Medicamentos orais para o tratamento do pé de atleta (tinea pedis) / Oral medications for the treatment of athlete's foot (tinea pedis)

Introdução: Cerca de 15% da população mundial tem pé de atleta ( frieira, ou tinea pedis), uma infecção fúngica do pé. Existem várias formas clínicas da doença; a tinea dos dedos do pé, da sola (interdigital), do calcanhar e lateral do pé (plantar) são as formas mais comuns. A tinha plantar é conhecida como ?pé em mocassim?. Uma vez adquirida, a in¬fecção pode disseminar-se para outras áreas do pé, inclusive para as unhas, que se tornam fonte de reinfecção. A terapia oral é frequentemente usada para quadros crônicos de tinea ou quando o tratamento tópico não resolveu o problema. Objetivos: Avaliar a efetividade dos tratamentos orais para infecções fúngicas da pele do pé (tinea pedis). Métodos: Métodos de busca: Para esta atualização da revisão, foram feitas buscas nas seguintes bases de dados até julho de 2012: Cochrane Skin Group Specialised Register, Central, Medline (a partir de 1946), Embase (a partir de 1974), e CINAHL (a par¬tir de 1981). Também foi feita uma busca nas referências bi¬bliográficas citadas nos estudos encontrados e nas platafor¬mas de registros de ensaios clínicos. Critérios de seleção: Ensaios clínicos controlados e ran¬domizados que avaliaram medicamentos orais para partici¬pantes com diagnóstico clínico de tinea pedis, confirmado pela microscopia e pelo crescimento de dermatófitos ( fun¬gos) na cultura. Coleta de dados e análise: Dois autores da revisão realiza¬ram a seleção de estudos, a avaliação do risco de viés e a extra¬ção de dados, de modo independente. Principais resultados: Incluímos 15 ensaios clínicos que envolveram 1.438 participantes. Segundo dois ensaios clínicos (71 participantes) que compararam terbinafina versus griseo¬fulvina, a razão de risco (RR) de cura foi de 2.26 [intervalo de confiança de 95% (IC 95%) 1,49 a 3,44] em favor da terbinafina. Apesar de a maioria dos estudos ser pequena, não foi detectada

Oral treatments for fungal infections of the skin of the foot.

BACKGROUND: About 15% of the world population have fungal infections of the feet (tinea pedis or athlete's foot). There are many clinical presentations of tinea pedis, and most commonly, tinea pedis is seen between the toes (interdigital) and on the soles, heels, and sides of the foot (plantar). Plantar tinea pedis is known as moccasin foot. Once acquired, the infection can spread to other sites including the nails, which can be a source of re-infection. Oral therapy is usually used for chronic conditions or when topical treatment has failed. OBJECTIVE: To assess the effects of oral treatments for fungal infections of the skin of the foot (tinea pedis). SEARCH METHODS: For this update we searched the following databases to July 2012: the Cochrane Skin Group Specialized Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), and CINAHL (from 1981). We checked the bibliographies of retrieved trials for further references to relevant trials, and we searched online trials registers. SELECTION CRITERIA: Randomized controlled trials of oral treatments in participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes (fungi) in culture. DATA COLLECTION AND ANALYSIS: Two review authors independently undertook study selection, "Risk of bias" assessment, and data extraction. MAIN RESULTS: We included 15 trials, involving 1,438 participants. The 2 trials (71 participants) comparing terbinafine and griseofulvin produced a pooled risk ratio (RR) of 2.26 (95% confidence interval (CI) 1.49 to 3.44) in favors of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole, fluconazole and itraconazole, fluconazole and ketoconazole, or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo: terbinafine (31 participants, RR 24.54, 95%CI 1.57 to 384.32) and itraconazole (72 participants, RR 6.67, 95%CI 2.17 to 20.48). All drugs reported adverse effects, with gastrointestinal effects most commonly reported. Ten of the trials were published over 15 years ago, and this is reflected by the poor reporting of information from which to make a clear "Risk of bias" assessment. Only one trial was at low risk of bias overall. The majority of the remaining trials were judged as "unclear" risk of bias because of the lack of clear statements with respect to methods of generating the randomization sequence and allocation concealment. More trials achieved blinding of participants and personnel than blinding of the outcome assessors, which was again poorly reported. AUTHORS' CONCLUSIONS: The evidence suggests that terbinafine is more effective than griseofulvin; and terbinafine and itraconazole are more effective than no treatment. In order to produce more reliable data , a rigorous evaluation of different drug therapies needs to be undertaken with larger sample sizes to ensure they are large enough to show any real difference when two treatments are being compared. It is also important to continue to follow up and collect data , preferably for six months after the end of the intervention period, to establish whether or not the infection recurred.

