Manifestações cutâneo-mucosas da coccidioidomicose: estudo de trinta casos procedentes dos estados do Piauí e Maranhão

Abstract

Resumo: FUNDAMENTOS: A coccidioidomicose é micose sistêmica usualmente manifesta como infecção benigna de resolução espontânea; porém, uma pequena proporção dos infectados desenvolve quadros progressivos potencialmente fatais, podendo atingir a pele com lesões pleomórficas disseminadas. OBJETIVOS: Identificar e descrever as manifestações cutâneo-mucosas da coccidioidomicose, as ocupações de risco relacionadas à doença e o quadro clínico associado. MÉTODOS: Estudo realizado entre os anos 2003 e 2006 em 30 pacientes portadores de coccidioidomicose provenientes dos estados do Piauí e Maranhão e diagnosticados por exame microscópico direto, cultivo do escarro ou sorologia de triagem de imunodifusão dupla em gel de ágar, aliados à anamnese e exame físico. RESULTADOS: Identificaram-se lesões extrapulmonares em 13 casos (43,3%), com predomínio de manifestações dermatológicas de hipersensibilidade: eritema nodoso (26,6%), exantema com lesões eritemato-escamosas (26,6%) e eritema multiforme (23,3%), além de úlceras de língua (13,3%) e lábio (6,6%) e abscesso subcutâneo (3,3%). Tais manifestações foram observadas na fase aguda da doença. CONCLUSÕES: As manifestações cutâneas associadas à infecção respiratória aguda fortalecem a hipótese diagnóstica desta doença, especialmente, em caçadores de tatus ou pessoas expostas à escavação do solo. Palavras-chave: Coccidioidomicose; Diagnóstico; Epidemiologia; Eritema multiforme; Eritema nodoso; Exantema Abstract: BACKGROUND: Coccidioidomycosis is a systemic mycosis that usually presents as a benign infection. Patients generally recover spontaneously; however, a small proportion of infected individuals develop progressive complications that may affect the skin in the form of disseminated pleomorphic lesions and may become fatal. OBJECTIVES: To identify and describe skin and mucous membrane manifestations of coccidioidomycosis, to identify occupational hazards associated with the disease and to determine its associated clinical presentation. METHODS: A study conducted between 2003 and 2006 involving 30 patients from the Brazilian states of Piauí and Maranhão with coccidioidomycosis diagnosed by direct microscopy, sputum culture or screening serology using agar gel double immunodiffusion, in association with anamnesis and physical examination. RESULTS: Extrapulmonary lesions were found in 13 cases (43.3%), consisting predominantly of dermatological manifestations of hypersensitivity: erythema nodosum (26.6%), exanthema with erythematosquamous lesions (26.6%) and erythema multiforme (23.3%), as well as ulcerations of the tongue (13.3%), lip ulcers (6.6%) and subcutaneous abscess (3.3%). These manifestations were seen during the acute phase of the disease. CONCLUSIONS: Skin manifestations associated with an acute respiratory infection reinforce the hypothesis of a diagnosis of coccidioidomycosis, particularly in individuals who hunt armadillos or in those exposed to soil excavation.

Coccidioidomycosis in a reference center in Northeast Brazil: clinical/epidemiological profile and most common radiological findings

“…The most common type of activity for exposure was armadillo hunting. Similar results were published by Deus Filho et al (2010) 4 , where 96.4% of cases were related to armadillo hunting, and only one case was related to well digging. In a coccidioidomycosis case review for the State of Ceará from 1995-2007, Cordeiro et al 3 reported that armadillo hunting was the most important source of exposure 3 .…”

“…Certain activities, such as agriculture, construction, and hunting, especially armadillo hunting, which are common in Northeast Brazil, increase the risk of infection 3 . This is owing to a higher exposure of these individuals to fungal microniche disturbances in soil, with a higher probability of conidia inhalation and infection 4 .…”

Morphology of laryngeal cartilage of the nine‐banded armadillo (Dasypus novemcinctus) Linnaeus, 1758

“…Despite the ecological importance, armadillos are intensively exploited as a source of trade and food (Balamayooran et al, ; Kerr et al, ). This condition results in fauna and human harm since these animals are important intermediates in the food chains, besides being reservoirs of microorganisms that cause diseases such as leprosy and paracoccidioidomycosis (Deps et al, ; Deus Filho, Deus, Menezes, Soares, & Lira, ; Richini‐Pereira et al, ; Truman et al, ). The morphological knowledge about armadillos is fundamental in order to allow the adequate management of these animals in the clinic and their preservation in the environment.…”

Plasmocitoma Ósseo Solitário Em Cães: Relato De Três Casos

“…As osteomielites fúngicas mais frequentemente citadas na literatura incluem blastomicose e coccidioidomicose, porém as mesmas são raras ou não acontecem em determinadas regiões do Brasil (JOHNSON et al, 2003;DEUS-FILHO et al 2010). As osteomielites bacterianas normalmente estão associadas a lesões de continuidade como traumas, cirurgias ortopédicas, mordidas ou ferimentos.…”