[Study of 50 patients with sporotrichosis. Clinical and laboratory assessment]. / Estudio de 50 pacientes con esporotricosis. Evaluación clínica y de laboratorio.

Because sporotrichosis is the most frequent subcutaneous mycosis in Mexico and the clinical aspect is not always characteristic, the aim of this study was to evaluate laboratory diagnosis techniques. Fifty patients with clinical diagnosis of subcutaneous sporotrichosis were studied including clinical and epidemiologic data. Metabolic antigen was used to elicit delayed hypersensitivity skin reaction in all patients. Exudate was plated on Sabouraud agar and biopsy material was submitted to indirect immunofluorescence and histopathology. Results showed that sporotrichosis frequency was higher in women (62%), in children and adolescents under 20 years of age (34%) and adults older than 50 years of age (28%). Disease was predominant in farmers (44%) followed by housewives (30%). Lymphangitic form accounted for 82% of cases and these were localized in upper limbs (54%). In 66% of cases, histopathology showed S. schenckii yeasts; hypersensitivity skin reaction was positive in 76% and culture in 94%. By indirect immunofluorescence, parasitic elements were demonstrated in all patients corresponding to both sensitivity and specificity 100%. In this work, indirect immunofluorescence was the most efficient sporotrichosis diagnostic method followed by culture, hypersensitivity skin reaction, and histopathologic study.

Prospective immunological follow-up in household contacts of Mexican leprosy patients.

A 6-year prospective study of 79 household contacts of leprosy cases was made in order to correlate the development of the disease with their specific T-cell immunity, measured by the Mitsuda test, and levels of anti-Mycobacterium leprae antibodies determined in three consecutive observations with the FLA-ABS test. Overall in the contacts, 71.7% were Mitsuda positive and 93.6% showed seropositivity, without regard to their age, sex, or leprosy type of their index case. Households were divided into lower-risk and higher-risk groups according to either the paucibacillary or multibacillary character of their index case. The lower-risk group consisted of 19 contacts of 2 tuberculoid (TT) and 5 indeterminate cases. The higher-risk group was made up of 60 household contacts of 18 active lepromatous (LL) cases. All but two contacts in the former group had a positive Mitsuda reaction; the most common antibody titer was 1:160, with a tendency to stabilize or decrease over time. In the two Mitsuda-negative contacts, increased antibody levels were observed. In the higher-risk group, 61.6% were Mitsuda positive and showed a humoral profile similar to those Mitsuda positive in the lower-risk group. In most of the Mitsuda-negative LL contacts, the antibody levels remained constant or progressively increased, suggesting a high probability of active subclinical infection. This assumption was partially supported by the finding of a new borderline lepromatous (BL) leprosy case in the Mitsuda-negative LL contact group. Nevertheless, the contribution of the close and extensive contact with a multibacilliferous case as a risk factor was difficult to evaluate because of the small size of the sample studied.

[Phagocytosis of Candida albicans by polymorphonuclear leucocytes from patients with nodular lepromatous leprosy]. / Phagocytose de Candida albicans par des leucocytes polynucléaires obtenus de malades atteints de lèpre lépromateuse nodulaire.

Patients suffering from nodular lepromatous leprosy are deficient in cellular immunity but may not be more susceptible to other infections. Therefore it is possible that other defense mechanisms are operational in dealing with other infectious agents these patients may be exposed to. In this report, the phagocytic and fungicidal activity of polymorphonuclear (PMN) cells against Candida albicans was examined using PMN from 20 nodular lepromatous patients and from 20 healthy subjects (controls). The method used was that of PMN adherence to glass. The phagocytic activity was evaluated after 15 mn and 45 mn. We observed that there was phagocytized by 94 % of the PMN from patients and by 95 % of the PMN from the controls. The phagocytic index of the yeasts ingested by the PMN were 4.47 and 4.10 for, respectively, patients and controls. The frequencies of yeasts killed by PMN from patients and controls were, respectively, 29.6 and 29.4 %. The results indicated that PMN from patients and healthy controls had the same capacity to phagocytize and to destroy yeasts of C. albicans.

Comparative merits of two topical corticosteroid antimicrobial drugs.

The anti-inflammatory and antimicrobial activities of two topical creams, one containing halcinonide, neomycin and nystatin (HNN), and the other betamethasone valerate, gentamicin, iodochlorhydroxyquin and tolnaftate (BGI), were compared in a randomized, parallel study of 154 patients (eighty-seven secondarily infected eczematous dermatoses; sixty-seven cutaneous candidiasis). Repeated clinical assessments showed that the two creams produced equivalent therapeutic responses both in patients with infected eczematous lesions and candidiasis. HNN and BGI creams eradicated the bacterial pathogens isolated prior to treatment in 80% and 76%, respectively, of the patients with eczematous dermatoses. The organism most frequently isolated in these patients was S. aureus. Local irritation prompting discontinuance of therapy occurred in just one patient receiving HNN, and two patients receiving BGI.

[Fixed lupus erythematosus (its treatment with thalidomide)]. / Lupus eritematoso fijo (su tratamiento con talidomida).

The results obtained from the first 20 cases of Discoid Lupus Erithematosus treated with Thalidomide showed evidence of its great efficacy, evident from the first 15 days of treatment. In the incipient cases the results were even spectacular. 2. The minimum dosage used by the authors seems to be adequate on the basis of the results obtained. 3. The precise mode of action of thalidomide but it is thought that in acts on the hypothalamus. 4. The intolerance to Thalidomide and its undesireable side effects consisted slight somnolence; only one case had fever, cephalea, arthralgia, vertigo, nausea and urticaria which is unknown made it necessary to discontinue the medication. 5. The teratogenic effect of thalidomide obliges us to redouble the vigilance in women in age of reproduction by using of parenteral contraceptives applied by or in presence of the investigator. This study included one case that started treatment during the 7th month of pregnancy, without any problem and with an excellent result. The patient gave birth to a healthy full term infant. 6. It is recognized that this preliminary study should be continued with a greater number of cases and that these should be continued for a longer follow-up evaluation. At the present time, the authors believe that thalidomide is the best treatment for Discoid Lupus Erythematosus.