Mário A.P. Moraes

Paracoccidioidomicose no Hospital Universitário de Brasília

Seventy-six paracoccidioidomycosis patients attended at the university hospital of Brasilia from 1984 to 2005 were studied. 82.9% were male and the mean age was 42 years. 54.9% of the patients were engaged in farming activities. Among the patients with the chronic form, 87% were smokers and 55.3% consumed alcohol. Among 71 patients without HIV/AIDS coinfection: a) paracoccidioidomycosis was recurrent in 21 (29.6%); b) the chronic or mixed form affected 77.5% of patients, predominantly in the oropharynx (70.9%) and lungs (67.3%), with lymph node lesions in 29.8%, laryngeal lesions in 27.3% and cutaneous lesions in 16.4%; c) in the acute/subacute form, lymph node lesions predominated (81.3%), followed by cutaneous lesions in 43.8%, which resulted in severe disease in 62.5% and moderate disease in 37.5%. Five patients had HIV/AIDS coinfection and three of them presented disseminated fungal infection together with marked immunosuppression.Seventy-six paracoccidioidomycosis patients attended at the university hospital of Brasilia from 1984 to 2005 were studied. 82.9% were male and the mean age was 42 years. 54.9% of the patients were engaged in farming activities. Among the patients with the chronic form, 87% were smokers and 55.3% consumed alcohol. Among 71 patients without HIV/AIDS coinfection: a) paracoccidioidomycosis was recurrent in 21 (29.6%); b) the chronic or mixed form affected 77.5% of patients, predominantly in the oropharynx (70.9%) and lungs (67.3%), with lymph node lesions in 29.8%, laryngeal lesions in 27.3% and cutaneous lesions in 16.4%; c) in the acute/subacute form, lymph node lesions predominated (81.3%), followed by cutaneous lesions in 43.8%, which resulted in severe disease in 62.5% and moderate disease in 37.5%. Five patients had HIV/AIDS coinfection and three of them presented disseminated fungal infection together with marked immunosuppression.

Lobomycosis: diagnosis and management of relapsed and multifocal lesions

We report a case of lobomycosis in the left leg of a patient that had traveled to the endemic Brazilian Amazon region. After surgical resection of the lesion, there was relapse with local dissemination of the disease and the treatment was successfully performed by oral itraconazole and cryosurgery.

Pseudomicetoma dermatofítico: relato de um caso devido a Trichophyton tonsurans

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.

Adiaspiromicose humana. Relato de um caso tratado com cetoconazol

A case of human disseminated pulmonary adiaspiromycosis is reported. The patient, from Goianesia, GO, was admitted to the Brasilia University Hospital, in November 1992, with wet cough, dyspnea and weight loss ¾ manifestations that had appeared two months before. Prior to admission, he had been treated for a suspected miliary tuberculosis, because a chest roentgenogram had shown a diffuse reticulonodular infiltrate in both lungs. This therapy brought no improvement to the patient status. An open chest biopsy was then performed, and the microscopic examination of the lung tissue revealed the fungal nature of the disease. Ketoconazole, 400mg/day, was started and the patient discharged from the hospital. He was seen again two months later: the respiratory manifestations had disappeared and a new chest roentgenogram showed complete resolution of the pulmonary lesions. The usefulness of ketoconazole is, however, questioned, since, as there is no multiplication of the fungus in the host organism ¾ adiaspiromycosis. is believed to be, usually, a self-healing disease -, the efficacy of this imidazole derivative against the agent in animal tissues remains to be confirmed.

Zigomicose nasofacial no Estado do Pará: registro de dois casos

Two new cases of nasofacial zygomycosis from the State of Para, Brazil, are reported. Both cases were treated with ketoconazole and the response to the drug was considered to be good; the patients improved rapidly and the nasal obstruction was the first manifestation to disappear. As five cases have been described in recent years from the State of Para, this form of zygomycosis can no longer be considered as a rare disease in Northern Brazil.

Adiaspiromicose humana: lesões cicatriciais em linfonodos do mediastino

Chest roentgenogram of a sixty-year-old male patient, revealed a tumoral mass in the right lung, that was later demonstrated by transbronchial biopsy, to be a bronchogenic adenocarcinoma. There was no tomographic evidence of distant metastasis, however, in order to assess the mediastinal involvement for staging of the tumor, biopsies from the regional lymph nodes were obtained. Microscopic examination of the sample tissues failed to show any metastatic lesion, but, unexpectedly, revealed the presence of cicatricial granulomas in an advanced stage of fibrosis. They contained a few round, empty and collapsed corpuscles, limited by a thick PAS-positive, membrane. These structures were identified as adiaconidia of Emmonsia crescens, the etiological agent of human adiaspiromycosis. In the tissue sections, a large amount of carbon dust (anthracosis) was also seen.

Prototecose cutânea: relato de caso

A case of cutaneous protothecosis was reported in a 78-year-old man that was in treatment for pemphigus foliaceus and phaeohyphomycosis. He presented erythematous lesions which were infiltrated into his right leg. The diagnosis was made histopathologically and confirmed by culture, and the patient was successfully treated with itraconazole.

Zigomicose nasofacial: relato de um caso do estado do Pará, Brasil

Um caso de zigomicose nasofacial, causado por Conidiobolus coronatus, e descrito em paciente de 64 anos, do sexo feminino, procedente de Barcarena, Estado do Para. Trata-se de doenca rara na Regiao Norte do pais - a maioria dos casos brasileiros tem sido registrada em Estados da Regiao Nordeste -, e o achado confirma a ocorrencia do agente no Estado do Para. A resposta ao iodeto de potassio, droga administrada a paciente, logo apos a comprovacao do diagnostico pelo isolamento do fungo, foi boa, com resolucao parcial das lesoes em algumas semanas. A paciente continua ainda em tratamento, tendo-se associado o itraconazol ao iodeto

Rhinoscleroma causing severe bilateral nasal obstruction

Rhinoscleroma is a chronic, infectious and granulomatous disease of the respiratory tract. There is often a delay in diagnosis due to unfamiliarity with the disease and also because culture is not always positive. We report a case in a 26-year-old woman with granular mass obstructing bilateral nasal cavities and causing breathing difficulty. Histopathological examination showed characteristic Mikulicz histiocytes containing numerous Gram-negative intracellular rod-shaped bacilli consistent with the diagnosis of rhinoscleroma. The patient was treated with gemifloxacin and tetracycline and remains asymptomatic over a year follow-up period. It is important to consider rhinoscleroma in cases of chronic nasal obstruction. As culture is not always positive, histopathological examination may be crucial to the diagnosis.

Polycystic hydatidosis: casual finding of calcified hydatid cyst simulating mesenteric neoplasm

A case of abdominal hydatidosis, without hepatic involvement, in a patient from the State of Acre is reported. The hydatid, already in degeneration and partially calcified, was discovered incidentally by a radiologic examination of the vertebral column, carried out for evaluating the state of an intervertebral disk prolapse. Although the images suggested a mesenteric tumor, attached to the intestinal wall, the finding of rostellar hooklets in the dense contents of the cyst, after surgical removal, revealed the parasitic nature of the lesion.