RESUMO
INTRODUCCIÓN: Las micosis superficiales constituyen un importante problema de salud a nivel mundial, siendo mayor su frecuencia en niños y adultos jóvenes. Existen escasos estudios científicos publicados en Ecuador sobre esta patología, en particular en la provincia del Azuay. El objetivo del estudio fue determinar la frecuencia de micosis superficiales en niños escolares y sus agentes etiológicos. MÉTODO: Se realizó un estudio descriptivo transversal, con 294 pacientes, las edades entre 3 y 14 años, pertenecieron a una escuela fiscal de la parroquia rural "El Valle", provincia del Azuay - Cuenca, Ecuador. Se examinó físicamente a cada participante para caracterizar lesiones sugestivas de micosis; a las muestras tomadas de las lesiones, se aplicó las técnicas de diagnóstico micológico como análisis directo, cultivo e identificación de agentes fúngicos mediante caracterización macroscópica y microscópica de las colonias. RESULTADOS: De los 294 pacientes evaluados (72.8 % hombres), 234 (79.6 %) presentaron lesiones sugestivas de micosis superficial; en 179 participantes (60.9 %) se identificó al menos un agente fúngico en las muestras analizadas, sin diferencias significativas entre género y edad (p: > 0.05). Los dermatofitos fueron los hongos más frecuentes (58.2 %), siendo Trichophyton schoenleinii y Trichophyton mentagrophytes las especies mayormente reportadas. CONCLUSIONES: Se concluyó que las micosis superficiales afectaron a más de la mitad de los niños en edad escolar en la población estudiada. Los dermatofitos son los principales agentes etiológicos aislados, de los cuales se identificaron ciertas especies que varían en frecuencia con relación a lo reportado en otros países de Latinoamérica.
BACKGROUND: Superficial mycoses constitute a health problem worldwide, being a major frequency in children and young adults. There are few scientific studies published in Ecuador on this pathology, in particularin the province of Azuay. The aimofthe study was to determine the frequency of superficialmycoses in school children and their etiological agents. METHODS: A cross-sectional descriptive study was carried out, with 294 patients, aged between3and14 years,belongingtoafiscal schoolinthe ruralparish"ElValle",provinceofAzuay - Cuenca, Ecuador. Each participant was physically examined to characterize lesions suggestive of mycosis; to the samples taken from the lesions, the techniques of mycological diagnosis were applied as direct analysis, culture, and identification of fungal agents by means of macroscopic andmicroscopic characterization ofthe colonies. RESULTS: The 294 patients evaluated (72.8 % men), 234 participants (79.6 %) had lesions suggestive of superficialmycosis; in the 179 participants atleast one fungal agent was identified in the analyzed samples (60.9 %), with no significant differences between gender and age (p: > 0.05). Dermatophytes were the most frequently identified fungal agent (58.2%, n= 201), with Trichophyton schoenleinii and Trichophytonmentagrophytes being themostfrequently reported species. CONCLUSIONS: Itis concluded that superficialmycoses affectedmore than half of school-age children in the study population. Dermatophytes were the main isolated etiological agents, from which certain species had been identified that vary in frequency in relation to thatreported in other Latin American countries.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Criança , Dermatomicoses/epidemiologia , Micoses/classificaçãoRESUMO
The classification of human fungal infections in medical reports is sometimes confusing. This occurs because some agents act as opportunistic organisms in immunosuppressed patients, whereas others affect the subcutaneous tissue and also cause disseminated or systemic disease. Finally, some clinically similar infections caused by aerobic actinomycetic bacteria and others caused by parasites (rhinosporidiosis) have been traditionally included in the descriptions of mycotic diseases. This contribution provides the clinician with a classification of subcutaneous, systemic, and opportunistic fungal infections.
Assuntos
Micoses/classificação , Infecções Oportunistas/classificação , Tela Subcutânea/microbiologia , HumanosRESUMO
Introducción: La esporotricosis linfocutánea es una micosis subcutánea de evolución sub-aguda o crónica, que es más frecuente en adultos entre los 16 y 30 años de edad pero que también se presenta en la niñez, sobre todo en áreas rurales. Se caracteriza por nódulos que se reblandecen y luego se ulceran, lo cual constituye el chancro inicial. Dos o tres semanas después se observan nódulos eritematovioláceos, no dolorosos siguiendo el trayecto linfático regional. El diagnóstico definitivo se realiza al aislar el agente causal mediante cultivo. En nuestro país el tratamiento usual y eficaz sigue siendo el yoduro de potasio. Caso Clínico: Se presenta el caso de un paciente masculino de 2 años de edad, con dermatosis de 2 semanas de evolución con historia de trauma 2 semanas antes del inicio de las lesiones, caracterizada por úlcera costrosa en dorso de mano derecha con presencia de adenopatías blandas, no dolorosas siguiendo la cadena ganglionar de antebrazo y brazo derecho. Conclusiones: La esporotricosis puede presentarse a cualquier edad aún en niños tan pequeños como este paciente de 2 años. La solución saturada de yoduro de potasio es muy eficaz en el manejo de esta patología por lo que aunado a su bajo costo sigue siendo de elección en países en vías de desarrollo...
