Parte 1: micosis subcutáneas. Cutaneous Involvement in the Deep Mycoses: A Literature Review. Part I—Subcutaneous Mycoses. Visits. Download PDF. Board index Free Unlimited PDF Downloads Free Downloads. Forum 3 Please , help me to find this mpto 00 33a pdf download. Thanks!. Unanswered posts; Active topics; Search; The team. FAQ; Login; Register. Board index Free Unlimited PDF Downloads Free Downloads.

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Results 1 - 12 of kaz-news.info Aug 9, - La coccidioidomicosis es una micosis sistemica. MICOLOGIA MEDICA ARENAS EPUB - Top Pdf. Micología Médica ePub File Size: Mb. ISBN: Downloads: This page intentionally left blank SKIN INFECTIONS Diagnosis and TreatmentThis is the first textbook linking the tw.

Specificity can be very high, as in a case of molluscum contagiosum or rhinoscleroma, or very low, such as in a grossly superinfected ulcer, where one can see many bacterial colonies on the surface. The sensitivity can be very high, in a case of South American blastomycosis paracoccidioidomycosis , or very low in a case of sporotrichosis. Biopsies can be considered suggestive of, compatible with, or diagnostic of a specific infectious disease. How we use these terms, although subjective, may be based on the frequency of specific histological patterns seen associated with a specific agent, or the findings of the microorganism itself in the histological cuts.

Biopsies also allow establishing the inflammatory or neoplastic nature of a lesion. The prevalence of a specific cell in a pattern will also direct our diagnosis:. For example a plasma cell—rich liquenoid infiltrate with histiocytes will be in favor of a spirochete-induced disease either syphilis or borreliosis.

Vacuolated histiocytes accompanied by a lymphoplasmacytic infiltrate are commonly seen in leishmaniasis, rhinoscleroma, and granuloma inguinale. Suppurative granulomas are indicative of mycobacteria and deep fungal infection.

A dense perivascular and interstitial, superficial and deep inflammatory infiltrate rich in eosinophils, with extension into the subcutaneous tissue, is suggestive of a deep larva migrans or gnathostomiasis. An important fact obtained from the skin biopsy is the granulomatous nature of an infiltrate. Many chronic infectious diseases are characteristically granulomatous. Granulomas can be divided into five types: tuberculous, suppurative, foreign body, palisaded, or sarcoidal.

It should be mentioned that tuberculous granulomas are not exclusively seen in tuberculosis but in several other entities. Caseation necrosis is a more reliable sign of tuberculosis, but in its absence, other diagnostic possibilities for tuberculoid granulomas may include leishmaniasis, tuberculoid leprosy, and sporotrichosis. Even caseation necrosis may not be that specific as it can be seen in nontuberculous processes such as rosacea.

Suppurative granulomas, containing neutrophils in the center, are commonly seen in deep fungal infections such as North American blastomycosis, paracoccidioidomycosis, chromoblastomycosis, and sporotrichosis, as well as in some atypical mycobacterioses. A pseudocarcinomatous hyperplasia may be seen on top of the granuloma. Stellate necrosis in a granuloma is suggestive of cat scratch disease.

Sarcoidal granulomas can be seen in sarcoidosis but also as a reaction to foreign materials such as silica and beryllium.

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Rarely, leprosy and paracoccidioidomycosis can be quite sarcoidal in appearance. The diagnosis by histological patterns of the inflammatory diseases of the skin, as was outlined by Dr. Ackerman, can also be applied to these infections. There are some patterns that are quite specific for certain diseases like rhinoscleroma, bartonellosis, lepromatous leprosy, and Buruli ulcer. In rhinoscleroma there is a diffuse infiltrate that occupies all of the dermis.

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The infiltrate is made up of foamy histiocytes, arranged in mantles. Plasma cells are intermixed in the infiltrates. Some of these cells accumulate such an amount of immunoglobulin within their cytoplasm that they develop into eosinophilic globules, so-called Russell bodies.

Occasionally, rod-shaped Diagnostic Techniques in Dermatology — 7 bacteria will be seen within some of the histiocytes. These represent the causal agent, Klebsiella rhinoscleromatis.

The cutaneous lesions of bartonellosis including verruga peruana and bacillary angiomatosis are characterized by a dome-shaped silhouette. Below a flattened epidermis there is a capillary vascular proliferation, with a background of histiocytes intermingled with small neutrophilic abscesses. Occasionally in cases of bacillary angiomatosis, there is a purple material in the intercellular space representing aggregates of bartonellas.

