomycetoma, a granulomatous disease more frequent in men than women, which is thought to be related to a higher occupational risk in men. Therefore, it has been suggested that differences in clinical presentation could be related to sex steroid hormone levels. Attempting to explain the differences in actinomycetoma prevalence between men and women, in this work, the effect of progesterone and dihydrotestosterone on the genetic expression of N. brasiliensis was investigated using a differential display polymerase chain reaction assay. The results showed that both hormones affected the expression of genes encoding proteins related to central metabolism and hypothetical proteins with unknown functions. This study also demonstrated the utility of differential display in this modern era and provided a first approach to the effect of sex hormones on N. brasiliensis gene expression.
Assuntos
Micetoma , Nocardiose , Di-Hidrotestosterona/farmacologia , Feminino , Humanos , Masculino , Micetoma/microbiologia , Nocardia , Nocardiose/microbiologia , Reação em Cadeia da Polimerase , Progesterona/farmacologiaRESUMO
Resumen: Los primeros compuestos con actividad antifúngica específica fueron identificados a mediados del siglo pasado como un producto del metabolismo secundario de bacterias del orden Actinomycetales, y su uso en la clínica redujo de manera importante la morbilidad y la mortalidad relacionadas con infecciones severas por hongos de varios géneros. Muchos de estos compuestos biosintéticos se caracterizan por tener una estructura química de tipo poliénico, con un número variable de dobles enlaces carbono-carbono. Actualmente, además de los fármacos poliénicos, existe otro tipo de compuestos con actividad antimicótica, como los azoles, que se utilizan con mayor frecuencia y que presentan menor toxicidad en los pacientes; sin embargo, se han documentado casos de falla terapéutica con tales compuestos, por lo que el uso de los poliénicos se ha mantenido como la mejor alternativa en esos casos. El presente trabajo brinda información acerca de las propiedades y las aplicaciones de los antifúngicos poliénicos teniendo como modelo a la anfotericina B.
Abstract The first compounds with specific antifungal activity were identified in the middle of the last century as a product of the secondary metabolism of bacteria of the order Actinomycetales, and their clinical use significantly diminished the morbidity and mortality associated with severe fungal infections. Many of such biosynthetic compounds are characterized by a chemical polygenic structure, with a variable number of carbon-carbon double bonds. Currently, besides polygenic antimycotics, there are other antifungal agents, such as the azole compounds, that have less toxicity in patients; however, cases of therapeutic failure with such compounds have been documented, therefore, the use of polygenics is still the best alternative in such cases. This review presents data about the properties and applications of antifungal-polygenic compounds using amphotericin B as a model.
RESUMO
Background: Esophageal candidiasis (EC) is the most common cause of infectious esophagitis. So far, its main risk factor has been HIV infection; in recent years, EC has been favoured by the increasing of diabetes mellitus, wide-spread use of acid-lowering agents, broad-spectrum antibiotics, and inhaled steroids. In Mexico EC has been poorly studied. Objectives: To determine the clinical and epidemiological characteristics of EC, and to identify its etiological agents as well as its antifungal susceptibility. Methods: Patients who revealed the presence of scattered white spots through an upper gastrointestinal system endoscopy, in a period of one year, in a tertiary care hospital, were included. Samples from patches were collected for microscopic examination, culture, and susceptibility tests. Results: Out of 1763 patients studied, 23 had scattered white spots, and most of them presented Kodsi grade I; 13 were men; half of the patients were between the ages 20 to 40; main comorbidity was liver cirrhosis; use of omeprazole was significant. 22 isolates were obtained from 17 patients. The most frequent species were C. albicans (14) and C. parapsilosis (3). In five cases we found a two-species association v. g. Candida famata with Trichosporon mucoides. Half of the isolates showed resistance to one or several antifungal drugs. Conclusions: EC frequency in this study was similar to other studies' results. Obtained isolates showed high resistance to azolic compounds and to caspofungin, which is relevant information to take a therapeutic decision.
Introducción: la candidiasis esofágica (CE) es la causa más común de esofagitis infecciosa. Su principal factor de riesgo ha sido la infección por VIH. En México ha sido poco estudiada. Objetivos: determinar las características clínico-epidemiológicas de la CE e identificar sus agentes etiológicos y su sensibilidad a antifúngicos. Métodos: se incluyeron pacientes a quienes se les detectaron placas blanquecinas durante una endoscopía esofágica, en un periodo de un año, en un hospital de tercer nivel de atención. Se tomó muestra de las placas para examen microscópico, cultivo, y estudios de sensibilidad. Resultados: de 1763 pacientes estudiados, 23 presentaron placas blanquecinas; 13 fueron hombres; la mitad tenía de 20 a 40 años de edad; la principal comorbilidad fue cirrosis hepática; el uso de omeprazol fue significativo. Se obtuvieron 22 aislados de 17 pacientes; predominaron Candida albicans (14) y Candida parapsilosis (3). En cinco casos se encontró asociación de dos especies v. g. Candida famata con Trichosporon mucoides. La mitad de los aislados mostró resistencia a antimicóticos. Conclusiones: la frecuencia de CE fue similar a la de otras casuísticas. Los aislados obtenidos mostraron resistencia elevada a compuestos azólicos y a caspofungina, información relevante para tomar una decisión terapéutica.
