ABSTRACT Fusarium species are a group of fungi that cause superficial infections, locally invasive and disseminated disease, which occur mainly in immunocompromised hosts, and occasionally in immunocompetent individuals. We present three cases that show three different clinical forms of Fusarium spp. disease that affected different types of patients (patients with hematological malignancy, chronic kidney disease in peritoneal dialysis and post-surgical for osteoarticular pathology), each with its own characteristics that merit discussion. These cases show different clinical forms of invasive fusariosis caused by Fusarium solani complex species in patients with different pathologies and therapeutic management that could be risk factors for the development of the disease. The clinical recognition of fusariosis, not only in oncohematological patients, together with a timely diagnosis and treatment contribute to the success of the treatment and a reduction in mortality.

RESUMEN Las especies de Fusarium son un grupo de hongos que causan infecciones superficiales, localmente invasivas y enfermedad diseminada, que ocurren principalmente en huéspedes inmunocomprometidos, y ocasionalmente en individuos inmunocompetentes. Presentamos tres casos que ponen en manifiesto tres diferentes formas clínicas de la enfermedad por Fusarium spp., que afectaron diversos tipos de pacientes (pacientes con malignidad hematológica, enfermedad renal crónica en diálisis peritoneal y post-quirúrgico por patología osteoarticular), cada una con características propias que ameritan su discusión. Estos casos ponen de manifiesto diferentes formas clínicas de fusariosis invasiva causadas por especies del complejo Fusarium solani en pacientes con diferentes patologías y manejo terapéutico que podrían ser factores de riesgo para el desarrollo de la enfermedad. El reconocimiento clínico de la Fusariosis, no solo en pacientes oncohematólogicos, junto con un diagnóstico y tratamiento oportuno contribuyen al éxito del tratamiento y a una reducción en la mortalidad.

Fusarium species are a group of fungi that cause superficial infections, locally invasive and disseminated disease, which occur mainly in immunocompromised hosts, and occasionally in immunocompetent individuals. We present three cases that show three different clinical forms of Fusarium spp. disease that affected different types of patients (patients with hematological malignancy, chronic kidney disease in peritoneal dialysis and post-surgical for osteoarticular pathology), each with its own characteristics that merit discussion. These cases show different clinical forms of invasive fusariosis caused by Fusarium solani complex species in patients with different pathologies and therapeutic management that could be risk factors for the development of the disease. The clinical recognition of fusariosis, not only in oncohematological patients, together with a timely diagnosis and treatment contribute to the success of the treatment and a reduction in mortality.

Las especies de Fusarium son un grupo de hongos que causan infecciones superficiales, localmente invasivas y enfermedad diseminada, que ocurren principalmente en huéspedes inmunocomprometidos, y ocasionalmente en individuos inmunocompetentes. Presentamos tres casos que ponen en manifiesto tres diferentes formas clínicas de la enfermedad por Fusarium spp., que afectaron diversos tipos de pacientes (pacientes con malignidad hematológica, enfermedad renal crónica en diálisis peritoneal y post-quirúrgico por patología osteoarticular), cada una con características propias que ameritan su discusión. Estos casos ponen de manifiesto diferentes formas clínicas de fusariosis invasiva causadas por especies del complejo Fusarium solani en pacientes con diferentes patologías y manejo terapéutico que podrían ser factores de riesgo para el desarrollo de la enfermedad. El reconocimiento clínico de la Fusariosis, no solo en pacientes oncohematólogicos, junto con un diagnóstico y tratamiento oportuno contribuyen al éxito del tratamiento y a una reducción en la mortalidad.

Background: Sporothricosis is endemic in numerous Latin American countries and the rest of the world. In Peru is concentrated in regions with warm and humid climate being little known in the rest of the country. Aim: To describe the epidemiological, clinical and laboratory characteristics of patients diagnosed of sporotrichosis in a tertiary-care level hospital in Lima, Peru from 1991 to 2014. Methods: This was a retrospective, case series. Results: Ninety four patients were involved; most of them were male adults. This condition was acquired more frequently in Cajamarca, Apurímac, and Amazonas. Fixed and lymphocutaneous form were the most frequent forms of presentation in adults and were mostly distributed in upper limbs. Lesions located in head and neck were most frequent in children. Comorbidities were present in 15% of patients and were more frequent in those who presented disseminated cutaneous form. Seventy eight percent of cultures from skin lesions were positive within 7 days. The time to positivity of cultures was longer if the sample came from skin biopsies than skin scraping or skin aspiration. Conclusions: Most cases of sporotrichosis were acquired in areas of extreme poverty in Peru. The clinical, epidemiological and laboratory findings were similar to those reported elsewhere. The time to positivity of cultures varies based on the type of skin sample. This finding needs to be further evaluated in studies with an increased number of cases.

