Clarisse Zaitz

Identificação de espécies de Candida e susceptibilidade antifúngica in vitro: estudo de 100 pacientes com candidíases superficiais

BACKGROUND: Yeasts of the genus Candida create colonization, superficial infections and systemic infections in immunodeficient individuals. The presentations of the disease lead to the necessity of using various diagnostic methods and treatments. OBJECTIVES: To differentiate among the Candida species, correlate them with the anatomical region involved and evaluate in vitro susceptibility to ketoconazole, fluconazole, itraconazole and amphotericin B. METHODS: An evaluation of 100 cases of immunocompetent patients with cutaneous or mucous candidiasis attended at the Santa Casa de Sao Paulo Hospital from May 1999 to July 2001. This study attempted to correlate the site of the involvement and the Candida species, isolated using the CHROMagar Candida® technique. The species were evaluated using the Etest® antifungal susceptibility to ketoconazole, fluconazole, itraconazole and amphotericin B. RESULTS: C. albicans was isolated in 76% of the material, C. krusei in 19% and C. tropicalis in 1%. It was not possible to establish a significant correlation between the involved area and the species isolated. Most of the samples proved to be susceptible to the antifungals tested. CONCLUSIONS: C. albicans was the most commonly observed species. The majority of samples presented susceptibility to the tested antifungals.

Cutaneous protothecosis: report of a third Brazilian case

The present report describes a case of cutaneous protothecosis caused by Prototheca wickerhamii in a nonimmunocompromised Brazilian female. Dermatological examination revealed a 15‐cm diffusely infiltrated eczema‐like plaque recovered with many pustule‐like lesions on the right forearm. We emphasize the mycological and pathological aspects of this infection that can lead to misdiagnosis. The patient was successfully treated with itraconazole.

Subcutaneous phaeohyphomycosis caused by Phoma cava: report of a case and review of the literature

We report a case of subcutaneous phaeohyphomycosis observed in a male patient presenting pulmonary sarcoidosis and submitted to corticosteroid treatment. He presented nodular erythematous-violaceous skin lesions in the dorsum of the right hand. Histopathological examination of the biopsied lesion revealed dematiaceous hyphae and yeast-like cells, with a granulomatous tissual reaction. The isolated fungus was identified as Phoma cava. A review of the literature on fungal infection caused by different Phoma species, is presented. The patient healed after therapy with amphotericin B. followed by itraconazole.

Cutaneous sporotrichosis treatment with potassium iodide: a 24 year experience in São Paulo state, Brazil

BACKGROUND Sporotrichosis is a subacute or chronic disease caused by a dimorphic fungus, Sporothrix schenckii. The first and most traditional treatment is potassium iodide in satured solution (SSKI) used by DE BEURMANN in 1907. For its effectiveness, it is still used for cutaneous sporotrichosis. OBJECTIVE To evaluate the treatment of cutaneous sporotrichosis with SSKI in relation to clinical cure, side effects, length of treatment and reactivation. METHODS We conducted a retrospective analysis of medical records over a 24-year period (1981-2005). Patients of all ages who were treated in the hospital´s division of dermatology were included in the study providing that they had a positive culture of S. schenckii. Satured solution of potassium iodide (3 to 6g per day) was the treatment prescribed. For children, half of the dose was prescribed. RESULTS The lymphocutaneous disease was prevalent, the cure rate was 94.7%, side effects were described in 5.5% of the cases, mean length of treatment was 3.5 months and possible reactivation was observed in 11.1%. CONCLUSION SSKI is an effective drug, with many side effects, but with low frequency. Resolution was for maximum six months of treatment. SSKI has been found to be a very effective drug in this retrospective study of culture-proven cases of cutaneous and lymphocutaneous sporotrichosis. It should be used as first drug of choice especially in resource-limited settings.

Efficacy and safety of itraconazole pulse therapy: Brazilian multicentric study on toenail onychomycosis caused by dermatophytes

BACKGROUND Itraconazole is a large spectrum triazole with known efficacy in both continuous and pulse therapy for various mycoses. OBJECTIVES Evaluate the efficacy and tolerability of itraconazole pulse therapy for onychomycosis of the toenails due to dermatophytes, in a prospective, open, non-comparative and multicentric investigation. Patients and methods The trial was completed by 72 patients of an initial total of 89. Treatment consisted of four cycles of itraconazole, 200 mg twice a day, for seven consecutive days each month. Patients were evaluated clinically, mycologically and biochemically before, during and at the end of the investigation, and were divided into two groups according to the measure of normal portion of the most affected nail (target nail), as follows: Group 1: 0-5.9 mm; and Group 2: more than 6 mm. RESULTS Improvement was satisfactory and progressive. Results were statistically significant, when comparing the three moments of the study: pre-treatment, end of therapy (fourth month) and follow-up (ninth month) in both groups. CONCLUSIONS Itraconazole pulse therapy was efficient and safe for the treatment of onychomycosis caused by dermatophytes, although a much higher daily dosage than the known continuous administration was used. Group 1, with nails initially more extensively affected, had a more evident improvement, by the mean variation in millimeters of normal portion of the target nail. This group showed a very satisfactory response, although not reaching total cure, thus demonstrating the great importance of early treatment of this disease. A residual therapeutic effect is maintained even after suspension of the drug. Group 2 obtained better total cure rates, and four pulses were, in general, sufficient, whereas more cycles would have been beneficial for the Group 1 patients with more extensive involvement.