Assuntos
Candidíase/microbiologia , Esofagite/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/classificação , Candida/isolamento & purificação , Candidíase/induzido quimicamente , Estudos Transversais , Esofagite/induzido quimicamente , Esofagoscopia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Adulto JovemRESUMO
Background: Infectious endocarditis of fungal origin is rare but of high mortality. The agents involved are mainly opportunists of the genus Candida and Aspergillus; however other fungi can also cause this disease. Clinical case: The case of a woman who suffered unknown origin intermittent fever for several months; and in who, by blood culture (after lysis-centrifugation) and molecular biology techniques, Histoplasma capsulatum was identified as etiological agent. The histological study showed abundant intracellular yeasts and hyphae in intracardiac vegetations. Conclusion: This first report of infectious endocarditis by H. capsulatum in Mexico highlights the importance of using in addition to manual blood culture (lysis-centrifugation) and histological study, faster and more sensitive diagnostic methods, such as serology and molecular biology, to confirm or rule out an invasive fungal infection and identify the agents.
Introducción: la endocarditis infecciosa de etiología micótica es una patología poco frecuente, pero con elevada mortalidad. Los agentes implicados generalmente son oportunistas de los géneros Candida y Aspergillus; sin embargo, otros hongos también pueden ocasionar la enfermedad. Caso clínico: se presenta el caso de una mujer quien cursó con fiebre intermitente de causa desconocida por varios meses y en la que, por medio de estudios de imagen, hemocultivo manual (después de lisis-centrifugación) y técnicas de biología molecular, se identificó Histoplasma capsulatum. El estudio histológico de las vegetaciones intracardiacas mostró abundantes levaduras e hifas. Conclusión: este primer reporte de endocarditis infecciosa por H. capsulatum en México pone en evidencia la importancia de utilizar, además del hemocultivo manual (lisis-centrifugación) y el estudio histológico, métodos de diagnóstico más rápidos y sensibles, como la serología y la biología molecular, para confirmar o descartar una infección fúngica invasiva e identificar los agentes.
Assuntos
Endocardite/microbiologia , Histoplasmose/complicações , Endocardite/epidemiologia , Feminino , Histoplasma/isolamento & purificação , Histoplasmose/epidemiologia , Humanos , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
Chromoblastomycosis is a chronic infection, caused by pigmented fungi affecting skin and subcutaneous tissues characterized by verrucous nodules or plaques. Fonsecaea pedrosoiand Cladophialophora carrionii are the prevalent agents in the endemic areas. Phoma is an uncommon agent of human infection and involved mainly with phaeohyphomycosis cases. The case of a patient with a history of laceration in foot followed by verrucous aspect and scaly lesions, which had evolved for 27 years is presented. On physical examination disease was clinically compatible with chromoblastomycosis and the microscopic examination of scales showed fumagoid cells. On culture a dematiaceous fungus was grown. The agent was confirmed to be Phoma insulana based on its morphology and PCR-sequencing. This fungal agent has not been previously reported in association with this pathology (AU)
La cromoblastomicosis es una infección crónica causada por hongos pigmentados que afecta la piel y el tejido subcutáneo y que se caracteriza por nódulos o placas verrugosas. Fonsecaea pedrosoi y Cladophialophora carrionii son los agentes prevalentes en las áreas endémicas. Phoma es un agente raro de infección humana y está involucrado principalmente en casos de feohifomicosis. Se presenta el caso de un paciente con antecedente de laceración en el pie, seguida de lesiones de aspecto verrugoso y descamativas, que evolucionaron durante 27años. En el examen físico la enfermedad fue clínicamente compatible con cromoblastomicosis y el examen microscópico de escamas mostró células fumagoides. En el cultivo creció un hongo dematiáceo. El agente fue confirmado como Phoma insulana en base a su morfología y PCR seguida de secuenciación. Este agente fúngico no ha sido reportado previamente en asociación con esta patología (AU)
Assuntos
Humanos , Masculino , Idoso , Cromoblastomicose/diagnóstico , Cromoblastomicose/microbiologia , Micoses/etiologia , Micoses/microbiologia , Úlcera do Pé/microbiologia , Cromoblastomicose/complicações , Feoifomicose/complicações , Feoifomicose/diagnóstico , Úlcera do Pé/terapia , Micologia/métodos , Antifúngicos/uso terapêuticoRESUMO
Chromoblastomycosis is a chronic infection, caused by pigmented fungi affecting skin and subcutaneous tissues characterized by verrucous nodules or plaques. Fonsecaea pedrosoi and Cladophialophora carrionii are the prevalent agents in the endemic areas. Phoma is an uncommon agent of human infection and involved mainly with phaeohyphomycosis cases. The case of a patient with a history of laceration in foot followed by verrucous aspect and scaly lesions, which had evolved for 27 years is presented. On physical examination disease was clinically compatible with chromoblastomycosis and the microscopic examination of scales showed fumagoid cells. On culture a dematiaceous fungus was grown. The agent was confirmed to be Phoma insulana based on its morphology and PCR-sequencing. This fungal agent has not been previously reported in association with this pathology.
