Luis Calegari

Treatment of human cutaneous sporotrichosis with itraconazole

Summary. Eighteen adult white male patients with cutaneous sporotrichosis were treated with itraconazole following different daily dose schemes. Cure was obtained in all cases after periods of 15–75 days (median 44 days) with total doses between 3.1 and 14.8 g (median 8.4 g). No serious side effects were observed and no relapses occurred in the follow‐up period of between 1 and 26 months (median 14.7). These results show that itraconazole represents a safe and effective drug for the treatment of sporotrichosis. Comparison with other studies leads us to consider a daily dose of 200 mg as the most appropriate. A concomitant warming of the affected limbs should be recommended.

Excretion-secretion products and proteases from live Sporothrix schenckii yeast phase: immunological detection and cleavage of human IgG

Antigenic preparations from Sporothrix schenckii usually involve materials from mixed cultures of yeast and mycelia presenting cross-reactions with other deep mycoses. We have standardized pure yeast phase with high viability of the cells suitable to obtain specific excretion-secretion products without somatic contaminations. These excretion-secretion products were highly immunogenic and did not produce noticeable cross-reactions in either double immunodiffusion or Western blot. The antigenic preparation consists mainly of proteins with molecular weights between 40 and 70 kDa, some of them with proteolytic activity in mild acidic conditions. We also observed cathepsin-like activity at two days of culture and chymotrypsin-like activity at four days of culture consistent with the change in concentration of different secreted proteins. The proteases were able to cleave different subclasses of human IgG suggesting a sequential production of antigens and molecules that could interact and interfere with the immune response of the host.

Estudio comparativo de la inmunoelectroforesis (IEF) y de la inmunoelectroosmoforesis-inmunodifusion (IEOF-ID) aplicadas al diagnostico de la paracoccidioidomicosis

Se diferencian 5 arcos de precipitatión en la técnica de inmunoelectroforesis (IEF) luego de enfrentar sueros de 16 pacientes de paracoccidioidomicosis a la paracoccidioidina. El arco ‘l’ presente en todos los sueros es asimilado a arcos presuntamente específicos descritos previamente. En immunoelectroosmoforesis-inmunodifusión (IEOF-ID) se observaron bandas ‘anódicas’ y bandas ‘catódicas’ en todos los casos. La comparación de los resultados obtenidos con las 2 técnicas reveló siempre un mayor número de arcos en IEOF-ID lo que se debería a la aparición de los arcos de localizatión catódica ‘1’ y ‘2’ del inmunoelectroforegrama, tanto en el lado anódico como en el catódico de las láminas de IEOF-ID.SummaryImmunoelectroporesis (IEF) and immunoelectroosmophoresis-immunodiffusion (IEOP-ID) (1) were comparatively used in the diagnosis of 16 patients with mycologically proved paracocidioidomycosis.In IEF, 5 different precipitin arcs were found and identified with arable numbers. Arc. ‘1’, cathodic, present in all the patients, is assimilated to specific arcs previously described by other authors.In IEOP-ID both ‘cathodic’ and ‘anodic’ arcs were observed in all the sera.A high number of precipitin arcs were revealed by IEOP-ID technique in comparison to IEF in every case. This should be due to the presence of cathodic arcs ‘1’ and ‘2’ of the immunoelectrophoregram at both sides of the IEOP-ID preparate.

Patogenicidad Experimental de Cepas de Nocardia Asteroides, Nocardia Brasiliensis y Nocardia Caviae de Diferentes Procedencias

SummaryThe experimental pathogenicity of 14 isolates of Nocardia brasiliensis, 15 of N. asteroides, and 5 of N. caviae was investigated for the white Swiss mice inoculated intraperitoneally and in the foot pad, and for the guinea-pig and the hamster (Mesocricetus auratus) both inoculated intratesticularly. The guinea-pig was remarkably sensitive to N. asteroides, with an apparent relationship between pathogenicity and thermotolerance, confirming previous observations. Mice were in general less susceptible to this species. In both guinea-pigs and hamsters it was possible to observe typical granules with or without clubs. N. caviae was highly pathogenic for the guinea-pig and the hamster but no mycetomas were produced in the mice inoculated in the foot pad. Isolates of N. brasiliensis from natural sources were scarcely virulent for the different animals. Those of human origin produced significant lesions in the mice inoculated intraperitoneally with granules. Foot pad inoculation of mice with N. brasiliensi...

Seroprevalencia de la infección por Trypanosoma cruzi en escolares de seis y doce años de edad de tres departamentos endémicos de Uruguay

The last national survey on seroprevalence of T. cruzi human infection in Uruguay, showed a 3.4% in adults from endemic areas. Since 1983, antivectorial actions of the control program have been carried out continually. In consequence, household infestation by Triatoma infestan, the main vector of T. cruzi in Uruguay, decreased in all endemic areas and was completely eliminated in some of them. The objectives of the present work are to evaluate the new seroepidemiological situation. A representative sampling of rural and urban population was undertaken, to include six and twelve year-old school children from three departments: Artigas, Rivera and Tacuarembo. The whole sample included 4,722 school children, evaluated by the indirect immunofluorescence (IFI) test for Chagaś disease. The seroprevalence of T. cruzi infection in the six year-old group was 0.3% in Artigas, 0.6% in Rivera and 1.0% in Tacuarembo. The seropositive children with seropositive mothers support the possible congenital transmission.

