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1.
An Bras Dermatol ; 95(2): 241-243, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32165024

RESUMO

Sporotrichosis is a deep mycosis of subacute or chronic evolution, caused by the dimorphic fungus of the genus Sporothrix. The treatment is carried out with antifungal orally or intravenously. Therapeutic success can be affected by several factors, such as altered gastrointestinal physiology by surgery. More and more patients are submitted to bariatric surgeries and the literature for the alterations of the absorption of medications in this context is very scarce. We intend to contribute to a better understanding with this case report of cutaneous-lymphatic sporotrichosis in a patient after bariatric surgery without response to itraconazole treatment, even at high doses.


Assuntos
Antifúngicos/uso terapêutico , Cirurgia Bariátrica/efeitos adversos , Itraconazol/uso terapêutico , Esporotricose/tratamento farmacológico , Adulto , Feminino , Absorção Gastrointestinal , Humanos , Esporotricose/patologia , Falha de Tratamento
2.
Niger J Clin Pract ; 23(2): 270-272, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32031105

RESUMO

A 63-year-old patient was presented with faciocervical erythema and ulcers of 3 months duration. Pathological examination showed infiltration of inflammatory cells. Pathogenic microorganism cultivation was negative. However, empirical therapy with itraconazole proved effective.


Assuntos
Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Imunocompetência , Itraconazol/uso terapêutico , Úlcera Cutânea/tratamento farmacológico , Criptococose/diagnóstico , Criptococose/imunologia , Cryptococcus neoformans , Eritema , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Cutânea/microbiologia , Úlcera Cutânea/patologia
3.
Medicine (Baltimore) ; 99(6): e18938, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028403

RESUMO

RATIONALE: Behçet's disease (BD) is an inflammatory disease that leads to multisystemic immune dysfunction and that involves pulmonary system alterations. PATIENT CONCERNS: A 26-year-old woman presented with dull right chest pain for 30 days and intermittent cough with expectoration for 5 days. She had a history of recurrent oral ulcer and constitutional rash 2 months prior. DIAGNOSES: The patient was diagnosed with BD complicated by IPA and Aspergillus auriculatus infection. INTERVENTIONS: The patient was administered itraconazole oral solution (200 mg b.i.d) to treat the fungal infection. After a diagnosis of BD was made, she received 40 mg of methylprednisolone sodium succinate daily for 1 week.Then, she also received 24 mg of methylprednisolone sodium succinate daily, which was decreased by 2 mg per half month, until the rash had resolved. The patient continued to receive 200 mg Q. D itraconazole orally for 3 months. Thereafter, itraconazole was stopped, while daily oral administration of 10 mg of methylprednisolone sodium succinate was continued. OUTCOMES: The rash was observed to resolve, and CT revealed that the lesions in both the right and left lung were reduced. During a telephone follow-up performed after 6 months, the patient stated that no symptoms had recurred during the follow-up period. LESSONS: This case illustrates that for patients with BD, ignoring extrapulmonary symptoms often leads to a delayed diagnosis. Physicians should perform a thorough medical history and physical examination of these patients, as the information obtained in this manner may provide important clues for disease diagnosis and treatment.


Assuntos
Aspergillus/isolamento & purificação , Síndrome de Behçet/diagnóstico , Aspergilose Pulmonar Invasiva/diagnóstico , Adulto , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Dor no Peito/etiologia , Tosse/etiologia , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Tomografia Computadorizada por Raios X
4.
J Cancer Res Clin Oncol ; 146(2): 297-304, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31960187