The combination of histiocytes, vascular proliferation, and neutrophilic abscesses should be considered suggestive of infection by this group of bacteria. Lepromatous leprosy is characterized by a proliferation of foamy histiocytes at the level of the reticular dermis, either in a diffuse or linear form, following vascular or neural structures.

Commonly a zone of uninvolved papillary dermis separated from the epidermis may be seen which is referred to as the Grenz Zone. Basophilic globi represent clumps of intracellular mycobacteria. Buruli ulcer, an infection induced by M. This pattern of bacteria-rich necrotizing panniculitis is not seen in any other mycobacterioses like tuberculosis or leprosy. Depending on how easily the causative microorganism can be seen, skin biopsies can be divided into three categories: biopsies of high, medium, and low sensitivity.

The first category is those biopsies that have a high diagnostic sensitivity. Examples in this category include molluscum contagiosum, K. Easily detectable as well are the sulphur grains of actinomycosis, eumycetomas, and actinomycetomas. The acid-fast stain allows the detection of innumerable bacilli in lepromatous leprosy and Buruli ulcer.

PAS and Gomori stains typically reveal large amounts of hyphae in mucormycosis or in immunosuppresed patients with invasive aspergillosis. The second category includes entities with biopsies of medium diagnostic sensitivity. In such cases the infectious agent is not always visible in the routine cuts.

Agents occasionally seen in skin biopsies include leishmaniasis, free living amebas, bartonellas in cases of bacillary angiomatosis with Warthin-Starry stain , and dermatophytes.

In leishmaniasis the number of visible parasites is related to the different evolutionary stages and the degree of immunity developed by the host. In early lesions the Leishmania spp. In cases of poor immune response the so-called diffuse cutaneous leishmaniasis , the parasites are observed in great numbers as intracellular forms. In long-standing cases, the infiltrate is made of lymphocytes and plasma cells, and the possibility of finding parasites is small.

If present, they are scarce, and they can easily be confused with fragments of plasma cells. So, in leishmania cases the specificity of the biopsy diminishes as a method of diagnosis.

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It is better to take a panel approach, including intradermal leishmanin tests, direct examination and culture, and where available, PCR studies. In syphilis cases, an inmunoperoxidase stain is now available that can facilitate the identification of treponemes in tissue cuts.

The last category is of those biopsies with very little diagnostic sensitivity, where the microorganism is particularly difficult to visualize, even with special stains. This includes parasites causing cutaneous larvae migrans, gnathostomiasis, fungi such as Sporotrichum, and bacteria such as the bartonellas of verruga peruana.

Also difficult to see are M. In sporotrichosis, diagnosis is based on culture isolation, which is by far the method of greatest sensitivity.

In tuberculosis, the direct examination and culture also have a low sensitivity. Commonly, just a tuberculous granulomatous inflammation is seen. It is in this group of diseases that PCR technology appears very promising. Special stains such as rodamine or immunoperoxidases such as anti-BCG may allow better detection.

In summary, the biopsy of skin is of variable utility from a diagnostic point of view. The diagnosis can be suggested by a specific pattern, but absolute certainty is only obtained when the causal agent can be seen. The clinician should consider these limitations. Rather than depending only on special stains, the pathologist should familiarize himself or herself with the histological pattern of the disease, as well as with the frequency the causal organisms are seen in routine cuts.

Intradermal tests in dermatology-I: tests for infectious diseases. Indian J Dermatol Venereol Leprol ;72 6 — Nelson K. Tuberculin testing to detect latent tuberculosis in developing countries. Epidemiology ;18 3 — Evaluation of leishmanin skin test and its relationship with the clinical form and duration of cutaneous leishmaniasis. Dermatol Online J ;12 7 Hall As with all of medicine, correct therapy depends on a correct diagnosis, which is established through clinical and laboratory see chapter on techniques in diagnosing manifestations of infections observations.

The progress of an infection can be more carefully monitored in the skin than in any other organ due to ease of clinical observation. Additional signs include induration, erosion or ulceration, vesiculation, pustulation, linear streaking along lymphatics, lymphadenopathy, asymmetry, vasculitic appearance, necrosis, and progression.

This progression can be visually monitored and marking the edge with an indelible marker can help demonstrate the spread or regression of the edge of the infection. These clinical signs can all be less apparent in the growing population of immunocompromised patients who do not mount the typical immune response. On the contrary, immunocompromised patients may have worse clinical signs that appear at a faster rate than those seen in nonimmunocompromised individuals.