Paracoccidioidomicosis: A proposito de 3 nuevos casos nacionales

Three new Uruguayan paracoccidioidomycosis human cases are presented. Two of them correspond to the disseminated form with metastatic lesions at the oral mucosa; the remaining one, with important pulmonary bilateral lesions corresponds to the pure chronic pulmonary form of the disease which is recognized by the first time in the country. No doubt, these clinical forms will be found much more frequently in the endemic areas of Latin America if serological surveys are developed in the near future.Three new Uruguayan paracoccidioidomycosis human cases are presented. Two of them correspond to the disseminated form with metastatic lesions at the oral mucosa; the remaining one, with important pulmonary bilateral lesions corresponds to the pure chronic pulmonary form of the disease which is recognized by the first time in the country. No doubt, these clinical forms will be found much more frequently in the endemic areas of Latin America if serological surveys are developed in the near future.ResumenSe refieren 3 nuevos casos nacionales de paracoccidioidomicosis, 2 de los cuales son formas diseminadas con lesiones mucosas metastásicas y el otro una forma pulmonar pura progresiva, diagnosticados primariamente mediante la aplicación de pruebas de inmunoprecipitación en agar. A propósito de los mismos se enfatiza la utilidad de tales técnicas, en particular para el despistaje de las formas pulmonares puras de la afección.

Paracoccidioidal infection in the wife of a patient with paracoccidioidomycosis

Three agar immunoprecipitin techniques (double immunodiffusion, immunoelectrophoresis and immunoelectroosmophoresis-immunodiffusion) made with paracoccidioidin and serum of a paracoccidioidomycosis patients wife, permitted us to observe a specific band in 6 successive samples of blood taken from the wife over a period of 21 months. The case represents an example of a subclinical paracoccidioidomycosis infection that is usually diagnosed in its disseminated, progressive form. Three possible sources of infection are discussed. But an interhuman contagion appears to be the most feasible.

Transmisión vertical del Trypanosoma cruzi. Consideraciones y recomendaciones acordadas en la Mesa Final de laJornada

Once vectorial transmission of Trypanosoma cruzi disappeared and transfusion-transmission was controlled, vertical infection constitutes the only relevant transmission mode in our country. The fact that there are chronically infected adults leads to the risk of congenital Chagas Disease, which may occur in more than one generation with the same ascendancy. Indeed, constant human migration results in the risk of congenital transmission being present throughout the country, thus exceeding the endemic areas initially defines by the presence of domicile vector. Therefore, vertical transmission of Trypanosoma cruzi does not respect borders or generation boundaries and its sub-diagnosis has resulted in the emergence of several cases. Thus, reality leads to the remarks and recommendations that follow below, with the purpose of promoting the right control of this parasitosis.La rabia es una zoonosis de causa viral que provoca una encefalitis aguda y progresiva invariablemente fatal, causante de unas 60.000 muertes anuales. La mayoría de los casos humanos se reportan en África y Asia, pero su distribución es mundial. Se bien se trata de una enfermedad en vías de eliminación en las Américas, ha habido un resurgimiento con nuevas áreas y países afectados en los últimos años. En áreas endémicas los casos humanos están relacionados con mordeduras por perros infectados, mientras que en el resto de los países se asocia a mordeduras de animales silvestres. Luego de las mordeduras, el uso apropiado de la profilaxis posexposición es universalmente efectiva. Por lo tanto, para disminuir la carga global de rabia humana, es fundamental el control de la rabia canina y la expansión de la disponibilidad de profilaxis. En Uruguay, si bien se eliminó la rabia humana en la década de 1960, desde el año 2007 asistimos a una situación epidemiológica compleja con la reintroducción de la rabia animal vinculada a murciélagos. Esto debe poner en alerta a la comunidad médica y veterinaria para evitar el resurgimiento de la rabia humana. Se necesita del esfuerzo conjunto de la medicina humana, veterinaria, de la población y del gobierno a través de políticas públicas con el fin de mantener la vigilancia epidemiológica, actuar sobre el control de la población de perros y aplicar medidas de profilaxis en humanos luego de la mordedura de animales. En la presente revisión se describe la situación en Uruguay, la presentación clínica de esta enfermedad y las indicaciones de profilaxis.

Manejo clínico de la equinococosis quística hepática, estadio CE3b, combinando tratamiento médico-estrategia de vigilancia y espera: a propósito de un caso

La hidatidosis o equinococosis quistica es una enfermedad zoonotica que tiene presentaciones clinicas muy heterogeneas. Los quistes sintomaticos y complicados habitualmente son resueltos mediante cirugia siguiendo las reglas de la WHO-IWGE. Sin embargo, en las formas transicionales (CE3) los criterios terapeuticos continuan en discusion. Asimismo, en quistes asintomaticos y en pacientes con alto riesgo quirurgico, la opcion del tratamiento medico con benzoimidazolicos y su combinacion con la estrategia de vigilar y esperar puede ser una alternativa terapeutica segura. Se presenta un caso de hidatidosis hepatica CE3b con caracteristicas clinico-evolutivas excepcionales y alto riesgo quirurgico en que se adopto un manejo de vigilancia clinica y tratamiento con albendazol. Se analizan los beneficios y riesgos de esta terapeutica.