RESUMO

PURPOSE: Itraconazole is an antifungal drug that has been clinically used for over 30 years. In recent years, scholars have discovered that it possesses an anticancer effect. Moreover, its mechanism has been clarified to some degree. What deserves to be mentioned is that itraconazole acting on the Hedgehog pathway has made a new progress in the treatment of cancers. While interestingly, studies have demonstrated that the Hedgehog pathway is largely activated in different cancer cells. RESULT: This review tries to highlight the effect of itraconazole on smoothened receptor (SMO) in the Hedgehog pathway, thereby reducing the glioma-associated oncogene homolog (GLI) release and finally exhibiting a range of anticancer effects, promoting apoptosis of cancer cells, and inhibiting proliferation by indirect inhibition of NF-κB pathway and inflammation, moreover, promoting the expression of cyclin-dependent kinase inhibitors, inhibiting the expression of target genes transcribed by GLI such as BCL-2 and Cyclin-D1. Besides, itraconazole increases the number of Bnip3, subsequently, inducing the dissociation of the Beclin-1/BCL-2 binding complex, as a result of ultimately promoting autophagy of cancer cells. CONCLUSION: As a new anticancer drug, whether itraconazole eventually entering clinical application requires the joint eforts of all scholars. In any case, an in-depth study on itraconazole will bring new hope for cancer patients in the near future.


Assuntos
Proteínas Hedgehog/metabolismo , Itraconazol/farmacologia , Neoplasias/tratamento farmacológico , Neoplasias/metabolismo , Animais , Ensaios Clínicos Fase II como Assunto , Humanos , Itraconazol/uso terapêutico , Terapia de Alvo Molecular , Neoplasias/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transdução de Sinais/efeitos dos fármacos , Receptor Smoothened/metabolismo
5.
BMC Infect Dis ; 20(1): 32, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931738

RESUMO

BACKGROUND: Vaginal candidiasis is frequent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the prevalence of candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated Candida strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes. METHODS: A total of 258 pregnant women with vaginal discharge at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 14 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method. RESULTS: Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42, 41 and 17% of the women, respectively. C. albicans was significantly associated only with gestational diabetes while C. krusei or C. glabrata had significant positive associations with other gestational complications. The antifungal susceptibility tests of C. albicans isolates revealed 97.5, 90, 87.5 and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively. CONCLUSION: The current study revealed high incidence of both C. albicans and non-C. albicans Candida strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Candida screening as antenatal follow up is advised to minimize the risk of adverse neonatal outcome or gestational complications.


Assuntos
Candida albicans/efeitos dos fármacos , Candidíase Vulvovaginal/tratamento farmacológico , Candidíase Vulvovaginal/epidemiologia , Farmacorresistência Fúngica/efeitos dos fármacos , Descarga Vaginal/microbiologia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Candida glabrata/efeitos dos fármacos , Candida glabrata/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Estudos Transversais , Feminino , Fluconazol/uso terapêutico , Seguimentos , Humanos , Incidência , Recém-Nascido , Itraconazol/uso terapêutico , Líbano/epidemiologia , Testes de Sensibilidade Microbiana , Gravidez , Prevalência , Voriconazol/uso terapêutico
6.
Int J Antimicrob Agents ; 55(3): 105886, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31926286

RESUMO

OBJECTIVE: The objective of this study was to compare itraconazole with posaconazole for antifungal prophylaxis in acute myeloid leukemia (AML) patients undergoing intensive chemotherapy. METHODS: Adult patients with AML received either itraconazole or posaconazole for antifungal prophylaxis while undergoing intensive chemotherapy. The primary endpoint was incidence of prophylaxis failure (change in antifungal agent due to suspected invasive fungal infection [IFI], drug intolerance, drug interaction, or adverse event). RESULTS: From February 2016 to January 2018, 90 patients were included in the itraconazole group and 45 patients in the posaconazole group. Prophylaxis failure occurred in 88% of itraconazole recipients compared with 33% of posaconazole recipients (P<0.001). The primary reason for prophylaxis failure with itraconazole was suspected IFI (58%) whereas for posaconazole, failure predominantly related to drug interaction (60%). An antifungal regimen was continued upon discharge in 47% of itraconazole recipients compared with 9% of posaconazole recipients (P<0.001). The use of breakthrough IFI diagnostic tests was not significantly different in the two groups. A larger proportion of drug concentrations were collected in the posaconazole group. CONCLUSIONS: In AML patients undergoing intensive chemotherapy, posaconazole was associated with significantly lower rates of prophylaxis failure and less need for continued antifungal therapy on discharge compared with itraconazole.


