Dynamics of dermatophytosis frequency in Mexico: an analysis of 2084 cases.

We analysed 15,101 biological samples from patients presenting with superficial mycoses who attended outpatient services over a 10-year period. Scale samples were processed for direct microscopic examination with 15% KOH and cultured on Sabouraud glucose agar plus chloramphenicol and cycloheximide. Laboratory examination confirmed 4,709 cases of superficial mycosis (31.18%), of which 2,084 (44.26%) were dermatophytoses. The species most frequently encountered was Trichophyton rubrum (71.2%), followed by T. tonsurans (6.9%), T. mentagrophytes (5.5%), Microsporum canis (4.5%) and Epidermophyton floccosum (1.3%). The most frequent clinical form of dermatophytosis was tinea unguium (59.9%), followed by tinea pedis (24.5%). We demonstrate that the number of cases of T. rubrum is increasing in Mexico.

[Detection of Coccidioides immitis infection in Coahuila, Mexico]. / Detección de infección por Coccidioides immitis en zonas del estado de Coahuila, México.

Coccidioidomycosis is a mycosis firstly pulmonar caused by Coccidioides immitis; it can be disseminated to central nervous system, bones and skin, principaly. In Mexico, the real frequency of the disease is unknown. The aim of this work was to determine, by skin test and by serology, the infection cases by C. immitis in twelve communities (10 rural and two urban), attended in the Hospital Rural No 79 at the Instituto Mexicano del Seguro Social (IMSS) from the Coahuila State, Mexico. Six hundred and sixty eight adult individuals of both sexes were studied, to whom 0.1 ml of coccidioidin by intradermal route was applied; 72 h after, the induration diameter was measured. One hundred eighty individuals were selected and seric anti-C. immitis immunoglobulins levels were determined by ELISA. Six hundred twenty one individuals (93%) were positive to coccidioidin, the frequency was much higher than that previously reported in Coahuila. From 180 sera studied, the means of optical density (OD) were: IgG1, 1.55; IgG2, 0.94; total IgG, 0.33; IgG3, 0.29; IgG4, 0.27; IgM, 0.08. The values of IgG1, IgG2 and IgM compared with the other immunoglobulins were statistically significant. The high values of IgG1 and IgG2 suggest frequent contact with the antigen, and probable cases of undiagnosed disease.

Detección de infección por Coccidioides immitis en zonas del estado de Coahuila, México / Detection of Coccidioides immitis infection in Coahuila, Mexico

La coccidioidomicosis es una micosis inicialmente pulmonar causada por Coccidioides immitis; puede diseminarse principalmente a sistema nervioso central, huesos y piel. En México se desconoce la frecuencia exacta de esta enfermedad. Nuestro objetivo fue determinar, por intradermorreacción y por serología, los casos de infección por C. immitis en 12 comunidades (10 rurales y dos urbanas) atendidas en el Hospital Rural Nº 79 del Instituto Mexicano del Seguro Social (IMSS) del estado de Coahuila, México. Se estudiaron 668 individuos adultos de ambos sexos; se les aplicó 0,1 ml de coccidioidina por vía intradérmica; después de 72 hs. se midió el diámetro de induración. Fueron seleccionados 180 individuos y a partir del suero se determinaron los niveles de inmunoglobulinas anti-C. immitis por ELISA. Fueron positivos a la coccidioidina 621 sujetos (93%), frecuencia mucho mayor a la reportada previamente en Coahuila. De los 180 sueros estudiados los promedios de densidad óptica (DO) fueron: IgG1, 1,55; IgG2, 0,94; IgG total, 0,33; IgG3, 0,29; IgG4, 0,27; IgM, 0,08. Los valores de IgG1, IgG2 e IgM comparados con las otras inmunoglobulinas fueron estadísticamente significativos. Los valores de IgG1 e IgG2 sugieren contacto frecuente con los antígenos e incluso probables casos de enfermedad no diagnosticada.

