Sporotrichosis: hyperendemic by zoonotic transmission, with atypical presentations, hypersensitivity reactions and greater severity

Abstract In recent decades, an alarming increase in the number of sporotrichosis cases has been reported in southern and southeastern Brazil, especially in the state of Rio de Janeiro, has been considered a long-term hyperendemic condition associated with feline transmission. According to phenotypic classifications, the Sporothrix species recovered from cats were classified as S. brasiliensis in 96.5% of the studied cases. This finding has also been demonstrated in humans, which confirms the zoonotic transmission associated with this predominant species in Brazil. The zoonotic transmission of the fungus and its important virulence in the context of the hyperendemic situation in Rio de Janeiro have changed the approach to the disease, which in its classic form was restricted to certain professional groups and very specific regions in the Brazilian territory, into a public health challenge of scientific interest. Its atypical manifestations and hypersensitivity reactions are increasingly frequent, constituting a new sporotrichosis aspect, which deserves attention from the medical community, as well as from other health professionals.

Sporotrichosis: hyperendemic by zoonotic transmission, with atypical presentations, hypersensitivity reactions and greater severity.

In recent decades, an alarming increase in the number of sporotrichosis cases has been reported in southern and southeastern Brazil, especially in the state of Rio de Janeiro, has been considered a long-term hyperendemic condition associated with feline transmission. According to phenotypic classifications, the Sporothrix species recovered from cats were classified as S. brasiliensis in 96.5% of the studied cases. This finding has also been demonstrated in humans, which confirms the zoonotic transmission associated with this predominant species in Brazil. The zoonotic transmission of the fungus and its important virulence in the context of the hyperendemic situation in Rio de Janeiro have changed the approach to the disease, which in its classic form was restricted to certain professional groups and very specific regions in the Brazilian territory, into a public health challenge of scientific interest. Its atypical manifestations and hypersensitivity reactions are increasingly frequent, constituting a new sporotrichosis aspect, which deserves attention from the medical community, as well as from other health professionals.

Dermatoscopic findings as a complementary tool in the differential diagnosis of the etiological agent of tinea capitis.

Tinea capitis is a scalp infection caused by fungi. In Brazil, the main causative agents are Microsporum canis and the Trichophyton tonsurans. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. We reveal the dermoscopic findings that enable distinction between the main causative agents of Tinea capitis, M. canis and T. tonsurans. The association of clinical and dermatoscopic findings in suspected Tinea capitis cases may help with the differential diagnosis of the etiological agent, making feasible the precocious, specific treatment.

Dermatoscopic fi ndings as a complementary tool in the differential diagnosis of the etiological agent of tinea capitis

Tinea capitis is a scalp infection caused by fungi. In Brazil, the main causative agents are Microsporum canis and the Trichophyton tonsurans. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. We reveal the dermoscopic findings that enable distinction between the main causative agents of Tinea capitis, M. canis and T. tonsurans. The association of clinical and dermatoscopic findings in suspected Tinea capitis cases may help with the differential diagnosis of the etiological agent, making feasible the precocious, specific treatment.

Esporotricose cutâneo linfática com transmissão zoonótica / Cutaneous-lymphatic sporotrichosis with zoonotic transmission

Os autores apresentam o caso de uma paciente do sexo feminino, de 43 anos, com esporotricose cutâneo linfática, transmitida por seu gato que apresentava lesão na face. O caso de esporotricose humana foi notificado e o felino encaminhado para avaliação veterinária.

Treatment of superficial mycoses: review - part II / Atualizacao terapeutica das micoses superficiais: artigo de revisao parte II

Superficial fungal infections of the hair, skin and nails are a major cause of morbidity in the world. Choosing the right treatment is not always simple because of the possibility of drug interactions and side effects. The first part of the article discusses the main treatments for superficial mycoses - keratophytoses, dermatophytosis, candidiasis, with a practical approach to the most commonly-used topical and systemic drugs , referring also to their dosage and duration of use. Promising new, antifungal therapeutic alternatives are also highlighted, as well as available options on the Brazilian and world markets.

As infecções fúngicas superficiais dos cabelos, pele e unhas representam uma causa importante de morbidade no mundo. O tratamento nem sempre é simples, havendo dificuldade na escolha dos esquemas terapêuticos disponíveis na literatura, assim como suas possíveis interações medicamentosas e efeitos colaterais. A segunda parte do trabalho aborda os principais esquemas terapêuticos das micoses superficiais - ceratofitoses, dermatofitoses, candidíase -, possibilitando a consulta prática das drogas tópicas e sistêmicas mais utilizadas, sua dosagem e tempo de utilização. Novas possibilidades terapêuticas antifúngicas também são ressaltadas, assim como as apresentações disponíveis no mercado brasileiro e mundial.

