RESUMO
PURPOSE: Diabetic patients seem to be predisposed to cutaneous candidiasis. In this study, we evaluated the interference of diabetic conditions in alloxan-induced diabetic mice in relation to the development of C. albicans infection, density of M1 and M2 macrophages, distribution of collagen type I and III and anti-inflamamatory cytokines involved in tissue repair. METHODOLOGY: The mice were treated with intravenous alloxan, and all animals with blood glucose levels >250 mg dl-1 were inoculate with C. albicans intradermally in the hind paw and were studied for up to 21 days. Control groups without alloxan were used. The fungal burden was evaluated by periodic acid-Schiff (PAS) and by counting the colony forming units. Total population of macrophages were targeted with antibody to F4/80 antigen and M2 macrophages with anti-arginase antibody. Anti-inflammatory cytokines from popliteal lymph nodes were determined by capture ELISA procedures. Picrosirius red staining allowed qunantification of collagen types I and III in the infected skin by using a polarized light microscope.Results/Key findings. Diabetic mice, versus non-diabetic mice, showed a significant lower density of F4/80 and M2 macrophages, higher fungal burden, deficiency in interleukin (IL)-4 production, and delayed IL-13 responses. The later clearance of C. albicans enhanced tissue injury, leading to a decrease in collagen type I. Moreover, collagen type III was increased by interference of IL-13 and transforming growth factor-ß cytokines. CONCLUSION: These findings highlight some important changes in diabetic animal responses to C. albicans infection that may be important to the pathophysiological processes underpinning cutaneous candidiasis in diabetic patients.
Assuntos
Candidíase Cutânea/microbiologia , Candidíase Cutânea/fisiopatologia , Diabetes Mellitus Experimental/complicações , Cicatrização , Animais , Glicemia/análise , Candida albicans/crescimento & desenvolvimento , Candida albicans/imunologia , Candida albicans/fisiologia , Candidíase Cutânea/etiologia , Candidíase Cutânea/imunologia , Colágeno/análise , Citocinas/análise , Citocinas/imunologia , Diabetes Mellitus Experimental/imunologia , Diabetes Mellitus Experimental/fisiopatologia , Modelos Animais de Doenças , Interleucina-13/análise , Interleucina-4/análise , Macrófagos/imunologia , Masculino , Camundongos , Pele/químicaRESUMO
We present the case of a 42-year-old man, HIV-positive, with low CD4(+) T cell count (31 cells/µl), who was admitted to Hospital de Infecciosas F. J. Muñiz in Buenos Aires (Argentina) due to a severe lower back pain. He had a history of several highly active antiretroviral therapy treatments and he also had diabetes and chronic B and C viral hepatitis. A spinal cord CT scan showed two lytic bone lesions in L2 and L3. A bone biopsy was carried out and its microbiological study allowed the isolation of a methicillin-resistant Staphylococcus aureus. Intravenous vancomycin was prescribed, together with a corset and physical rest. A few days later the patient presented with acute dermatitis with papules, vesicles, scales and erythema, which spread over the whole lumbar region. The mycological study of the scales led to the isolation in culture of Candida albicans and Candida parapsilosis. With the diagnosis of decubitus candidiasis he was initially treated with a topical ointment containing 3% salicylic acid and 6% benzoic acid, but only slow, partial improvement was observed. The treatment was changed to oral fluconazole at a daily dose of 200mg. With the latter the patient showed a rapid, complete clinical response.
