Nail dermatophytoma in HIV-infected patients in Cali, Colombia

INTRODUCTION

A dermatophytoma is a mass of hyphae that is observed at direct examination, it responds poorly to treatment with antifungal drugs, some authors have proposed that it is actually a biofilm. This pathology is underdiagnosed, and its true incidence is unknown.

OBJECTIVES

This study presents the clinical findings of dermatophytoma in HIV/AIDS patients from Colombia presenting onychomycosis.

MATERIAL AND METHODS

A transversal observational descriptive study was carried out in a third level university hospital. One hundred thirty HIV positive patients diagnosed using ELISA and Western Blot that presented nail lesions on their hands and/or feet compatible with onychomycosis were included. Samples taken from affected nails were observed in direct examination with KOH and seeded onto Sabouraud agar, mycosel agar and dextrose-potato agar. Molds were identified based on macroscopic and microscopic characteristics.

RESULTS

Six (4.6%) individuals presented dermatophytoma. Average age was 43 years (range 33-50); nails more commonly affected (5/6) were on the toes, principally the hallux. Clinical manifestations included a yellow or white, rounded or linear dense area on the nail. Superficial white onychomycosis was present in 83.3% of the patients. Fungal cultures were obtained in only 5 patients; Trichophyton mentagrophytes complex was found in 2 individuals while T. rubrum, T. tonsurans and Epidermophyton floccosum were in the other 3. Average cell count for CD4⁺T lymphocytes was 86.8 cells/mm³ (range 9-282).

CONCLUSIONS

This is the first report in Colombia of dermatophytoma in HIV/AIDS patients, most of them had a CD4+ T lymphocytes count less than 200 cells/mm3. Several clinical forms of onychomycosis were observed, the most frequent was the white superficial onychomycosis.

Candida auris infection in the central catheter of a patient without sepsis symptoms

Background

Candida auris is an emerging yeast frequently reported as resistant to multiple antifungal drugs commonly used to treat Candida infections. This specie can colonize the patient's skin and has great ability for producing outbreaks in hospitals. C. auris is phylogenetically related to other Candida species, can be misidentified using conventional biochemical or commercial methods and requires specific technology for its identification.

Case report

We report the first isolate of C. auris in Cali, Colombia, from a central venous catheter in a 37-year-old patient with rheumatoid arthritis and endocarditis who did not have symptoms of sepsis. The yeast was initially misidentified as C. haemulonii using the Phoenix system and subsequently identified as C. auris by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The broth microdilution method was used to determine the minimum inhibitory concentration; the isolate was susceptible to fluconazole, itraconazole, voriconazole and amphotericin B.

Conclusions

This report contributes to knowledge of the epidemiology of C. auris infections in individuals with underlying disease and describes an isolate with a behavior different from what is usually reported.

Prototecosis cutánea: ún caso con énfasis en la histopatología

Prototecosis cutánea: presentación de un caso con énfasis en la histopatología La prototecosis es una infección infrecuente causada por algas del género Prototheca. Su diagnóstico se hace mediante estudios microbiológicos o por la identificación del alga en biopsias por su morfología característica. Se presenta el hallazgo histopatológico de prototecosis en una mujer de 72 años con diagnóstico presuntivo de dermatitis actínica crónica; en el estudio anatomopatológico de una biopsia de piel se observaron estructuras con septos internos típicas de Prototheca. Se hace una revisión de todos los registros de esta enfermedad en Colombia.