BACKGROUND Sporotrichosis is a subcutaneous mycosis caused by dimorphic pathogenic fungi belonging to the Sporothrix genus. Pathogenic Sporothrix species typically produce melanin, which is known to be a virulence factor. OBJECTIVES The aim of this study was to perform phenotypic, genotypic, and virulence analyses of two distinct Sporothrix brasiliensis strains isolated from the same lesion on a patient from Rio de Janeiro. METHODS AND FINDINGS Genotypic analyses by partial sequencing of the calmodulin, β-tubulin, and chitin synthase genes, as well as polymerase chain reaction (PCR)-fingerprinting by T3B, M13, and GACA, showed that the isolates were very similar but not identical. Both isolates had similar phenotypic characteristics and effectively produced melanin in their yeast forms, accounting for their ability of causing disease in a murine sporotrichosis model. Remarkably, isolate B was albino in its environmental form but caused more severe disease than the pigmented A isolate. CONCLUSIONS These findings indicate that the patient was infected by two genetically and biologically distinct S. brasiliensis that vary in their production of melanin in their environmental forms. The results underscore the importance of characterizing phenotypically different isolates found in the same clinical specimen or patient.

Resumo: A esporotricose é uma micose subcutânea de distribuição global e, em geral, os pacientes são tratados ambulatorialmente. Desde 1998, observa-se aumento dos casos no Estado do Rio de Janeiro, Brasil, especialmente por transmissão zoonótica envolvendo gatos. Os pacientes coinfectados pelo vírus da imunodeficiência humana (HIV), muitas vezes, necessitam de hospitalizações e evoluem a óbito. Este estudo analisa e descreve dados de 1992 a 2015, provenientes de bancos de dados do Sistema Único de Saúde. No Brasil, ocorreram 782 hospitalizações e 65 óbitos. Em 6% das hospitalizações e 40% dos óbitos, havia coinfecção pelo HIV. No Rio de Janeiro, foram 250 hospitalizações e 36 óbitos, com aumento progressivo, ao longo do período. Destacaram-se, ainda, São Paulo e Goiás. Homens, não brancos, com baixa escolaridade evoluíram mais frequentemente a óbito. Conclui-se que a esporotricose está associada a hospitalizações e óbitos em todo o Brasil, com destaque para o Rio de Janeiro.

Abstract: Sporotrichosis is a subcutaneous mycosis with global distribution, and patients generally receive outpatient treatment. Since 1998 there has been an increase in cases in the state of Rio de Janeiro, Brazil, mainly via zoonotic transmission involving cats. Patients coinfected with the human immunodeficiency virus (HIV) often require hospitalization and evolve to death. This study analyzes and describes data from 1992 to 2015 obtained from the database of the Brazilian Unified National Health System (SUS). There were 782 hospitalizations and 65 deaths in Brazil. Six percent of the hospitalizations and 40% of the deaths involved coinfection with HIV. There were 250 hospitalizations and 36 deaths in Rio de Janeiro, with a progressive increase over the course of the period. The states of São Paulo and Goiás also showed high numbers. Men, non-whites, and individuals with low schooling evolved more frequently to death. In conclusion, sporotrichosis is associated with hospitalizations and deaths throughout Brazil, especially in the state of Rio de Janeiro.

Resumen: La esporotricosis es una micosis subcutánea de distribución global y, en general, los pacientes son tratados ambulatoriamente. Desde 1998, se observa un aumento de los casos en el estado de Río de Janeiro, Brasil, principalmente por transmisión zoonótica implicando gatos. Los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH), muchas veces, necesitan de hospitalizaciones y evolucionan a óbito. Este estudio analiza y describe datos de 1992 a 2015, provenientes de bancos de datos del Sistema Único de Salud (SUS). En Brasil, se produjeron 782 hospitalizaciones y 65 óbitos. En un 6% de las hospitalizaciones y 40% de los óbitos, había coinfección por el VIH. En Río de Janeiro, fueron 250 hospitalizaciones y 36 óbitos, con un aumento progresivo a lo largo del período. Se destacaron, incluso, São Paulo y Goiás. Hombres, no blancos, con baja escolaridad evolucionaron más frecuentemente a óbito. Se concluye que la esporotricosis está asociada a hospitalizaciones y óbitos en todo Brasil, destacando Río de Janeiro.