Assuntos
Antifúngicos/uso terapêutico , Infecções Fúngicas Invasivas/prevenção & controle , Itraconazol/uso terapêutico , Leucemia Mieloide Aguda/complicações , Triazóis/uso terapêutico , Adulto , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Humanos , Infecções Fúngicas Invasivas/etiologia , Leucemia Mieloide Aguda/tratamento farmacológico , Estudos Retrospectivos
7.
Am J Trop Med Hyg ; 102(2): 352-354, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31769387

RESUMO

The incidence of tuberculosis in India is quite high. In such a situation, empirical antitubercular therapy (ATT) is often resorted to, when some of the investigation findings are clearly diagnostic of tuberculosis. This may mean missing out on coinfections. Whereas this is particularly true for immunosuppressed patients, rarely even immunocompetent patients may present with such diagnostic dilemmas. We present the case of an adolescent boy who had been previously asymptomatic and who presented with fever with lymphadenopathy, splenomegaly, and pancytopenia. Initially, ATT was administered based on the detection of acid-fast bacteria in lymph node, caseating granulomas with Langhans giant cells, and a positive cartridge-based nucleic acid amplification test specific for Mycobacterium tuberculosis. However, when the patient failed to respond fully to the treatment, additional investigation in the form of bone marrow fungal culture led to the diagnosis of histoplasmosis.


Assuntos
Histoplasmose/complicações , Histoplasmose/tratamento farmacológico , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Adolescente , Antifúngicos/uso terapêutico , Antimaláricos/uso terapêutico , Histoplasmose/epidemiologia , Humanos , Imunocompetência , Índia/epidemiologia , Itraconazol/uso terapêutico , Masculino , Tuberculose/epidemiologia
8.
Mycoses ; 63(1): 52-57, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31596519

RESUMO

Tinea capitis is an infectious dermatological disorder caused by dermatophytes that occur primarily in children. It has recently been brought under effective control in Korea since the introduction of oral antifungal medications and the implementation of concerted public health initiatives. Therefore, its incidence rate has decreased considerably. We investigated changes in the epidemiological and mycological characteristics of tinea capitis patients under the age of 10 in Korea. Using medical records from Kyungpook National University Hospital and the Catholic Skin Disease Clinic from 1989 to 2018, we retrospectively investigated the characteristics of 786 patients with tinea capitis. Of the 786 patients, 744 were KOH-positive. The annual incidence of tinea capitis was decreased from 120 to less than 10 between 1989 and 2018. Overall, 446 (56.74%) were male and 340 (43.26%) were female, representing a ratio of 1:0.8. In terms of the seasonality of it, 276 (35.11%) visited hospital in winter, 193 (24.55%) in spring, 177 (22.52%) in fall and 140 (17.81%) in summer. Dermatophytes were cultured from 628 patients. Microsporum canis was the most common dermatophyte (73.16%), followed by Trichophyton verrucosum and Trichophyton rubum. Of the 786 patients, 577 (73.41%) lived in urban areas and 209 (26.59%) in rural areas. Changes in the epidemiological and mycological characteristics of children with tinea capitis were shown in incidence, sex distribution, seasonality and causative dermatophytes. The incidence of tinea capitis has fallen significantly in prepubertal children. Nevertheless, continuous surveillance is needed to prevent tinea capitis in Korea.


Assuntos
Arthrodermataceae/isolamento & purificação , Microsporum/isolamento & purificação , Pele/microbiologia , Tinha do Couro Cabeludo , Trichophyton/isolamento & purificação , Antifúngicos/uso terapêutico , Criança , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Itraconazol/uso terapêutico , Masculino , República da Coreia/epidemiologia , Estudos Retrospectivos , Estações do Ano , Distribuição por Sexo , Pele/patologia , Terbinafina/uso terapêutico , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Tinha do Couro Cabeludo/epidemiologia , Tinha do Couro Cabeludo/etiologia
9.
Mycoses ; 63(1): 71-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31603597

