Infection of the lymphatic system by Aureobasidium pullulans in a patient with erythema nodosum leprosum

Aureobasidium pullulans is a causal agent of phaeohyphomycosis, occasionally found in men and animals. As an agent of different opportunistic fungal processes, it may cause fungemia, systemic infections and abscesses in different viscera. This paper aims to report a case of a patient with infection of the lymphatic system by A. pullulans. A 23-year-old patient being treated for erythema nodosum leprosum presented a 60-day complaint of daily fever, hoarseness, odynophagia and weight loss. Laboratory tests showed pancytopenia with severe neutropenia, cervical adenomegaly and solid contrast uptake lesion in the oropharyngeal region. Due to neutropenia and sepsis the patient was initially treated with cefepime and vancomycin, but there was no clinical improvement. Lymph node puncture-aspiration showed yeast-form fungus identified as A. pullulans by sequencing ITS region. The patient was treated with amphotericin B deoxycholate, leading to complete recovery of bone marrow function and regression of adenomegaly and the oropharyngeal lesion

TUMORES FILÓIDES GIGANTES (VARIANTES BENIGNA E MALIGNA): ALTERAÇÕES CLÍNICAS, TRATAMENTO CIRÚRGICO E SEGUIMENTO AMBULATORIAL – RELATOS DE CASOS

Phyloid Tumors are rare fibroepithelial tumors of the breast, representing less than 1% of all breast neoplasms, affecting women in the age group with the highest incidence between 40 and 50 years. With a variable biological behavior, the spectrum of benign presentation is confused with cellular fibroadenoma and, not the other extreme, the malignant presents similarities with other malignant neoplasms of the breast. Indicate, appear as a palpable, smooth, multinodular, firm, mobile and painless tumor, with abnormal mammographic and ultrasound findings. Tumor growth is usually rapid, with no correlation with increased risk of malignancy. The diagnosis is confirmed by histopathological evaluation. The treatment is eminently surgical, with excision with free margins and even mastectomy, a tumor-dependent extension being indicated. The presence of margins is important, since this contributes to the reduction of local recurrences, very common in this type of tumor. Adjuvant radiotherapy is controversial in the literature, but it appears to reduce recurrence without changing mortality. This article requires 02 cases of Phyloid Tumor, a benign and malignant variant, with which we aim to emphasize the importance of differential diagnosis and adequate surgical treatment, especially less postoperative morbidity.Os Tumores Filoides são tumores fibroepiteliais raros da mama, representando menos de 1% de todas as neoplasias mamárias, acometendo mulheres na faixa etária de maior incidência entre 40 e 50 anos. Com comportamento biológico variável, o espectro de apresentação benigna se confunde com o fibroadenoma celular e, no outro extremo, o maligno apresenta semelhanças com outras neoplasias malignas da mama. Geralmente, aparecem na forma de tumoração palpável, lisa, multinodular, firme, móvel e indolor, com achados mamográficos e ultrassonográficos anormais. O crescimento tumoral costuma ser rápido, sem correlação com maior risco de malignidade. O diagnóstico é confirmado por avaliação histopatológica. O tratamento é eminentemente cirúrgico, sendo indicada excisão com margens livres e, até mesmo, mastectomia, a depender da extensão tumoral. É importante a presença de margens livres, visto que isso contribui para a redução das recidivas locais, muito comuns nesse tipo de tumor. Radioterapia adjuvante é controversa na literatura, mas parece reduzir a recorrência, sem alterar a mortalidade. Esse artigo descreve 02 casos de Tumor Filoides, variante benigna e maligna, com os quais objetivamos ressaltar a importância do diagnóstico diferencial e adequado tratamento cirúrgico, visando menor morbidade pós-operatória

Tratamento cirúrgico da onicocriptose: excisão do tecido mole circunjacente ao leito ungueal utilizando radioeletro-cirurgia e criocirurgia

Introdução: A onicocriptose ou unha encravada é processo doloroso originário dapenetração da lâmina ungueal no tecido mole circunjacente.Várias opções terapêuticas,cirúrgicas ou conservadoras são utilizadas. Em contraste com outros tratamentos invasivos,a técnica combinada da radioeletrocirurgia com criocirurgia não causa dano permanenteà matriz ou prega ungueal, tendo várias vantagens em relação aos tratamentos usuais.Objetivo: Avaliar eficácia e segurança da associação de radioeletrocirurgia e criocirurgiano tratamento da unha encravada.Métodos: Estudo retrospectivo observacional. Dezesseis pacientes com onicocriptose, foramsubmetidos à eletrocirurgia com radiofrequência para remoção do tecido de granulação pro-movendo a acomodação da lâmina ungueal, seguida de congelamento com nitrogêniolíquido.Resultados: Após 10 dias os pacientes relataram melhora do desconforto causado por suapatologia, podendo retomar o uso de sapatos.Durante o seguimento, de 24 meses, apenasum paciente apresentou recidiva em uma das unhas, sendo repetida a técnica.Conclusões: A técnica descrita mostrou-se conveniente devido à fácil execução, ao baixocusto, aos bons resultados cosméticos e à satisfação do paciente