Assuntos
Humanos , Masculino , Criança , Esporotricose/diagnóstico , Micoses/classificação , Iodeto de Potássio/uso terapêutico , Dermatoses da Mão/complicações , Úlcera Cutânea/diagnósticoRESUMO
Introducción: La esporotricosis linfocutánea es una micosis subcutánea de evolución sub-aguda o crónica, que es más frecuente en adultos entre los 16 y 30 años de edad pero que también se presenta en la niñez, sobre todo en áreas rurales. Se caracteriza por nódulos que se reblandecen y luego se ulceran, lo cual constituye el chancro inicial. Dos o tres semanas después se observan nódulos eritematovioláceos, no dolorosos siguiendo el trayecto linfático regional. El diagnóstico definitivo se realiza al aislar el agente causal mediante cultivo. En nuestro país el tratamiento usual y eficaz sigue siendo el yoduro de potasio. Caso Clínico: Se presenta el caso de un paciente masculino de 2 años de edad, con dermatosis de 2 semanas de evolución con historia de trauma 2 semanas antes del inicio de las lesiones, caracterizada por úlcera costrosa en dorso de mano derecha con presencia de adenopatías blandas, no dolorosas siguiendo la cadena ganglionar de antebrazo y brazo derecho. Conclusiones: La esporotricosis puede presentarse a cualquier edad aún en niños tan pequeños como este paciente de 2 años. La solución saturada de yoduro de potasio es muy eficaz en el manejo de esta patología por lo que aunado a su bajo costo sigue siendo de elección en países en vías de desarrollo...(AU)
Assuntos
Humanos , Masculino , Criança , Esporotricose/diagnóstico , Micoses/classificação , Iodeto de Potássio/uso terapêutico , Dermatoses da Mão/complicações , Úlcera Cutânea/diagnósticoRESUMO
A partir de fichas individuais, fizemos um levantamento da incidência de casos de micose superficial, diagnosticadas sob o ponto de vista clínico em quatro Unidades de Saúde da Família de Patos-PB, no ano de 2007. Tivemos uma amostra de 197 notificações positivas, onde as mais incidentes foram: Pitiríase e Tínea, sendo a maior prevalência na faixa etária de 11 a 20 anos e o sexo feminino, o mais acometido. Um número elevado de infecções não identificadas foi encontrado: 46,19 por cento, no entanto, a identificação destes agentes torna-se inacessível, por não serem infecções de notificação obrigatória.
A survey of the incidence of clinically diagnosed cases of superficial mycosis was carried out using individual report cards in four Family Health units in Patos-PB, in 2007. We had a sample of 197 positive records with Pityriasis and Tinea as the most incident mycoses. There was a higher prevalence among female patients who were between 11 - 20 years of age. A high number of non-identified infections was found: 46,19 percent. The identification of the agents of such non-identified infections is not possible as they are not infections of compulsory notification.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Micoses/epidemiologia , Distribuição por Idade , Brasil/epidemiologia , Incidência , Micoses/classificação , Distribuição por SexoRESUMO
UNLABELLED: Amphotericin B deoxycholate is associated with infusion-related toxicity and renal toxicity. PURPOSE: To evaluate medical indications of this compound in a tertiary care center, analyze adverse reactions, infusion protocols and outcome of treated patients. PATIENTS AND METHODS: Retrospective analysis of 39 treatments indicated in 33 patients during 2007, exploring indications, infusion protocols and renal protective measures, infusion-related adverse reactions, nephrotoxicity, hypokalemia and outcomes. RESULTS: On average, therapy lasted 12 days (2 to 39) and reached 600 mg of accumulated dose (100 to 1950) respectively. 24-hours infusions were applied in 63.2% of prescriptions and 35.9% received a 4-6 hour infusion schedule. In addition, 36.8% received daily a saline infusion before amphotericin. Adverse reactions were observed in 40% of treatments, predominating fever (25%). Nonetheless, nephrotoxicity was infrequent (9.4%), of low magnitude, only affecting patients without previous renal disease, and not requiring dialysis. Hypokalemia developed in 21.6% of treatments. More than half of medical indications were empirical (59%), for presumed infections by either filamentous fungi or yeasts. In the subgroup with microbiological information, main indications were invasive aspergillosis (15.4% of total), systemic candidiasis (12.8%) or meningeal cryptococcosis (10.3%). A favorable response was registered in 41%, and only 48.5% of patients survived. In a multivariate analysis, only age > 60 years remained as an independent factor for developing infusion-related adverse reactions. In the same manner, a SOFA score > 3 and corticosteroids administration at the same time than amphotericin B, were independently associated to a fatal outcome. CONCLUSION: infusion-related adverse reactions are frequent during amphotericin B deoxycholate therapy, but renal toxicity is occasionally observed. Amphotercin B was used mainly as empirical therapy in this study.