Probably the best example of the importance of these principles in all of medicine is illustrated in the case of necrotizing fasciitis, the sine qua non of importance for the skin and infectious diseases. Each chapter will have a brief history about the disease or diseases covered at the beginning as well as a reminder of potential pitfalls and myths at the end.

The pitfalls and myths section will help to serve as a summary of where it is easy to go wrong clinically and where you want to go right. Necrotizing fasciitis will be used as a brief sample of how each chapter will be laid out in the book.

Opportunistic mycoses are caused by ubiquitous fungi, including those present in commensal flora. Mycotic invasion is controlled by intact skin and mucous membranes, neutrophil activity, and cell-mediated immune response led by CD4 cells and macrophages.

There is no common response to all fungi, and distinguishing clinical features have been identified: low CD4 levels are associated with pathogens such as Pneumocystis and Cryptococcus, while neutropenia can lead to Aspergillus and Mucoralean infections.

Types of immunosuppression associated with these mycoses are listed in Table 1. It is worth noting that many of the risk factors mentioned are associated with the chronic use of high-dose corticosteroids, underlining the need for careful adjustment of immunosuppression and consideration of therapeutic alternatives.

Table 1. Risks Factors for Opportunistic Mycosis. Detailed history and examination may guide diagnosis: involvement of paranasal sinuses may be suggestive of Mucor, skin lesions in disseminated disease may be a good source for biopsy, etc. With regard to diagnosis, chest X-ray may be normal, so computed tomography is the imaging test of choice.

The yield of serological testing in immunocompromised patients is poor.

Biopsy has been conventionally considered as the unequivocal test for demonstrating invasive fungal proliferation, but in many cases, the clinical status of the patient prevents sampling. Moreover, the extreme seriousness of these diseases means that appropriate empirical treatment must be started as soon as possible.

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It is important to point out that treatment does not depend exclusively on the administration of antifungals. Immunosuppression must also be addressed and reduced or reversed to achieve a level of balance that remains poorly defined.

In a situation of irreversible immunosuppression, there will be little response to antifungal treatment, while recovery of the immune response may be associated with clinical worsening, due to the inflammatory response.

They are acquired by inhalation of conidia, which in an immunocompetent individual are eradicated by alveolar macrophages and neutrophils. Disease develops when this line of defense breaks down, or, more rarely, in situations of excessive inhalation of conidia, such as occurs during landslides or great catastrophes.

Severe, generalized immunosuppressive states, such as prolonged neutropenia, are associated with acute invasive disease, while moderate, localized immunosuppression, such as preexisting cavities, favors the development of forms such as aspergilloma.

Association between degree of immunodeficiency and type of pulmonary aspergillosis. It is caused by massive proliferation of Aspergillus, with tissue invasion and high vascular tropism, promoting ischemia and dissemination. Serious risk factors include prolonged neutropenia in patients with hematological malignancies, hematopoietic stem cell HSC and solid organ transplants, particularly lung and heart.

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Other factors thought to be intermediate include intensive care unit admission, chronic obstructive lung disease COPD treated with inhaled or systemic corticosteroids, chemotherapy and radiation therapy, AIDS, etc. IPA progresses with fever, cough, expectoration, hemoptysis, dyspnea, and pleuritic pain.

Tracheobronchial involvement may be observed, particularly in lung transplantation.

Phylogenetic tree suggests that S. The environmental species S. Distinct profiles produced by analysis of different species by this method can be classified in groups A and B.

Species in each type are closely related to each other and show a geographical aggregation.

American isolates belong to group A and those from Japan belong to group B. Remarkably, type 14 has been found in a high frequency in Latin America [ 3micologia medica arenas26 ] Figure 5. The nuclear marker CAL obtain by PCR is consider the gold standard micologia medica arenas molecular methods because it clearly separate species between clades in the phylogenetic tree.Table 1.

PCR is also available for the second and third most common mycobacteriosis around the world, which are, Mycobacterium leprae and Mycobacterium ulcerans. Each chapter will have a brief history about the disease or diseases covered at the beginning as well as a reminder of potential pitfalls and myths at the end.

Holgate Richard F. Subsequently, as the disease progresses, peripheral necrosis and cavitation with the air crescent sign, or necrosis and central attenuation with the reversed halo sign may develop.