Coccidioidomycosis is a mycosis firstly pulmonar caused by Coccidioides immitis; it can be disseminated to central nervous system, bones and skin, principaly. In Mexico, the real frequency of the disease is unknown. The aim of this work was to determine, by skin test and by serology, the infection cases by C. immitis in twelve communities (10 rural and two urban), attended in the Hospital Rural Nº 79 at the Instituto Mexicano del Seguro Social (IMSS) from the Coahuila State, Mexico. Six hundred and sixty eight adult individuals of both sexes were studied, to whom 0.1 ml of coccidioidin by intradermal route was applied; 72 h after, the induration diameter was measured. One hundred eighty individuals were selected and seric anti-C. immitis immunoglobulins levels were determined by ELISA. Six hundred twenty one individuals (93%) were positive to coccidioidin, the frequency was much higher than that previously reported in Coahuila. From 180 sera studied, the means of optical density (OD) were: IgG1, 1.55; IgG2, 0.94; total IgG, 0.33; IgG3, 0.29; IgG4, 0.27; IgM, 0.08. The values of IgG1, IgG2 and IgM compared with the other immunoglobulins were statistically significant. The high values of IgG1 and IgG2 suggest frequent contact with the antigen, and probable cases of undiagnosed disease.

Detección de infección por Coccidioides immitis en zonas del estado de Coahuila, México. / [Detection of Coccidioides immitis infection in Coahuila, Mexico]

Coccidioidomycosis is a mycosis firstly pulmonar caused by Coccidioides immitis; it can be disseminated to central nervous system, bones and skin, principaly. In Mexico, the real frequency of the disease is unknown. The aim of this work was to determine, by skin test and by serology, the infection cases by C. immitis in twelve communities (10 rural and two urban), attended in the Hospital Rural No 79 at the Instituto Mexicano del Seguro Social (IMSS) from the Coahuila State, Mexico. Six hundred and sixty eight adult individuals of both sexes were studied, to whom 0.1 ml of coccidioidin by intradermal route was applied; 72 h after, the induration diameter was measured. One hundred eighty individuals were selected and seric anti-C. immitis immunoglobulins levels were determined by ELISA. Six hundred twenty one individuals (93

) were positive to coccidioidin, the frequency was much higher than that previously reported in Coahuila. From 180 sera studied, the means of optical density (OD) were: IgG1, 1.55; IgG2, 0.94; total IgG, 0.33; IgG3, 0.29; IgG4, 0.27; IgM, 0.08. The values of IgG1, IgG2 and IgM compared with the other immunoglobulins were statistically significant. The high values of IgG1 and IgG2 suggest frequent contact with the antigen, and probable cases of undiagnosed disease.

Inmunoglobulinas en pacientes con actinomicetoma por Nocardia brasiliensis / Immunoglobulins in patients with Nocardia brasiliensis actinomycetoma

Considerando que algunos autores han reportado un aumento en la cantidad de algunas inmunoglobulinas en los pacientes con actinomicetoma, en este trabajo nos propusimos determinar diferencias en la producción de IgG1, IgG2, IgG3, IgG4 e IgM en 25 pacientes con actinomicetoma por Nocardia brasiliensis y 25 personas sanas provenientes de una zona endémica de micetoma. La determinación de inmunoglobulinas se realizó por medio de la técnica de ELISA. Para sensibilizar las placas se emplearon 6 antígenos de N. brasiliensis: un antígeno crudo denominado NB y cinco derivados del mismo (NB2, NB4, NB6, NB8 y NB10) separados por punto isoeléctrico. Los niveles de las cuatro subclases de IgG fueron mayores en los sueros de los pacientes que en el suero de los controles, con una diferencia máxima en IgG3 e IgG4; para esta última subclase, los seis antígenos fueron altamente reactivos. La concentración de IgM fue igual en ambos grupos. Es probable que como ocurre en otras infecciones, en la fisiopatogenia del actinomicetoma influya no sólo el aumento o deficiencia de una clase de inmunoglobulina, sino la relación que existe entre las diferentes subclases.

Considering that some authors have reported an increasing of some immunoglobulins in actinomycetoma patients, in this study we propose to determine differential production of IgG1, IgG2, IgG3, IgG4 and IgGM in 25 patients with actinomycetoma and 25 healthy individuals from a mycetoma endemic area. Immunoglobulins were determined by ELISA technique. To sensibilize the plates, six Nocardia brasiliensis antigens were used: a crude antigen denominated NB and five derivatives (NB2, NB4, NB6, NB8 and NB10) obtained by their isoelectric point. Results showed that all IgG subclasses were higher in the patients’ sera than in control sera, with a maximal difference to IgG3 and IgG4. To the latter subclass, six antigens were highly reactives. IgM levels were similar in both groups. As it occurs in other infections, in the actinomycetoma pathogenesis probably participate the increase or deficiency of a determined immunoglobulin class, as well as the relationship between different subclasses.