Dermatite de contato agravada por outra sensibilidade em automedicação

Introducción: la obesidad aumenta el riesgo a padecer de enfermedades crónicas no transmisibles (ECNT) y afecta el curso de enfermedades de origen infeccioso. Objetivo: examinar la literatura sobre cómo influye la obesidad en la gravedad del cuadro clínico de algunas de las enfermedades no transmisibles y transmisibles de mayor impacto en el Perú. Métodos: investigación documental. Se hace un análisis de contenidos de artículos y documentos de estudios desarrollados en diversos contextos asociados a la presencia de obesidad junto con infecciones o ECNT y en base de datos. Resultados: la condición de obesidad alcanzada por malos hábitos de consumo y baja actividad física, es la principal responsable del elevado índice de las ECNT y por consecuente de las tasas de mortalidad. Conclusiones: el exceso de peso afecta al sistema inmunológico, contribuyendo específicamente en los fenómenos exacerbados de respuesta inflamatoria sistémica, determinada por el aumento de secreción de adipocitoquinas, que predispone al organismo a desarrollar y contraer ECNT y enfermedades infecciosas.Dermatite alérgica de contato é uma doença cutânea inflamatória, não infecciosa, cuja base do tratamento é a identificação e eliminação do agente causal. Cocoamidopropil betaína é um surfactante muito utilizado nos produtos de uso pessoal, notadamente de uso capilar. Essa substância não está presente na bateria padrão brasileira. Neomicina é um antibiótico usado em preparações tópicas. Objetivamos mostrar paciente que desenvolveu alergia no couro cabeludo e que fez erroneamente automedicação com produto que continha substância a qual era ainda mais sensível. O caso é de uma mulher, 36 anos, evoluindo há dois meses com eczema pruriginoso, em áreas de implantação capilar e nuca. Relatava progressiva piora. Diante da suspeita de dermatite de contato, foi realizado teste de contato, utilizando-se da bateria padrão Latino-Americana. Com 96 horas (D4) evidenciou-se positividade leve (+) para cocoamidopropil betaína e forte (++) para neomicina. O resultado positivo para a neomicina foi intrigante, uma vez que a observação do rótulo dos produtos de uso pessoal não a continha. Diante do resultado do teste, após ser questionada novamente, ela confirmou a omissão da automedicação diária com pomada de neomicina. Em conclusão, mostramos a alergia a produtos de uso capilar. Reforçamos a necessidade de se fazer um teste de contato com bateria padrão atualizada. Por fim, alertamos sobre o risco da automedicação.Allergic contact dermatitis is an inflammatory, non-infectious skin disease. The treatment is based on the identification and elimination of the causal agent. Cocamidopropyl betaine is a surfactant widely used in products for personal use, especially capillary use. This substance is not present in the Brazilian baseline series. Neomycin is an antibiotic used in topical preparations. We aimed to show a patient who developed na allergy in the scalp and mistakenly self-medicated with a product that contained a substance to which it was even more sensitive. The case is of a woman, 36 years old, evolving for 2 months with pruritic eczema, in areas of capillary and nape implantation. She reported progressive worsening. When contact dermatitis was suspected, a contact test was performed using the Latin American baseline series. At 96 hours (D4) there was mild positivity (+) for cocamidopropyl betaine and strong (++) for neomycin. The positive result for neomycin was intriguing, since the observation of the label of products for personal use did not contain it. In view of the test result, after being questioned again, she confirmed the omission of daily self-medication with neomycin ointment. In conclusion, we showed the allergy to hair products. We reinforced the need for an updated baseline series patch test. Finally, we warned about the risk of self-medication.

Infection of the lymphatic system by Aureobasidium pullulans in a patient with erythema nodosum leprosum

Aureobasidium pullulans is a causal agent of phaeohyphomycosis, occasionally found in men and animals. As an agent of different opportunistic fungal processes, it may cause fungemia, systemic infections and abscesses in different viscera. This paper aims to report a case of a patient with infection of the lymphatic system by A. pullulans. A 23-year-old patient being treated for erythema nodosum leprosum presented a 60-day complaint of daily fever, hoarseness, odynophagia and weight loss. Laboratory tests showed pancytopenia with severe neutropenia, cervical adenomegaly and solid contrast uptake lesion in the oropharyngeal region. Due to neutropenia and sepsis the patient was initially treated with cefepime and vancomycin, but there was no clinical improvement. Lymph node puncture-aspiration showed yeast-form fungus identified as A. pullulans by sequencing ITS region. The patient was treated with amphotericin B deoxycholate, leading to complete recovery of bone marrow function and regression of adenomegaly and the oropharyngeal lesion