Update on therapy for superficial mycoses: review article part I.

Superficial fungal infections of the hair, skin and nails are a major cause of morbidity in the world. Choosing the right treatment is not always simple because of the possibility of drug interactions and side effects. The first part of the article discusses the main treatments for superficial mycoses - keratophytoses, dermatophytosis, candidiasis, with a practical approach to the most commonly-used topical and systemic drugs , referring also to their dosage and duration of use. Promising new, antifungal therapeutic alternatives are also highlighted, as well as available options on the Brazilian and world markets.

Update on therapy for superficial mycoses: review article part I / Atualizacao terapeutica das micoses superficiais: artigo de revisao parte I

Superficial fungal infections of the hair, skin and nails are a major cause of morbidity in the world. Choosing the right treatment is not always simple because of the possibility of drug interactions and side effects. The first part of the article discusses the main treatments for superficial mycoses - keratophytoses, dermatophytosis, candidiasis, with a practical approach to the most commonly-used topical and systemic drugs , referring also to their dosage and duration of use. Promising new, antifungal therapeutic alternatives are also highlighted, as well as available options on the Brazilian and world markets.

As infecções fúngicas superficiais dos cabelos, pele e unhas representam uma causa importante de morbidade no mundo. O tratamento nem sempre é simples, havendo dificuldade na escolha dos esquemas terapêuticos disponíveis na literatura, assim como suas possíveis interações medicamentosas e efeitos colaterais. A primeira parte do trabalho aborda os principais esquemas terapêuticos das micoses superficiais - ceratofitoses, dermatofitoses, candidíase - possibilitando a consulta prática das drogas tópicas e sistêmicas mais utilizadas, sua dosagem e tempo de utilização. Novas possibilidades terapêuticas antifungicas também são ressaltadas, assim como as apresentações disponíneis no mercado brasileiro e mundial.

Treatment of superficial mycoses: review. Part II.

Superficial fungal infections of the hair, skin and nails are a major cause of morbidity in the world. Choosing the right treatment is not always simple because of the possibility of drug interactions and side effects. The first part of the article discusses the main treatments for superficial mycoses - keratophytoses, dermatophytosis, candidiasis, with a practical approach to the most commonly-used topical and systemic drugs , referring also to their dosage and duration of use. Promising new, antifungal therapeutic alternatives are also highlighted, as well as available options on the Brazilian and world markets.

Systemic mycoses in immunodepressed patients (AIDS).

Infectious and noninfectious skin diseases are observed in about 90% of HIV patients, and their incidence increases and is more severe as the immune system weakens. Cutaneous manifestations are considered good clinical predictors for the immunological condition of the patient with AIDS and the introduction of highly effective antiretroviral therapy totally changed the prognosis of the mycoses, among other diseases associated with AIDS, permitting longer survival and acceptable level of quality of life for these patients. This contribution describes the systemic mycoses that are more frequent in the seropositive population, that is, patients with HIV/AIDS, which are cryptococcosis, histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, sporotrichosis, penicilliosis, and aspergillosis. Their causative agents, mode of transmission, clinics, laboratorial diagnosis and therapy, in the aspects related to immunodepressed patients, are reviewed.

Lesões molusco-símiles em paciente com esporotricose / Molluscum-like lesions in a patient with sporotrichosis

Esporotricose é uma infecção fúngica subcutânea, adquirida por inoculação direta, causada pelo Sporothrix schenckii. Embora a apresentação clássica linfocutânea represente a maioria dos casos, as formas clínicas atípicas e graves têm aumentado em ocorrência. Esporotricose sistêmica e esporotricose cutânea disseminada são variantes raras, usualmente associadas à imunodeficiência celular ou a estados debilitantes. Relatamos o primeiro caso na literatura de lesões molusco-símiles em esporotricose cutaneomucosa múltipla. Os exames micológico direto e histopatológico apresentavam-se ricos em células leveduriformes.

Sporotrichosis is a subcutaneous fungal infection caused by Sporothrix schenckii and acquired by direct inoculation. Although the majority of cases consist of the classic lymphocutaneous presentation, the frequency of atypical and severe clinical forms of the disease has increased progressively. Systemic and disseminated cutaneous sporotrichosis constitute rare variants and such cases are generally associated with cellular immunodeficiency or debilitated states. The present paper describes the first published case of molluscum-like lesions in disseminated mucocutaneous sporotrichosis. Direct mycological examination and histopathology revealed numerous yeast cells.

Molluscum-like lesions in a patient with sporotrichosis.