RESUMO

Onychomycosis contributes as many as half of all nail disorder cases. In 2017, the incidence of onychomycosis was 15% of all dermatomycosis cases at our hospital, a tertiary hospital in Indonesia, with only 25% of the patients achieving mycological cure. This study aims to identify the prognostic factors influencing the treatment outcome of onychomycosis Candida. This is a retrospective study, using data obtained from outpatient registry at our hospital. Fifty-four onychomycosis patients were included in this study. Potential prognostic factors were analysed by STATA15.0. Retrospective analysis with cox proportional-hazard was used to measure the contribution of each variable to the treatment's outcome. Onset of disease, history of nail disorder, and site of infection were not associated with mycological cure (P > .05). Based on retrospective analysis, age[odds ratio (OR)1.46; 95% confidence interval (CI)1.07-2.03], onset of disease (OR 1.14; 95%CI 1.11-1.17), comorbidities (OR 1.07; 95%CI 1.03-1.11), type of onychomycosis (OR 1.08; 95%CI 1.05-1.16), site of infection (OR 1.12; 95%CI 1.04-1.22) and number of infected nails (OR 1.50; 95%CI 1.25-1.68) were significantly associated with poor treatment outcome, while type of treatment and type of systemic agents showed no significant association with the outcome. Kaplan-Meier curves showed that subjects elderly age and more than 3 infected nails had the lowest median survival. Elderly, longer onset, presence of comorbidities, multiple sites of infection, and high number of infected nails can affect the mycological cure negatively. Unstandardised treatment was associated with the mycological cure despite not affecting the prognosis. Therefore, the management's goal is to identify these specific prognostic features.


Assuntos
Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Onicomicose/tratamento farmacológico , Prognóstico , Resultado do Tratamento , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/efeitos dos fármacos , Criança , Feminino , Humanos , Itraconazol/uso terapêutico , Pessoa de Meia-Idade , Doenças da Unha/tratamento farmacológico , Doenças da Unha/microbiologia , Unhas/microbiologia , Unhas/patologia , Onicomicose/patologia , Estudos Retrospectivos , Adulto Jovem
12.
BMC Infect Dis ; 19(1): 1034, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31805893

RESUMO

BACKGROUND: The incidence of Taralomyces marneffei infection in HIV-infected individuals has been decreasing, whereas its rate is rising among non-HIV immunodeficient persons, particularly patients with anti-interferon-gamma autoantibodies. T. marneffei usually causes invasive and disseminated infections, including fungemia. T. marneffei oro-pharyngo-laryngitis is an unusual manifestation of talaromycosis. CASE PRESENTATION: A 52-year-old Thai woman had been diagnosed anti-IFNÉ£ autoantibodies for 4 years. She had a sore throat, odynophagia, and hoarseness for 3 weeks. She also had febrile symptoms and lost 5 kg in weight. Physical examination revealed marked swelling and hyperemia of both sides of the tonsils, the uvula and palatal arches including a swelling of the epiglottis, and arytenoid. The right tonsillar biopsy exhibited a few intracellular oval and elongated yeast-like organisms with some central transverse septum seen, which subsequently grew a few colonies of T. marneffei on fungal cultures. The patient received amphotericin B deoxycholate 45 mg/dayfor 1 weeks, followed by oral itraconazole 400 mg/day for several months. Her symptoms completely resolved without complication. CONCLUSION: In patients with anti-IFN-É£ autoantibodies, T. marneffei can rarely cause a local infection involving oropharynx and larynx. Fungal culture and pathological examination are warranted for diagnosis T. marneffei oro-pharyngo-laryngitis. This condition requires a long term antifungal therapy.


Assuntos
Antifúngicos/uso terapêutico , Laringite/tratamento farmacológico , Micoses/tratamento farmacológico , Faringite/tratamento farmacológico , Talaromyces/patogenicidade , Anfotericina B/uso terapêutico , Autoanticorpos/sangue , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Interferon gama/imunologia , Itraconazol/uso terapêutico , Laringite/microbiologia , Laringite/patologia , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Mycobacterium abscessus/patogenicidade , Micoses/etiologia , Micoses/microbiologia , Faringite/microbiologia , Faringite/patologia , Tailândia
14.
BMC Infect Dis ; 19(1): 956, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31706289

