Biomedical subjects
Publications and source records attributed to A Bonifaz.
We describe a 64-year-old man with an actinomycetoma of the frontal region of the head caused simultaneously by two aetiological agents, Nocardia brasiliensis and N. asteroides. This case is presented due to the unusual body site affected and, above all, because two aetiological agents were isolated.
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An open, prospective, comparative, randomised and parallel-group study of 65 patients was conducted to evaluate the efficacy and safety of topical 1 % emulsion-gel of terbinafine versus 2% ketoconazole cream in the treatment of tinea corporis and tinea cruris. Treatment for terbinafine emulsion-gel was applied once daily for 1 week, whereas ketoconazole cream was applied once daily for 2 weeks; patients were followed for 2 weeks. Thirty-three patients in the terbinafine group and 32 in the ketoconazole group were evaluated for efficacy and safety. At the end of the study, rates of mycological cure were 94% for terbinafine emulsion-gel and 69% for ketoconazole cream (p = 0.027). A clinical and mycological overall evaluation was obtained for 72% of patients receiving terbinafine emulsion gel and 31% of patients receiving ketoconazole cream (p = 0.002). A total of four patients (1 in the terbinafine group and 3 in the ketoconazole group) had contact dermatitis-like side effects. We conclude that a 1-week course of terbinafine 1% emulsion-gel is significantly more effective than ketoconazole 2% cream in the treatment of tinea corporis and tinea cruris as regards clinical and mycological cure and treatment safety.
The treatment of mycetomas varies according to their etiological agents and the clinical state of the patient. For the treatment of eumycetomas, the azole derivatives are the drugs of choice, with itraconazole rendering better results than ketoconazole and presenting better tolerance. Actinomycetomas are treated according to different therapeutic schemes: dapsone plus sulfamethoxazol-trimethoprim (SMT), and streptomycin or amikacin or amoxicillin plus clavulanic acid. The first therapeutic scheme is very useful in the treatment of Nocardia mycetoma, while the association of amikacin plus SMT is the best treatment for those cases produced by Actinomadura madurae. Ciprofloxacin is a very useful drug for the treatment of actinomycotic mycetomas with bone lesions. Although there are several criteria for evaluating clinical outcome there is no accepted criterion of cure. During the 1990s, there was a remarkable increase in the incidence of coccidioidomycosis in California, USA. An almost ten-fold increase in the number of cases was registered during 1992 and 1993 over the usual incidence. A gradual reduction in coccidioidomycosis cases was observed in the late 1990s. This particular coccidioidomycosis outbreak took place in areas of low endemicity, as well as in those of usual high endemicity. Among the factors believed to have influenced this phenomenon were a drought followed by abundant winter/spring rainfall, increased immigration of susceptible individuals, increase in excavation/construction work and a better diagnosis of the infection, particularly in the last part of the decade. The majority of patients presented the usual clinical manifestations of symptomatic primary infection but an unusual number of cases with acute respiratory failure were observed.
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Fifty (13 men and 37 women) consecutive patients, attending the Dermatology. Department of the General Hospital of Mexico, with mycologically proven onychomycosis of the finger and toenails were included in an open clinical trial. These patients received a pulse regimen of itraconazole (200 mg twice daily) given after meals during the first week of each month, for 3 consecutive months. After the last dose, the drug was discontinued, and patients were followed-up for 9 months. Initially, the patients underwent a clinical and fungal evaluation. The study included those with positive potassium hydroxide (KOH) preparation and mycologic cultures, who had not been treated either with a systemic antifungal agent for a period of 3 months prior to the study or with a topical agent for a 1-month period prior to the study. Complete blood count and liver test functions that included transaminase, total bilirubin, alkaline phosphatase, and lactic dehydrogenase were carried out at the beginning of the study, after the first half of the study (second pulse), and 2 weeks after completion of treatment. Exclusion criteria were pregnant or lactating women, patients receiving antimycotic treatment during the 3 previous months or patients under treatment for gastric hyperacidity. Three mycologic examinations were carried out: before starting treatment in order to identify the fungal species; after the third pulse; and 3, 6, and 9 months after the last drug administration. The effectiveness of the drug was evaluated based on Zaias' method to estimate the reduction of the affected area. A 400 mg/day dose of oral itraconazole was administered in two takes: 200 mg after breakfast and 200 mg after dinner for 1 week (first pulse). The drug was discontinued for a 3-week period and this regimen was applied twice. This meant that only three treatment periods or pulses were carried out. Follow-up visits were scheduled at 6 months after completion of treatment for handnails and 9 months for toenails. At the end of the study, a correlation between clinical-mycologic outcome and liver function tests were carried out to assess the effectiveness and safety of the proposed treatment regimen.