Assuntos
Ascomicetos/isolamento & purificação , Cromoblastomicose/microbiologia , Traumatismos do Pé/microbiologia , Infecção dos Ferimentos/microbiologia , Idoso , Ascomicetos/patogenicidade , Cromoblastomicose/etiologia , Evolução Fatal , Traumatismos do Pé/complicações , Humanos , Lacerações/complicações , Lacerações/microbiologia , Úlcera da Perna/complicações , Úlcera da Perna/parasitologia , Masculino , Miíase/complicações , Sapatos/efeitos adversos , Fatores de Tempo , Recusa do Paciente ao Tratamento , Infecção dos Ferimentos/etiologiaRESUMO
Objective: To identify the most frequent Candida species in specimens from patients hospitalized in different medical centers of Mexico City, with suspected fungal infection. Methods: Specimens were grown on Sabouraud dextrose agar at 28°C for 72 h. In addition, DNA was extracted. Isolates were grown on CHROMagar Candida™, at 37°C for 48 h. The molecular identification was performed by polymerase chain reaction (PCR) using primers specific for four species. Results: Eighty one specimens were processed and included: bronchial lavage, pleural, cerebrospinal, peritoneal, ascites and bile fluids; blood, sputum, bone marrow, oro-tracheal cannula and ganglion. By culture, 30 samples (37%) were positive, and by PCR, 41 (50.6%). By PCR, the frequency of species was: Candida albicans 82.9%, Candida tropicalis 31.7%, Candida glabrata 24.4%, and Candida parapsilosis 4.9%. In 34.1% of specimens a species mixture was detected suggesting a co-infection: Two species in five specimens (C. albicans-C tropicalis and C. albicans-C glabrata), and three species in three specimens (C. albicans-C. glabrata-C. tropicalis). Conclusions: The PCR is an useful tool for detection the most common Candida species causing infection in hospitalized patients, it avoids the requirement of culture weather we start from clinical specimen and it favors the early diagnosis of invasive candidiasis.
Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Hospitalização , Reação em Cadeia da Polimerase/métodos , Adulto , Idoso , Candidíase/diagnóstico , Candidíase/microbiologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Factors such as cancer, HIV infection, use of corticosteroids and antibiotics, favors the increase in the number of invasive fungal infections (IFI) worldwide. METHODS: To determine the frequency and epidemiological aspects of IFI at a mexican, a review of the proven cases diagnosed over the past 21 years (1993-2013) in the Laboratory of Medical Mycology was performed. RESULTS: A total of 472 cases were identified as: 261 candidiasis, 82 mucormycosis, 60 cryptococcosis, 43 aspergillosis and 16 histoplasmosis. A decrease in the frequency of candidiasis was observed, with 74 cases in the first 6 years and 48 in the last five. C. albicans was the most common agent and pulmonary infection the most prevalent. Cryptococcosis also declined from 24 to 10 cases, mainly caused by C. neoformans; two cases of C. laurentii and C. terreus and C unigutulatus were isolated once. Mucormycosis remained steady, but aspergillosis increased significantly, and from 2 cases found in the first studied period, it rose to 23 in the last one. CONCLUSIONS: It is important that High Specialty Hospitals have well-equipped laboratories of Medical Mycology. We suggest the creation of a National Reference Center for Mycoses to collect all the data of these infections, in order to help to the development of strategies for health education, prevention, diagnosis and treatment of them.
Introducción: Factores como el cáncer, la infección por VIH, así como el uso de esteroides y antibióticos, incrementan el número de micosis invasivas (MI). Métodos: Para conocer la frecuencia y algunos aspectos epidemiológicos de las MI en un hospital del IMSS, se revisaron los casos probados diagnosticados en los últimos 21 años (1993-2013) en el Laboratorio de Micología Médica. Resultados: Se identificaron 472 casos, distribuidos en: 261 candidosis, 82 mucormicosis, 60 criptococosis, 43 aspergilosis y 16 histoplasmosis. La candidosis disminuyó de 74 casos en los primeros 6 años, a 48 en los cinco últimos. La localización principal fue pulmonar y el principal agente fue C. albicans. La criptococosis también disminuyó de 24 a 10 casos, principalmente fue causada por C. neoformans, aunque hubo dos casos de C. laurentii, uno de C. terreus y uno de C. unigutulatus. La mucormicosis se mantuvo constante, pero la aspergilosis se incrementó pasando de 2 casos en el primer periodo a 23 en el último. Conclusiones: Es importante que los hospitales de alta especialidad, cuenten con laboratorios de micología médica para realizar el diagnóstico de MI. Se sugiere crear un Centro Nacional de Referencia de Micosis donde se concentren los datos de estas infecciones y contribuya en la elaboración de planes de educación para la salud, prevención, diagnóstico y tratamiento de las mismas.