Resumo: A esporotricose é uma micose subcutânea de distribuição global e, em geral, os pacientes são tratados ambulatorialmente. Desde 1998, observa-se aumento dos casos no Estado do Rio de Janeiro, Brasil, especialmente por transmissão zoonótica envolvendo gatos. Os pacientes coinfectados pelo vírus da imunodeficiência humana (HIV), muitas vezes, necessitam de hospitalizações e evoluem a óbito. Este estudo analisa e descreve dados de 1992 a 2015, provenientes de bancos de dados do Sistema Único de Saúde. No Brasil, ocorreram 782 hospitalizações e 65 óbitos. Em 6% das hospitalizações e 40% dos óbitos, havia coinfecção pelo HIV. No Rio de Janeiro, foram 250 hospitalizações e 36 óbitos, com aumento progressivo, ao longo do período. Destacaram-se, ainda, São Paulo e Goiás. Homens, não brancos, com baixa escolaridade evoluíram mais frequentemente a óbito. Conclui-se que a esporotricose está associada a hospitalizações e óbitos em todo o Brasil, com destaque para o Rio de Janeiro.

Abstract: Sporotrichosis is a subcutaneous mycosis with global distribution, and patients generally receive outpatient treatment. Since 1998 there has been an increase in cases in the state of Rio de Janeiro, Brazil, mainly via zoonotic transmission involving cats. Patients coinfected with the human immunodeficiency virus (HIV) often require hospitalization and evolve to death. This study analyzes and describes data from 1992 to 2015 obtained from the database of the Brazilian Unified National Health System (SUS). There were 782 hospitalizations and 65 deaths in Brazil. Six percent of the hospitalizations and 40% of the deaths involved coinfection with HIV. There were 250 hospitalizations and 36 deaths in Rio de Janeiro, with a progressive increase over the course of the period. The states of São Paulo and Goiás also showed high numbers. Men, non-whites, and individuals with low schooling evolved more frequently to death. In conclusion, sporotrichosis is associated with hospitalizations and deaths throughout Brazil, especially in the state of Rio de Janeiro.

Resumen: La esporotricosis es una micosis subcutánea de distribución global y, en general, los pacientes son tratados ambulatoriamente. Desde 1998, se observa un aumento de los casos en el estado de Río de Janeiro, Brasil, principalmente por transmisión zoonótica implicando gatos. Los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH), muchas veces, necesitan de hospitalizaciones y evolucionan a óbito. Este estudio analiza y describe datos de 1992 a 2015, provenientes de bancos de datos del Sistema Único de Salud (SUS). En Brasil, se produjeron 782 hospitalizaciones y 65 óbitos. En un 6% de las hospitalizaciones y 40% de los óbitos, había coinfección por el VIH. En Río de Janeiro, fueron 250 hospitalizaciones y 36 óbitos, con un aumento progresivo a lo largo del período. Se destacaron, incluso, São Paulo y Goiás. Hombres, no blancos, con baja escolaridad evolucionaron más frecuentemente a óbito. Se concluye que la esporotricosis está asociada a hospitalizaciones y óbitos en todo Brasil, destacando Río de Janeiro.

BACKGROUND Cutaneous tuberculosis (CTB) is a rare extrapulmonary form of tuberculosis (TB). Despite the increase in the number of cases of TB and HIV, few cases of CTB have been reported. OBJECTIVE To describe CTB cases among patients with HIV infection from a cohort with tuberculosis. METHODS We describe a series of 15 CTB and HIV cases, based on secondary data from 2000 to 2016. Diagnosis was based on isolation of Mycobacterium tuberculosis in culture or clinical response to anti-tuberculous treatment associated with positive smear or histopathologic findings from affected skin or an adjacent lymph node. FINDINGS Scrofuloderma was present in 12 (80%) patients and solitary gumma in three (20%) patients. One case of scrofuloderma was associated with papulonecrotic tuberculid. Seven (46.6%) patients had pulmonary TB. Diagnosis was based on culture in nine patients (60%). The median CD4 cell count was 262 cells/µL. All patients were cured at the end of treatment (median time 6 months). Three patients presented with immune reconstitution inflammatory syndrome. CONCLUSIONS In this study, CTB associated with HIV infection presented as localised forms or in association with pulmonary TB. In patients with HIV who have subacute and chronic skin lesions, CTB should be considered in differential diagnosis, which may represent a good opportunity for early diagnosis of active TB.

