Leishmaniasis is caused by an intracellular parasite transmitted to humans by the bite of a sand fly. It is endemic in Asia, Africa, the Americas, and the Mediterranean region. Worldwide, 1.5 to 2 million new cases occur each year, 350 million are at risk of acquiring the disease, and leishmaniasis causes 70,000 deaths per year. Clinical features depend on the species of Leishmania involved and the immune response of the host. Manifestations range from the localized cutaneous to the visceral form with potentially fatal outcomes. Many drugs are used in its treatment, but the only effective treatment is achieved with current pentavalent antimonials.
Resumo:A prevalência da onicomicose na infância, principalmente quando provocada por dermatófitos e Candida sp, tem aumentado. Tais infecções em crianças parecem infreqüentes em países desenvolvidos, mas não são excepcionais na América Latina. O objetivo principal deste trabalho foi analisar a literatura médica atual. Foi observada a onicomicose por dermatófitos em crianças com idade a partir de dois anos. A faixa entre 12-16 anos é a mais afetada (66,4%), provavelmente devido aos fatores de risco aumentado, como a prática de esportes e os hormônios da puberdade. Os pais foram a fonte de infecção em 46,2% dos casos, e 65% dos parentes de pacientes apresentavam onicomicose ou tinea pedis. As unhas dos dedos dos pés são afetadas por dermatófitos, sendo mais freqüente a onicomicose distal subungueal (88,5%); contudo, também se observam as formas superficial branca e branca subungueal proximal. A suspeita de diagnóstico é obtida com o exame clínico, mas a confirmação micológica é necessária. Os principais agentes dermatófitos são: T. rubrum (69%-92,7%), T. tonsurans (8,8%), T. mentagrophytes var interdigitale (5,4%) e M. canis (2,9%). A griseofulvina constitui o tratamento de primeira linha, mas itraconazol, fluconazol e terbinafina também são recomendados para o tratamento sistêmico. O tratamento tópico com ciclopirox a 8%, amorolfina a 5% e uréia a 40% associada a bifonazol a 1% pode ser considerado alternativa terapêutica. Dada a escassez de relatos de onicomicose em crianças, não foi possível uma conclusão sobre a melhor abordagem terapêutica. Mais dados clínicos são necessários para estabelecer o perfil de segurança dos novos agentes antimicóticos a fim de determinar a conduta ideal na onicomicose infantil. Palavras-chave: criança; onicomicose. Summary:The prevalence of onychomycosis in childhood has been increasing, mainly caused by dermatophytes and also by Candida sp. These infections in children seem to be infrequent in the developed countries, while in Latin American they are not exceptional. Our main objective was to analyze the current medical literature. We have found dermatophyte onychomycosis in children as young as 2 years. The 12-16-year-old age group is reported as the most affected (66.4%), probably related to increased risk factors, such as sports and puberty/hormones. The source of infection was the parents in 46.2%, and 65% of relatives had onychomycosis or tinea pedis. Toenails are affected in dermatophyte infections and the most frequent variety is distal subungual onychomycosis (88.5%), but we also observed the white superficial form and the proximal white subungual form. Diagnosis is suspected on clinical examination, but mycological confirmation is necessary. The main dermatophyte agents are: T. rubrum (69%-92.7%), T. tonsurans (8.8%), T. mentagrophytes var interdigitale (5.4%) and M. canis (2.9%). Griseofulvin is the first line treatment, but itraconazole, fluconazole and terbinafine are also recommended for systemic treatment. Topical treatment with 8% cyclopirox, 5% amorolfine and 40% ur...
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