Assuntos
Infecções Fúngicas Invasivas/epidemiologia , Feminino , Hospitais Públicos , Hospitais Especializados , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/etiologia , Masculino , México/epidemiologia , Prevalência , Fatores de RiscoRESUMO
Background. Mycotic ocular infections caused by the Scedosporium apiospermum species complex are challenging to treat because of the delayed diagnoses and poor responses to antifungal drugs and surgical treatment. Case report. A case of a 69-year-old male patient with a history of diabetes mellitus type 2 and prior surgery on the right femur is described. In the 10 days prior to the ophthalmic consultation he started with ocular pain, adding to a previous and progressive loss of visual acuity in his right eye. The diagnosis of endophthalmitis of probable endogenous origin was established. Despite medical treatment, the patient's condition worsened and, due to the imminent risks, an enucleation was performed. Smears of the enucleation tissue revealed fungal cells, and the cultures yielded a fungus belonging to the S. apiospermum species complex, which was identified as Scedosporium boydii by morphological characteristics and sequencing of a PCR amplicon. Conclusions. A diagnosis of endophthalmitis of probable endogenous origin in the right eye was based on a previous right femur surgery. Potential risk to the patient led to enucleation (AU)
Antecedentes. Las infecciones micóticas oculares causadas por el complejo de especies de Scedosporium apiospermum son un reto en el tratamiento por su diagnóstico tardío y la pobre respuesta a los antimicóticos y al tratamiento quirúrgico. Caso clínico. Se describe el caso de un paciente de sexo masculino de 69 años con antecedentes de diabetes mellitus de tipo 2 y cirugía previa del fémur derecho. Diez días antes de la consulta oftalmológica comenzó con dolor ocular que se sumaba a una pérdida previa y progresiva de la capacidad visual en el ojo derecho. Se estableció el diagnóstico de endoftalmitis de posible origen endógeno. A pesar del tratamiento, el paciente no presentó mejoría y por los inminentes riesgos se decidió llevar a cabo una enucleación. El frotis a partir del tejido enucleado mostró células fúngicas y los cultivos revelaron un hongo perteneciente al complejo S. apiospermum, identificado como Scedosporium boydii por procedimientos morfológicos y por secuenciación de un amplicón de PCR. Conclusiones. El diagnóstico de endoftalmitis de probable origen endógeno en el ojo derecho se basó en el antecedente de una cirugía previa de fémur, cuyos riesgos para el paciente condujeron a una enucleación (AU)
Assuntos
Humanos , Masculino , Idoso , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Endoftalmite/terapia , Enucleação Ocular/métodos , Enucleação Ocular , Micoses/epidemiologia , Micoses/microbiologia , Micoses/cirurgia , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/cirurgia , Endoftalmite/cirurgia , Scedosporium/isolamento & purificação , Reação em Cadeia da Polimerase/instrumentação , Reação em Cadeia da Polimerase/métodosRESUMO
BACKGROUND: Mycotic ocular infections caused by the Scedosporium apiospermum species complex are challenging to treat because of the delayed diagnoses and poor responses to antifungal drugs and surgical treatment. CASE REPORT: A case of a 69-year-old male patient with a history of diabetes mellitus type 2 and prior surgery on the right femur is described. In the 10 days prior to the ophthalmic consultation he started with ocular pain, adding to a previous and progressive loss of visual acuity in his right eye. The diagnosis of endophthalmitis of probable endogenous origin was established. Despite medical treatment, the patient's condition worsened and, due to the imminent risks, an enucleation was performed. Smears of the enucleation tissue revealed fungal cells, and the cultures yielded a fungus belonging to the S. apiospermum species complex, which was identified as Scedosporium boydii by morphological characteristics and sequencing of a PCR amplicon. CONCLUSIONS: A diagnosis of endophthalmitis of probable endogenous origin in the right eye was based on a previous right femur surgery. Potential risk to the patient led to enucleation.