Introducción: La esporotricosis es una afección endémica en numerosos países latinoamericanos y en el resto del mundo. En Perú se concentra en regiones con clima cálido y húmedo, siendo poco conocida en el resto del país. Objetivo: Describir las características epidemiológicas, clínicas y de laboratorio de esporotricosis en pacientes de un hospital de tercer nivel en Lima-Perú, entre los años 1991 y 2014.Método: Estudio descriptivo, retrospectivo, tipo serie de casos. Resultados: Se incluyeron 94 pacientes, la mayoría de los cuales fueron adultos del sexo masculino. Los lugares de adquisición más frecuentes fueron Cajamarca, Apurímac, y Amazonas. Las formas linfo-cutánea y cutánea fija fueron observadas con mayor frecuencia en adultos y, en especial de localización en los miembros superiores. Las localizaciones en la cabeza y el cuello fueron más frecuentes en niños. Co-morbilidades estuvieron presentes en 15% de pacientes, en particular en aquellos con la forma cutánea diseminada. El 78% de los cultivos procedentes de lesiones cutáneas fueron positivos dentro de siete días, y el tiempo de positividad fue mayor en cultivos de biopsia que en las muestras por raspado-aspirado. Conclusiones: Esporotricosis fue adquirida mayoritariamente en zonas del Perú con pobreza extrema. Las características clínicas, epidemiológicas y de laboratorio no difieren de las reportadas en otros estudios. El tiempo de positividad de los cultivos varía según tipo de muestra, lo que deberá ser mejor evaluado en estudios futuros.

La familia Furnariidae constituye uno de los grupos de aves con mayor riqueza de especies en el Neotrópico y es considerada como vulnerable ante eventos de perturbación de su hábitat. En esta familia el sexaje de sus individuos es complejo, ya que no presentan dimorfismo sexual aparente, lo cual limita la investigación en estudios de dinámica poblacional y evolutivos. En este trabajo, se analizó el ADN obtenido del cálamo de plumas, por el método fenolcloroformo-alcohol isoamílico, de 15 especies de furnáridos capturados en cuatro localidades del departamento de Caldas entre agosto del 2009 y marzo del 2010. La amplificación por PCR de los genes CHD-Z y CHD-W con los iniciadores P2-P8 y 2550F-2718R, permitieron la diferenciación de machos y hembras de siete especies (Synallaxis azarae, S. brachyura, Xenops minutus, Dendrocincla tyrannina, Lepidocolaptes lacrymiger, Campylorhampus trochilirostris, C. pusillus), de las cuales no se tenían reportes de su sexaje molecular. Se demostró la eficacia (80,65%) de la fuente para la extracción de ADN (cálamo de plumas), como método no invasivo, de fácil manipulación y almacenaje; que puede ser aplicado en estudios de dinámica poblacional, estructura genética, sistemas reproductivos y de comportamiento, y de manera amplia, en el manejo y conservación de esta familia.

The Furnariidae family is one of the most diverse groups of birds in the Neotropics, and it is considered as a vulnerable to habitat disturbance group. The sexing of individuals in this family is complex due the lack of clear sexual dimorphism which limits the research in population dynamics and evolutionary studies. In this study, the DNA was extracted from the quill of the feathers using the phenol-chloroform-isoamyl alcohol method in 15 furnarids species captured in four localities from the Department of Caldas between August 2009 and March 2010. The PCR amplification of CHD-Z and CHD-W genes with primers P2-P8 and 2550F-2718R, allowed the differentiation of males from females of seven species (Synallaxis azarae, S. brachyura, Xenops minutus, Dendrocincla tyrannina, Lepidocolaptes lacrymiger, Campylorhampus trochilirostris, C. pusillus), from which there was not previous report of molecular sexing. The efficiency of the source for DNA extraction (80.65%) from feathers as a non-invasive, easy to use, handle and storage method that can be used in population dynamics, genetic structure, reproductive systems and behavioral studies, and in a wider way, in the management and conservation of this family was demonstrated.

We report here the antifungal activities of the ethanolic extracts of Thevetia peruviana (Pers.) K. Schum. (Apocynaceae), Spondias mombin L. (Anacardiaceae), Calycophyllum spruceanum (Benth.) Hook. f. ex K. Schum. (Rubiaceae) and Psidium acutangulum DC (Myrtaceae), four plants used in peruvian traditional medicine against skin mycosis. The most active sample against the evaluated fungi (Candida albicans, Sporothrix schenckii and Trychophyton mentagrophytes) was the ethanol extract of Psidium acutangulum, which was submitted to bioassay-guided fractionation, leading to the isolation of 3'-formyl-2',4',6'- trihydroxydihydrochalcone. This compound showed minimum inhibitory concentrations of 16-512 µg/mL against Cryptococcus neoformans, S. schenckii and several Candida species. All these results support the use of Psidium acutangulum in Peruvian traditional medicine. Its antifungal activity is due mainly to the 3'-formyl-2',4',6'-trihydroxydihydrochalcone.