Evolução da moléstia de Hansen (MH) em onze doentes com HIV+ e AIDS* / The evolution of Hansen's disease in eleven patients with AIDS

A Moléstia de Hansen(MH) e a AIDS são importantes problemas de saúde pública no Brasil. Este trabalho visa verificar a incidência de co-infecção pelo HIV e AIDS num grupo de doentes de hanseníase. Foram examinados 620 doentes de hanseníase, com ou sem estado reacional....(AU(

The Hansen disease (HD) and AIDS are important problems of public health in Brazil. This work aims to verify the incidence of co-infection for HIV and AIDS in a group of patients with Hansen'disease...

Pesquisa de Mycobacterium leprae em biópsias de mucosa oral por meio da reação em cadeia da polimerase / Molecular detection of Mycobacterium leprae by polymerase chain reaction in oral mucosa biopsy specimens

FUNDAMENTOS - A hanseníase é endêmica na América do Sul, sendo responsável por 3 por cento do total dos casos mundiais e, particularmente, no Brasil, por 85 por cento dos casos sul-americanos. Seu agente pode ser encontrado na mucosa oral sem qualquer alteração evidente, e apenas testes laboratoriais muito sensíveis podem detectar sua presença. OBJETIVOS - Determinar se o genoma do Mycobacterium leprae pode ser encontrado pelo teste da PCR em biópsias com punch da mucosa oral de pacientes com hanseníase. MATERIAL E MÉTODOS - Realizou-se biópsia da mucosa oral normal de sete pacientes com hanseníase multibacilar. Cinco estavam em tratamento durante o estudo, e apenas um, ainda sem tratamento, teve o diagnóstico confirmado pela hematoxilina-eosina e coloração de Fite-Faraco para M. leprae. As peças foram incluídas em parafina e submetidas à PCR para pesquisa de M. leprae. RESULTADOS - Seis dos sete casos foram positivos para M. leprae, e um para Mycobacterium sp., demonstrando-se alta sensibilidade e especificidade do método. CONCLUSÃO - A PCR é método rápido, fácil e confiável para a investigação de rotina da infecção por micobactéria, mesmo quando a doença ainda é assintomática. O diagnóstico pode ser obtido a partir de simples biópsia ambulatorial.

BACKGROUND - Hansen's disease is endemic in South America, which accounts for 3 percent of total world cases, and particularly in Brazil, which accounts for 85 percent of all South American cases. The bacteria can be found in the oral mucosa with no evident signs of infection, and only very sensitive laboratory assays can detect its presence. OBJECTIVES - The aim of this study was to ascertain if the M. leprae genome can be detected by PCR in small punch biopsy specimens from the oral mucosa of patients with Hansen's disease. METHODS - The normal oral mucosas of seven multibacillary Hansen's disease patients were biopsied. Five of them were under treatment at the time of the study. Diagnosis of Hansen's disease could be determined by conventional hematoxylineosin and Fite-Faraco staining for M. leprae in only one patient. This patient had not received treatment prior to the time of the biopsy. The paraffin embedded specimens were submitted to PCR for M. leprae. RESULTS - Six out of seven cases showed positivity for M. leprae, and the remaining case showed positivity for Mycobacterium sp., demonstrating the high sensitivity and specificity of this method. CONCLUSIONS - PCR is a fast, easy and reliable method for routine investigation of mycobacterial infection, even during nonsymptomatic periods. Diagnosis can be achieved through a simple oral biopsy at an outpatient clinic.