Assuntos
Endoftalmite/microbiologia , Infecções Oculares Fúngicas/microbiologia , Complicações Pós-Operatórias/microbiologia , Scedosporium/isolamento & purificação , Idoso , Diagnóstico Tardio , Diabetes Mellitus Tipo 2/complicações , Suscetibilidade a Doenças , Endoftalmite/diagnóstico , Endoftalmite/cirurgia , Enucleação Ocular , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/cirurgia , Fêmur/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgiaRESUMO
BACKGROUND: The changes in psoriatic nails can closely resemble an onychomycosis. Therefore, the fungal infection may be underdiagnosed. It was investigated the frequency of mycosis in fingernails and toenails in 150 patients with psoriasis in a dermatology department. METHODS: The clinical data suggestive of onychomycosis were investigated. Nail scales were obtained and cultured on Sabouraud dextrose agar with and without antibiotic. A direct examination with KOH was also performed. RESULTS: Out of 150 patients, 67 (45 %) had healthy nails; 42 (28 %) presented onychomycosis and 41 (27 %) showed nail changes without infection. Fingernail changes were more associated with psoriatic onychopathy (82.5 %), unlike toenail changes that were more frequently caused by fungal infection (26.4 % vs. 9.45 % in psoriasis). Out of 20 positive cultures, 22 fungi were isolated, of which 11 belonged to Candida spp. (50 %). As risk factor to develope an onychomycosis, only the psoriasis evolution time showed a significant difference (p = 0.033). CONCLUSIONS: In patients with psoriasis, fingernail disorders are mainly due to the own disease, while toenail disorders changes can be associated with onychomycosis. The main etiological agents were yeasts from the genus Candida. The only factor associated with a higher incidence of onychomycosis in these patients was a long lasting psoriasis.
Introducción: los cambios ungueales en los pacientes con psoriasis pueden ser muy parecidos a la onicomicosis y, por lo tanto, las infecciones fúngicas pueden ser subdiagnosticadas. Se investigó la frecuencia de onicomicosis en manos y pies de 150 pacientes con psoriasis de un servicio de dermatología. Métodos: se obtuvieron los datos clínicos de la psoriasis. Se cultivaron escamas de las uñas en agar dextrosa Sabouraud con y sin antibióticos y se hizo un examen directo con KOH. Resultados: de los 150 pacientes, 67 (45 %) presentaron uñas sanas; 42 (28 %) tuvieron onicomicosis, y 41 (27 %) onicopatía sin infección. Las alteraciones ungueales en las manos estuvieron más asociadas con onicopatía psoriásica (82.5 %); los cambios de las uñas de los pies se asociaron más frecuentemente a infección fúngica (26.4 frente a 9.45 % en psoriasis). De 20 cultivos positivos, se aislaron 22 agentes: 11 Candida spp. (50 %). Como factor de riesgo para desarrollar onicomicosis, el tiempo de evolución de la psoriasis mostró una diferencia significativa (p = 0.03). Conclusión: en los pacientes con psoriasis, las alteraciones ungueales de manos se deben principalmente a psoriasis, mientras que los cambios ungueales en los pies se asocian a onicomicosis. Esta fue causada principalmente por Candida sp. El único factor de riesgo asociado para onicomicosis fue la larga evolución de la psoriasis.
Assuntos
Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Onicomicose/etiologia , Psoríase/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Humanos , Incidência , Masculino , México , Pessoa de Meia-Idade , Onicomicose/epidemiologia , Estudos Prospectivos , Fatores de Risco , Centros de Atenção TerciáriaRESUMO
Paracoccidioidomycosis (PCM) is an endemic systemic infection in several countries of Latin America. The few registered cases in Mexico most likely do not reflect the real frequency. Disseminate the epidemiological and clinical data of unreported cases of PCM in Mexico from 1972 until 2012 is the aim of this work. Epidemiological and clinical information of non-published cases of PCM was requested from the principal mycological diagnosis centres in Mexico. A total of 93 cases were received. The infection was found predominantly in men (95.7%), peasants (88.5%) and individual between 31 and 60 years of age. Most of the cases were found in tropical areas of the Gulf of Mexico (54.84%) and the Pacific littoral (20.3%). The main sites of dissemination were the oral mucosa (39.38%) and skin (34.05%). The most effective treatments were itraconazole alone and the combination of itraconazole with sulfamethoxazole-trimethoprim. PCM is a subdiagnosed pathology in Mexico. Therefore, adequate training is necessary to determine the current status of this mycosis.