Sporotrichosis is a subcutaneous fungal infection caused by Sporothrix schenckii and acquired by direct inoculation. Although the majority of cases consist of the classic lymphocutaneous presentation, the frequency of atypical and severe clinical forms of the disease has increased progressively. Systemic and disseminated cutaneous sporotrichosis constitute rare variants and such cases are generally associated with cellular immunodeficiency or debilitated states. The present paper describes the first published case of molluscum-like lesions in disseminated mucocutaneous sporotrichosis. Direct mycological examination and histopathology revealed numerous yeast cells.

Sporotrichosis: Part I.

Sporotrichosis is the most common subcutaneous mycosis in South America. Classic infection is associated with traumatic inoculation of soil, vegetables, and organic material contaminated with Sporothix schenckii. Animals of various species, including humans, are affected by this disease. This subcutaneous mycosis is an infection of implantation. The most frequent clinical form is the lymphocutaneous form. The fixed cutaneous form is characterized by infiltrated nodular, ulcerated, or erythematosquamous lesions located on exposed areas where fungal inoculation occurred. The disseminated cutaneous forms have mainly been observed among immunosuppressed patients, especially human immunodeficiency virus-positive individuals. Sporotrichosis is the only subcutaneous mycosis for which direct examination or histology is of little or no value for diagnosis. The diagnosis rests solely on the isolation of S schenckii in culture. Since 1998, researchers from Brazil suggested that feline transmission of sporotrichosis was associated with a large and long-lasting outbreak of the disease in the city of Rio de Janeiro.

Sporotrichosis: Part II.

Sporotrichosis is a subcutaneous mycosis of implantation. It is the only subcutaneous mycosis for which direct examination or histology is of little or no value for diagnosis. The diagnosis solely rests on the isolation of Sporothrix schenckii in culture. On pathologic examination, causative organisms are rarely seen. Staining with fluorescent-labeled antibodies may aid in visualizing the cigar-shaped yeast forms; however, the organisms are still difficult to identify. Topical therapy is not effective. Potassium iodide is an effective treatment for sporotrichosis, but this agent has not been subjected to specific treatment trials comparing its efficacy against azoles or allylamine alternatives. Itraconazole is generally safe and well tolerated, and the relapse rate is low. Terbinafine could be another therapeutic alternative to treat the disease. Since 1998, researchers from Brazil suggested that feline transmission of sporotrichosis in Rio de Janeiro city was associated with a large and long-lasting outbreak of the disease. To understand the outbreak, there have been studies on the epidemiology and antifungal susceptibility of the S schenckii strains through molecular diagnosis. Data suggest that all isolated strains were genetically related.

Clinical assessment of azithromycin dihydrate in the treatment of pediatric impetigo / Avaliação clínica de azitromicina di-hidratada no tratamento de impetigo pediátrico

The primary objective of this double-blind, randomized, controlled clinical trial was to assess the use of azithromycin dihydrate in oral suspension form in the treatment of impetigo in children. The secondary objectives were to compare the efficacy and safety of two presentations of azithromycin dihydrate in the treatment of impetigo in children, on wound healing and on wound pruritus. After screening and obtaining informed consent of the parents or legal guardians, a total of 100 patients ranging in age from 2-8 years old and presenting impetigo were randomized to one of two groups for a 3-day treatment period using azithromycin dihydrate in oral suspension in single doses of 10mg/kg/day: Group A (manufactured by Merck S.A.), and Group B (manufactured by Pfizer). Patients returned to the study center at the end of the 3-day treatment (Visit 2) and 7 days after the Pretreatment visit (Visit 3) for efficacy assessments and safety monitoring. Pretreatment demographic data and impetigo characteristics (type, location, number of lesions, pruritus) were homogenous between treatment groups. At the end of the study, all patients in both groups presented either ?improvement? or ?cured? lesions, with the majority (72.9%) of the patients presenting ?cured? lesions. We observed a statistically significant decrease in pruritus severity at Visit 2 and Visit 3 in relation to pretreatment, with no significant between-group difference at either study visit. Reported adverse events were transient and mild-to moderate in severity in both treatment groups, with no serious adverse events reported during the study. Based on the data collected during this study, we conclude that the two presentations of azithromycin were safe and effective in the treatment of impetigo in the population evaluated.

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.

Nondermatophytic filamentous fungi infection in South America--reality or misdiagnosis?

For the last 10 years, a steady increment in the diagnosis of nondermatophyte filamentous fungal infections has been observed. This trend also applies to the valuation of the medical mycology. It can be attributed, in part, to the increased concern of the population with the aesthetic aspect, the easiest access to health information, and the increased demand for specialized jobs. Moreover, increase in the diagnosis of new emerging fungi is also caused by the improvement of the diagnostic techniques available as well as the qualification and constant update of the professionals in medical mycology. Another relevant aspect is the valorization of medical mycology in the medical curriculum. Misdiagnosis can lead to treatment failures, because not all nail diseases are caused by fungi. Therefore, the importance of clinical diagnosis is strictly associated with laboratory results.