RESUMO
AIM: Toenail fungal infections account for half of all nail disease cases, and a highly negative impact on patient quality of life. Our aim was to compare the efficacy and safety of commercially available oral antifungals for onychomycosis. METHODS: A systematic review was performed in PubMed and Scopus. Randomized controlled trials evaluating the effect of oral antifungals on mycological cure, discontinuation and adverse events were included. Network meta-analyses were built for each outcome. Results were reported as odds ratios (OR) with 95% credibility intervals (CrI). Ranking probabilities were calculated by surface under the cumulative ranking analysis (SUCRA). RESULTS: We included 40 trials (n = 9568). Albaconazole 400 mg (OR 0.02 [95% CrI 0.01-0.07] versus placebo), followed by posaconazole 200-400 mg and terbinafine 250-350 mg were considered the best therapies (SUCRA probabilities over 75%). For the networks of discontinuation and individual adverse events, few significant differences among treatments were observed, but itraconazole 400 mg was considered the safest drug (SUCRA around 25%). Albaconazole 400 mg, posaconazole 200-400 mg, and terbinafine 250-350 mg were the most effective therapies for onychomycosis, while itraconazole 400 mg was the safest. CONCLUSION: The profile of albaconazole and posaconazole compared to current first-line therapies should be further investigated in well-designed trials.
Assuntos
Dermatoses do Pé , Onicomicose , Antifúngicos/uso terapêutico , Dermatoses do Pé/tratamento farmacológico , Humanos , Itraconazol/uso terapêutico , Unhas , Metanálise em Rede , Onicomicose/tratamento farmacológico , Qualidade de Vida , Resultado do TratamentoRESUMO
Introduction. Onychomycosis infections currently show a significant increase, affecting about 10â% of the world population. Trichophyton rubrum is the main agent responsible for about 80â% of the reported infections. The clinical cure for onychomycosis is extremely difficult and effective new antifungal therapy is needed.Hypothesis/Gap Statement. Ex vivo onychomycosis models using porcine hooves can be an excellent alternative for evaluating the efficacy of new anti-dermatophytic agents in a nail lacquer.Aim. Evaluation of the effectiveness of a nail lacquer containing a quinoline derivative on an ex vivo onychomycosis model using porcine hooves, as well as the proposal of a plausible antifungal mechanism of this derivative against dermatophytic strains.Methodology. The action mechanism of a quinoline derivative was evaluated through the sorbitol protection assay, exogenous ergosterol binding, and the determination of the dose-response curves by time-kill assay. Scanning electron microscopy evaluated the effect of the derivative in the fungal cells. The efficacy of a quinoline-derivative nail lacquer on an ex vivo onychomycosis model using porcine hooves was evaluated as well.Results. The quinoline derivative showed a time-dependent fungicidal effect, demonstrating reduction and damage in the morphology of dermatophytic hyphae. In addition, the ex vivo onychomycosis model was effective in the establishment of infection by T. rubrum.Conclusion. Treatment with the quinoline-derivative lacquer showed a significant inhibitory effect on T. rubrum strain in this infection model. Finally, the compound presents high potential for application in a formulation such as nail lacquer as a possible treatment for dermatophytic onychomycosis.
Assuntos
Antifúngicos/farmacologia , Arthrodermataceae/efeitos dos fármacos , Dermatoses do Pé/microbiologia , Casco e Garras/microbiologia , Onicomicose/tratamento farmacológico , Quinolinas/farmacologia , Administração Tópica , Animais , Modelos Animais de Doenças , Dermatoses do Pé/tratamento farmacológico , Humanos , Laca , Onicomicose/microbiologia , SuínosAssuntos
Angioedema/virologia , COVID-19/complicações , Dermatite Esfoliativa/virologia , Dermatoses do Pé/virologia , Dermatoses da Mão/virologia , Angioedema/tratamento farmacológico , Criança , Dermatite Esfoliativa/tratamento farmacológico , Feminino , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Prurido/tratamento farmacológico , Prurido/virologiaRESUMO
Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum subspecies pallidum. Its association with other STIs, including HIV, demands early diagnosis and immediate treatment of patients. We herein report an unusual serpiginous form of secondary syphilis.
Assuntos
Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Sífilis/complicações , Adulto , Antibacterianos/administração & dosagem , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Humanos , Injeções Intramusculares , Masculino , Penicilina G Benzatina/administração & dosagem , Sífilis/diagnóstico , Sífilis/tratamento farmacológicoRESUMO
Mycetoma cases are predominantly found in tropical regions and are a rare finding in the United States. These masses that are fungal or bacterial in origin can result in significant destruction of soft tissue and bone. We present a case of a patient who emigrated from Mexico to Indianapolis. He presented with a soft-tissue mass that was excised and ultimately found to be a eumycetoma of the hallux of his left foot. Successful treatment included surgical resection in combination with postoperative terbinafine, which was pulse dosed to decrease its impact on hepatic function.