[Immunoglobulins in patients with Nocardia brasiliensis actinomycetoma]. / Inmunoglobulinas en pacientes con actinomicetoma por Nocardia brasiliensis.

Considering that some authors have reported an increasing of some immunoglobulins in actinomycetoma patients, in this study we propose to determine differential production of IgG1, IgG2, IgG3, IgG4 and IgGM in 25 patients with actinomycetoma and 25 healthy individuals from a mycetoma endemic area. Immunoglobulins were determined by ELISA technique. To sensibilize the plates, six Nocardia brasiliensis antigens were used: a crude antigen denominated NB and five derivatives (NB2, NB4, NB6, NB8 and NB10) obtained by their isoelectric point. Results showed that all IgG subclasses were higher in the patients' sera than in control sera, with a maximal difference to IgG3 and IgG4. To the latter subclass, six antigens were highly reactives. IgM levels were similar in both groups. As it occurs in other infections, in the actinomycetoma pathogenesis probably participate the increase or deficiency of a determined immunoglobulin class, as well as the relationship between different subclasses.

Inmunoglobulinas en pacientes con actinomicetoma por Nocardia brasiliensis. / [Immunoglobulins in patients with Nocardia brasiliensis actinomycetoma]

Considering that some authors have reported an increasing of some immunoglobulins in actinomycetoma patients, in this study we propose to determine differential production of IgG1, IgG2, IgG3, IgG4 and IgGM in 25 patients with actinomycetoma and 25 healthy individuals from a mycetoma endemic area. Immunoglobulins were determined by ELISA technique. To sensibilize the plates, six Nocardia brasiliensis antigens were used: a crude antigen denominated NB and five derivatives (NB2, NB4, NB6, NB8 and NB10) obtained by their isoelectric point. Results showed that all IgG subclasses were higher in the patients sera than in control sera, with a maximal difference to IgG3 and IgG4. To the latter subclass, six antigens were highly reactives. IgM levels were similar in both groups. As it occurs in other infections, in the actinomycetoma pathogenesis probably participate the increase or deficiency of a determined immunoglobulin class, as well as the relationship between different subclasses.

Fungal peritonitis in 15 patients on continuous ambulatory peritoneal dialysis (CAPD).

Peritonitis is a frequent complication in patients with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) treatment. The aim of this study was to know the prevalence of fungal peritonitis on patients undergoing CAPD, and to determine the antifungal susceptibility pattern of the identified isolates. Samples of the peritoneal dialysis fluid from 165 patients on CAPD treatment with peritonitis manifestations were submitted to mycological study (direct microscopic examination, culture and antifungal susceptibility test). Ten Candida isolates were identified, being C. albicans and C. parapsilosis the most common species. From isolates obtained, three species (C. albicans, C. parapsilosis, and C. guilliermondii) presented itraconazole resistance while C. glabrata was resistant to both itraconazole and ketoconazole. Aspergillus fumigatus was associated to peritonitis in three cases and Acremonium sp. in two.

[Identification and typing of yeast isolates from hospital patients in Mexico City]. / Identificación y tipificación de levaduras aisladas de pacientes de un hospital de la ciudad de México.

Nosocomial yeast infections have become a major cause of morbidity and mortality in immunocompromised patients. This study presents the frequency of yeasts isolated from different biological products from a Mexico City hospital's patients during one year. C. albicans was isolated in 72.3% of patients, followed by C. glabrata (13.4%) and C. parapsilosis (8%). Twenty different morphotypes were identified and the serotype B was the most frequent (79%).

Identificación y tipificación de levaduras aisladas de pacientes de un hospital de la ciudad de México / Identification and typing of yeast isolates from hospital patients in Mexico City

Nosocomial yeast infections have become a major cause of morbidity and mortality in immunocompromised patients. This study presents the frequency of yeasts isolated from different biological products from a Mexico City hospital's patients during one year. C. albicans was isolated in 72.3 of patients, followed by C. glabrata (13.4) and C. parapsilosis (8). Twenty different morphotypes were identified and the serotype B was the most frequent (79).