Assuntos
Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Ácido Desoxicólico/efeitos adversos , Micoses/tratamento farmacológico , Adolescente , Adulto , Idoso , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Chile , Ácido Desoxicólico/administração & dosagem , Combinação de Medicamentos , Feminino , Hospitais Universitários , Humanos , Nefropatias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Micoses/classificação , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
Amphotericin B deoxycholate is associated with infusion-related toxicity and renal toxicity. Purpose: To evaluate medical indications of this compound in a tertiary care center, analyze adverse reactions, infusion protocols and outcome of treated patients. Patients and methods: Retrospective analysis of 39 treatments indicated in 33 patients during 2007, exploring indications, infusion protocols and renal protective measures, infusion-related adverse reactions, nephrotoxicity, hypokalemia and outcomes. Results: On average, therapy lasted 12 days (2 to 39) and reached 600 mg of accumulated dose (100 to 1950) respectively. 24-hours infusions were applied in 63.2 percent of prescriptions and 35.9 percent received a 4-6 hour infusion schedule. In addition, 36.8 percent received daily a saline infusion before amphotericin. Adverse reactions were observed in 40 percent of treatments, predominating fever (25 percent). Nonetheless, nephrotoxicity was infrequent (9.4 percent), of low magnitude, only affecting patients without previous renal disease, and not requiring dialysis. Hypokalemia developed in 21.6 percent of treatments. More than half of medical indications were empirical (59 percent), for presumed infections by either filamentous fungi or yeasts. In the subgroup with microbiological information, main indications were invasive aspergillosis (15.4 percent of total), systemic candidiasis (12.8 percent) or meningeal cryptococcosis (10.3 percent). A favorable response was registered in 41 percent, and only 48.5 percent of patients survived. In a multivariate analysis, only age > 60 years remained as an independent factor for developing infusion-related adverse reactions. In the same manner, a SOFA score > 3 and corticosteroids administration at the same time than amphotericin B, were independently associated to a fatal outcome. Conclusion: infusion-related adverse reactions are frequent during amphotericin B deoxycholate therapy, but renal...
Anfotericina B deoxicolato se asocia a reacciones adversas durante la infusión y a nefrotoxicidad. Objetivo: Evaluar las indicaciones de anfotericina B deoxicolato en un hospital universitario, las reacciones adversas asociadas, los protocolos de administración y el desenlace de los pacientes tratados. Pacientes y Métodos: Se efectuó un estudio retrospectivo con el total de tratamientos efectuados durante el año 2007 en el Hospital Clínico de la Universidad de Chile, identificando 39 tratamientos en 33 pacientes. Se analizaron las indicaciones, dosis, protocolos de administración, efectos adversos relacionados a la infusión (fiebre, calofríos, vómitos o flebitis), nefrotoxicidad, hipokalemia y además la evolución de los pacientes. Resultados: La duración promedio del tratamiento fue de 12 días (2-39) con una dosis acumulada promedio de 600 mg totales (100-1.950 mg). Un 63,2 por ciento de los tratados recibió infusiones de 24 horas y 35,9 por ciento, infusiones de 4 a 6 horas. Además, 36,8 por ciento fue sometido a precargas salinas. Un 40 por cientoo de los tratamientos se acompañó de reacciones adversas asociadas a la infusión, predominando la fiebre (25 por ciento). Sin embargo, la nefrotoxicidad fue de baja magnitud (9,4 por cientoo), sólo presente en pacientes sin falla renal previa y en ningún caso determinó el inicio de diálisis. La hipokalemia se presentó en ocho tratamientos (21,6 por ciento). Más de la mitad de las indicaciones fueron empíricas (59 por cientoo), ya fuese para el tratamiento presunto de hongos filamentosos (aspergilosis o mucormicosis) o levaduras (candidiasis sistémica). En el subgrupo con datos micro-biológicos, las principales indicaciones fueron aspergilosis invasora (15,4 por ciento de los 39 tratamientos), candidiasis sistémica (12,8 por ciento) o criptococosis meníngea (10,3 por ciento). Un 41 por cientoo de los pacientes tuvo una respuesta favorable a los tratamientos y sólo 48,5 por cientoo sobrevivió...
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Ácido Desoxicólico/efeitos adversos , Micoses/tratamento farmacológico , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Chile , Combinação de Medicamentos , Ácido Desoxicólico/administração & dosagem , Hospitais Universitários , Nefropatias/induzido quimicamente , Micoses/classificação , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
A survey of the incidence of clinically diagnosed cases of superficial mycosis was carried out using individual report cards in four Family Health units in Patos-PB, in 2007. We had a sample of 197 positive records with Pityriasis and Tinea as the most incident mycoses. There was a higher prevalence among female patients who were between 11 - 20 years of age. A high number of non-identified infections was found: 46,19%. The identification of the agents of such non-identified infections is not possible as they are not infections of compulsory notification.
Assuntos
Micoses/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Micoses/classificação , Distribuição por Sexo , Adulto JovemRESUMO
Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (approximately 51.2%). When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9%) appeared at the top of the list, followed by candidiasis (30.2%), histoplasmosis (10.1%) and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.