BACKGROUND: Chromoblastomycosis is a subcutaneous mycosis, seen frequently in tropical areas, and caused by dematiaceous fungi. It produces nodulo-verrucous lesions in the arms and legs. There is no treatment of choice for this disease and sometimes a combination of chemotherapy and physical therapy is necessary. METHODS: The study included 12 patients diagnosed with chromoblastomycosis by means of fungal and histopathologic tests. The patients were assigned to three treatment groups: patients with small lesions, not greater than 15 cm2 in area, were assigned to Group 1, in which the treatment consisted of itraconazole 300 mg/day, or to Group 2, in which the treatment consisted of one or more sessions of open-spray cryosurgery. Patients with large lesions were assigned to Group 3 and started treatment with itraconazole 300 mg/day, until a maximal reduction of lesions occurred, and then underwent one or several cryosurgery sessions. Clinical, fungal, and laboratory tests were performed in each group before, during, and at the completion of treatment. RESULTS: Positive cultures of Fonsecaea pedrosoi were obtained in 11 out of 12 patients. Two out of four patients in Groups 1 and 3 had a clinical and fungal cure and the remaining patients experienced significant improvement. All four patients included in Group 2 achieved a cure. No important side-effects were seen among the patients included in any of the two itraconazole groups, and only two out of eight patients reported gastric discomfort. The cryosurgery group reported only normal complications of the process, such as edema and pain; two out of eight patients had a superimposed infection. CONCLUSIONS: The results of itraconazole and cryosurgery were good in cases with small lesions; antifungal therapy being more appropriate for flexion areas. The combination of itraconazole, to reduce the size of the lesions, with subsequent treatment of the remaining lesions with cryosurgery, represents a new alternative in the treatment of patients with large lesions. Both types of therapy are considered safe, with few side-effects.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: Mycetoma is a relatively frequent disease in tropical countries. Drugs commonly used need a long period of treatment, and some cases are resistant to these drugs, especially those with bone or visceral involvement. The combination of amoxicillin-clavulanic acid has shown effectiveness against strains of Nocardia brasiliensis in vitro. METHODS: We have used this combination in two cases of mycetoma caused by N. brasiliensis, both with bone involvement and resistance to the drugs usually used. A dose of three tablets a day for 5 to 6 months was given (each tablet contains 500 mg of amoxicillin and 125 mg of clavulanic acid). RESULTS: Clinical and mycologic amelioration was observed in the two cases after completing the treatment. There were no side effects or relapses after 3 to 6 months of follow-up after treatment. CONCLUSIONS: We propose this antibiotic as a new option for the treatment of some special cases of actinomycetoma with bone or visceral involvement or resistance to the drugs commonly used in this disease.
Itraconazole is an effective medication against the most common dermatophytoses. It has been shown to be more active than griseofulvin and ketoconazole. Ease of use, affinity for keratinized tissues, lack of toxicity, continued activity after discontinuation, and the possibility of using fixed schedules are advantages of itraconazole. The fixed schedules indicated by pharmacokinetics and clinical studies are one 100 mg capsule daily for 15 days in cases of tinea corporis and tinea cruris and the same dosage for 30 days in cases of tinea pedis and tinea manuum. These fixed treatments have some limitations, and they are not recommended for treating tinea capitis and tinea unguium. The drug is well tolerated.
Mycetoma is the most frequent deep mycosis in Mexico and is caused by Nocardia brasiliensis in 86% of the cases. Two cases of mycetoma due to Nocardia caviae, the first in Mexico, are reported. The strains were identified by their biochemical properties according to the criteria of Gordon and Mihm (1962). Few cases of mycetoma caused by this actinomycete have been reported in the world. One of our cases was unusual: occurring on the trunk as a tumor and diagnosed by finding the "grains" on histologic examination.
We assessed the safety and efficacy of a two-phase topical treatment with bifonazole-urea ointment in children with onychomycosis. Twenty-five children younger than 16 years old with proved onychomycosis were included in the study. Bifonazole-urea ointment was administered under occlusion until the nontraumatic removal of the nail was achieved. Bifonazole cream was then applied for 4 weeks and a follow-up visit 4 weeks after cessation of medication was scheduled. During the study, periodic clinical and mycologic evaluations were carried out. Of the 25 patients included, 17 were cured (68%), 6 improved, and 2 failed treatment. The main etiologic agent isolated was Trichophyton rubrum (92%). Two patients had minor side effects, both during the occlusive phase, one each with mild pain and a probable dermatitis from the adhesive strips. Treatment was not discontinued in both of these cases. We concluded that a two-phase treatment with bifonazole-urea is effective and safe, and represents a new therapeutic choice for onychomycosis in children.