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Objetivo: La histoplasmosis es una infección fúngica sistémica prevalente en la región del Río de la Plata. Puede exhibir manifestaciones orales, cutáneas y/o sistémicas. Las lesiones bucales significan un desafío diagnóstico debido a su semejanza clínica con el carcinoma oral de células escamosas (COCE). El objetivo de este trabajo fue presentar una serie de casos de histoplasmosis oral enfatizando la importancia del diagnóstico diferencial clínico con el COCE. Casos clínicos: Se describen casos de histoplasmosis oral diagnosticados en los últimos 5 años en la Cátedra de Estomatología "A" de la Facultad de Odontología de la Universidad Nacional de Córdoba, Córdoba, Argentina. En forma paralela, se realizó una revisión de la literatura de los últimos 10 años. Los casos corresponden a 9 pacientes, 6 varones y 3 mujeres, cuya edad promedio fue de 58,6 años. 4 pacientes eran VIH positivos. Se planteó la sospecha de COCE en 5 pacientes, cuya presentación clínica intraoral consistía en úlceras o lesiones ulcerovegetantes, mayormente únicas, ubicadas en la encía. La revisión bibliográfica arrojó un resultado de 48 artículos que incluyeron 60 casos de histoplasmosis oral, con una prevalencia mayor en hombres y similitudes clínicas con COCE en el 80% de los casos. La lesión más predominante fue la úlcera en el 85% de los casos, ubicada en lengua, seguido por el paladar. El diagnóstico de histoplasmosis oral es desafiante y requiere un amplio diferencial, ya que se asemeja a múltiples patologías, debiendo ser considerada ante lesiones ulcerativas orales. Un diagnóstico preciso, de manera interdisciplinaria, es esencial para un tratamiento efectivo.(AU)
Aim: Histoplasmosis is a systemic fungal infection prevalent in the Río de la Plata region. It could present oral, cutaneous and/or systemic manifestations. Oral lesions represent a diagnostic challenge due to their clinical similarity to oral squamous cell carcinoma (OSCC). The objective of this work is to present a case series of oral histoplasmosis emphasizing the importance of clinical differential diagnosis with OSCC. Clinical cases: Cases of oral histoplasmosis diagnosed in the last 5 years in the Oral Medicine Department "A" of the Facultad de Odontología of the Universidad Nacional de Córdoba, Córdoba, Argentina are discribed. Alongside, a literature review of the last 10 years was carried out. 9 patients are described, 6 men and 3 women, whose average age was 58.6 years. 4 patients were HIV positive. The suspicion of OSCC was raised in 5 patients, whose intraoral clinical presentation consisted of single ulcers or vegetating ulcers, mostly single, located in the gingiva. The literature review included a total of 48 articles with 60 cases of oral histoplasmosis, with a higher prevalence in men and clinical similarities with OSCC in 80% of cases. The most predominant lesion was the ulcer in 85% of the cases, mostly located on the tongue, followed by the palate. The diagnosis of oral histoplasmosis is challenging and requires a wide differential, since it can mimic multiple pathologies, and should be considered in oral ulcerative lesions. An accurate diagnosis, in an interdisciplinary framework, is essential for effective treatment.(AU)
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Cat-transmitted sporotrichosis is caused by the emerging fungal pathogen Sporothrix brasiliensis and constitutes a significant public health issue that affects people living in resource-poor urban centers in Brazil. The lack of knowledge about transmission dynamics makes it difficult to propose public health policies to contain the advance of sporotrichosis. We describe the recent emergence of 1,176 cases of sporotrichosis in cats (2016 to 2021) in the metropolitan region of Recife, Brazil, leading to significant zoonotic transmission and an overwhelming occurrence of S. brasiliensis as the etiological agent. Most cases were from cats in the cities of Olinda (408/1,176; 34.70%), Jaboatão dos Guararapes (332/1,176; 28.23%), and Recife (237/1,176; 20.15%). Molecular typing using amplified fragment length polymorphism (EcoRI-GA/MseI-AG) revealed low polymorphic information content (PIC = 0.2499) and heterozygosity (H = 0.2928), typical of an outbreak scenario. Dendrogram and multivariate cluster analysis revealed that isolates from Pernambuco are closely related to Rio de Janeiro isolates. We report a substantial occurrence of MAT1-2 idiomorphs in the metropolitan region of Recife (0:60 ratio; χ2 = 60.000, P < 0.0001). The limited population differentiation and genetic diversity of the isolates from Pernambuco suggest a recent introduction, possibly via a founder effect, from the parental population in Rio de Janeiro. Our findings emphasize the critical importance of molecular surveillance of S. brasiliensis for outbreak response. A comprehensive one-health strategy is mandatory to control the spread of cat-transmitted sporotrichosis driven by S. brasiliensis, encompassing sanitary barriers, quick diagnosis, and treatment.
