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Three cases of chronic pulmonary histoplasmosis affecting aged patients with chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lung lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion test and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of Histoplasma capsulatum var. capsulatum in selective media. The treatment was carried out with amphothericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed. In addition data on the epidemiology of histoplasmosis in the state of Rio de Janeiro, Brazil, were presented.

A case of paracoccidioidomycosis presenting as a solitary pulmonary nodular lesion in a patient with acquired immunodeficiency syndrome (AIDS) is presented. This case illustrates that restricted lung lesions can also be found and diagnosed in immunodeficient patients.

The study of the clinical isolates of Cryptococcus neoformans from 83 Brazilian patients with disseminated cryptococcosis showed that 75 were C. neoformans var. neoformans and 8 were var. gattii. Twenty-seven isolates were serotyped; all 19 var. neoformans were serotype A and all 8 var. gattii were serotype B. The correlation of the varieties of C. neoformans with the presence or not of hosts predisposing conditions to the mycosis showed that: (1) cryptococcosis caused by gattii variety occurred in 7 (58.3%) of the 12 nonimmunosuppressed patients, and (2) cryptococcosis caused by neoformans variety occurred in 65 (98.5%) of the 66 AIDS patients and in all 5 patients with other immunosuppressive conditions. The comparison of the distribution of the gattii and neoformans varieties between the nonimmunosuppressed and immunosuppressed patients showed a significant statistical difference (p0.01).8 mycologists reviewed the medical records of 83 patients with disseminated crypttococcosis living in Brazil to examine the varieties of Cryptococcus neoformans. 12 patients were not immunosuppressed (group 1). 65 patients had AIDS (group 2). 5 patients either also had another disease and/or used immunosuppressive drugs (group 3). Almost all the clinical isolates were from the cerebrospinal fluid and/or blood (80 isolates [96.4%]. C. neoformans var. gattii caused cryotococcosis in 58.3% (7) of the nonimmunosuppressed patients. C. neoformans var. neoformans was responsible for crypttococcosis in all but 1 of the AIDS patients (98.5%) and in all 5 patients who had another disease and/or used immunosuppressive drugs. 6 of the 8 cases with crypttococcosis caused by C. neoformans var. gatti lived in rural areas during their first 10 years. A statistically significant difference existed between the nonimmunosuppressed group (group 1) and the immunosuppressed patients (groups 2 and 3) in the comparison of the distribution of the gattii and neoformans varieties (p.01). The omnipresence of C. neoformans var. neoformans, the urban population's regular exposure to C. neoformans var. neoformans, and predisposing conditions (i.e., immunosuppression) to crypttococcosis likely accounted for the neoformans variety mainly being the cause of crypttococcosis in areas in Brazil where C. neoformans var. gattii is indigenous.

A case of solitary pulmonary paracoccidioidal lesion – paracoccidioidoma – is related. It is the first reported case in Brazil. The literature on spontaneously regressive lesion of paracoccidioidomycosis is commented upon.

Three cases of chronic pulmonary histoplasmosis affecting aged patients with chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lung lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion test and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of Histoplasma capsulatum var. capsulatum in selective media. The treatment was carried out with amphothericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed. In addition data on the epidemiology of histoplasmosis in the state of Rio de Janeiro, Brazil, were presented.

A case of paracoccidioidomycosis presenting as a solitary pulmonary nodular lesion in a patient with acquired immunodeficiency syndrome (AIDS) is presented. This case illustrates that restricted lung lesions can also be found and diagnosed in immunodeficient patients.

The Pulmonary Disease Service, University Hospital of Santa Maria, Santa Maria, RS, Brazil Received 13 December i995; accepted 10 June 1996 Abstract A case of unilateral paracoccidioidal pulmonary lesion simulating a neoplasm is reported. Key words: paracoccidioidomycosis, pseudotumoral Introduction Chronic pulmonary paracoccidioidomycosis is the des- ignation for the mycosis when paracoccidioidal lesions are circumscribed to the lungs. Symptoms and signs are usually inspecific, but the radiological picture is very suggestive when symmetric bilateral infiltrates are distributed throughout the middle and lower fields of both lungs. However, early and sometimes later in the course of the disease, radiological lesions present no characteristic features and, sometimes, may occur as unilateral or apical infiltrations and, rarely, as a solitary mass [1-3]. Case report A 55-year-old heavy smoker agricultural worker com- plained of a month-duration chest pain, fever, non- productive cough, general malaise and weight loss. A pleural rub was heard at the base of the right lung. Chest X-ray revealed a mass in the right hilum (Figure 1), which suggested a pulmonary neoplasm. Fiberop- tic bronchoscopy was performed and an endobronchial lesion in the right lower lobe was seen and excised. The histological sections of the biopsy did not reveal neoplastic cells. The patient was then submitted to a lobectomy (Figure 2). A chronic granulomatous reac- tion was observed in HE later on, when sections were stained by Grocott, P brasiliensis was disclosed (Figure 3). Discussion Pulmonary neoplasms may be considered in the diag- nosis of a solitary nodule or a mass revealed by chest X-ray. Pulmonary criptococcosis may also present as nodule or mass, however, rarely this presentation has been observed in paracoccidioidomycosis [ 1-9].

