Manifestações cutâneo-mucosas da coccidioidomicose: estudo de trinta casos procedentes dos estados do Piauí e Maranhão Skin and mucous membrane manifestations of coccidioidomycosis: a study of thirty cases in the Brazilian states of Piauí and Maranhão

FUNDAMENTOS: A coccidioidomicose é micose sistêmica usualmente manifesta como infecção benigna de resolução espontânea; porém, uma pequena proporção dos infectados desenvolve quadros progressivos potencialmente fatais, podendo atingir a pele com lesões pleomórficas disseminadas. OBJETIVOS: Identificar e descrever as manifestações cutâneo-mucosas da coccidioidomicose, as ocupações de risco relacionadas à doença e o quadro clínico associado. MÉTODOS: Estudo realizado entre os anos 2003 e 2006 em 30 pacientes portadores de coccidioidomicose provenientes dos estados do Piauí e Maranhão e diagnosticados por exame microscópico direto, cultivo do escarro ou sorologia de triagem de imunodifusão dupla em gel de ágar, aliados à anamnese e exame físico. RESULTADOS: Identificaram-se lesões extrapulmonares em 13 casos (43,3%), com predomínio de manifestações dermatológicas de hipersensibilidade: eritema nodoso (26,6%), exantema com lesões eritemato-escamosas (26,6%) e eritema multiforme (23,3%), além de úlceras de língua (13,3%) e lábio (6,6%) e abscesso subcutâneo (3,3%). Tais manifestações foram observadas na fase aguda da doença. CONCLUSÕES: As manifestações cutâneas associadas à infecção respiratória aguda fortalecem a hipótese diagnóstica desta doença, especialmente, em caçadores de tatus ou pessoas expostas à escavação do solo.<br>BACKGROUND: Coccidioidomycosis is a systemic mycosis that usually presents as a benign infection. Patients generally recover spontaneously; however, a small proportion of infected individuals develop progressive complications that may affect the skin in the form of disseminated pleomorphic lesions and may become fatal. OBJECTIVES: To identify and describe skin and mucous membrane manifestations of coccidioidomycosis, to identify occupational hazards associated with the disease and to determine its associated clinical presentation. METHODS: A study conducted between 2003 and 2006 involving 30 patients from the Brazilian states of Piauí and Maranhão with coccidioidomycosis diagnosed by direct microscopy, sputum culture or screening serology using agar gel double immunodiffusion, in association with anamnesis and physical examination. RESULTS: Extrapulmonary lesions were found in 13 cases (43.3%), consisting predominantly of dermatological manifestations of hypersensitivity: erythema nodosum (26.6%), exanthema with erythematosquamous lesions (26.6%) and erythema multiforme (23.3%), as well as ulcerations of the tongue (13.3%), lip ulcers (6.6%) and subcutaneous abscess (3.3%). These manifestations were seen during the acute phase of the disease. CONCLUSIONS: Skin manifestations associated with an acute respiratory infection reinforce the hypothesis of a diagnosis of coccidioidomycosis, particularly in individuals who hunt armadillos or in those exposed to soil excavation

Relato de caso de Lagochilascariose humana procedente do Estado do Pará, Brasil Report a case of human lagochilascariasis coming from the Pará State, Brazil

Mais um caso de lagochilascariose em criança procedente do Município de Xinguara PA. No Hospital das Clínicas da UFG, foi feita drenagem do abscesso localizado na região cervical direita, constatando-se a presença de ovos e vermes adultos de Lagochilascaris minor. Instituída terapia com albendazol 400mg/dia (durante 30 dias) e antibioticoterapia, houve regressão do quadro clinico.<br>A new case of lagochilascariasis is reported in a child from Xinguara PA, Brazil. The patient had an abscess in the right cervical region, which was drained at the Clinical Hospital of UFG. Eggs and adult stages of Lagochilascaris minor were found in the secretion of the abscess. Treatment with albendazol, at a dosage of 400mg/day for 30 days, associated with antibiotics promoted regression of the lesion

Endemic mycoses in americas

American continent concentrates important endemic mycoses, both systemic and subcutaneous, such as coccidioidomycosis, blastomycosis, histoplasmosis, paracoccidioidomycosis and sporotrichosis. The common factor among these mycoses is the dimorphic nature of their etiologic agents, like Coccidioides spp., Blastomyces spp., Histoplasma spp., Paracoccidioides spp. and Sporothrix spp., respectively. Human and animal coccidioidomycoses are found in the USA (states of California, Texas, Arizona and New Mexico), Brazil (states of Piauí and Ceará) and Argentina (states of Catamarca, Santiago del Estero, San Luis and Córdoba). Blastomycosis is restricted to North America, mainly in the valleys of the Mississippi and Ohio Rivers of the USA, and is predominantly observed in dogs. Cases of classical histoplasmosis in humans and animals occur mainly in the USA (Mississippi, Missouri, Ohio River valley), Canada (Ontario and Montreal) and in some regions of Latin America (Colombia and Brazil). Paracoccidioidomycosis is the most important systemic mycosis in Latin American countries, highlighting Brazil, Colombia, Venezuela and Argentina. It predominantly affects humans, despite some cases of animal disease being recently reported. In Brazil, there was a special situation concerning sporotrichosis, where thousands of cases of human disease were transmitted due to cat scratches, characterizing a great epidemic of zoonotic transmission. The most prevalent species reported was Sporothrix brasiliensis which is considered to be one of the most virulent species of Sporothrix species complex.Laboratory of Medical Mycology Department of Microbiology and Immunology Institute of Biosciences Universidade Estadual Paulista, UNESP/BotucatuLaboratory of Fungal Biology Department of Microbiology and Immunology Institute of Biosciences Universidade Estadual Paulista, UNESP/BotucatuLaboratory of Medical Mycology Department of Microbiology and Immunology Institute of Biosciences Universidade Estadual Paulista, UNESP/BotucatuLaboratory of Fungal Biology Department of Microbiology and Immunology Institute of Biosciences Universidade Estadual Paulista, UNESP/Botucat