En el presente trabajo se evaluó la actividad antifúngica de los extractos etanólicos de Thevetia peruviana (Pers.) K. Schum. (Apocynaceae), Spondias mombin L. (Anacardiaceae), Calycophyllum spruceanum (Benth.) Hook. f. ex K. Schum. (Rubiaceae) y Psidium acutangulum DC (Myrtaceae), cuatro plantas utilizadas en la medicina tradicional peruana contra las infecciones micóticas de la piel. El extracto etanólico de Psidium acutangulum fue el más activo contra los hongos evaluados (Candida albicans, Sporothrix schenckii y Trychophyton mentagrophytes), por lo que fue sometido a fraccionamiento biodirigido que condujo al aislamiento de 3'-formil-2',4',6'- trihidroxidihidrochalcona. Este compuesto mostró concentraciones inhibitorias mínimas en el rango de 16-512 µg/mL contra los hongos Cryptococcus neoformans, S. schenckii y varias especies de Candida. Los resultados obtenidos apoyan el uso de Psidium acutangulum en la medicina tradicional peruana. Su actividad antifúngica se debe principalmente a la 3'-formil-2',4',6'- trihidroxidihidrochalcona.

Eumicetoma e cromoblastomicose são infecções fúngicas crônicas do tecido subcutâneo que evoluem com aspecto desfigurado, raramente involuindo espontaneamente. A maioria dos pacientes não apresenta melhora sustentada por longo tempo com os tratamentos disponíveis, sendo de grande importância as novas opções terapêuticas. A eficácia do posaconazol, um novo agente antifúngico de amplo espectro do grupo dos triazóis, foi estudada em 12 pacientes com eumicetoma ou cromoblastomicose refratária às terapêuticas antifúngicas disponíveis. Os pacientes receberam por no máximo 34 meses, doses divididas de 800 mg/dia de posaconazol. Resposta clínica parcial ou completa foi considerada como sucesso; doença estável ou falha terapêutica foi considerada como insucesso. Todos os 12 pacientes tinham infecções comprovadas ou prováveis, refratárias à terapêutica padrão preconizada. Sucesso clínico foi registrado em cinco de seis pacientes com eumicetoma e cinco de seis pacientes com cromoblastomicose. Em dois pacientes observou-se doença estável. Como parte do protocolo de extensão do tratamento, dois pacientes com eumicetoma que inicialmente tinham tido sucesso terapêutico e que após um intervalo maior de 10 meses apresentaram recidiva da micose, foram retratados com sucesso com posaconazol. Posaconazol foi bem tolerado durante o longo período de administração (até 1015 dias). A terapêutica com posaconazol foi seguida de sucesso na maioria dos pacientes com eumicetoma ou cromoblastomicose refratária à terapêutica padrão, sugerindo que tal droga possa ser uma importante opção no tratamento de tais doenças.

Eumycetoma and chromoblastomycosis are chronic, disfiguring fungal infections of the subcutaneous tissue that rarely resolve spontaneously. Most patients do not achieve sustained long-term benefits from available treatments; therefore, new therapeutic options are needed. We evaluated the efficacy of posaconazole, a new extended-spectrum triazole antifungal agent, in 12 patients with eumycetoma or chromoblastomycosis refractory to existing antifungal therapies. Posaconazole 800 mg/d was given in divided doses for a maximum of 34 months. Complete or partial clinical response was considered a success; stable disease or failure was considered a nonsuccess. All 12 patients had proven infections refractory to standard therapy. Clinical success was reported for five of six patients with eumycetoma and five of six patients with chromoblastomycosis. Two patients were reported to have stable disease. As part of a treatment-use extension protocol, two patients with eumycetoma who initially had successful outcome were successfully retreated with posaconazole after a treatment hiatus of > 10 months. Posaconazole was well tolerated during long-term administration (up to 1015 d). Posaconazole therapy resulted in successful outcome in most patients with eumycetoma or chromoblastomycosis refractory to standard therapies, suggesting that posaconazole may be an important treatment option for these diseases.