Assuntos
Paracoccidioidomicose/epidemiologia , Paracoccidioidomicose/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Criança , Feminino , Humanos , Itraconazol/uso terapêutico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Mucosa Bucal/microbiologia , Exposição Ocupacional , Paracoccidioidomicose/tratamento farmacológico , Fatores Sexuais , Pele/microbiologia , Topografia Médica , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto JovemRESUMO
UNLABELLED: Mycetoma is one of the most frequent chronic subcutaneous infections in many tropical and subtropical regions. OBJECTIVE: To update the epidemiological data of mycetoma cases in Mexico. METHOD: A survey in the main mycological diagnosis centers in this country was performed. Each mycologist was requested for number of diagnosed mycetoma cases, age, sex, occupation, geographic origin, type of mycetoma, and etiological agents. RESULTS: Until 2012, we have registered 3,933 cases in the last 54 years. Sex distribution corresponds to 75.6% for men and 24.4% for women. In 75.72% is present in adults between 16-50 years old. The predominant work group of patients is farmers (58.41%) followed by housewives (21.79%). Most of patients come from Jalisco, Morelos, Nuevo Leon, Guerrero, Veracruz and Michoacan states. The most affected body areas are limbs (60.29%) and trunk (19.76%). Actinomycetoma has a frequency of 96.52%, and the commonest etiological agent is Nocardia brasiliensis (65.58%). Eumycetoma (3.48%) is mainly caused by Madurella grisea (28.47%) and M. mycetomatis (26.28%). CONCLUSIONS: Mycetoma is an under-diagnosed pathology representing a health problem in rural regions and must be attended with more interest by the health institutions.
Assuntos
Micetoma/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: fungal invasive infections are frequent in patients with immunosuppression. A common clinical feature is the presence of fever of unknown origin (FUO) in any of its several presentations. The aim of this study was to know the frequency of FUO associated to invasive mycosis in hospitalized patients. METHODS: samples from 34 patients were studied by immunological and microbiological procedures in order to investigate candidiasis, cryptococcosis, aspergillosis and Pneumocystis infection. RESULTS: fungal infection diagnosis was established in 12 (35 %) from 34 patients who full criterion. The fungal species isolated were Candida albicans (six), Aspergillus fumigates (four) and Cryptococcus sp. (two). All candidiasis cases were diagnosed only by microbiological studies, aspergillosis by immunological and microbiological studies, and cryptococcosis only by immunological studies. CONCLUSIONS: we concluded that is important the searching of mycosis in immunocompromised patients with fever of unknown origin by microbiological and immunological procedures.
Assuntos
Febre de Causa Desconhecida/imunologia , Hospedeiro Imunocomprometido , Micoses/imunologia , Adulto , Idoso , Feminino , Febre de Causa Desconhecida/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/complicações , Micoses/microbiologia , Adulto JovemRESUMO
Antecedentes. Las levaduras representan la segunda causa mundial de infecciones fúngicas ungueales, donde Candida albicans y Candida parapsilosis son las dos especies más frecuentes. Objetivos. Conocer la frecuencia de especies de levaduras y su sensibilidad antifúngica in vitro, obtenidas de pacientes con manifestaciones clínicas sugestivas de onicomicosis. Métodos. En México se realizó un estudio prospectivo en pacientes atendidos en cuatro centros de atención dermatológica de 2004 a 2007. El diagnóstico clínico fue corroborado por examen directo y cultivo. La especie de levadura fue determinada por pruebas morfológicas y bioquímicas. A cada aislamiento se le determinó la sensibilidad a ketoconazol, itraconazol y fluconazol mediante el método de microdilución en caldo (documento M27-A2). Resultados. Se obtuvieron 166 aislamientos levaduriformes; las especies más frecuentes fueron C. parapsilosis (31,9%), C. albicans (22,4%) y Candida guilliermondii (12,7%). De todos los aislamientos, 51 mostraron resistencia a uno o varios de los azoles probados: 33 a itraconazol, 12 a ketoconazol y 6 a fluconazol. Fue notable que los 4 aislamientos de Candida glabrata fueron resistentes a los tres compuestos azólicos; C. guilliermondii y Candida famata fueron resistentes a itraconazol en el 42,9% y en el 54,5%, respectivamente. Conclusión. Los resultados obtenidos demuestran la importancia de identificar al agente etiológico y realizar pruebas de sensibilidad para evitar fracasos terapéuticos en las onicomicosis(AU)