Pseudomicetoma dermatofítico: relato de um caso devido a Trichophyton tonsurans Dermatophytic pseudomycetoma: report of a case caused by Trichophyton tonsurans

É descrito um caso de pseudomicetoma dermatofítico, recidivante, em paciente com lesões no couro cabeludo. O exame histopatológico de uma das lesões mostrou, nos tecidos, os agregados micelianos ou pseudogrânulos, característicos da enfermidade. Dos tecidos frescos de outras lesões foi isolado o dermatófito Trichophyton tonsurans. Exames micológicos adicionais falharam em demonstrar a existência de tinea capitis, possível fonte do pseudomicetoma. A raridade dessa forma de dermatofitose profunda justifica a presente publicação.<br>A case of dermatophytic pseudomycetoma, in a patient with a history of recurrent lesions in the scalp, for over two years, is reported. Histopathological examination of the affected tissues revealed the mycelial aggregates or pseudogranules characteristic of the disease. Cultures of fresh tissues samples detected a fungus identified as Trichophyton tonsurans. Additional examinations failed to demonstrate lesions of tinea capitis, a probable source of the deep infection. Dermatophytic pseudomycetoma is an extremely rare form of dermatophytosis, and the rarity of such cases is the motive for the present communication

A novel Sporothrix brasiliensis genomic variant in Midwestern Brazil: evidence for an older and wider sporotrichosis epidemic.

Sporotrichosis is a subcutaneous infection caused by fungi from the genus Sporothrix. It is transmitted by inoculation of infective particles found in plant-contaminated material or diseased animals, characterizing the classic sapronotic and emerging zoonotic transmission, respectively. Since 1998, southeastern Brazil has experienced a zoonotic sporotrichosis epidemic caused by S. brasiliensis, centred in the state of Rio de Janeiro. Our observation of feline sporotrichosis cases in Brasília (Midwestern Brazil), around 900 km away from Rio de Janeiro, led us to question whether the epidemic caused by S. brasiliensis has spread from the epicentre in Rio de Janeiro, emerged independently in the two locations, or if the disease has been present and unrecognized in Midwestern Brazil. A retrospective analysis of 91 human and 4 animal cases from Brasília, ranging from 1993 to 2018, suggests the occurrence of both sapronotic and zoonotic transmission. Molecular typing of the calmodulin locus identified S. schenckii as the agent in two animals and all seven human patients from which we were able to recover clinical isolates. In two other animals, the disease was caused by S. brasiliensis. Whole-genome sequence typing of seven Sporothrix spp. strains from Brasília and Rio de Janeiro suggests that S. brasiliensis isolates from Brasília are genetically distinct from those obtained at the epicentre of the outbreak in Rio de Janeiro, both in phylogenomic and population genomic analyses. The two S. brasiliensis populations seem to have separated between 2.2 and 3.1 million years ago, indicating independent outbreaks or that the zoonotic S. brasiliensis outbreak might have started earlier and be more widespread in South America than previously recognized

A novel Sporothrix brasiliensis genomic variant in Midwestern Brazil: evidence for an older and wider sporotrichosis epidemic.

Sporotrichosis is a subcutaneous infection caused by fungi from the genus Sporothrix. It is transmitted by inoculation of infective particles found in plant-contaminated material or diseased animals, characterizing the classic sapronotic and emerging zoonotic transmission, respectively. Since 1998, southeastern Brazil has experienced a zoonotic sporotrichosis epidemic caused by S. brasiliensis, centred in the state of Rio de Janeiro. Our observation of feline sporotrichosis cases in Brasília (Midwestern Brazil), around 900 km away from Rio de Janeiro, led us to question whether the epidemic caused by S. brasiliensis has spread from the epicentre in Rio de Janeiro, emerged independently in the two locations, or if the disease has been present and unrecognized in Midwestern Brazil. A retrospective analysis of 91 human and 4 animal cases from Brasília, ranging from 1993 to 2018, suggests the occurrence of both sapronotic and zoonotic transmission. Molecular typing of the calmodulin locus identified S. schenckii as the agent in two animals and all seven human patients from which we were able to recover clinical isolates. In two other animals, the disease was caused by S. brasiliensis. Whole-genome sequence typing of seven Sporothrix spp. strains from Brasília and Rio de Janeiro suggests that S. brasiliensis isolates from Brasília are genetically distinct from those obtained at the epicentre of the outbreak in Rio de Janeiro, both in phylogenomic and population genomic analyses. The two S. brasiliensis populations seem to have separated between 2.2 and 3.1 million years ago, indicating independent outbreaks or that the zoonotic S. brasiliensis outbreak might have started earlier and be more widespread in South America than previously recognized