Assuntos
Doenças do Gato , Sporothrix , Esporotricose , Esporotricose/transmissão , Esporotricose/microbiologia , Esporotricose/veterinária , Esporotricose/epidemiologia , Gatos , Brasil/epidemiologia , Sporothrix/genética , Sporothrix/isolamento & purificação , Sporothrix/classificação , Animais , Doenças do Gato/microbiologia , Doenças do Gato/transmissão , Doenças do Gato/epidemiologia , Tipagem Molecular , Zoonoses/transmissão , Zoonoses/microbiologia , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Doenças Transmissíveis Emergentes/transmissão , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/epidemiologia , Genótipo , FilogeniaRESUMO
Chitin is a polymer of N-acetylglucosamine and an essential component of the fungal cell wall. Chitosan is the deacetylated form of chitin and is also important for maintaining the integrity of this structure. Both polysaccharides are widely distributed in nature and have been shown to have a variety of applications in biomedicine, including their potential in immune sensing and as potential antifungal agents. In addition, chitin has been reported to play an important role in the pathogen-host interaction, involving innate and adaptive immune responses. This paper will explore the role of chitin and chitosan when incorporated into nanobiocomposites to improve their efficacy in detecting fungi of medical interest and inhibiting their growth. Potential applications in diagnostic and therapeutic medicine will be discussed, highlighting their promise in the development of more sensitive and effective tools for the early diagnosis of fungal infections. This review aims to highlight the importance of the convergence of nanotechnology and biology in addressing public health challenges.
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Antifúngicos , Quitina , Quitosana , Fungos , Quitina/química , Quitina/farmacologia , Quitosana/química , Quitosana/farmacologia , Antifúngicos/farmacologia , Antifúngicos/química , Fungos/efeitos dos fármacos , Fungos/química , Humanos , Nanocompostos/química , Micoses/imunologia , Micoses/tratamento farmacológico , Micoses/diagnósticoRESUMO
We report a case of difficult-to-control mycosis fungoides (MF), where the role of the dental surgeon was crucial for the control and prognosis of the disease. A 62-year-old female patient diagnosed with MF had a previous record of red patches and small raised bumps on the face, along with a cancerous growth in the cervical and vulvar region. The patient was initially treated with methotrexate and local radiotherapy without resolution. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone was then started (CHOP protocol). The dental team of a reference hospital was consulted to evaluate swelling in the anterior region of the palate, which had been developing for two months, reporting discomfort when eating. The role of the dentistry team was fundamental in the differential diagnosis of oral lesions with dental infections, second neoplasia, or even a new site of disease manifestation, in addition to controlling mucosal changes resulting from chemotherapy. After ruling out dental infection, the dentistry team performed a lesion biopsy to confirm the diagnosis. The histopathological and immunohistochemical analysis showed atypical lymphoid infiltration of T cells (CD3+/CD4+/CD7-/CD8-), coexpression of CD25, and presence of CD30 cells, corresponding to the finding for MF. Identifying CD30 + allowed for a new chemotherapy protocol with brentuximab vedotin (BV) combined with gemcitabine. This protocol effectively controlled MF, which previous protocols had failed to do. The diagnosis by the dental team was essential for therapeutic change and improvement of the patient's clinical condition without the need for invasive medical procedures.
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Protocolos de Quimioterapia Combinada Antineoplásica , Micose Fungoide , Humanos , Feminino , Pessoa de Meia-Idade , Micose Fungoide/patologia , Micose Fungoide/tratamento farmacológico , Micose Fungoide/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/tratamento farmacológico , Doxorrubicina/uso terapêutico , Brentuximab Vedotin/uso terapêutico , Vincristina/uso terapêutico , Prednisona/uso terapêutico , Ciclofosfamida/uso terapêutico , Equipe de Assistência ao Paciente , Diagnóstico Diferencial , Neoplasias Palatinas/patologia , Neoplasias Palatinas/tratamento farmacológicoRESUMO
The incidence and distribution of coccidioidomycosis are increasing. Information scarcity is evident in Mexico, particularly in non-endemic zones and specific populations. We compared the treatment and outcomes for patients with isolated pulmonary infections and those with disseminated coccidioidomycosis, including mortality rates within six weeks of diagnosis. Of 31 CM cases, 71% were male and 55% were disseminated. For 42% of patients, there was no evidence of having lived in or visited an endemic region. All patients had at least one comorbidity, and 58% had pharmacologic immunosuppressants. The general mortality rate was 30%; without differences between disseminated and localized disease. In our research, we describe a CM with a high frequency of disseminated disease without specific risk factors and non-significant mortality. Exposure to endemic regions was not found in a considerable number of subjects. We consider diverse reasons for why this may be, such as climate change or migration.
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Paracoccidioidomycosis (PCM) is a systemic mycosis endemic in Latin American countries and one of the most important fungal diseases regarding incidence and mortality in humans. PCM has also been described in some animal species such as dogs. In this study we describe a new case of PCM disease in a dog that differed from previous records in the literature which includes a progressive evolution of fungal dermatitis causing a deforming lesion in the nose, like those found in human patients, and humoral response against gp70 instead of gp43, the major diagnostic antigen for human PCM. The clinical isolate through the ITS and partial gp43 gene phylogenetic analysis was grouped in the Paracoccidioides brasiliensis complex. This case describes several features which may contribute to improving diagnosis and understanding of canine paracoccidioidomycosis.