BACKGROUND Sporothrix brasiliensis is the most virulent sporotrichosis agent. This species usually responds to antifungal drugs, but therapeutic failure can occur in some patients. Antifungal susceptibility tests have been performed on this species, but no clinical breakpoints (CBPs) are available. In this situation, minimal inhibitory concentration (MIC) distributions and epidemiological cutoff values (ECVs) support the detection of identification of resistant strains. OBJECTIVES To study the MIC distributions of five antifungal drugs against S. brasiliensis and to propose tentative ECVs. METHODS MICs of amphotericin B (AMB), itraconazole (ITR), ketoconazole (KET), posaconazole (POS), and terbinafine (TRB) against 335 S. brasiliensis strains were determined by the Clinical and Laboratory Standards Institute broth microdilution method. FINDINGS The proposed ECV, in µg/mL, for AMB, ITR, KET, POS, and TRB were 4.0, 2.0, 1.0, 2.0, and 0.25, respectively. Percentages of wild-type strains in our population for the above antifungal drugs were 98.48, 95.22, 95.33, 100, and 97.67%, respectively. MAIN CONCLUSIONS These ECVs will be useful to detect strains with resistance, to define CBPs, and to elaborate specific therapeutic guidelines for S. brasiliensis. Rational use of antifungals is strongly recommended to avoid the emergence of resistant strains and ensure the therapeutic effectiveness of sporotrichosis.

Sporotrichosis associated with exposure to domestic cats is hyperendemic in Rio de Janeiro, Brazil. A review of the clinical records at our institute revealed four patients with clinical signs of dacryocystitis and a positive conjunctival culture for Sporothrix who were diagnosed with Sporothrix dacryocystitis. Three patients were children (< 13 years of age) and one patient was an adult. Two patients reported contact with a cat that had sporotrichosis. Dacryocystitis was associated with nodular, ulcerated lesions on the face of one patient and with granulomatous conjunctivitis in two patients; however, this condition manifested as an isolated disease in another patient. All of the patients were cured of the fungal infections, but three patients had chronic dacryocystitis and one patient developed a cutaneous fistula. Sporotrichosis is usually a benign disease, but may cause severe complications when the eye and the adnexa are affected. Physicians, especially ophthalmologists in endemic areas, should be aware of the ophthalmological manifestations and complications of sporotrichosis.

Relatamos o caso de um paciente adulto, imunocompetente, com eumicetoma por Madurella mycetomatis, localizado nos glúteos e coxas, diagnosticado após 30 anos de evolução clínica. Tratado no decorrer de quatro anos com fluconazol e itraconazol, associado a cinco tempos cirúrgicos de exérese dos nódulos subcutâneos. No oitavo ano de follow-up ocorreu recidiva de apenas um nódulo na região infraglútea, o qual foi excisado cirurgicamente, mantendo-se assintomático desde então.

We report a case of eumycetoma by Madurella mycetomatis on the buttocks and thighs in an adult immunocompetent patient, diagnosed after 30 years of clinical development. He was treated over four years with fluconazol and itraconazol associated with five times surgical excisions of subcutaneous nodules. At the eighth year of follow-up, one nodule recurred on the right infragluteal region, which was excised surgically and has remained asymptomatic ever since.

A reconstrução de defeitos cirúrgicos na região pubiana é um desafio para qualquer cirurgião. Objetivamos demonstrar a aplicação do retalho bilobado na reconstrução da região pubiana, após excisão de HPV recidivante aos tratamentos convencionais. Apesar da utilização clássica deste retalho ser na região nasal, aplicações em áreas distintas também se mostraram com excelentes resultados funcionais e estéticos.

Reconstruction of surgical defects in the pubic region is a challenge to any surgeon. Our goal was to demonstrate the use of the bilobed flap to reconstruct the pubic region skin after the excision of a recurrent HPV lesion, resistant to conventional treatments. In spite of its classical use in nasal reconstructions, the bilobed flap has applications in extranasal defects, with excellent functional and aesthetic results.

O sarcoma de Kaposi é a neoplasia mais diagnosticada em pacientes com SIDA e a expressão do antígeno nuclear latente-1 do herpesvírus humano tipo-8 (HHV-8) tem se mostrado útil no seu diagnóstico histológico. O objetivo deste estudo é confirmar que o método imuno-histoquímico é uma ferramenta útil para diferenciar o sarcoma de Kaposi cutâneo de seus simuladores histológicos em pacientes HIV positivos. Análise histológica e imuno-histoquímica foram realizadas em 49 casos de sarcoma de Kaposi cutâneo e 60 casos de seus simuladores histológicos. Positividade à imuno-histoquímica para o antígeno nuclear latente 1 do HHV-8 foi observada nos 49 casos de sarcoma de Kaposi e nenhuma reação foi detectada nos 60 simuladores analisados, resultando em 100% de sensibilidade e especificidade. A detecção do HHV-8 por imuno-histoquímica é uma ferramenta útil para o diagnóstico de sarcoma de Kaposi, especialmente na lesão inicial cujo caráter neoplásico não é evidente, e contribui para seu diagnóstico diferencial histológico.