Background. Yeasts represent the second cause of nail fungal infection in the world, and Candida albicans and Candida parapsilosis are the two most common species. Objectives. To determine the yeast species frequency and their in vitro antifungal susceptibility, obtained from patients with clinical features suggestive of onychomycosis. Methods. A prospective study was carried out in four dermatological care centers in Mexico from 2004 to 2007. Clinical diagnosis was corroborated by direct examination and culture. The yeast species was determined by morphological and biochemical tests. An antifungal susceptibility test to ketoconazole, itraconazole and fluconazole by the broth microdilution method was performed on each isolate (document M27-A2). Results. One hundred sixty-six yeast isolates were obtained; the most frequently found species were C. parapsilosis (31.9%), C. albicans (22.4%) and Candida guilliermondii (12.7%). Of all isolates, 51 showed resistance to one or several of the azole compounds: 33 to itraconazole, 12 to ketoconazole and 6 to fluconazole. It was remarkable that the four Candida glabrata isolates were resistant to the three azole compounds; C. guilliermondii and Candida famata were resistant to itraconazole in 42.9% and 54.5%, respectively. Conclusion. The results obtained show the importance of identifying the aetiological agent and antifungal susceptibility testing in order to avoid therapeutic failures in onychomycosis(AU)
Assuntos
Leveduras/isolamento & purificação , Técnicas e Procedimentos Diagnósticos/tendências , Leveduras/patogenicidade , Onicomicose/microbiologia , Sensibilidade e Especificidade , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Técnicas e Procedimentos Diagnósticos , Doenças da Unha/diagnóstico , Doenças da Unha/etiologia , Estudos Prospectivos , Cetoconazol/análise , Itraconazol/análise , Fluconazol/análise , 28599RESUMO
BACKGROUND: Yeasts represent the second cause of nail fungal infection in the world, and Candida albicans and Candida parapsilosis are the two most common species. OBJECTIVES: To determine the yeast species frequency and their in vitro antifungal susceptibility, obtained from patients with clinical features suggestive of onychomycosis. METHODS: A prospective study was carried out in four dermatological care centers in Mexico from 2004 to 2007. Clinical diagnosis was corroborated by direct examination and culture. The yeast species was determined by morphological and biochemical tests. An antifungal susceptibility test to ketoconazole, itraconazole and fluconazole by the broth microdilution method was performed on each isolate (document M27-A2). RESULTS: One hundred sixty-six yeast isolates were obtained; the most frequently found species were C. parapsilosis (31.9%), C. albicans (22.4%) and Candida guilliermondii (12.7%). Of all isolates, 51 showed resistance to one or several of the azole compounds: 33 to itraconazole, 12 to ketoconazole and 6 to fluconazole. It was remarkable that the four Candida glabrata isolates were resistant to the three azole compounds; C. guilliermondii and Candida famata were resistant to itraconazole in 42.9% and 54.5%, respectively. CONCLUSION: The results obtained show the importance of identifying the aetiological agent and antifungal susceptibility testing in order to avoid therapeutic failures in onychomycosis.
Assuntos
Antifúngicos/farmacologia , Onicomicose/microbiologia , Leveduras/isolamento & purificação , Adulto , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase Cutânea/epidemiologia , Candidíase Cutânea/microbiologia , Farmacorresistência Fúngica , Fluconazol/farmacologia , Humanos , Itraconazol/farmacologia , Cetoconazol/farmacologia , México/epidemiologia , Onicomicose/epidemiologia , Pichia/efeitos dos fármacos , Pichia/isolamento & purificação , Estudos Prospectivos , Rhodotorula/efeitos dos fármacos , Rhodotorula/isolamento & purificação , Especificidade da Espécie , Trichosporon/efeitos dos fármacos , Trichosporon/isolamento & purificação , Leveduras/efeitos dos fármacosRESUMO
Antecedentes Las queratomicosis tienen como desencadenante traumatismos corneales o quirúrgicos (pueden aparecer tras un trasplante de córnea), el uso de lentes de contacto contaminadas o alteración lagrimal. Su diagnóstico y su tratamiento son un reto para conservar una buena función visual.ObjetivoRevisión retrospectiva, descriptiva y lineal del diagnóstico, la epidemiología, la etiología y la evolución de 219 casos de queratomicosis en México.MétodoSe estudió el diagnóstico, el tratamiento y la evolución de 219 pacientes a los que se había atendido en el Servicio de Córnea en un hospital de atención oftalmológica de la Ciudad de México, provenientes de diversos estados de la República de México.ResultadosEl antecedente de traumatismo se refirió en 77 casos (36%), de los que 12 (5,4%) fueron traumatismos quirúrgicos; en 142 casos (64,8%) no se refirió traumatismo alguno. Ciento sesenta y cinco pacientes (75,3%) eran de sexo masculino y 54 (24,6%) de sexo femenino, con una media de edad de 46 años. Para su recuperación clínica y visual se recurrió a tratamientos con antimicóticos tópicos y orales y a cirugías. En 81 pacientes (36,9%) se practicaron una o más cirugías. En 62 casos (28,3%) se practicó trasplante de córnea y en 19 (8,7%) se llevaron a cabo recubrimientos conjuntivales o parches corneoesclerales.ConclusionesEn México, las queratomicosis afectan a pacientes de sexo masculino en una proporción de 4:1 respecto a las mujeres. Fusarium solani fue el hongo más frecuente en nuestro estudio (37,2%), y el mayor número de evisceraciones se presentó en los pacientes afectados por el género Aspergillus (26%). La mejor respuesta clínica se obtuvo con combinaciones de antimicóticos tópicos en las infecciones por hongos dematiáceos(AU)