Identificación y tipificación de levaduras aisladas de pacientes de un hospital de la ciudad de México / Identification and typing of yeast isolates from hospital patients in Mexico City

Nosocomial yeast infections have become a major cause of morbidity and mortality in immunocompromised patients. This study presents the frequency of yeasts isolated from different biological products from a Mexico City hospitals patients during one year. C. albicans was isolated in 72.3 of patients, followed by C. glabrata (13.4) and C. parapsilosis (8). Twenty different morphotypes were identified and the serotype B was the most frequent (79).(AU)

Identificación y tipificación de levaduras aisladas de pacientes de un hospital de la ciudad de México. / [Identification and typing of yeast isolates from hospital patients in Mexico City]

Nosocomial yeast infections have become a major cause of morbidity and mortality in immunocompromised patients. This study presents the frequency of yeasts isolated from different biological products from a Mexico City hospitals patients during one year. C. albicans was isolated in 72.3

of patients, followed by C. glabrata (13.4

) and C. parapsilosis (8

). Twenty different morphotypes were identified and the serotype B was the most frequent (79

).

[Combined cefotaxime and amikacin for immunomodulation in the treatment of actinomycetoma resistant to conventional treatment]. / Cefotaxima más amikacina asociadas a inmunomodulación en el tratamiento de actinomicetoma resistente a tratamiento convencional.

Actinomycetoma is a chronic disease that affects subcutaneous tissue. We present a case of a patient with abdominal actinomycetoma caused by Nocardia brasiliensis resistant to different treatments over several years, who also presented phagocyte immunodeficiency. He received two cycles (23 day cycles) of cefotaxime, 1 g every 8-h, and amikacin, 500 mg every 12 hours. Immunomodulation was carried out with levamisole 300 mg per week, during 4 weeks and bacterial antigen (at a concentration of 600,000,000 bacteria per mL), twice for a week during 20 months. The importance of susceptibility testing and immunological function investigation in this type of patients is discussed.

[Variation in mycoses frequency in Mexico]. / Variación en la frecuencia de micosis en México.

We show the records about diagnosed mycoses in a hospital in Mexico City in two periods of time: from 1967 to 1977 and from 1993 to 1997. In the former 15,429 patients were studied and in the latter, 5,998. Striking differences among frequency, etiological agents and clinical outcome, were observed. The most frequent infections in both lapses were the superficial ones, however the most recent scores showed a notorious increase in opportunistic infections. We diagnosed only one histoplasmosis case during the period from 1993 to 1997. Etiological agents have also changed, dermatophytes frequency like Trichophyton mentagrophytes and T. tonsurans have diminished while T. rubrum increased from 60% to 80% of the whole dermatophytoses cases. Even though Criptococcus neoformans used to be the only agent causing criptococosis, in the most recent report we found that C. laurentii, C. terreus and C. unigutulatus were also isolated. Another important difference was mortality in rhinocerebral mucormicosis: twenty years ago it was fairly 80%, nowadays it has decreased to 20%.

Variación en la frecuencia de micosis en México. / [Variation in mycoses frequency in Mexico]

We show the records about diagnosed mycoses in a hospital in Mexico City in two periods of time: from 1967 to 1977 and from 1993 to 1997. In the former 15,429 patients were studied and in the latter, 5,998. Striking differences among frequency, etiological agents and clinical outcome, were observed. The most frequent infections in both lapses were the superficial ones, however the most recent scores showed a notorious increase in opportunistic infections. We diagnosed only one histoplasmosis case during the period from 1993 to 1997. Etiological agents have also changed, dermatophytes frequency like Trichophyton mentagrophytes and T. tonsurans have diminished while T. rubrum increased from 60

to 80

of the whole dermatophytoses cases. Even though Criptococcus neoformans used to be the only agent causing criptococosis, in the most recent report we found that C. laurentii, C. terreus and C. unigutulatus were also isolated. Another important difference was mortality in rhinocerebral mucormicosis: twenty years ago it was fairly 80

, nowadays it has decreased to 20

.

Nocardia brasiliensis: in vitro and in vivo growth response to steroid sex hormones.

As actinomycetoma is more frequent in males than in females, the possibility that hormones might modify the Nocardia brasiliensis growth and the course of experimental actinomycetoma was explored. Five N. brasiliensis strains were grown on Sabouraud agar containing estradiol, progesterone or testosterone, in 3 different concentrations. Colony diameters were measured weekly for 7 weeks. N. brasiliensis strains were also grown in Sabouraud broth containing hormones. Glucose concentration was measured weekly for 6 weeks. Finally, experimental actinomycetoma was produced in male and female hormone-treated mice. Invasion rate, plantar pad diameter and positive retrocultures were assessed. In vitro experiments showed that progesterone and testosterone inhibit N. brasiliensis growth, manifested by lower colony diameters and greater glucose concentrations. In vivo experiments demonstrated that estradiol limits actinomycetoma development. Progesterone and testosterone induced greater diameters of inoculated plantar pads and greater invasion rates with greater positive culture numbers than estradiol. Results partially explain the resistance of females to actinomycetoma.