RESUMO

BACKGROUND: Current available treatments (benznidazole and nifurtimox) for Chagas disease (CD) show limited efficacy in chronic phase and frequent undesirable effects. Ergosterol synthesis inhibitors (ESI) had been considered as promising drugs for CD treatment and despite its recent poor results in several clinical trials, different strategies have been proposed to optimize its role in this infection. CASE PRESENTATION: We present a case of chronic Chagas disease in patient diagnosed with HIV who received treatment for histoplasmosis with itraconazol during twelve months. Even though T. cruzi rt-PCR was persistently negative during treatment, when itraconazol was stopped she presented with a positive blood rt-PCR. CONCLUSION: Several studies using different ESI had been published for CD treatment. Either in vitro or in vivo assays demonstrated activity against T. cruzi of the different triazole derivatives so different clinical trials had been carried out to evaluate its efficacy and safety. Despite contradictory evidence in the animal model, longer treatments along with other treatment strategies previously proposed suggests that ESI failure rates in positive peripheral blood rt-PCR are higher than that obtained with the current treatments of choice.


Assuntos
Doença de Chagas/tratamento farmacológico , Itraconazol/uso terapêutico , Tripanossomicidas/uso terapêutico , Adulto , Animais , Contagem de Linfócito CD4 , Doença de Chagas/complicações , Doença Crônica , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Itraconazol/farmacologia , Tomografia Computadorizada por Raios X , Tripanossomicidas/farmacologia , Trypanosoma cruzi/efeitos dos fármacos
15.
PLoS Negl Trop Dis ; 13(10): e0007849, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31671098

RESUMO

BACKGROUND: Chromoblastomycosis is a chronic skin and subcutaneous fungal infection caused by dematiaceous fungi and is associated with low cure and high relapse rates. In southern China, Fonsecaea monophora and Fonsecaea pedrosoi are the main causative agents. PRINCIPAL FINDINGS: We treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The isolates were assayed for susceptibility to antifungal drugs and ALA-PDT in vitro, revealing sensitivity to terbinafine, itraconazole and voriconazole, with ALA-PDT altering the cell wall and increasing reactive oxygen species production. CONCLUSIONS: These results provide the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis.


Assuntos
Ácido Aminolevulínico/uso terapêutico , Antifúngicos/uso terapêutico , Ascomicetos/efeitos dos fármacos , Ascomicetos/efeitos da radiação , Cromoblastomicose/tratamento farmacológico , Cromoblastomicose/radioterapia , Fotoquimioterapia/métodos , China , Cromoblastomicose/patologia , DNA Fúngico , Feminino , Humanos , Itraconazol/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pele/metabolismo , Terbinafina/uso terapêutico , Voriconazol/uso terapêutico
16.
Am J Case Rep ; 20: 1740-1744, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31761896

RESUMO

BACKGROUND Disseminated histoplasmosis, a disease that can present years after exposure to the causative organism, may manifest in many diverse ways. Although the gastrointestinal tract is involved in most cases, the initial presentation occurring along the gastrointestinal tract, including the colon and rectum, is infrequent. CASE REPORT This case report describes a 66-year-old male patient who presented with an indurated painful perianal lesion that appeared highly suspicious for malignancy on imaging. The patient had no known history of well-established immunocompromised state except for a short course of prednisolone for chronic obstructive pulmonary disease management. A biopsy of the mass was performed, showing chronic inflammation with clusters of epithelioid histiocytes containing characteristic, PAS-fungus stain-positive, intracellular yeast forms consistent with histoplasmosis. There was no evidence of malignancy. A subsequent work-up revealed perihilar nodularity on chest X-ray suggestive of calcified granuloma, a positive Histoplasma Capsulatum Antigen test result, and mildly decreased CD4: CD8 ratio of unknown significance. HIV testing was negative. Treatment with itraconazole and terbinafine was initiated, and at 5-months follow-up, the patient reported significant improvement in signs and symptoms, with undetectable Histoplasma antigen on repeat testing. CONCLUSIONS This case represents an extremely rare presentation of histoplasmosis infection, and highlights the fact that presenting symptoms of histoplasmosis can be vague and may mimic other disease processes, including neoplasia. Biopsy of the lesion with PAS staining and serologic testing is critical in establishing the correct diagnosis.