Kaposi's sarcoma is the most common neoplasia diagnosed in AIDS patients and the expression of the human herpesvirus-8 (HHV-8) latent nuclear antigen-1 has been useful for its histological diagnosis. The aim of this study is to confirm that immunohistochemistry is a valuable tool for differentiating KS from its simulators in skin biopsies of HIV patients. Immunohistochemical and histological analyses were performed in 49 Kaposi's sarcoma skin biopsies and 60 of its histological simulators. Positivity was present in the 49 Kaposi's sarcoma skin biopsies and no staining was observed in the 60 simulators analyzed, resulting in sensibility and specificity of 100%. HHV-8 immunohistochemical detection is an effective tool for diagnosing Kaposi's sarcoma, especially in early lesions in which neoplastic features are not evident. It also contributes to its histological differential diagnosis.

Na literatura científica, a esporotricose esteve associada por anos a profissionais que lidam com a terra, local onde o fungo causador habita. Recentemente, numa área urbana tem sido registrada a ocorrência relacionada à transmissão zoonótica. Este trabalho objetivou contribuir para o conhecimento sobre a esporotricose em área urbana, por intermédio da analise exploratória de sua distribuição socioespacial no Rio de Janeiro, Brasil, entre 1997 e 2007, identificando os espaços de transmissão mais intensos. Utilizando-se base de dados do Serviço de Vigilância em Saúde, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, foram realizadas análises de frequência da doença e sua distribuição espacial. No período estudado, foram registrados 1.848 casos de esporotricose, com predomínio em mulheres adultas fora do mercado de trabalho. A fonte de contaminação predominante foi ferimento causado pelo gato doméstico, o que contribuiu para a disseminação da esporotricose em área urbana. O georreferenciamento de 1.681 casos evidenciou um cinturão de transmissão ao longo da divisa entre a capital e os municípios da região metropolitana.

In the scientific literature, sporotrichosis has traditionally been associated with agricultural work, since the causative agent is found naturally in the soil. However, cases have been reported recently in an urban area, related to zoonotic transmission. The current study aimed to contribute to knowledge on sporotrichosis in an urban area through an exploratory analysis of its socio-spatial distribution in Rio de Janeiro, Brazil, from 1997 to 2007, identifying the areas with the heaviest transmission. The database from the Health Surveillance Service at the Evandro Chagas Institute for Clinical Research, Oswaldo Cruz Foundation, was used to estimate incidence rates and spatial distribution. During the study period, 1,848 cases of sporotrichosis were reported, predominantly in adult women not currently in the labor market. The leading source of infection was wounds caused by domestic cats, which contributed to the spread of sporotrichosis in this urban area. Georeferencing of 1,681 cases showed a transmission belt along the border between the city of Rio de Janeiro and the adjacent municipalities in the Greater Metropolitan Area.

Na literatura científica, a esporotricose esteve associada por anos a profissionais que lidam com a terra, local onde o fungo causador habita. Recentemente, numa área urbana tem sido registrada a ocorrência relacionada à transmissão zoonótica. Este trabalho objetivou contribuir para o conhecimento sobre a esporotricose em área urbana, por intermédio da analise exploratória de sua distribuição socioespacial no Rio de Janeiro, Brasil, entre 1997 e 2007, identificando os espaços de transmissão mais intensos. Utilizando-se base de dados do Serviço de Vigilância em Saúde, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, foram realizadas análises de frequência da doença e sua distribuição espacial. No período estudado, foram registrados 1.848 casos de esporotricose, com predomínio em mulheres adultas fora do mercado de trabalho. A fonte de contaminação predominante foi ferimento causado pelo gato doméstico, o que contribuiu para a disseminação da esporotricose em área urbana. O georreferenciamento de 1.681 casos evidenciou um cinturão de transmissão ao longo da divisa entre a capital e os municípios da região metropolitana.

In the scientific literature, sporotrichosis has traditionally been associated with agricultural work, since the causative agent is found naturally in the soil. However, cases have been reported recently in an urban area, related to zoonotic transmission. The current study aimed to contribute to knowledge on sporotrichosis in an urban area through an exploratory analysis of its socio-spatial distribution in Rio de Janeiro, Brazil, from 1997 to 2007, identifying the areas with the heaviest transmission. The database from the Health Surveillance Service at the Evandro Chagas Institute for Clinical Research, Oswaldo Cruz Foundation, was used to estimate incidence rates and spatial distribution. During the study period, 1,848 cases of sporotrichosis were reported, predominantly in adult women not currently in the labor market. The leading source of infection was wounds caused by domestic cats, which contributed to the spread of sporotrichosis in this urban area. Georeferencing of 1,681 cases showed a transmission belt along the border between the city of Rio de Janeiro and the adjacent municipalities in the Greater Metropolitan Area.

