Histoplasmosis and leishmaniasis are neglected and endemic diseases in Argentina, and generally are found associated with immunosuppression. We report the case of an immunocompetent 16-years-old man with simultaneous occurrence of central nervous system histoplasmosis and cutaneous leishmaniasis. Upon admission, the patient showed a one-month old skin lesion in a leg and mild paraparesis. Imaging studies detected thickening and edema in the spinal cord and the cerebrospinal fluid analysis was within normal range. The case was diagnosed as a demyelinating disorder and treated with high-dose short-term steroids. Seventy-two hours later the patient showed severe paraparesis and nuclear magnetic resonance imaging revealed nodular lesions in the spinal cord. Histoplasma capsulatum belonging to the phylogenetic species LamB was isolated from cerebrospinal fluid samples. The patient received intravenous antifungal therapy with amphotericin B for 30 days, followed by oral fluconazole and itraconazole for one year. Three months after initiation of antifungal treatment, the cutaneous lesion recrudesced and Leishmania amastigotes were observed on microscopic examination. The cutaneous leishmaniasis was treated with intramuscular meglumine antimoniate. The patient´s outcome was favorable after treatment for both diseases.

La histoplasmosis y la leishmaniasis son enfermedades olvidadas, endémicas en Argentina, y generalmente se asocian a inmunocompromiso. Presentamos el caso de un varón de 16 años, inmunocompetente, con histoplasmosis del sistema nervioso central y leishmaniasis cutánea. Inicialmente, el paciente presentó una lesión en la pierna de un mes de evolución seguida de paraparesia leve, diagnosticada como un proceso de desmielinización mediante estudios de imágenes. El cuadro fue tratado con altas dosis de corticoides y en 72 horas evolucionó a paraparesia grave con lesiones nodulares en las vértebras cervicales, observadas en las imágenes de resonancia magnética nuclear. Se aisló Histoplasma capsulatum de líquido cefalorraquídeo, genotípicamente identificado como perteneciente a la especie filogenética LamB. El paciente recibió tratamiento intravenoso con anfotericina B deoxicolato durante 30 días y posteriormente fluconazol e itraconazol oral durante un año. A los tres meses de iniciado el tratamiento con antifúngicos se reactivó la lesión de la pierna y en el examen directo se observaron amastigotes de Leishmania. La leishmaniasis cutánea fue tratada con antimoniato de meglumina intramuscular. La respuesta clínica al tratamiento de ambas enfermedades fue favorable.

Abstract Introduction Fusarium spp are ubiquitous fungi recognized as opportunistic agents of human infections, and can produce severe infections in burn patients. The literature on Fusarium spp infections in pediatric burn patients is scarce. Objectives To describe the clinical and epidemiological features as well as outcome of Fusarium spp infections in pediatric burn patients. Patients and methods Retrospective, descriptive study of Fusarium spp infections in a specialized intensive care burn unit. Results In 15 patients Fusarium spp infections were diagnosed. Median age was 48 months. Direct fire injury was observed in ten patients. The median affected burn surface area was 45%. Twelve patients had a full thickness burn. Fourteen patients had a Garces Index ≥3. Fungal infection developed at a median of 11 days after burn injury. Fungi were isolated from burn wound in 14 patients and from the bone in one patient. Amphotericin B was the drug of choice for treatment followed by voriconazole. Median time of treatment completion was 23 days. One patient (7%) died of fungal infection-related causes. Conclusion In our series Fusarium spp was an uncommon pathogen in severely burnt patients. The burn wound was the most common site of infection and mortality was low.

Objective. Retrospective description of fungal infections in a specialized intensive care burn unit. Results. A total of 41 (21%) of 195 patients admitted from January 2002 to March 2006 developed fungal infections at any site. The median age of patients was 48 months (interquartile range: 18-84), and the affected burn surface was 40% (interquartile range 30 and 65% The median time lapse between admission and fungal infections was 13 days (interquartile range 8-20 d) The most frequent site of isolation was burnt wound in 38 patients (93%) and in blood cultures in 3 patients (7%). In 93% of patients bacterial infections were also found. The predominant fungus recovered was Candida spp in 20 patients (49%); followed by Aspergillus sp in 6 patients (15%), Anphotericin B was the drug of choice. The median time of complete treatment was 23 days (interquartile range: 15-30). One patient died (2%) from causes related to fungal infection. Conclusion. A total of 41 (21%) of 195 patients admitted from January 2002 to March 2006 developed fungal infections. Candida sp was the most frequently found. Mortality was low.

Métodos. Estudio descriptivo y retrospectivo de pacientes con infecciones fúngicas en una unidad de quemados pediátrica. Resultados. De 195 pacientes internados entre enero de 2002 y marzo de 2006, 41 (21%) desarrollaron infección fúngica documentada. La mediana de edad fue de 48 meses (rango intercuartílico: 18-84) y la mediana de superficie quemada fue de 40% (rango intercuartílico 30-65%) El tiempo entre la internación y la infección fúngica fue (mediana) de 13 días (rango intercuartílico 8-20). Se aisló el hongo en la superficie quemada en 38 (93%) pacientes y, en hemocultivos, en 3 (7%)pacientes. En 38 p (93%) había una infección bacteriana concomitante. El hongo más frecuentemente aislado fue Candida spp en 20 p (49%) seguido por Aspergillus sp en 6 p (15%). Anfotericina b fue la droga inicial de elección. La mediana de tiempo de tratamiento fue de 23 días (rango intercuartílico: 15- 30 d). Un paciente falleció (2%) por causas relacionadas con la infección fúngica. Conclusión. La infección fúngica se documentó en 41 de 195 pacientes quemados. Candida spp fue el gérmen más frecuente. La mortalidad fue baja.