From March 1999 to March 2000, we conducted a prospective multicenter study of candidemia involving five tertiary care hospitals from four countries in Latin America. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to the National Committee for Clinical Laboratory Standards microbroth assay method. During a 12 month-period we were able to collect a total of 103 bloodstream isolates of Candida spp. C. albicans was the most frequently isolated species accounting for 42% of all isolates. Non-albicans Candida species strains accounted for 58% of all episodes of candidemia and were mostly represented by C. tropicalis (24.2%) and C. parapsilosis (21.3%). It is noteworthy that we were able to identify two cases of C. lusitaniae from different institutions. In our casuistic, non-albicans Candida species isolates related to candidemic episodes were susceptible to fluconazole. Continuously surveillance programs are needed in order to identify possible changes in the species distribution and antifungal susceptibility patterns of yeasts that may occurs after increasing the use of azoles in Latin American hospitals.

This study was done in patients with HIV infection and upper digestive symptoms as odinophagia, dysphagia and/or retrosternal pain who attended the Cayetano Heredia National Hospital in Lima, Perú. Those included in the study had an upper endoscopy and a CD4 count. Also previous opportunistic infections were determined. Samples were taken from the oropharyngeal cavity and sent for direct exam and culture. During endoscopy, photos were taken from the upper, middle, and lower third of the esophagus and the esophageal compromise was clasified. Biopsies and brushings samples were obtained and sent for direct exam, histopathology and culture. RESULTS: 751 patients with HIV infection attended the Cayetano Heredia National Hospital between May 1996 and June 1999, 83 were included due to esophageal symptoms. Male / Female ratio: 4/1, mean age: 30.95 +/- 9.87. Cultures positive for Candida: 84.30% of esophageal biopsies samples, 88% of esophageal brushings and 60.2% of oropharyngeal cavity. Albicans specie was isolated in 95.7% of biopies, 93% of brushings and 96% of oropharyngeal cavity. The most common endoscopic finding was white plaques (71%), endocopic grade 3 (36.1%). The most frequent previous opportunistic infection was PCP pneumonia followed by TBC. The positive predictive value for white plaques in patients with dysphagia and odynophagia was 89.8%. CD4 count between 0 and 50 lymphocytes per mm3 was seen in 70% of the cases. The mean of CD4 lymphocytes of these patients was lower (p< 0.01) when compared to the mean of patients in the control group with no symptoms. CONCLUSIONS: Candida albicans was the most common isolated pathogen in the esophagus in patients with HIV infection and with esophageal symptoms, a significant difference in CD4 count between these patients and the control group was determined. The positive predictive value for finding esophageal white plaques in patients dysphagia and odinophagia was high, and there was no difference between the average of CD4 count and the endoscopic grade of esophageal involvement.

El presente estudio se realizó en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) que acudieron al Hospital Nacional Cayetano Heredia entre mayo de 1996 y junio de 1999. A todos ellos se les encuestó para determinar si tenían síntomas digestivos como odinofagia, disfagia y/o dolor retroesternal que nos pudiesen hacer sospechar compromiso esofágico. De estar presente estos síntomas se les realizó una esofagogastroduodenoscopía, determinó el número de linfocitos CD 4 y evaluó para determinar enfermedades oportunistas. Se les tomó muestras de la cavidad orofaríngea con un hisopo que fueron examinadas directamente y cultivadas. Durante la endoscopía se tomó fotos de los tres tercios del esófago y se clasificó el compromiso esofágico. Además se realizó cepillados y biopsias del esófago que se enviaron para estudio directo, anatomopatológico y para cultivo. RESULTADOS : De 751 pacientes que acudieron al HNCH con el VIH, 83 fueronestudiados por síntomas digestivos .Se obtuvo una relación hombre / mujer de 4 a 1, con una media de edad de 30.95 + 9.87. Hubo cultivos positivos para Cándida en 84.30% de biopsias, 88% de cepillado y en el 60.20% de la cavidad orofaríngea, y la especie albicans se aisló en 95.70%, 93% y 96% respectivamente. El hallazgo endoscópico más frecuente fueron placas blanquecinas en el 71% de los casos, siendo el grado endoscópico 3 el más frecuentemente encontrado (36.10%). La presencia de disfagia más odinofagia predecía en el 89.80% el hallazgo endoscópico de placas blanquecinas en esófago. El 70% de pacientes tuvieron cifras de CD 4 entre 0 a 50. La media de linfocitos CD 4 del grupo de estudio fue significativamente menor (p < 0.01) comparado con la media de un grupo control sin síntomas. CONCLUSIONES: Cándida albicans fue el patógeno más frecuentemente aislado en el esófago en pacientes con el VIH y síntomas que sugerían compromiso esofágico, se determinó diferencia significativa (p < 0.01) entre medias de CD 4 de pacientes con y sin sintomatología esofágica, el valor predictivo de encontrar la infección por Candida en el esófago cuando hay disfagia más odinofagia es alto, y no hubo diferencia significativa entre las medias de CD 4 y el grado de compromiso esofágico (p0.05).