Background Some of the most common precipitating events for keratomycoses (fungal keratitis), include surgical trauma (after cornea transplantation), the use of contaminated contact lenses or alterations in lacrimal secretions. Diagnosis and treatment (to avoid loss of vision) for these type of infections are challenging.ObjectiveRetrospective review of the diagnosis, epidemiology, etiology and response to treatment in 219 patients with fungal keratitis in Mexico.MethodsWe have studied the diagnosis, epidemiology, etiology and response to treatment in 219 patients from different states in the Mexican Republic in the Cornea Department at an Ophthalmology Hospital in Mexico D.F.ResultsTrauma was the precipitating event in 77 patients (36%), of which 12 (5.4%) were due to surgical trauma; 152 patients (64.8%) did not report any prior trauma. There were 165 male (75.3%) and 54 female (24.6%) patients, with an average age of 46 years old. For clinical and visual treatment patients were treated with topical and oral antifungals and surgery. One or more surgeries were performed on a total of 81 patients (36.9%). A total of 62 patients (28.3%) received a corneal transplant, and 19 patients (8.7%) were subjected to conjunctival flap or scleral-conjunctival surgery.ConclusionsIn Mexico, keratomycoses affect mostly male patients in a 4:1 ratio over females. Fusarium solani was the most frequent agent of fungal keratitis in our study (37.2%), and the highest number of corneal ulcers and eviscerations (26%) was present in patients infected by Aspergillus. The best therapeutic responses were with combination of topical antifungals against dematiaceous fungi(AU)
Assuntos
Humanos , Infecções Oculares Fúngicas/epidemiologia , Ceratite/microbiologia , México/epidemiologia , Fusarium/patogenicidade , Aspergillus/patogenicidade , Arthrodermataceae/patogenicidade , Distribuição por Sexo , Evisceração do OlhoRESUMO
BACKGROUND: Some of the most common precipitating events for keratomycoses (fungal keratitis), include surgical trauma (after cornea transplantation), the use of contaminated contact lenses or alterations in lacrimal secretions. Diagnosis and treatment (to avoid loss of vision) for these type of infections are challenging. OBJECTIVE: Retrospective review of the diagnosis, epidemiology, etiology and response to treatment in 219 patients with fungal keratitis in Mexico. METHODS: We have studied the diagnosis, epidemiology, etiology and response to treatment in 219 patients from different states in the Mexican Republic in the Cornea Department at an Ophthalmology Hospital in Mexico D.F. RESULTS: Trauma was the precipitating event in 77 patients (36%), of which 12 (5.4%) were due to surgical trauma; 152 patients (64.8%) did not report any prior trauma. There were 165 male (75.3%) and 54 female (24.6%) patients, with an average age of 46 years old. For clinical and visual treatment patients were treated with topical and oral antifungals and surgery. One or more surgeries were performed on a total of 81 patients (36.9%). A total of 62 patients (28.3%) received a corneal transplant, and 19 patients (8.7%) were subjected to conjunctival flap or scleral-conjunctival surgery. CONCLUSIONS: In Mexico, keratomycoses affect mostly male patients in a 4:1 ratio over females. Fusarium solani was the most frequent agent of fungal keratitis in our study (37.2%), and the highest number of corneal ulcers and eviscerations (26%) was present in patients infected by Aspergillus. The best therapeutic responses were with combination of topical antifungals against dematiaceous fungi.
Assuntos
Infecções Oculares Fúngicas/epidemiologia , Ceratite/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Lentes de Contato/efeitos adversos , Lentes de Contato/microbiologia , Transplante de Córnea , Suscetibilidade a Doenças , Síndromes do Olho Seco/complicações , Contaminação de Equipamentos , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/cirurgia , Feminino , Hospitais Especializados/estatística & dados numéricos , Humanos , Lactente , Ceratite/tratamento farmacológico , Ceratite/etiologia , Ceratite/microbiologia , Ceratite/cirurgia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: An increase in mycosis associated with therapeutic failure has been observed worldwide. The dearth of data in Mexico led us to study antifungal resistance. MATERIAL AND METHODS: Seventy six isolates of patients from the Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social were included: 36 with dermatophytoses and 40 with candidiasis. Dermatophytes were assesed using the E-test method and Candida spp. using the broth microdilution method. Antifungal drugs included itraconazole, ketoconazole and fluconazole for dermatophytes; in addition, voriconazole and amphotericin B were used to treat yeasts. RESULTS: From the 36 dermatophytes, seven isolates (19.4%) showed resistance to one or more antifungal drugs: three to Trichophyton rubrum, three to T. mentagrophytes and one to T. tonsurans. One T. rubrum isolate was resistant to the three azoles; the other six isolates were resistant to fluconazole only. From the 40 Candida isolates, 11 (27.5%) showed resistance: seven to ketoconazole and itraconazole; three only to itraconazole and one to ketoconazole. One C. glabrata isolate showed resistance to the four azoles. None of the yeasts showed resistance to amphotericin B. CONCLUSION: Therapeutic failure could be caused by drug resistance. In our study we found an antifungal resistance of 20% and 27.5% in dermatophytes and in yeasts respectively.