Four cases of Tinea Nigra by Exophiala werneckii, observed in Porto Alegre, RS, during the period 1981-1992 were related. A boy presented bilateral palmar lesions, one girl had plantar lesions and the remaining two girls had lesions on the palms. Three cases were autochthonous and the remaining patient was infected during a trip to Chile. A review of Brazilian literature and comments on the epidemiology and clinical aspects of the mycosis is presented.

Data on 34 patients with progressive pulmonary paracoccidioi domycosis seen in the State of Rio Grande do Sul (Brazil) are reviewed. Clinical manifestations were similar to those of a prolonged or a recurrent undifferentiated respiratory infection. Roentgenographic findings were also non-characteristic. A mycologic diagnosis was readily made when sputum was available.

A case of pulmonary paracoccidioidomycosis in a nine year old girl is reported. This is the first proven case of exclusive pulmonary paracoccidioidal lesions observed in a child. A review of the mycosis among children 0 to 10 years old is also presented.

p. 101 - 104 Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-02-25T20:18:09Z No. of bitstreams: 1 77777q.pdf: 658641 bytes, checksum: d6fd7f112aac4242c3643f53d88419ec (MD5) Approved for entry into archive by Fatima Cleômenis Botelho Maria (botelho@ufba.br) on 2013-03-05T13:49:26Z (GMT) No. of bitstreams: 1 77777q.pdf: 658641 bytes, checksum: d6fd7f112aac4242c3643f53d88419ec (MD5) Made available in DSpace on 2013-03-05T13:49:26Z (GMT). No. of bitstreams: 1 77777q.pdf: 658641 bytes, checksum: d6fd7f112aac4242c3643f53d88419ec (MD5) Previous issue date: 1979 There were described the first three South American cases of subcutaneous zygomycosis caused by B. haptosporus. The patients were children from nearby towns lying just north of 13 ? latitude S. The diagnosis was based on histopathological aspects plus cultural isolation of the fungus. Salvador

A case ofP. boydii fungus ball occurring in a patient with an active tuberculosis is reported. A critical review on pertinent literature is also presented.

There was described the first cultural proven case of gastrointestinal entomophthoramycosis caused by B. haptosporus. A review of the literature on gastrointestinal zygomycosis led us to presume that similar clinical reported cases have been also caused by this fungus. A commentary on the designation of the clinical forms of the infections caused by Zygomycetes was also made.

Thirty four cases of the progressive form of histoplasmosis, five epidemics of the mycosis, many histoplasmin skin test surveys and few clinical or histological evidences of the benign form of the disease were reported in Brazil. The occurrence of the infection in animals and the isolation of H. capsulatum from soil have also been reported.

During a seventeen day period an A. niger fungus ball evolved within a healed tuberculous cavity of a patient. Symptoms were a cough with a chocolate brown expectoration and dyspnea. The patient died and necropsy was performed. Crystals of calcium oxalate were deposited in the cavity lining and in the adjacent tissue of the lung. Fibrosis, mononuclear infiltration and intraalveolar purulent exudate were seen in these tissues. Some small vessels presented recent thrombosis and deposition of calcium oxalate. The bronchus connected with the cavity presented a disrupted epithelial layer, edema, polymorphonuclear infiltration and birefringent crystals. Scattered areas of tubular atrophy, glomerular sclerosis and lymphoid infiltration were seen in the cortex of the kidney. Oxalate crystals were also seen within the renal tubuli.

A case of spontaneously healed pulmonary paracoccidioidal lesions is reported. The correlation of reported cases of regressive lesions with the clinical forms of the mycosis is attempted.

Fifteen cases of animal rhinosporidiosis seen in Brazil are briefly reviewed. Additional cases of the disease in two horses and one mule are reported.

The first two Brazilian cases of human pulmonary nocardiosis are reported. Diagnosis was established on material obtained by direct lung puncture. A review of selected aspects on pulmonary nocardiosis in Latin American countries is presented.