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Doenças do Cão , Paracoccidioides , Paracoccidioidomicose , Filogenia , Paracoccidioidomicose/veterinária , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/microbiologia , Animais , Cães , Paracoccidioides/isolamento & purificação , Paracoccidioides/genética , Doenças do Cão/microbiologia , Doenças do Cão/diagnóstico , Masculino , Doença CrônicaRESUMO
We report a case of unusual paracoccidioidomycosis reactivation after eyebrow micropigmentation in a Brazilian patient. The cutaneous lesion was the only clinical manifestation. Direct cutaneous inoculation in dermal tissues with Paracoccidioides sp. is extremely rare, explaining why paracoccidioidomycosis is not classically considered a cutaneous implantation mycosis.
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Male cat, 2 years old, with a refractory infection by Sporothrix brasiliensis, presents a single nodular lesion in the left auricular pavilion. To confirm the diagnosis, cytology, fungal culture, antifungal susceptibility test, molecular analysis, and, to aid in the differential diagnosis, bacterial culture, antibiogram, and histopathology of the lesion were performed. In the absence of therapeutic success with conventional antifungals, photodynamic therapy (PDT) was introduced, demonstrating a satisfactory response in the sixth treatment session.
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Se presenta el caso de un paciente masculino de 15 años con diagnóstico de fibrosis quística. Este desarrolló una sintomatología caracterizada por tos húmeda, no cianozante ni emetizante, sin un patrón temporal específico. Asociado a esto, nuevas lesiones nodulares bilaterales fueron identificadas en una tomografía de tórax. El abordaje diagnóstico incluyó una broncoscopia y la toma de un lavado broncoalveolar, que identificó la presencia de un microorganismo micótico poco común: Penicillium spp. Se inició tratamiento con voriconazol oral durante 14 días, resultando en una mejora clínica y radiológica significativa. El cultivo de expectoración posterior mostró un resultado negativo para Penicillium spp. Aunque la incidencia de exacerbaciones pulmonares causadas por agentes micóticos en pacientes con fibrosis quística es relativamente baja, se observa un incremento gradual, posiblemente relacionado con el uso prolongado de antimicrobianos de amplio espectro. La importancia de reportar este caso radica en el papel incierto que estos microorganismos juegan en la progresión del daño pulmonar, subrayando la necesidad de un seguimiento a mediano y largo plazo en estos pacientes.
This report discusses a 15-year-old male patient diagnosed with cystic fibrosis who developed clinical symptoms characterized by productive cough, not associated with cyanosis or vomiting, and without a specific time pattern. Associated with these symptoms, new bilateral nodular lesions were identified in a chest CT scan. Diagnostic approach included bronchoscopy and bronchoalveolar lavage, which identified a rare fungal organism: Penicillium spp. Treatment with oral voriconazole for 14 days was initiated, resulting in significant clinical and radiological improvement. Subsequent sputum culture showed a negative result for Penicillium spp. Although the incidence of pulmonary exacerbations caused by fungal agents in patients with cystic fibrosis is relatively low, there is a gradual increase, possibly related to the prolonged use of broad-spectrum antimicrobials. The importance of reporting this case lies in the uncertain role these organisms play in the progression of lung damage, highlighting the need for medium and long-term follow-up in these patients.
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Humanos , Masculino , Adolescente , Fibrose Cística/complicações , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Penicillium , Tomografia Computadorizada por Raios X , Voriconazol/administração & dosagem , Pneumopatias Fúngicas/diagnóstico por imagem , Antifúngicos/administração & dosagemRESUMO
BACKGROUND: Mycosis fungoides is the most frequent form of cutaneous T-cell lymphoma. It is characterized by a chronic, slow, and progressive course, and is associated with mortality rates that depend on several factors, such as clinical staging. A median survival time of up to 13 months is found in patients with advanced stages that require more aggressive treatments, with greater toxicity and higher costs. In Latin America, few prognostic studies of the disease are available. OBJECTIVE: To determine the rate of progression from early stages (IA, IB, IIA) to more advanced stages (> IIB) in patients older than 18 years with mycosis fungoides treated at two medical centers in Colombia between January 1, 2010, and December 31, 2019. METHODS: Retrospective cohort study with a longitudinal design. RESULTS: 112 patients diagnosed with early mycosis fungoides were included. 56.2% were male (n = 63), with a median age of 53 years (IQR 43â67). The most frequent clinical variant was classic (67.9%; n = 76), followed by folliculotropic (16%; n = 18), and hypopigmented (10.7%; n = 12). The most common first-line treatment was NB-UVB phototherapy (27.7%; n = 31), followed by PUVA phototherapy (25.8%; n = 29%), and topical corticosteroids (25%; n = 28). The global rate of disease progression was 8% (n = 9), with an overall mortality of 12.5% (n = 14). STUDY LIMITATIONS: Its retrospective design and the lack of molecular studies for case characterization. CONCLUSIONS: Early mycosis fungoides is a disease with a good prognosis in most patients, with a progression rate of 8% (n = 9).