Assuntos
Antifúngicos/uso terapêutico , Doenças do Ânus/tratamento farmacológico , Histoplasmose/tratamento farmacológico , Itraconazol/uso terapêutico , Terbinafina/uso terapêutico , Idoso , Doenças do Ânus/microbiologia , Diagnóstico Diferencial , Histoplasma , Humanos , Masculino
17.
An Bras Dermatol ; 94(5): 574-577, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31780436

RESUMO

The authors report a case of 40-year-old male patient with a five-year history of chromoblastomycosis on his right leg. Diagnosis was performed by direct 40% KOH exam of skin scales, culture with micro- and macromorphologic analysis, and genotypic characterization (sequencing of a fragment of the ITS region and phylogenetic analysis) of the isolated fungus. Rhinocladiella aquaspersa was identified as the etiological agent. Initially, the treatment was with oral itraconazole 200mg/day for one year. However, the presence of "sclerotic cells" with filaments ("Borelli spiders") resulted in a change of medical treatment: a higher dose of itraconazole (400mg/day) and surgery, achieving clinical and mycological cure in one year. This is the first report of chromoblastomycosis caused by R. aquaspersa in Guatemala.


Assuntos
Ascomicetos/isolamento & purificação , Cromoblastomicose/microbiologia , Adulto , Antifúngicos/uso terapêutico , Ascomicetos/ultraestrutura , Cromoblastomicose/tratamento farmacológico , Cromoblastomicose/patologia , Guatemala , Humanos , Itraconazol/uso terapêutico , Masculino , Resultado do Tratamento
19.
An Bras Dermatol ; 94(4): 470-472, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644624

RESUMO

Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.


Assuntos
Glucocorticoides/efeitos adversos , Paracoccidioidomicose/etiologia , Paracoccidioidomicose/patologia , Prednisona/efeitos adversos , Adolescente , Antifúngicos/uso terapêutico , Humanos , Itraconazol/uso terapêutico , Masculino , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/tratamento farmacológico , Sarcoidose/diagnóstico , Sarcoidose/patologia , Resultado do Tratamento
20.
J Vet Med Sci ; 81(11): 1628-1631, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31611481

RESUMO

Pulmonary mycosis is a fungal disease that commonly affects bottlenose dolphins (Tursiops truncatus) and is generally treated by the oral administration of azoles, such as itraconazole (ITZ) and voriconazole (VRZ). However, antifungal susceptibility testing of clinical isolates has not been well performed as a routine clinical examination in aquaria. In this study, we collected fungal species from the blowholes of 14 bottlenose dolphins, of which 12 were treated with ITZ or VRZ. All dolphins were housed in the Port of Nagoya Public Aquarium. The fungal species Candida albicans, C. tropicalis, C. glabrata, Aspergillus fumigatus, and A. niger were isolated. E-tests were performed to determine the minimum inhibitory concentrations (MICs) of ITZ and VRZ on these isolates. VRZ-resistant C. tropicalis (MIC: >32 µg/ml) and A. niger (MIC: >32 µg/ml) were isolated from three dolphins treated with ITZ or VRZ. Additionally, azole-resistant isolates of C. albicans and C. glabrata were collected from two dolphins that had never received azole therapy. To the best of our knowledge, our study is the first to report the isolation of VRZ-resistant C. albicans, C. tropicalis, and A. niger from the blowholes of bottlenose dolphins. Thus, antifungal susceptibility testing is a crucial strategy for selecting antifungal agents to treat respiratory fungal infections in bottlenose dolphins in aquaria.


Assuntos
Aspergillus niger/efeitos dos fármacos , Golfinho Nariz-de-Garrafa/microbiologia , Candida albicans/efeitos dos fármacos , Candida tropicalis/efeitos dos fármacos , Animais , Antifúngicos/uso terapêutico , Aspergillus niger/isolamento & purificação , Candida albicans/isolamento & purificação , Candida tropicalis/isolamento & purificação , Farmacorresistência Fúngica , Itraconazol/uso terapêutico , Japão , Testes de Sensibilidade Microbiana/veterinária , Micoses/tratamento farmacológico , Micoses/veterinária , Voriconazol/uso terapêutico
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