An epidemic of sporotrichosis, a subcutaneous mycosis caused by the fungus Sporothrix schenckii, is ongoing in Rio de Janeiro, Brazil, in which cases of human infection are related to exposure to cats. In an attempt to demonstrate the zoonotic character of this epidemic using molecular methodology, we characterised by DNA-based typing methods 19 human and 25 animal S. schenckii isolates from the epidemic, as well as two control strains. To analyse the isolates, the random amplified polymorphic DNA (RAPD) technique was performed using three different primers, together with DNA fingerprinting using the minisatellite derived from the wild-type phage M13 core-sequence. The analyses generated amplicons with considerable polymorphism. Although isolates exhibited high levels of genetic relatedness, they could be clustered into 5-10 genotypes. The RAPD profiles of epidemic S. schenckii isolates could be distinguished from that of the United States isolate, displaying 20% similarity to each primer and 60% when amplified with the M13 primer. DNA fingerprinting of S. schenckii isolated from the nails (42.8%) and the oral cavities (66%) of cats were identical to related human samples, suggesting that there is a common infection source for animals and humans in this epidemic. It is clear that cats act as a vehicle for dissemination of S. schenckii.

Neste estudo retrospectivo analisamos 70 pacientes HIV positivos com criptococose em um período de 16 anos. Os espécimes com melhor rendimento diagnóstico foram o LCR (97,8%), seguido do cultivo do sedimento urinário (86,7%) e sangue (58,8%). Concluímos que a urina pode ser uma ferramenta útil para o diagnostico da criptococose.

In this retrospective study we analyzed 70 HIV patients with cryptococcosis over a 16-years period. The specimens with the best positivity were CSF (97.8%) followed by the culture of urine sediment (86.7%) and blood culture (58.8%). We conclude that the urine could be a useful tool for the diagnosis of cryptococcosis.

Foram tratados 24 indivíduos com sífilis e infecção pelo HIV, de Março de 1997 a Janeiro de 2003, no ambulatório de Dermatologia Infecciosa do Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. Foram 20 homens (83,3%) e quatro mulheres (16,7%) com idade média de 38,04 anos e contagem média de linfócitos T CD4 de 389,5 céls/mm³. A sífilis foi classificada como secundária em 16 pacientes (62,5%), latente tardia em oito (33,3%) e terciária em uma paciente (4,2%). As manifestações de sífilis secundária foram de lesões cutâneas eritematopapulosas em regiões palmar e plantar em nove (37,5%), exantema papuloso em quatro (16,7%), alopecia em clareira em três (12,5%) e osteocondrite em um paciente (4,2%). A sífilis terciária apresentou-se como lesão verrucosa. Cinco pacientes (20,8%) apresentavam neurossífilis, sendo a cefaléia a única manifestação presente em dois pacientes. As drogas utilizadas foram penicilina benzatina, ceftriaxone, eritromicina e penicilina. A cura ocorreu em 18 pacientes (75%). Seis pacientes (25%) foram retratados, sendo que três apresentavam história de re-exposição. Este estudo confirmou a importância de se estabelecer o diagnóstico de neurossífilis em pacientes com infecção pelo HIV, assim como de se realizar seguimento clínico e laboratorial após o tratamento da sífilis.

A total of 24 patients with syphilis and HIV infection were treated from January 1997 to March 2003 at the Infectious Dermatology Outpatient Clinic of the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. The caseload consisted of 20 males (83.3%) and four females (16.7%), with a mean age of 38.04 years and mean T CD4+ count of 389.5 cells/mL. Syphilis was diagnosed as secondary in 16 (62.5%) patients, late latent in eight (33.3%), and tertiary in one (4.2%). Manifestations of secondary syphilis were palmar and plantar erythematopapulous cutaneous lesions in nine (37.5%), papulous exanthema in four (16.7%), patchy alopecia in 3 (12.5%) and osteochondritis in one patient (4.2%). Tertiary syphilis was characterized by verrucous lesions. Neurosyphilis was diagnosed in four patients (16.7%), with headache as the only manifestation in two patients. Drugs used in treatment included benzathine penicillin, ceftriaxone, erythromycin, and crystalline penicillin. Cure was achieved in 18 patients (75%). Five patients (20.8%) were retreated, three of whom presented a history of re-exposure. This study confirms the importance of establishing the diagnosis of neurosyphilis in patients with HIV infection, in addition to performing follow-up on treatment for syphilis.