Novos aspectos na evolução clínica da pitiríase versicolor

FUNDAMENTO: A pitiriase versicolor e uma doenca infecciosa causada por varias especies de Malassezia com uma tendencia a se tornar recidivante ou cronica. OBJETIVOS: Este trabalho foi conduzido na tentativa de conhecer a evolucao clinica da pitiriase versicolor em relacao ao numero de recidivas apos um tratamento adequado no periodo de 12 meses e correlacionar o numero de recidivas com as especies de Malassezia isoladas. MATERIAL E METODOS: Cento e dois pacientes com diagnostico clinico e laboratorial de pitiriase versicolor foram acompanhados por um periodo de 12 meses para observarmos o numero de recidivas da doenca. RESULTADOS: A pitiriase versicolor, apos um tratamento adequado, apresentou tres tipos de evolucao clinica num periodo de 12 meses: pitiriase versicolor sem nenhum episodio de recidiva (32,35%); pitiriase versicolor recidivante, com um a quatro episodios de recidiva (52,94%) devidos a fatores de predisposicao relacionados; e pitiriase versicolor cronica, com mais de quatro episodios de recidiva (14,70%) sem nenhuma relacao com fatores de predisposicao. CONCLUSOES: A pitiriase versicolor apresentou uma evolucao clinica de acordo com o numero de episodios de recidiva da doenca analisados durante um periodo de 12 meses que pode ser considerada da seguinte maneira: pitiriase versicolor com cura clinica e micologica, pitiriase versicolor recidivante e pitiriase versicolor cronica.

HLA in Brazilian Ashkenazic Jews with chronic dermatophytosis caused by Trichophyton rubrum

The frequency of HLA (Human Leucocyte Antigens) was analyzed in 25 non-consanguineous Brazilian Ashkenazic Jews, resident in the city of Sao Paulo, Brazil, suffering from chronic dermatophytosis caused by T. rubrum, and in 25 non-infected individuals belonging to the same ethnic group. Statistically significant values (p<0.05) were observed for HLA-B14 associated with resistance to chronic dermatophytosis and HLA-DQB1*06 (p=0.05) possibly related to susceptibility. These findings suggest that genes on the chromosome 6, in the region of the major histocompatibility complex, may influence the development of chronic dermatophytosis.

PCR in the diagnosis of cutaneous tuberculosis

Visando melhorar o diagnostico laboratorial da Tuberculose Cutânea, foi realizado o estudo da aplicacao da tecnica de PCR em amostras de tecidos cutâneos macerados, descontaminados (com H2SO4 4% para eliminacao da microbiota normal), neutralizados (com NaOH 4%) e armazenadas a -20oC. Das 37 amostras submetidas ao estudo, 16,22% apresentavam baciloscopias positivas para bacilos alcool-acidos resistentes (metodo concentrado) e em 43,24% houve o isolamento do Mycobacterium tuberculosis em meio de cultivo Lowenstein-Jensen. Utilizando-se de primers para a regiao 16S rDNA do M. tuberculosis, o DNA micobacteriano foi detectado em 24,32% das biopsias. A sensibilidade e especificidade da PCR foram 43,7% e 90,4%, respectivamente. Devido a baixa sensibilidade e resultados divergentes entre as tecnicas bacteriologicas e PCR (para a sequencia 16S rDNA), as amostras foram repetidas em um novo PCR com primers para a regiao IS6110. Tanto a sensibilidade como a especificidade da PCR com primers para IS6110 alcancaram 100% em relacao ao cultivo. Os resultados confirmam a eficacia da PCR utilizando primers para a sequencia IS6110 e oferecem a possibilidade da tecnica ser aplicada em amostras congeladas enviadas por servicos que nao identificam o M. tuberculosis por tecnicas de biologia molecular.

Dermatophytosis caused by Trichophyton raubitschekii. Report of the first case in São Paulo, Brazil

The authors report the first case of dermatophytosis caused by Trichophyton raubitschekii in a patient from the State of São Paulo with Tinea corporis lesions localized on the buttocks. Culture on Sabouraud-agar with cycloheximide permitted the isolation and identification of the fungus, and the diagnosis was confirmed by Dr. Lynne Sigler, University of Alberta, Canada. Systemic treatment with fluconazole, 150 mg/week for 4 weeks, in combination with topical treatment with isoconazole initially yielded favorable results, with recurrence of the lesions after the medication was discontinued. This is the fifth case of this dermatophytosis published in the Brazilian medical literature.

Pitiríase versicolor: isolamento e identificação das principais espécies de Malassezia

Species of the genus Malassezia isolated were: Malassezia sympodialis (16.66%), Malassezia furfur (12.50%), Malassezia globosa (11.45%), and Malassezia slooffiae (2.10%). Malassezia sympodialis predominated in the study. The species of Malassezia identified did not show correlation with clinical variants and with the distribution of pityriasis versicolor lesions in relation to areas of the body.Species of the genus Malassezia isolated were: Malassezia sympodialis (16.66%), Malassezia furfur (12.50%), Malassezia globosa (11.45%), and Malassezia slooffiae (2.10%). Malassezia sympodialis predominated in the study. The species of Malassezia identified did not show correlation with clinical variants and with the distribution of pityriasis versicolor lesions in relation to areas of the body.