[Exoenzymes of dermatophytes isolated from acute and chronic tinea]. / Exoenzimas de dermatofitos aislados de tiñas agudas y crónicas.

The presence of five enzymes (deoxyribonuclease, elastase, lipase, caseinase and hemolysin) in 76 strains of dermatophytes 47 of Trichophyton rubrum, 10 of T. mentagrophytes, five of T. tonsurans, 10 of Microsporum canis and four of Epidermophyton floccosum) isolated from 30 cases of acute dermatophytosis and from 46 chronic ones was determined by a qualitative plate assay; in the same way, the presence of these five enzymes with the acute and chronic dermatophytosis was correlated. It was observed that three of the enzymes were produced by the strains with a meaningful frequency; deoxyribonuclease was produced by 84.2% of the strains; elastase by 82.9%; and lipase by 65.8%. In T. rubrum the DNase was produced in 100% of strains. DNase and elastase were related to fungi which caused acute or chronic dermatophytosis in 93.3/78.2% and 96.6/74% respectively. On the other hand, lipase was present in 76% of strains, the ones that caused the chronic infections.

Dermatophytoses in Mexico City.

We analysed 2350 biological samples from patients with a clinical diagnosis of superficial mycoses who attended outpatient services over a 7-year period. Samples of scales were processed by direct microscopic examination with 15% KOH and cultured on Sabouraud glucose agar with chloramphenicol and cycloheximide. Laboratory examination confirmed dermatophytosis in 860 (36.6%) cases, of which 80.9% were caused by Trichophyton rubrum. The most frequently observed dermatophytoses were tinea unguium (60%) and tinea pedis (25.6%). In agreement with previous observations, we demonstrate that T. rubrum continues to increase in Mexico.

[Epidemiology of mycetoma in Mexico: study of 2105 cases]. / Epidemiología del micetoma en México: estudio de 2105 casos.

A survey was carried out in Mexico to determine the incidence and epidemiological characteristics of mycetoma. Data was collected from a total of 2105 cases of mycetoma throughout a 30 year period (1956-1985), with an average incidence of 70 cases per year. Results showed a sex distribution of 76.1% male and 23.9% females. Age distribution indicated a 35% between 16 to 30 and 23% between 31 to 40 year old population. Most cases occurred in land-workers (60.2%) and in housewives with rural residence (21.3%). Lesions occurred most frequently in lower limbs (64.1%), trunk (17.4%) and upper limbs (13.6%). The geographic distribution within Mexico revealed that the States with the highest incidence were: Jalisco, Nuevo León, San Luis Potosi, Morelos and Guerrero The predominant etiologic agents found 97.8% corresponded to actinomycetes, from which Nocardia brasiliensis (86.6%) and Actinomadura madurae (10.2%) showed the higher frequency. Eumycetoma (2.2%) was due to Madurella grisea and M. mycetomatis in most cases.

Observaciones de micosis pulmonares oportunistas / Opportunistic pulmonary mycosis

Para conocer la frecuencia y tipo de micosis oportunistas en 240 pacientes internados en un hospital de neumología, se practicaron historia clínica y estudios micológicos consistentes en el aislamiento de hongos a partir de muestras de esputo. En cada paciente se tomaron tres muestras seriadas, las cuales fueron procesadas por examen directo, frotis y cultivo de Sabouraud. Con la metodología empleada, los resultados mostraron que de los 240 pacientes en 191 se aislaron una o más especies de hongos oportunistas (79,5%). Sin embargo, de acuerdo a la valoración clínica y a los parámetros de laboratorio, se pudo hacer el diagnóstico de candidosis pulmonar en 57 pacientes (23,7% del total), siendo la micosis oportunista la de mayor frecuencia. Otras micosis observadas fueron: aspergilosis (once), geotricosis (ocho), y nocardiosis (cinco). Asimismo se comenta la utilidad y el valor diagnóstico que tienen los estudios micológicos en el análisis clínico de pacientes con micosis oportunista