Successful treatment of sporotrichosis with oral fluconazole: a report of three cases

We report three cases of sporotrichosis successfully treated with oral fluconazole. A verrucous lesion on the toe was cured after 126 days, and a lesion on the left foot resolved after 91 days' treatment. A case of lymphangitic-type sporotrichosis required 174 days of treatment to achieve a cure, and a higher dose (400 mg daily) was necessary in this case. Any side-effects were insignificant. We conclude that this new bis-triazole compound can be successfully used as an alternative treatment for sporotrichosis when conventional drugs must be avoided.

Mycetoma: a retrospective study of 41 cases seen in São Paulo, Brazil, from 1978 to 1989

Clinical and epidemiological aspects of 41 cases of mycetoma seen in São Paulo city from January 1978 to December 1989 are presented. Twenty-eight cases (68%) were caused by actinomycetes, while 13 (32%) were caused by true fungi. In only 22 (78%) actinomycetoma cases was it possible to identify the agent. Nocardia brasiliensis, by far the commonest actinomycete isolated, was responsible for 13 cases. Among eumycetomata, Madurella grisea was isolated from 3 cases, Scedosporium apiospermum from 2 cases, and Madurella mycetomatis from 1 case, and in 7 cases the agent was not identified. Distribution by sex and age was similar to that reported in the literature. Feet and legs were the commonest sites affected. The mean age of actinomycetoma patients was 33.2 years, while patients with eumycetomata were an average of 32.8 years. Mean duration of the disease was 6.8 and 9.8 years respectively. Most patients came from rural areas in the north-eastern region of the country and worked as field labourers. Bone involvement was frequent for both actinomycetomata and eumycetomata and was characterized by osteoporosis, periostal reaction and cavitation. The authors' elected treatment consists of combining sulfamethoxazole (800 mg) and trimethoprim (100 mg) with prednisone (10 mg) orally, daily.

[Black-grain eumycetoma due to Madurella grisea. A report of 2 cases]

Two cases of black grains eumycotic mycetoma, occurring on a foot, are reported. Both proceeded from the state of Bahia (Brazil), and in both the etiologic agent was Madurella grisea Mackinnon et al., 1949. The grains structure as well as the micromorphologic characteristics of the fungus in saprophytic life were studied. It is the author's belief that these observations correspond to the 7th and 8th cases reported in the Brazilian medical literature. The authors do consider the following Madurella species as nomen dubium or nomina confusa: M. ramiroi, M. oswaldoi, M. bovoi, M. tozeuri, M. mansonii, M. brumpti, M. reynieri, M. americana, M. lackawanna e M. ikedae and the same for Rubromadurella mycetomi. The only valid species must be Madurella mycetomatis McGinnis, 1980 (= Madurella mycetomi Brumpt, 1905) and Madurella grisea Mackinnon et al., 1949. Treatment with itraconazole in both reported cases, for a 3 month duration, did not produce any regression of the lesions, the clinical improvement being meager.

[Renal changes caused by pentavalent antimonial (Glucantime) hypersensitivity in American tegumentary leishmaniasis. Report of a case]

The authors report one case of leishmaniasis in a 60 year old patient who developed renal failure after treatment with Glucantime. With the interruption of these drug the patient recovered her normal renal function, and a new treatment with Amphotericin B was tried with complete cicatrization of the lesions.

[Itraconazole in the treatment of pityriasis versicolor: comparison between 5 and 7 days of treatment]

The authors present the results obtained in the treatment of pityriasis versicolor with Itraconazole, comparing two schemes of treatment, in an open trial: 200 mg daily, for 5 and 7 days. The clinical diagnosis was confirmed by Wood's light and mycologically, by direct examination. The patients were controlled 21 and 35 days after beginning the treatment. The evaluation of the results showed that both schemes were effective. At the second control, there was clinical and mycologic cure in 90% of the patients from the 5-day group and in 95% of the patients from the 7-day group. The tolerance was good: 2 patients from the 7-day group and 1 patient from the 5-day group showed side-effects. Since there was no significant difference between the two schemes of treatment, the authors recommend the shortest one, that is, 200 mg daily for 5 days.

[Tinea favosa. Report of a familial occurrence in Itapecerica da Serra (municipality of Greater São Paulo)]

Four cases of Tinea favosa occurred in the same family are reported in a small city of Brazil (Itapecerica da Serra--State of São Paulo). Trichophyton schoenleinii was isolated from all four cases. Treatment consisted of oral griseofulvin (10 mg/kg/day) for at least three months.

[Black grain mycetoma caused by Madurella grisea]

The authors reported one case of eumycotic mycetoma due to Madurella grisea (black grains) occurred on the right foot of the patient studied. The structure, microscopic morphology and therapeutic evolution are also studied and reported.

[Ulcero-vegetative candidiasis of the leg]

Os Autores apresentam caso de paciente portadora de lesão única, úlcero-vegetante, localizada no 1/3 inferior da perna direita, causada pela Candida albicans. Submetida à terapêutica com Ketoconazol na dose de 400 mg diários durante o primeiro mês de tratamento e 200 mg diários no segundo mês, evoluiu para cura, sem recidiva e com negativação do título de anticorpos anti Candida albicans (fixação do complemento).

Anti-leishmania IgA immunoenzymatic assay in mucocutaneous leishmaniasis (preliminary report)

The Authors describe an anti-Leishmania IgA-ELISA assay in mucocutaneous leishmaniasis. Increased titers were found in leishmaniasis patients, mainly in the first and second year of infection and in deep mycoses patients showing either mucosal involvement or widespread disease.