Assuntos
Candidíase Cutânea/etiologia , Infecções por HIV/complicações , Adulto , Antibacterianos/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Braquetes/efeitos adversos , Contagem de Linfócito CD4 , Candidíase Cutânea/tratamento farmacológico , Candidíase Cutânea/microbiologia , Infecção Hospitalar/microbiologia , Diabetes Mellitus Tipo 2/complicações , Fluconazol/uso terapêutico , Hepatite Viral Humana/complicações , Humanos , Hospedeiro Imunocomprometido , Vértebras Lombares/microbiologia , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Espondilite/complicações , Espondilite/microbiologia , Espondilite/terapia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Superinfecção , Decúbito Dorsal , Vancomicina/uso terapêuticoRESUMO
BACKGROUND: Candidoses are infections caused by yeasts of the genus Candida. 'Decubital candidosis' is a particular form of cutaneous candidosis that occurs on the dorsal skin of chronically bedridden patients; there are very few studies about this presentation in the medical literature. OBJECTIVE: To study the clinical, mycological and histopathological features of 26 cases of 'decubital candidosis' along with factors that may predispose to it. METHODS: Twenty-six patients were included and their general characteristics and clinical lesions were carefully studied. The presence of candidosis in other organs and the occurrence of predisposing factors were searched by reviewing the medical records. Mycological studies were performed and cutaneous biopsies were taken. RESULTS: Median age of patients was 46 years, 11 were male and 15 were female, 25 were caucasian, one was Asian and no one was Afro-Carribean. This finding suggests a greater resistance of Afro-Carribean skin to this form of candidosis. The median time of hospitalization until rash occurrence was 24.8 days. Clinical lesions consisted of erythema, erosions, pustules, papules and desquamation. The most significant predisposing factors for this eruption were prolonged bedrest and broad-spectrum antibiotics. Candidosis on other body sites was diagnosed in 10 cases and additional specific predisposing factors were observed in all 10. Potassium hydroxide examination was a reliable test for diagnosing this disease. Candida albicans was the agent in all 26 cases. Spongiform pustules were the most significant histopathological findings and yeasts were restricted to the horny layer in all biopsied cases. CONCLUSION: 'Decubital candidosis' is probably induced by prolonged bedrest and facilitated by long-term use of antibiotics. This cutaneous infection does not seem to predispose to systemic candidosis.
Assuntos
Candidíase Cutânea/etiologia , Úlcera por Pressão/etiologia , Adolescente , Adulto , Idoso , Candidíase Cutânea/patologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/patologiaRESUMO
La Diabetes Mellitus es una patología frecuente en la población, caracterizada por el aumento del nivel plasmático de la glucosa y por disturbios en el metabolismo de carbohidratos y lípidos. según diversos estudios, entre un 30 por ciento y un 100 por ciento de los pacientes diabéticos presentan alteraciones en la piel, las cuales pueden clasificarse en 4 grandes grupos: manifestaciones cutáneas relacionadas con descompensación metabólica, tales como infecciones de diversos tipos, aquellas relacionadas con complicaciones degenerativas crónicas como el pié diabético, desórdenes cutáneos que son más comunes en Diabetes Mellitus y que no se correlacionan con descompensación metabólica ni con cambios degenerativos como la acantosis nigricans y, por último, reacciones como consecuencia del tratamiento de la Diabetes Mellitus, entre las cuales se mencionan las erupciones morbiliformes
Assuntos
Humanos , Diabetes Mellitus/complicações , Dermatopatias/etiologia , Angiopatias Diabéticas/complicações , Candidíase Cutânea/etiologia , Dermatopatias Vesiculobolhosas/etiologia , Granuloma Anular/etiologia , Necrobiose Lipoídica/etiologia , Pé Diabético/etiologia , Vitiligo/etiologia , Xantomatose/etiologiaRESUMO
Introducción. La dermatitis de la zona del pañal (DZP), común en lactantes, se agrava frecuentemente con infecciones, principalmente por Candida albicans. Objetivo. Comparar la eficacia y tolerancia a la terbinafina en crema contra la de ketoconazol en crema en candidiosis de la zona del pañal. Material y métodos. Se realizó un ensayo clínico abierto, comparativo, aletorizado, separando 2 grupos, indicandoseles aplicar terbinafina en crema una vez al día durante 14 días al primer grupo y ketoconazol 2 veces al día, por mismo periodo, al segundo grupo. El seguimiento se realizó por 4 semanas. Resultados. Ingresaron 52 pacientes; 28 en el grupo de terbinafina, 24 en el ketoconazol; 28 del sexo masculino y 24 del femenino. Hubo un sólo caso de reacción adversa en el grupo de terbinafina y consistió en incremento del eritema y prurito. El resto de parámetros evolucionó en forma similar. Conclusiones. Los análisis estadísticos no reportan diferencia significativa. Se considera a la terbinafina como alterativa en una circunstancia clínica no estudiada antes