[Disseminated cryptococcosis in an immunocompetent patient]

Disseminated cryptococcosis is a serious opportunistic fungal infection caused by a yeast-encapsulated fungus of the genus Cryptococcus neoformans. It occurs most often in patients with a significant deficit of cellular immunity and preferentially affects the central nervous system. The skin and the lungs are the most commonly affected sites outside the neuro-subarachnoid location. We report the case of a patient apparently immunocompetent who had a disseminated cryptococcosis. The disease started with the multiple purplish skin lesions, large umbilicated on the face, groin, forearm and leg with progressively increasing volume. This symptomatology had evolved in the context of weight loss and poor general condition. The diagnosis was established by the presence of cryptococcal at the skin biopsy and cerebrospinal fluid. Research of immunosuppression common pathologies were negative. Treatment was initiated based on amphotericin B for 40 days. The patient's condition deteriorates onset of paraplegia and swallowing disorders causing death in an array of cachexia. This observation points out that disseminated cryptococcosis can occur in an immunocompetent patient. The skin lesions may be the first sign of the disease.

[The mould onychomycosis in Morocco: about 150 isolated cases in 20 years]

INTRODUCTION

the involvement of moulds in the fungal ungueal pathology is very variable. In fact a big confusion reigns because of numerous errors in the clinico-biological diagnosis, which could be responsible for therapeutic failure of onychomycosis.

AIMS OF STUDY

The aim of this study was to evaluate the relative frequency of moulds involved in onychomycosis over a period of 20 years.

PATIENTS AND METHODS

This is a retrospective study, conducted at the laboratory of parasitology-mycology of the Ibn Sina hospital over a period of 20 years. The patients were referred by dermatologists or general practitioners for suspected onychomycosis. The samples were studied according to good rules for performing mycological analysis.

RESULTS

One hundred and fifty cases of onychomycosis were diagnosed with mould, with global prevalency of 2.78%. They mainly concern the toes (95%) with a slight female predominance (60%). The total dystrophy of the nail was the predominant clinical representation (88.3%). Moulds isolated were Aspergillus spp. in 53 cases (35.3%) and Fusarium spp. in 45 cases (30%), 19 cases (12.7%) of Scopulariopsis brevicaulis, 17 cases (11.3%) of Penicillium spp., 14 cases (9.3%) of Acremonium spp., one case of Onychocola canadensis (0.7%) and one case of Scytalidium dimitiatum (0.7%).

CONCLUSION

A significant number of onychomycosis remains attributed to moulds, which highlights the contribution of the laboratory, which remains essential for the clinician to confirm the involvement of mould in onychomycosis, which allows taking into support early treatment avoiding the emergence of aesthetic complications.