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      Aislamiento microbiológico de Sporothrix Schenckii en un paciente inmunodeprimido. Presentación de un caso Translated title: Microbiological Isolation of Sporothrix Schenckii in an Immunocompromised Patient. A Case Report

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          Abstract

          La esporotricosis es una micosis subcutánea, de evolución variable, causada por un hongo del género Sporothrix. Se presenta el caso de un paciente de color de piel blanca, masculino, de 67 años de edad y de procedencia rural, con antecedentes patológicos personales de mielofibrosis con diez años de evolución para lo cual lleva tratamiento con talidomina y prednisona. Ingresó en agosto del 2013 en el Hospital General Universitario de Cienfuegos, por presentar lesiones en piel en regiones de la mejilla izquierda, tórax y antebrazos. Durante su estadía en sala de Hematología, por su enfermedad de base, se solicitaron interconsultas con el Servicio de Dermatología. Se manejaron varios diagnósticos y se impusieron tratamientos con múltiples antimicrobianos. No se observó mejoría clínica de las lesiones. Un estudio micológico arrojó la presencia de Sporothrix schencckii, por lo que le fue impuesto tratamiento para la esporotricosis. Por lo poco común que ha sido este diagnóstico en nuestro medio se decidió la presentación del caso.

          Translated abstract

          Sporotrichosis is a subcutaneous mycosis with a variable course caused by a fungus of the genus Sporothrix. We present the case of 67-year-old white patient of rural origin with a history of myelofibrosis that had evolved for ten years and was treated with thalidomide and prednisone. He was admitted to the University General Hospital of Cienfuegos in August 2013 because of skin lesions on the left cheek, chest and forearms. During his stay in the Hematology ward due to his underlying disease, we consulted with the specialists of the Dermatology Department. Several diagnoses were established and multiple antimicrobial treatments were prescribed. No clinical improvement of the lesions was observed. A mycological study showed the presence of Sporothrix schencckii; hence, the patient underwent treatment for sporotrichosis. Given the rarity of this diagnosis in our institution, we decided to present this case.

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          Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment.

          Implantation or subcutaneous mycoses are a frequent health problem in Latin American countries and other tropical and subtropical areas. Although such infections rarely cause disseminated or invasive disease, they have an important impact on public health, and timely diagnosis and appropriate treatment remain important. Although some implantation mycoses are found in immunocompromised persons, the immunocompetent population is the principal target in Latin America. Most etiologic agents are found in soil, vegetation, and decaying matter in tropical, subtropical, and humid environments and infection is commonly the result of penetrating injury. Infections primarily occur (1) among low socioeconomic groups, (2) among those living in rural areas or involved in farming, hunting, or other outdoor activities, and (3) particularly among adult men. This review focuses on the epidemiology of the most clinically significant implantation mycoses in Latin America, i.e., sporotrichosis, eumycetoma, chromoblastomycosis, subcutaneous phaeohyphomycosis, subcutaneous zygomycosis, and lacaziosis. Main epidemiologic findings, clinical manifestations, diagnosis, and treatment options are also discussed.
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            Diagnosis and Treatment of Lymphocutaneous Sporotrichosis: What Are the Options?

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              Therapeutic monoclonal antibody for sporotrichosis

              Sporotrichosis is a chronic subcutaneous mycosis that affects both humans and animals worldwide. This subcutaneous mycosis had been attributed to a single etiological agent, Sporothrix schenckii. S. schenckii exhibits considerable genetic variability, and recently, it was suggested that this taxon consists of a complex of species. Sporotrichosis is caused by traumatic inoculation of the fungus, which is a ubiquitous environmental saprophyte that can be isolated from soil and plant debris. The infection is limited to cutaneous forms, but recently, more severe clinical forms of this mycosis have been described, especially among immunocompromised individuals. The immunological mechanisms involved in the prevention and control of sporotrichosis are not well understood. Some studies suggest that cell-mediated immunity plays an important role in protecting the host against S. schenckii. In contrast, the role of the humoral immune response in protection against this fungus has not been studied in detail. In a previous study, we showed that antigens secreted by S. schenckii induced a specific humoral response in infected animals, primarily against a 70-kDa molecule, indicating a possible role of specific antibodies against this molecule in infection control. In another study by our group, we produced a mAb against a 70-kDa glycoprotein of S. schenckii to better understand the effect of the passive immunization of mice infected with S. schenckii. The results showed a significant reduction in the number of CFUs in various mice organs when the mAb was injected before or during S. schenckii infection. Similar results were observed when T-cell-deficient mice were used. The drugs of choice in the treatment of sporotrichosis require long periods, and relapses are frequently observed, primarily in immunocompromised patients. The strong protection induced by the mAb against a 70-kDa glycoprotein makes it a strong candidate as a therapeutic vaccine against sporotrichosis.
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                Author and article information

                Journal
                ms
                MediSur
                Medisur
                Universidad de Ciencias Médicas de Cienfuegos, Centro Provincial de Ciencias Médicas, Provincia de Cienfuegos. (Cienfuegos, , Cuba )
                1727-897X
                August 2014
                : 12
                : 4
                : 662-669
                Affiliations
                [01] Cienfuegos Cienfuegos orgnameHospital General Universitario Dr. Gustavo Aldereguía Lima Cuba
                Article
                S1727-897X2014000400011 S1727-897X(14)01200411
                562600e4-0422-4c09-98e8-4da32c2d1270

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 14 May 2014
                : 15 July 2014
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 8, Pages: 8
                Product

                SciELO Cuba

                Categories
                Presentaciones de Casos

                informes de casos,microbiología,huesped inmunocomprometido,esporotricosis,sporothrix,case reports,microbiology,immunocompromised host,sporotrichosis

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