Assuntos
Dermatoses do Pé/diagnóstico , Micetoma/diagnóstico , Adulto , Antifúngicos/uso terapêutico , Terapia Combinada , Emigrantes e Imigrantes , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/microbiologia , Dermatoses do Pé/cirurgia , Hallux/patologia , Humanos , Indiana , Masculino , México/etnologia , Micetoma/tratamento farmacológico , Micetoma/cirurgia , Terbinafina/uso terapêuticoRESUMO
Abstract: Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum subspecies pallidum. Its association with other STIs, including HIV, demands early diagnosis and immediate treatment of patients. We herein report an unusual serpiginous form of secondary syphilis.
Assuntos
Humanos , Masculino , Adulto , Sífilis/complicações , Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Penicilina G Benzatina/administração & dosagem , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Injeções Intramusculares , Antibacterianos/administração & dosagemAssuntos
Eritromelalgia/diagnóstico , Dermatoses do Pé/diagnóstico , Aminas/uso terapêutico , Aspirina/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Eritromelalgia/tratamento farmacológico , Feminino , Dermatoses do Pé/tratamento farmacológico , Gabapentina , Humanos , Adulto Jovem , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
BACKGROUND/AIM: Onychomycosis (OM) is one of the commonest superficial fungal infections. Patients undergoing hemodialysis (HD) treatment and kidney transplant recipients (KTR) are considered at risk of contracting fungal infections, but the few published data do not reach the conclusion of whether they are predisposed to OM. This study aimed to determine the prevalence and etiology of OM in these patients and to determine the antifungal susceptibility profile of the isolated fungal species. METHODS: We recruited 149 HD patients, 187 KTR, and a control group comprising 174 patients attending an internal medicine service with other diseases than renal diseases. All patients underwent an examination of all toenails to check for the presence of OM. Antifungal susceptibility tests were performed following the Clinical and Laboratory Standards Institute (CLSI) recommendations. RESULTS: The prevalence rates of OM in HD patients (23.4%) and KTR (23.0%) were significantly higher than those in age- and sex-matched control groups (13.2%). In HD patients, OM was associated with diabetes but not with the duration of dialysis. In KTR, OM was more prevalent in those without diabetes and likely also in those using mycophenolate mofetil or azathioprine but was not associated with the duration of transplantation. Trichophyton rubrum was the most prevalent species (45.9%) followed by T. mentagrophytes (24.5%) and Candida parapsilosis (18.0%). Fluconazole, itraconazole, voriconazole, and terbinafine were all efficient against the isolates of dermatophyte, with terbinafine showing the lowest and fluconazole the highest minimal inhibitory concentrations. All isolates of C. parapsilosis were sensitive to the antifungals according to the CLSI criteria. CONCLUSION: We found a high prevalence of OM in HD and KTR patients and suggest that these conditions should be considered a risk factor of OM. All 4 antifungals evaluated in the study showed good in vitro activity against the etiologic agents.
Assuntos
Dermatoses do Pé/etiologia , Transplante de Rim/efeitos adversos , Onicomicose/etiologia , Diálise Renal/efeitos adversos , Adulto , Antifúngicos/farmacologia , Candida parapsilosis/efeitos dos fármacos , Candidíase/tratamento farmacológico , Candidíase/etiologia , Candidíase/microbiologia , Suscetibilidade a Doenças , Feminino , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Fatores de Risco , Tinha/tratamento farmacológico , Tinha/etiologia , Tinha/microbiologiaRESUMO
Cutaneous larva migrans (CLM) is a parasitic infection most commonly found in tropical and subtropical areas. However, with the ease and increase of foreign travel to many countries around the world, the infection is not limited to these areas. CLM is an erythematous, serpiginous infection with skin eruption caused by percutaneous penetration of the larvae to the skin. In this report, a case diagnosed as imported CLM after an Amazon trip and treated with albendazole was presented. A 36 year-old male patient admitted to infectious diseases clinic with intense itching, erythematous, raised, streaklike serpiginious eruptionand some redness at bilateral foot especially at the right foot for about one week. The patient was living in Turkey, and travelled to Brazil for an Amazon trip three months ago and the lesions began immediately after this occasion. CLM was diagnosed with the typical lesions in the patient and oral albendazole treatment 2 x 400 mg/day for 3 consecutive days was carried out with oral amoxicillin/clavulanat 3 x 1 g/day for the secondary bacterial infection. The patient responded very well to oral albendazole treatment with a result of a rapid improvementof pruritus in days and no side effect was observed during the treatment period.After discharge, during his controlit was seenthat the lesions were regressed with leaving hyperpigmentation. In cases with cutaneous larva migrans, diagnosis is often made by the presence of pruritic typical lesions and tunnels, travel story to endemic regions, the story of barefoot contact with sand and soil in these regions, and the sun tanning story on the beach. The lesions are often seen in the lower extremities, especially in the dorsal and plantar surface of the foot. Laboratory findings are not specific. Temporary peripheral eosinophilia can be seen and biopsy can be done to confirm the diagnosis but usually no parasite is seen in the histopathological examination. Contact dermatitis, bacterial and fungal skin infections and other parasitic diseases should be considered in differential diagnosis. For the treatment ivermectin 1 x 200 mg/kg single dose or albendazole 400 mg/day for three days is recommended. As a result, cutaneous larva migrans should be kept in mind especially in patients with a history of travel to endemic areas and a history of bare feet contact with sandy beaches and soil in this region and with itchy, red and serpiginous skin lesions.